Rhetoric vs. reality, or, the not-yet-ready-for-prime-time universal health plans: Britain's NHS, Medicare (for All), and the FEHBP

Three examples of health plans are often touted by proponents of universal health care coverage: the Federal Employee Health Benefit Plan (FEHBP), Medicare and Britain’s National Health Service (NHS). 

Access to "the same health care choices as members of Congress" (the FEHBP) is an ever-popular populist mantra on the stump.  Low-overhead Medicare is likewise promoted as a panacea.  And the pointy-headed liberal crowd (OK, sometimes including me) looks across the pond to a reinvigorated NHS as a potential model for at least part of what needs to happen here.

Today’s question:  Do these solutions measure up?

Today’s answer:  Not really.  That doesn’t mean I’m joining the ranks of the Anti-Universal Coverage Club (see manifesto at Cato@Liberty), but while I recognize the difficulty of getting these things across in campaign-season sound bites, the candidates need to recognize the limitations inherent in these potential solutions and be a little more explicit about ways in which they would improve on them.

All this is brought to the fore, again, as the BBC reported on NHS bookkeeping yesterday:

NHS trusts have a £4bn backlog of key maintenance repairs which range from fixing heating to meeting fire safety rules, government figures suggest.

The figure is eight times this year’s much-heralded NHS surplus, which was achieved by making a variety of cuts.

Shadow Health Secretary Andrew Lansley, who obtained the figures, said they showed the surplus was a "sham".

For me, this echoes the reality that "Medicare for All" would not, in fact, represent that great a savings on administrative overhead, because much of Medicare’s overhead is off-budget (real estate occupancy costs, contractor operations, its own employee health benefits, etc.), and the emerging sense that FEHPB isn’t really built to handle a gajillion more subscribers.

So, my sage advice to the candidates (OK, to the Democratic candidates) today:  acknowledge these limitations and offer some concrete options to overcome them.

I know there are several other hurdles to overcome —  getting medical inflation in check, ensuring that prevention gets more attention (e.g., anti-obesity programs, which among other things might even include an adjustment to the federales’ subsidy of corn production in this country — but that’s a whole other story).  But on the financing of health care coverage side of things, a nod to the fact that the solution is not so simple might give the public greater confidence.

— David Harlow