I don’t care to delve too deeply into the clump of giant hogweed that is health policy but if Andrew Lasley succeeds in freezing health spending in real terms then he will have been one of the more successful cabinet ministers even if his ambitious reforms go nowhere or achieve nothing. It is annoying, as Pete says, that this will have to be a secret triumph since it has become an article of faith, apparently, that spending more money on the NHS is always the virtuous thing to do. Nevertheless, a secret triumph that cannot be proclaimed is better than failure.
Every developed country must confront the horror of sharply-increasing health costs as the price of human ingenuity becomes ever more expensive. If Lansley can achieve a real-terms freeze over the next four years then he’ll receive envious looks from some of his counterparts in other countries. Then again, by international standards the NHS is pretty cheap and delivers pretty average, just-about-good-enough outcomes. For all its faults – and they may be legion – this is not the worst bargain in the world even if we might not build it the way we have were we tasked with constructing a health system from scratch.
Meanwhile, in the Uited States, Robin Hanson has a typically provocative proposal for how best to control the rapidly-increasing cost of Medicare and Medicaid:
The United Kingdom, where, on average, people live longer than in the U.S., spends only about 9 percent of gross domestic product on medicine, compared with our 18 percent. The British control costs in part by having the will to empower a hard-nosed agency, the National Institute for Health and Clinical Experience (N.I.C.E.), to study treatments and declare some ineffective. Some hope the United States will create a similar agency, but I fear it would be hopelessly politicized and declawed.
My solution: admit we are cost-control wimps, and outsource our treatment evaluation to the U.K. Pass a simple law saying Medicare (and Medicaid) won’t cover treatments considered but not positively appraised by the Britain’s national health institute.
Don’t expect this idea to catch on. Even so, there’s something to be said for trying to cap healthcare costs at, say, no more than 10% of GDP. That’s a tough proposition but the kind of challenge a radical and reforming government should take on, even if for reasons of political expediency it won’t want to shout about it very much or very loudly.
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