Can a relatively low-tax country run a high-quality, taxpayer-funded health service thatâ€™s free to all? Britainâ€™s National Health Service suggests the answer is no.
The NHS is good at some things but bad, bordering on disastrous, at others. Its great virtue is truly universal coverage, no questions asked - and by international standards, the system is also cheap to run. As a result, though, itâ€™s perpetually short of money, and the service is erratic. Today the NHS is yet again dealing with a financial crisis and a surge of complaints about standards.
Prime Minister Theresa May has had to apologize to patients for a winter breakdown that has seen operations postponed and emergency-room waiting times rise well over the promised four-hour maximum. That comes a year after the British Red Cross declared the service was on the verge of a â€śhumanitarian crisis.â€ť
The NHSâ€™s problems - too many patients and not enough staff - arenâ€™t seasonal. Britainâ€™s population is growing and getting older, and as medicine advances, treatments become more sophisticated and expensive.
Many years of meager funding are taking their toll. In relation to population, the U.K. has fewer doctors, CT scanners and MRI units per capita than most other EU countries, and ranks toward to the bottom of the league on infant mortality.
More money by itself wonâ€™t cure the system. One former head of the Treasury called the NHS a â€śbottomless pit.â€ť Even so, bearing in mind how little the NHS costs, more money is surely part of the answer, as long as itâ€™s combined with further efforts to run the system more efficiently. For instance, social care for the elderly and other groups hasnâ€™t kept pace with whatâ€™s required, placing an added burden on more costly medical professionals.
Fixing that kind of misallocation would improve the systemâ€™s value for money.
The publicâ€™s devotion to the principle underlying the NHS is undiminished: The British see health care as a right. Increasingly, though, they are also demanding higher standards of care, and those come at a price.