Moving Down and Shaking Up

The National Health Service (NHS) has been the pride and joy of Britain’s people and government for decades. Back in June, The Economist reported that 77 percent of British citizens support it in its present state. And a whopping 91 percent subscribe to the institution’s mission statement that high-quality healthcare should be “free at the point of delivery.”

As the largest single-payer healthcare system in the world, the NHS is celebrated as a triumph of governance, leadership, and innovation. So why does the Care Quality Commission (CQC), the regulatory agency that oversees its practices, say that it is straining at the seams?

The NHS was created in 1948 as a public institution meant to protect public health by combatting prevalent diseases like polio and tuberculosis. Over the years, the services it offers have grown wider and more varied. Any resident of England can now access necessary medical procedures at any public hospital in the country at little to no cost. These services range from regular checkups to emergency operations. Some are even offered to temporary visitors of the country without citizenship or membership within the system. NHS’s popularity among the people it serves, therefore, comes as no surprise.

But under the shiny veneer of public enthusiasm and approval lies a deeply troubled system with an uncertain future. Last year, 2.5 million people spent over four hours in the emergency room, compared to 1.8 million in 2016. Much of the rise in numbers can be attributed to a rapidly aging population: there are now one million more people over 65 in Britain than there were five years ago. The influx of elderly patients means that hospitals must dedicate more of their time to emergency treatment rather than long-term care.

Even with the dedication of nurses and doctors across the country, hospitals are getting bogged down by bureaucracy and inefficiency. Over 91 percent of hospital beds were constantly occupied in 2017. David Behan, chief executive of the CQC, stated that the number of nurses in adult long-term care facilities is “insufficient” and that the NHS’s plight is “one of the greatest unresolved public policy issues of our time.”

The unforeseen consequences of the Brexit vote have not helped. The Conservative government has proved time and again that the process of leaving the European Union will not be as simple as it was made it out to be, leading many to believe that the British economy will suffer without access to the continental market. The speculative fears have led to an exacerbation of housing crises and decreased faith in the government, further weakening the basic foundations of the NHS.

More funding is not the solution. To celebrate the institution’s 70th birthday in July 2018, the government gifted it $33 billion to help with rising costs; the money has had no visible effect. To ask more of the British taxpayer would only be a temporary fix. Instead, the government should aim to take into account income and personal situations when creating public policy. A step in the right direction would be to implement a program similar to the Australian government’s superannuation system of private pensioning.

The Australian government mandates that employers set aside 9.5 percent of workers’ wages to be applied to post-retirement pensions. Though costly for the employee, the end result is that retired Australians have access to a massive pot of $1.9 trillion, the biggest in the world. Such a system is conceivably workable for the British healthcare system and would serve as a positive replacement of the current general taxation scheme.

In addition, the most vulnerable customers of the NHS are the low-income and working class population, whom the government refers to popularly as “just about managing.” Such a wage-based healthcare system should be structured around people like them. Percentages of wages put into a public fund like Australia’s should be proportional to income. For example, someone earning $50,000 a year would have three to five percent of their income transferred to the fund, and someone earning $200,000 a year would be subject to a higher rate of around 10-15 percent.

Critics saying that this system would have the well-off paying for the medical expenses of everyone else would be twisting the situation. The money would go to a public fund of guaranteed value and certainty—any citizen would have access to it, rich or poor. And considering the resounding success of the Australian scheme, a pension pot worth nearly $2 trillion, the funds would be more than enough to cover both emergency and long-term care for all British citizens.

Such a program would not be implemented without resistance. The NHS remains extremely popular in its current form, and the notion of setting aside a portion of income for healthcare is foreign to many British citizens. But serious shaking up is needed to avoid a long-term move down.