The Magazine

No NHS, Please, We're American

The computerization of Britain's National Health Service has been an expensive fiasco. Why does Obama want to emulate it?

Jul 27, 2009, Vol. 14, No. 42 • By FRASER NELSON and IRWIN M. STELZER
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Liberals like big systems: mass transit, yes; the individual motor car, no. A massive electric grid, yes; regional electric grids relying on informal arrangements among companies, no. A massive government health care insurer, yes; individual customers using competing insurers, no. It has to do with control. Use your car and you can go where and when you please. Use mass transit and you get on and off at stations selected by central planners at times their models tell them are optimal. Allow local control of electric grids, and individuals will decide on standards, construction needs and the like; replace them with a national grid, and those jobs and decisions move to Washington, to a Department of Energy that has never successfully completed an assigned task.

Worst of all from the liberal point of view, let control of the health care system slip from the grasp of the central government and consumers will be confused by competing insurance offers, have to deal with doctors who might not recommend a one-size-fits-all course of treatment, or who just might order that extra life-saving test that bureaucrats relying on statistical averages deem too costly. The same sort of people who thought they could model financial risk and develop techniques to eliminate it, the people who confidently predicted that the president's stimulus package would hold the unemployment rate to 8 percent, now have a way for us to save billions on health care: an Electronic Health Information Technology System. "Barack Obama and Joe Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records." So says "Organizing for America"--the reincarnation of the "Obama for America" campaign organization. If Messrs. Obama and Biden have that kind of cash to invest, more power to them. Unfortunately, they don't.

So it's to be taxpayer money, "the necessary federal resources to make it happen," which is a somewhat different thing. Private investors would have an incentive to drop this massive project if it turned out that it was costing more than planned; government bureaucrats' sole incentive would be to plunge on--to them, money is free, and job preservation, rather than efficiency-maximization, is the bottom line. Doubt that, and consider the unhappy facts of Britain's National Health Service.

The goal of all this is scarier than the hubristic notion that construction of such a massive system is within the reach of even the most talented individuals. When up and running the IT system, we're told, will reduce hospital stays, avoid unnecessary testing, require more appropriate drug utilization, and garner other efficiencies. But no "system" can do that. All it can do is provide central controllers with the information to enable them, instead of your doctor, to decide just how long you should be allowed to recover after surgery, whether you might be permitted to have the tests needed to make that decision other than by using broad statistical averages that ignore individual patient differences, and which medications are appropriate for you.

Sound extreme? Consider this further promise of the Obama organization: "Barack Obama and Joe Biden will require that [disease management] plans that participate in the new public plan .  .  . utilize proven disease management programs." Patients suffering from diabetes, heart disease, high blood pressure, and other chronic conditions will do it the Obama-Biden way or else be excluded from insurance coverage. And decisions about whether this is good medicine or not will be facilitated by the IT system, which, in the unlikely event that it works, would enable your doctor--and the system's managers--to find out all about you by pushing a button. The judgment as to what to do by way of treatment will, alas, be made by people you have never met but who nonetheless can decide whether what your doctor recommends should be covered by insurance or is wasteful or contradicts the findings in the latest statistical study, perhaps reflecting the results of a small statistical sample of patients in Norway.

Obama has made much of the fact that we spend a much larger portion of our GDP on health care than do countries such as Great Britain, which have a state-provided system covering all citizens (and noncitizens who are taken ill in Britain, including illegal immigrants). Leave aside the question of whether a richer country such as ours, which has more completely met basic food, housing, and other needs (not to mention desires), should not properly spend more on health care than a poorer country. Consider only the fact that the method used to keep health care costs lower in Britain, Canada, and other countries in which the government controls the system, is a simple one: rationing.