This article appeared in the Wall Street Journal of September 1st:
The latest indictment of Britain's single-payer health care.
Postcard from the National Health Service: In 2007, 239 patients died of malnutrition in British hospitals, the latest year for which figures are available. Age U.K., a charity that has campaigned to improve hospital feedings, says the "true figure may be much higher" due to under-reporting.
This latest indictment of British health care is nothing new; Age U.K.'s efforts have yielded results in terms of increased government awareness, screening, training, and inspection programs. But this flurry of activity has produced little by way of improvement. Monday's report noted that in 2007-2008, 148,946 Britons entered hospitals suffering from malnutrition and 157,175 left in that state, meaning that hospitals released 8,229 people worse-off nutritionally than when they entered. In 2008-2009, that worse-off figure was up to 10,443.
The problem is not insufficient food. Hospital malnutrition mostly affects the elderly or otherwise frail, who often need individualized mealtime assistance. Balanced against everything else that a nurse might be doing, spoon-feeding the elderly may not seem like the best use of time or resources, but for some it may literally be a matter of life and death. Yet the constant scarcities created by socialized medicine, along with the never-ending drive to cut costs, has led the NHS to give nurses additional responsibilities and powers in recent years. Inevitably, this leaves them with less time to make sure patients are getting fed.
Prime Minister David Cameron's new government was quick to remind Britons on Monday that these appalling outcomes reflect more than a decade of Labour rule. But an official also stressed that "local NHS trusts are responsible for developing their own nutritional care policies." The subtext is that you can't blame Westminster for local bureaucrats' failings. This excuse doesn't quite square with the government's strategy to improve British health, which boils down to more power and autonomy for local health providers and authorities. In any case, this is not a Labour problem or a Tory problem. It's a single-payer health-care problem.
Localizing decision-making can only accomplish so much when the local deciders have no control over their budgets. Allocations for local health budgets are made in London, using a single formula that factors in populations and local health-care needs. No matter how much latitude Mr. Cameron or Health Secretary Andrew Lansley grant local authorities and medical providers, they will never be truly free to focus on individuals' needs as long as they answer to politicians rather than patients.
Along with their promises of decentralization, Messrs. Cameron and Lansley are also upholding the one constant in British politics: to increase health spending, and thus to mitigate the horrors of inevitable rationing. But in a single-payer system, is any pot of money ever big enough? The NHS's budget doubled under Labour between 1997 and 2007—largesse that nonetheless brought us to Monday's dismal statistic. Can anyone still seriously believe that additional funding or a new organizational chart can prevent another discussion on starving patients in English hospitals, or worse, in a few years' time?
