From Oxford to Princeton

This has been a week of exploring problems and solutions in the health systems of the US and the UK, highlighted by a conversation with Lady Margaret Thatcher. Here's a chronology:

Saturday: Merton College (founded in 1264) at Oxford University in England.

Dr. Liam Fox, a Member of Parliament and health secretary in the Shadow Cabinet, hosted a conference organized by his new organization, The Atlantic Bridge, to exchange ideas about advancing market-based health reform.

During his talk, Dr. Fox gave chilling examples of ways in which the care of patients can be subordinated in Britain's socialized National Health Service (NHS) to meet the political target du jour.

The latest dictate to hospital administrators: Reduce the waiting time for patients in emergency rooms.

Some of the clever bureaucratic solutions: Drive patients around in ambulances or park the ambulances outside hospitals for hours until they can be seen. If there aren't enough ambulances, leave patients on gurneys in the hallways but take the wheels off the gurneys. Why? Because if it doesn't have wheels, it is, according to the rules, a hospital "bed." Voila! The waiting time vanishes from the records.

The UK has decided to increase its national expenditures on the NHS by about 3%, but so far virtually all of the new spending has gone to increased bureaucracy and almost none to patient care, Fox said. Surprise, surprise.

Despite this, it is extraordinarily difficult to talk with average British citizens about markets that have incentives to respond to consumer demands, and the importance of competitive pricing and intellectual property rights to induce innovation. The NHS is as beloved as Medicare in the US but even more decrepit. Dr. Fox and The Atlantic Bridge are courageously working to change their system and deserve great respect.

I stressed in my presentation that continued innovation in health care financing and medical advancements is the only answer to the health sector woes in our two countries. These changes can engage consumers in making value-based decisions and encourage ever better medical technologies that diagnose and treat disease earlier and less invasively to keep people healthier longer. Here's a link to my PowerPoint presentation. www.galen.org/news/Atlantic_Bridge.pdf.

Monday: Back in Washington for our briefing on Capitol Hill with the Council for Affordable Health Insurance focusing on tax credits as tax cuts for the uninsured.

Mark Pauly gave a brilliant presentation to our well-attended lunch briefing, making a convincing case that a tax credit for health insurance should be seen not as a public spending program but as a tax cut with the condition that people purchase health coverage.

He described a plan for a scaled, flat tax credit of $1,000 for individuals and up to $3,000 for families earning up to 300% of poverty. He estimates this would cover 70% or more of the uninsured for a total tax reduction of $48 - $60 billion a year, offset by $10 billion in uncompensated care.

This cost is, BTW, significantly less than the plans offered by the Democratic presidential candidates so far, with a very similar reduction in the number of uninsured. Here's a link to Mark's PowerPoint presentation. www.galen.org/news/Pauly_presentation.pdf

Jeff Lemieux of the Progressive Policy Institute backed Mark's plan, and Joel White of the House Ways and Means Health Subcommittee staff endorsed using the $50 billion earmarked in the congressional budget for tax credits, targeting the unemployed.

Wednesday: New York. Lady Thatcher was the guest of the Atlantic Bridge (a busy organization!) for a fund raising reception in Manhattan, and the Iron Lady was as steadfast and passionate as ever in making the case for individual liberty, private property rights, low taxation, and limited government.

Her talk was very inspiring for anyone who might be feeling discouraged about the difficulty of making progress on free-market ideas. We only need to remember the extraordinary political and economic battles she fought for 11 years as Prime Minister. "Never waver in your confidence," she implored.

Largely as a result of her victories, the British economy today has greater strength than its European neighbors with lower unemployment rates and stronger economic growth.

She talked of the wellspring of ideas that she and President Reagan shared to guide their vision, and said that both countries will be stronger by continuing to draw energy from each other to advance individual freedom - a key mission of The Atlantic Bridge.

Lady Thatcher said she felt very much at home in the reception hall at the beautifully restored St. Regis Hotel which, she said, looked just like Ten Downing Street. My husband, Douglas, and I actually had a short talk with her in which she stressed the importance of the rule of law.

Thursday and Friday: Princeton. I'm here for a conference on regional disparities in US health spending. Dartmouth researchers presented eye-opening data on the greater utilization of medical care for Medicare patients in high-spending regions, with some indications that quality and outcomes are worse! We'll be hearing much more about this.

Grace-Marie Turner