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		First Do No Harm: The National Health Service By Morgan Long, Political Assistant to Martin Callanan MEP In 1948 the British Government dropped millions of leaflets on its citizens' doorsteps introducing the National Health Service. The leaflets promised that the NHS would "provide you all medical, dental and nursing care. Everyone -- rich or poor -- [could] use it." However, the leaflets did not reveal that "free," socialized healthcare is rationed healthcare. While the British endured rationed food goods through 1953, many did not realize that their healthcare would be rationed well beyond the 20th century. The NHS's "free" service violates the most sacred oath in medicine, "first do no harm." It has turned British healthcare into a classist system: private service for those who can afford to buy themselves out of the NHS, and substandard public care for those who cannot. Government must remove itself from the role of provider and seek to better protect its people. By opening NHS to patient-driven, competitive care subject to market forces, Britons will no longer have a second class healthcare system, but one that enables every patient access to quality care. The Realities of Rationed Care Each year in the UK just under a million people wait in pain on waiting lists for surgery. Meanwhile, patients are frequently denied available treatments and life saving diagnostic tests on grounds of costs. All of this "treatment" costs roughly 8% of GDP, roughly the size of economy of Portugal. "Free" healthcare, apparently, comes at a dear price. Rationed healthcare produces morbid statistics. According to the Organisation for Economic Co-operation and Development (OECD), Britons are less likely to survive heart disease or cancer than continental Europeans or Americans. For a grim example, a woman in Britain has a 46% chance of dying from breast cancer, while if treated in the US her odds are only 25%. Men diagnosed with prostate cancer in Britain are faced with a 57% chance of dying, while those diagnosed in the US have a 19% chance. Compounding the problem is a shortage of doctors and equipment. UK doctors see twice as many patients as their American colleagues. The US also benefits from twice as many CT scanners as the UK. For those who can find a scanner, odds are is that it is past its recommended safe time life. In further testament to the demise of British healthcare, a recent OECD report has ranked the UK's healthcare system as the second worst among 19 nations. Despite how people may feel about "free from the point of service" healthcare, they should question the value of it. The Quick Fix of Cash Labour has viewed the chronic ailments of NHS has a money problem. However, despite health being drenched in cash -- with a budget increasing over 7% per year since 1997 -- the NHS is still plagued by resource restraints. Perhaps part of the cash drain is due to the bureaucratic nature of the NHS itself. The NHS spends £2 billion a year on administrative costs as three new managers are hired for every one doctor. Throwing larger and larger percentages of GDP at the NHS has failed to solve the problem of capacity shortfalls compounded by escalating UK immigration rates and an ageing population. Rather than divert more and more tax revenues to health, government must re-examine how British health needs will best be served. Making Improvements Under significant pressure from the public, the NHS is slowly starting to improve. From April 2005 hospitals will be paid by services rendered, rather than a flat operating budget. Also encouraging is the slow incorporation of the private sector. Currently 5% of publicly funded elective operations are provided by private services. Meanwhile Labour has promised to reduce the maximum waiting list to less than 18 months. However, 18 months is still shamefully longer than most people wait for treatment in many European countries and the United States. The greatest improvement so far has not been made by government bureaucrats but rather by individuals. Over 12% of the population is covered by private health insurance. Given that "free" healthcare has been tantamount to a national and moral right in Britain, government should listen carefully to the changing demands of its constituency. People want to choose more than just their GP, they want to choose their hospitals and their specialists. They want to see a doctor who has time to talk with them. They want access to life-saving diagnostic tests. They want to have say in how their healthcare is provided and who provides it. They want something better than the NHS and its meagre steps towards reform. Turning Healthcare into Quality Care The UK is not alone in its experience with an ailing national healthcare system. Switzerland and Sweden have both recently overhauled their healthcare systems. These decentralized systems incorporate consumer choice and introduce third party care providers. One of the most liberalized systems in Europe, the Swiss system limits the state's activity to a social safety net. This precaution ensures that people unable to afford premium health coverage do not receive inferior or inadequate care. Further, Swiss healthcare is a brilliant example of how the government need not be the single payer. The state shares the burden of health insurance with a market than includes public, subsidised private and fully private healthcare. In addition, it provides for local supervision of healthcare -- giving patients greater control over their hospitals while also encouraging innovation. Even the Swedish healthcare system -- built on socialist values of equality and government control -- has made tremendous reforms in Stockholm by decentralizing and introducing competition. Referred to as the "Stockholm Transition," there is now a clear division between purchaser and provider. Incentives are productivity-based and public contracts are open to a great number of private and public providers. By turning hospitals into limited companies, productivity levels have skyrocketed. One hospital increased productivity by 40%. Introducing market forces has not only produced better care, but also reduced costs for several services such as laboratory work and x-ray treatment. Most importantly, patients benefit from shorter waiting lists and enjoy a choice of providers. In the US, three states have also changed their state-government-paid Medicaid programmes to include consumer directed care. Under this programme, disabled Medicaid patients, those too poor to afford private health insurance, are given a cash allowance with which to purchase needed services. Initial reports have deemed the programmes a huge success, spurring several additional states to start similar programmes. In all of these cases, the introduction of patient choice and sharing government's role of provider with the private sector have resulted in better care for patients. Britain would be turning a blind eye by not seeking similar remedies to its failing healthcare system. To achieve a better healthcare system, the UK must acknowledge that "free" healthcare to all is not a moral or civil right. A socialist healthcare system is riddled with inequalities because it rations services. People, both poor and rich, will receive better care under a system that is open to competitive market forces where the state's role is limited to that of a social safety net. People should be encouraged to invest in their own coverage through health insurance tax deductions. Further, they should be asked and trusted to make their own decisions regarding the level of care they wish to receive based on co-payments and deductibles. Meanwhile, NHS hospitals should be forced to operate as businesses where they are judged on productivity and quality of care. Asking the state to care for more only ensures the poor will receive less. Open the NHS to competitive, demand-driven reforms and everyone -- patients, doctors and taxpayers -- will be better served. Morgan Long Morgan is the political assistant to Martin Callanan MEP. Prior to joining Martin's Brussels office, she served as the federal relations director and telecommunications expert for the American Legislative Exchange Council (ALEC) in Washington, DC. ALEC is a non-profit, state legislative organization with over 2200 state legislative members. Morgan has testified before various state legislators on telecommunications and information technology policy.