In July 1948, England established a National Health Service (NHS) that extended government-administered health insurance to all legal residents of the country.
Less than two years after NHS had been established, more than half a million Britons were on waiting lists for hospitalization, surgery, and other forms of care, and some 40,000 hospital beds were taken out of service because of a nationwide nurse shortage. By 1960 the country's hospital shortage had become so acute that hospitals routinely denied admission to the elderly and the chronically ill, who, once admitted, would have been difficult to discharge because their condition was so fragile.
In British industrial centers, it was not uncommon for individual doctors to be responsible for the care of as many as 4,000 registered patients each. In many cases, these doctors were able to give each patient only three minutes of their time per visit – for consultation, diagnosis, prescription, filling out official forms, and maintaining proper records for governmental inspectors.
During the decades since then, the situation has not improved, despite much analysis and discussion. As of 2008, more than a million Britons in need of medical care were on waiting lists for hospital admission. Another 200,000 were trying to get onto such waiting lists. Indeed, long waiting lists for all manner of medical procedures continue to be the norm in England. According to the BBC, British patients face an average wait time of 8 months for cataract surgery; 11 months for a hip replacement; 12 months for a knee replacement; 5 months for slipped-disc surgery; and 5 months for a hernia repair.
In many cases, the condition of patients with diseases that were curable at the time of diagnosis degrades to the point of incurability by the time treatment finally becomes available; other patients become too weak to undergo whatever surgical procedures had originally been recommended for them. Further, most British hospitals are, by American standards, of poor quality. Up to 40 percent of NHS patients are undernourished during their hospital stays.
The NHS bases its funding decisions on the recommendations of the quasi-governmental National Institute for Clinical Evaluation and Excellence (NICE), a panel that determines which patients merit preference over others in terms of the treatments for which they are eligible, medications they may be given, and how soon they may have access to a doctor. Because of cost considerations, NICE gives preference to young people over older people, and to healthy people over those with chronic disease or with destructive habits such as smoking or alcoholism. NICE is also explicitly tasked with limiting people’s access to many of the latest and most effective drugs, again basing its decisions on what it considers to be most “cost-effective.”
In recent years, many native Britons have traveled to other countries to undergo major operations that doctors in their homeland lacked the time to perform. As of October 2008, more than 70,000 of these so-called “health tourists” had procured treatment in at least four-dozen other nations. Their most popular destination was India, followed by Hungary, Turkey, Germany, Malaysia, Poland, and Spain. So widespread has this practice become, that “health tourists” are now openly courted on the Internet by foreign doctors and hospitals that go so far as to offer consultations online. As 2008 drew to a close, British authorities predicted that the aforementioned 70,000 figure would nearly triple by the end of 2010.
As of 2009, some 1.4 million people – mostly administrators – were employed by the National Health Service, making it the third largest employer in the world, trailing only the Red Army of Communist China and the Indian national railway system.
Adapted from: "Socialized Medicine," by Dan Smoot (1960); and "Affordable Health Care," by Walter E. Williams (October 22, 2008).