The Dangers of Health Care Rationing

Published July 1, 2007

One of the most fascinating books I have ever read on health economics is The Painful Prescription, an analysis of rationing in the British National Health Service (NHS) by Henry Aaron and William Schwartz. The Brookings Institution has now published an update, Can We Say No? and it’s every bit as rewarding as the original.

Britain spends less than half of what our country does on health care on a per-capita basis. The British also get less.

For more than a half-century, the NHS has promised health care free of charge to all citizens. Yet more than a million people are on waiting lists for care. Unable to get what they need from the public system, many pay out-of-pocket in the private sector, which provides one of every five surgeries and almost one-third of all hip operations.

Although equality of access to care has always been an overriding goal, gaps in mortality rates among British social classes have been widening over the past three decades.

Medical Envy

The authors show Britons are routinely denied services Americans take for granted. For example:

  • Per capita, bone marrow transplants take place 33 percent more often in the United States than in the U.K.
  • Britons provide only one-fourth as much coronary bypass surgery or angioplasty as the United States does.
  • Britain has only one-fourth as many CT scanners as the United States, and one-third as many MRI scanners.
  • The NHS hip replacement rate is only two-thirds what it is here.
  • To provide the level of intensive care unit (ICU) services that U.S. hospitals have, British hospitals would have to increase their spending fivefold.
  • The population-adjusted treatment rate for kidney failure (dialysis or transplant) is five times higher in the United States for patients age 45 to 84, and nine times higher for patients 85 or older.

Political Power

To achieve a level of care comparable to the U.S., Britain would have to increase its spending by one-third, according to the authors.

The one thing missing from the book was also missing in the original–a “public choice” explanation of how rationing choices in Britain flow logically from the politics of medicine.

I tried to fill that gap in a book I wrote almost 30 years ago. For the most recent version, see Lives at Risk, which I wrote with Gerry Musgrave and Devon Herrick.

John Goodman

For more information …

Can We Say No? by Henry Aaron and William B. Schwarz with Melissa Cox,

Lives at Risk by John Goodman, Gerry Musgrave, and Devon Herrick,