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.

Dodd-Frank is a triumph of overreach unrelated to problems

Instead of addressing the obvious flaws that led to the very real financial crisis that began in 2008, the Dodd-Frank bill’s labyrinth of regulatory overreach and ill-conceived changes is certain to injure our economy for years if not decades to come.

The fundamental principle of any reform has to be getting the right diagnosis, because without that you cannot possibly hope to find the right cure. The Dodd-Frank bill fails that crucial test in several ways.

First, and most importantly in this period of high unemployment, there is nothing in this bill that will help create jobs and much that will impede us in that goal. Through its numerous provisions that ban and ration credit products, make credit more costly and less available, and reduce consumer choices, the Dodd-Frank bill will be a private-sector job killer at a time when government policy ought to create an environment where private lenders lend responsibly to creditworthy consumers and small businesses. In fact, the only professions that may benefit from this bill are trial lawyers and government bureaucrats.

That sad fact gives way to yet another critical flaw in the Dodd-Frank bill: Massively expanding the size of government’s regulatory bureaucracy with new layers, agencies, and required rulemakings does not mean that oversight will get any better. In all likelihood, consumers will be worse off as the new alphabet soup of merged and restructured agencies struggle to organize, hire staff, stake out their jurisdictions and write an estimated minimum of 12 new government reports, 44 studies, and 243 new rulemakings required under the bill. All the while, banks and investors will sit cautiously on the sidelines waiting out the regulatory uncertainty of Dodd-Frank before they resume lending, Thus hampering our prospects for economic growth.