British National Health Service to empower patients and doctors

LONDON — Perhaps the only consistent thing about Britain’s socialized health care system is that it is in a perpetual state of flux, its structure constantly changing as governments search for the elusive formula that will deliver the best care for the cheapest price while costs and demand escalate.

The new British government’s plan to drastically reshape the socialized health care system would put local physicians like Dr. Marita Koumettou in north London in control of much of the national health budget.

Even as the new coalition government said it would make enormous cuts in the public sector, it initially promised to leave health care alone. But in one of its most surprising moves so far, it has done the opposite, proposing what would be the most radical reorganization of the National Health Service, as the system is called, since its inception in 1948.

Practical details of the plan are still sketchy. But its aim is clear: to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers.

The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.

In a document, or white paper, outlining the plan, the government admitted that the changes would “cause significant disruption and loss of jobs.” But it said: “The current architecture of the health system has developed piecemeal, involves duplication and is unwieldy. Liberating the N.H.S., and putting power in the hands of patients and clinicians, means we will be able to effect a radical simplification, and remove layers of management.”

The health secretary, Andrew Lansley, also promised to put more power in the hands of patients. Currently, how and where patients are treated, and by whom, is largely determined by decisions made by 150 entities known as primary care trusts — all of which would be abolished under the plan, with some of those choices going to patients. It would also abolish many current government-set targets, like limits on how long patients have to wait for treatment.

In Florida the Tea Party gets the arrows, but it's a reform agenda that drives Rubio's success

Marco Rubio appeared on a Sunday talk show this month to say something remarkable. The Republican running for Florida's Senate seat suggested we reform Social Security by raising the retirement age for younger workers. Florida is home to 2.4 million senior citizens who like to vote. The blogs declared Mr. Rubio politically suicidal.

The response from Mr. Rubio's primary competitor, Gov. Charlie Crist, was not remarkable. His campaign slammed Mr. Rubio's idea as "cruel, unusual and unfair to seniors living on a fixed income." Mr. Crist's plan for $17.5 trillion in unfunded Social Security liabilities? Easy! He'll root out "fraud" and "waste."

Let's talk Republican "civil war." Not the one the media is hawking, that pits supposed tea party fanatics like Mr. Rubio against supposed "moderates" like Mr. Crist. The Republican Party is split. But the real divide is between reformers like Mr. Rubio and Wisconsin Rep. Paul Ryan, who are running on principles and tough issues, and a GOP old guard that still finds it politically expedient to duck or demagogue issues. As Republicans look for a way out of the wilderness, this is the rift that matters.

And it's the divide playing out in Florida, even if that's not the press's preferred narrative. In conventional-wisdom world, Mr. Rubio is the darling of an angry grass roots, surging at the expense of the postpartisan Mr. Crist.

49 % favor opt-outs from failing Social Security

"Forty-nine percent (49%) of U.S. voters say working Americans should be allowed to opt out of Social Security and provide for their own retirement planning.

A new Rasmussen Reports national telephone survey finds that 37% disagree and do not believe Americans should be able to opt out of Social Security. Fifteen percent (15%) are not sure.

A majority of voters under 50 say workers should be allowed to opt out. A plurality of those over 50 disagree.

One of President Obama’s top economic advisers signaled this week that the president will try to reform Social Security before the end of his first term. Voters are also closely divided on whether this is a good idea despite news that the system may be closer to running out of money than previously reported."