America’s healthcare system is caught at the intersection of excessive costs and an aging population.
In a February study using 2021 dollar values, the Urban Institute estimated that the average low-income single male who starts receiving Medicare benefits in 2030 will have paid $45,000 in lifetime Medicare taxes but will receive $311,000 in lifetime Medicare benefits. By 2060, this discrepancy will rise to $63,000 in lifetime Medicare taxes for a stunning $573,000 in lifetime benefits. For a middle-class single male, the benefits-burden divergence is only slightly better: The 2030 lifetime Medicare tax figure is $159,000, and the 2060 figure is $230,000.
Considering that the federal debt is already out of control in both total figure and debt-to-GDP terms and that the U.S. population is aging (by 2040, 1 in 5 people will be over 65, versus 1 in 8 in 2000), this math underlines a coming crisis. Absent comprehensive reform, something will have to give. Either the economy will sink under the weight of structurally high interest rates needed to pay for an impossible debt load, or we’ll see a triage-based provision of inferior health services.
But if the U.S. healthcare system faces fiscal collapse, the British healthcare system is already in functional collapse.
The BBC offered an example on Monday. It reported how an 89-year-old man who had broken his hip and shoulder was recently “taken to hospital strapped to a plank in the back of a van after his granddaughter was told no ambulances were available.” With quite an understatement, the local ambulance service said these circumstances were “below what it aimed to offer.”
Yet this is not some isolated incident. Because the United Kingdom’s National Health Service lacks either enough emergency room or inpatient beds, and because the U.K. has a deep deficit of social care/assisted living capacity, ambulances are being forced into long waits outside hospitals before they can transfer their patients. Such delays can now exceed 20 hours. At every priority response level, ambulances are also significantly exceeding target times for reaching those in need. Critically ill patients are dying avoidable deaths, those whose care should be managed outside hospitals are stuck in the hospital taking up beds, and the general provision of emergency healthcare is in collapse. With the busy winter period approaching, things are set to get far worse.
But that’s just the tip of the iceberg. Waiting lists for treatments are also surging. Only 38% of urgent referral cancer patients in the U.K.’s second-most populous city, Birmingham, are now seen within the target of 62 days. In England at large, only 60% of urgent referral cancer patients are seen within the target period. It’s not just cancer. In the Oct. 2015-Oct. 2022 period, average delays in receiving senior-doctor-led elective care (including semi-urgent care such as heart surgery) have more than doubled to 3 1/2 months. A recent BBC investigation also found that doctors who raised concerns about the inferior provision of care to patients were being retaliated against by management.
A big challenge for the U.K. is resourcing. The Organization for Economic Cooperation and Development estimates U.S. per capita healthcare spending at $12,381. This figure far exceeds that of any other nation and is problematic for the aforementioned reasons. Indeed, thanks to the pharmaceutical lobby’s power, Congress allows U.S. residents to subsidize the prescription drug costs of the rest of the world. Banning the importation of drugs manufactured abroad, the U.S. forces patients to pay a premium at home. Americans thus fund the research and development of new drugs, while others around the world gain the benefits of pharmaceutical export agreements negotiated by their governments. Congress should restrict U.S. pharmaceutical companies from exporting drugs to high-wealth economies at lower than U.S. market prices.
Nevertheless, even evading drug cost burdens, Britain’s per capita health spending figure of $5,387 is obviously far too low to cope with the current situation. Worse is to come: The aging demographics of the U.K. are even more problematic than in the U.S. And unlike the generally socialized medical systems of France ($6,115 per capita) and Germany ($7,382 per capita), Britain does not adopt a partial personal insurance element to its healthcare system. This means that personal responsibility in terms of attending appointments and taking greater care of one’s health choices is largely absent from the U.K.
The issue here is not skill. NHS doctors and nurses are well trained and adopt a strong public service mantra with patriotic roots (my mother was an NHS nurse). I can personally attest that most surgeons are excellent. And although they avoid the American absurdity of having to complete expensive undergraduate and medical degrees (British doctors go straight to medical school after high school), British doctors are paid less than half what their U.S. counterparts earn. U.K. nurses earn approximately 35% less than their U.S. counterparts. As referenced, they also face very high workloads.
The top line, however, is clear. Unless the U.K. government can urgently match increased personal responsibility to significantly increased healthcare capacity, the NHS will implode.