United Kingdom: Should the NHS start charging fees?

England’s troubled National Health Service is getting a new chief executive—and he has some very American ideas, said Janan Ganesh in the Financial Times. Appointed last week, Simon Stevens—who served as a health adviser to former Prime Minister Tony Blair—is “one of the world’s superstar technocrats.” He spent the last six years in the U.S. running United-Health Group, a major insurance company that serves more customers than the population of the U.K. Stevens believes in competition and in using data on costs, doctor performance, and treatment effectiveness to “empower patients and reduce waste.” His openness to market-inspired techniques is just what the NHS needs to confront a future of “rising drug costs and an aging population.” The simple truth is that the NHS will “have to do more with less.”

The country faces “an unpalatable choice,” said Chris Smyth in The Times. According to a new report by the King’s Fund health foundation, we can either continue with the “failing system” of rationed, sometimes substandard care, or increase funding through higher taxes or charges for doctor appointments and emergency room visits. Another option is a monthly subscription, said Richard Ford, also in The Times. In a new report sponsored by the center-right think tank Reform, former Labor Health Minister Lord Warner recommends charging patients about $16 a month to use the NHS and about $32 per night for hospital stays, as well as raising the cost of prescription drugs and vaccinations and upping taxes on cigarettes and alcohol. “We can no longer pay homage to an out-of-date and unaffordable NHS,” Lord Warner said. To keep costs down, patients must pay something for their care.

“Over my dead body,” said John Prescott in the Daily Mirror. Lord Warner is a lobbyist for the private health-care industry, and his “heartless and repugnant views” are theirs. The entire premise of the NHS is that health care is free at the point of service—treatment is “based on need, not the ability to pay.” If fees were charged up front, vulnerable groups such as the poor and elderly would delay care until they were extremely sick, at which point treatment would cost more.

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Don’t be fooled: This isn’t about saving money, said Jacky Davis in The Guardian. Flat-rate charges would almost certainly cost more to administer than they would bring in. But the “health-industrial complex” knows that market reforms are a slippery slope. “Once the fundamental principles of the NHS are breached with up-front payments, it will be a short step to top-ups, copayments, and insurance to cover the escalating charges.” New NHS head Stevens, with his insurance industry background, has perhaps been listening to corporations more than patients. He “should not underestimate the strength of public feeling against undermining one of the founding principles of the NHS.”