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patients could be treated or the hospital would

lems, and few serious national health care

lose a portion of its funding.238 As the Daily

advocates look to it as a model. Yet it appears

in Moore's movie SiCKO as an example of

Telegraph explained:

how a national health care system should

work, so it is worth examining.

In a real competitive market, increased

The NHS is a highly centralized version of

demand can allow prices to rise, thus

a single-payer system. The government pays

increasing profits, which allow the mar-

directly for health care and finances the sys-

ket to grow. Efficient producers can then

tem through general tax revenues. Except for

reduce their unit costs and their prices,

small copayments for prescription drugs,

and so give a better deal to the con-

dental care, and optician services, there are

sumer. The prevailing logic is that the

no direct charges to patients. Unlike many

more customers who are served--or

other single-payer systems such as those in

products that are sold--in a given period

Canada and Norway, most physicians and

of time, the better the business does.

nurses are government employees.

But PCTs have budgets that are

For years, British health policy has focused

predetermined by Whitehall spend-

on controlling spending and in general has

ing limits, and there is no way for

been quite successful, with the system spend-

them to conjure extra revenue out of

ing just 7.5 percent of GDP on health care.232

the air or to grow their market. As a

result, the hospitals that are most

Yet the system continues to face serious finan-

successful in providing prompt treat-

cial strains. In fiscal year 2006, the NHS faced

ment are running through the finite

a deficit of £700 million, according to govern-

resources of their PCTs at an unac-

ment figures, and as much as £1 billion,

according to outside observers.233 This comes

ceptably rapid rate.239

despite a £43 billion increase in the NHS

annual budget over the past five years.234 By

The problem affects not only hospitals.

some estimates, NHS spending will have to

There are also lengthy waits to see physicians,

nearly triple by 2025 just to maintain the cur-

particularly specialists. In 2004, as a cost-cut-

rent level of services.235

ting measure, the government negotiated low

salaries for general practitioners in exchange

And that level of services leaves much to be

for allowing them to cut back the hours they

desired. Waiting lists are a major problem. As

practice. Few are now available nights or

many as 750,000 Britons are currently awaiting

weekends.240 Problems with specialists are

admission to NHS hospitals. These waits are

not insubstantial and can impose significant

even more acute. For example, roughly 40

risks on patients. For example, by some esti-

percent of cancer patients never get to see an

oncology specialist.241

mates, cancer patients can wait as long as eight

Explicit rationing

months for treatment.236 Delays in receiving

The government's official target for diag-

also exists for

treatment are often so long that nearly 20 per-

nostic testing is a wait of no more than 18

cent of colon cancer patients considered treat-

weeks by 2008. In reality, it doesn't come

some types of

close.242 The latest estimates suggest that for

able when first diagnosed are incurable by the

care, notably

time treatment is finally offered.237

most specialties, only 30 to 50 percent of

kidney dialysis,

patients are treated within 18 weeks. For trau-

In some cases, to prevent hospitals from

ma and orthopedics patients, the figure is only

using their resources too quickly, mandatory

open heart

20 percent. Overall, more than half of British

minimum waiting times have been imposed.

surgery, and some

patients wait more than 18 weeks for care.243

The fear is that patients will flock to the most

other expensive

efficient hospitals or those with smaller back-

Explicit rationing also exists for some

logs. Thus a top-flight hospital like Suffolk

types of care, notably kidney dialysis, open

procedures and

East PCT was ordered to impose a minimum

heart surgery, and some other expensive pro-

technologies.

cedures and technologies.244 Patients judged

waiting time of at least 122 days before

24