Why NHS spending cannot be cut

By Jeremy Warner Economics Last updated: June 25th, 2010

Much comment since the Budget on how David Cameron and his Chancellor, George Osborne, have missed a trick in ring fencing spending on the National Health Service from the coming cuts. If they had spread the planned departmental cuts across all departments, including health, they could have limited the real terms squeeze over the next five years to an average 14 per cent. By protecting health, the biggest spender, they increase the pain to 25 per cent for other departments. Education and defence are also to escape the worst of the squeeze, so on some estimates other departments will get clobbered by more than 30 per cent. Why not spread it around a bit, many have argued. It is not as if health spending couldn’t benefit from reform.

But it is not just the politics of the situation that demands health spending is protected; there is actually a very good practical reason for it too, which is that try as some post war governments have to shave money off the health budget, no-one has ever succeeded in doing it. Mrs Thatcher tried, and so did the spending squeeze of the Lamont/Clarke years. None of them were successful. Health spending continued to grow in real terms right through these periods of fiscal retrenchment. Even if the Government thought it desirable, it would in practice be virtually impossible.

Why is this? Lack of will or determination has little to do with it. Rather, it is because public expectations of health care rises at a far faster rate than other public services, including education. For every treatment which gets more cost effective over time, there are loads of new life enhancing and extending ones coming up in the wings. Patients reasonably demand the latest and the best.

Apologies for the almost illegible reproduction, but as you might be able to see from the chart above, UK expenditure on health, including private, trails other advanced European economies as a percentage of GDP by a considerable margin, and that’s even after taking account of much of the big increase in health spending that took place under the last Labour Government. British spending is infact below the OECD average and as little as half what is spent in the US.

Even accepting that much of this shortfall is caused by British reluctance to finance health spending privately, it is still a quite shameful gap. It’s a problem, but UK citizens expect their healthcare to be state funded. These attitudes plainly need to change. The Government could help matters enormously by establishing some form of state sponsored private health insurance scheme, such as exists in France. Most private health insurance in Britain is a waste of money, with the costs of treatment scandalously recouped through higher premiums in subsequent years.

Failure, or reluctance, to find privately funded solutions makes it virtually impossible to cap ever growing state healthcare spending. The demographics of an ageing population make the pressures even worse. Health spending tends to be back end loaded, with the vast bulk of it falling in the final years of life. As more people survive into old age, the overall costs of the NHS will continue to rise steeply.

Many years ago, I attended a lunch with Professor Richard Doll, the physiologist credited with establishing the link between smoking and lung cancer. Also at the lunch was a then prominent member of the anti-smoking lobby, who complained bitterly about the health costs to the nation of this life threatening habit. To the contrary, replied Professor Doll. Smokers tend to die young before they become a burden on the taxpayer, and net net therefore cost rather less in healthcare than someone who lives to a ripe old age. The same argument might be made about obesity, which costs the nation heavily while the sufferer is still alive but saves mightily in later years because of premature death.

But enough of this macabre analysis. The bottom line is that health spending cannot be cut even if the new Government wanted to. The political challenge rather is that of introducing fair methods of part payment, for though David Cameron may succeed in sustaining public spending on healthcare, he’s never through tax funded means alone going to keep pace with exponentially rising expectations.

http://blogs.telegraph.co.uk/finance/jeremywarner/100006687/why-nhs-spending-cannot-be-cut/

In Europe, Britain May Face Largest Debt Hurdle

In Europe, Britain May Face Largest Debt Hurdle
By LANDON THOMAS Jr.
Published: May 24, 2010


LONDON — As governments from Greece to Portugal to Spain try to sell markets on their budget-cutting zeal, the country that may face the biggest hurdle is Britain.

Propelled by a robust economy that finally collapsed in 2008, Britain’s spending boom was the most expansive in Europe, producing a welter of shiny hospitals, school buildings and highways, along with a cadre of well-paid public sector officials.

Now the new government must unwind not so much the debt incurred from two years of economic stimulus efforts, but more broadly, the structural deficits built up over more than a decade of expanded health care, education and pension commitments.

Prime Minister David Cameron has talked boldly of closing a British budget deficit now equal to 11 percent of its gross domestic product. But he also has said that he will allow health spending to outpace inflation, continuing a trend started by the Labour government that has doubled the cost of the government’s elephantine National Health Service since 2000.

It is this apparent disconnect between the promises of politicians and the harsh demands of investors for immediate and across the board spending cuts that is at the root of the financial crisis in Europe today.

Even after the nearly $1 trillion rescue package arranged by European Union leaders to shore up the weaker euro zone members, financial markets have gyrated as fears build that debt-plagued nations lack the will to stand up to powerful unions and pare back once generous welfare programs.

“You need a martyr to cut this type of deficit,” said Andrew Lilico, chief economist at Policy Exchange, a right-leaning London research group, who has argued that quick and immediate spending cuts would actually hasten economic recovery rather than derail it.

“You need someone to say, ‘I will do the right thing and everyone will hate me.’ ”

According to a recent analysis by Citigroup, Britain’s structural deficit — meaning the part of the budget gap that will not close even when the economy improves — was 9.2 percent of G.D.P. last year, ranking third in the world behind rapidly aging Japan and almost bankrupt Greece.

As is the case with other countries in Europe, like Spain, Greece and Ireland, Britain has a deficit that has grown mostly because of a decade of rising government outlays that seemed reasonable at the time, but rested heavily on rising tax revenue that disappeared when the bubble burst.

In a recent report, the International Monetary Fund warned that the countries that would have to make the biggest sacrifices in spending cuts and tax increases to return to precrisis levels of indebtedness — Britain, France, Ireland, Spain and the United States — also face the biggest increase in spending demands. These are driven by the rising number of the elderly, thus making the cuts all the harder to impose.

“All developed economies now have in-built structural components in their government deficits due to having pension and health systems and aging populations,” said Edward Hugh, an independent economist based in Barcelona. “And these costs will go up by the year.”

The British chancellor of the Exchequer, George Osborne, who has long urged the Conservative Party to trim the deficit, said on Monday that he would push through £6 billion ($8.65 billion) in spending cuts.

Though decidedly modest when compared with a budget deficit estimated to be about £178 billion, the cuts represent an effort to convince skittish markets that Mr. Cameron’s team is committed to fiscal restraint.

The latest menu of restrictions, freezes and spending reversals also represents an effort to convince the public that Britain must be in tune with the budget-cutting in Greece, Portugal, Spain and other parts of Europe.

“The years of public sector plenty are over,” Mr. Osborne said. “The more decisively we act, the more quickly we can come through these tough times.”

Mr. Cameron has fulminated publicly about cutting public sector pay and decreed that members of Parliament themselves take a 5 percent pay cut.

But it remains unclear whether he can force significant savings in what has become in many respects a public sector aristocracy of elite civil servants, heads of national railroads and top officials of obscure agencies, like the National Policing Improvement Agency and the Horserace Betting Levy Board. The heads of those two agencies, for example, were paid salaries last year that exceed Mr. Cameron’s pay of £197,000 (about $284,000) — £211,831 and £220,665, respectively.

Among the highest paid have been administrators and doctors within the country’s government-financed National Health Service, which has become its own separate economy with its 1.7 million employees and £100 billion plus budget.

For example, David Taube, a doctor, administrator and medical director for five hospitals comprising the Imperial College Healthcare N.H.S. Trust, was paid £260,000 (about $375,000) at the exchange rates last year. That is also more than the prime minister received.

According to the TaxPayers’ Alliance, an advocacy group for spending cuts, the highest-paid 805 government employees in Britain received a 5.4 percent pay increase last year, with the average official taking in £209,224.

Whether it be the £1.3 million paid to the chief executive of the Royal Mail, the £267,000 for the head of information technology in the Department for Work and Pensions, or the £270,000 earned this year by the chief executive of the Guy’s and St. Thomas Hospitals in London, the galloping pay of public sector workers in Britain has become a major component of the structural deficit and shows little sign of letting up.

“We have been doing this for five years now, and the numbers just get bigger and bigger,” said John O’Connell, an analyst at the TaxPayers’ Alliance.

Starting in 2000, the Labour government made it a priority to improve the N.H.S.’s lackluster reputation and invested billions in bricks and mortar as well as the salaries of its growing ranks of doctors and administrators.

Health care spending in Britain soared to 9 percent of G.D.P. from 3 percent. The image of the service has been transformed from one that exemplified drab inefficiencies of the British state to what is now hailed as a world archetype, even by Conservative politicians like Mr. Cameron.

As for Dr. Taube, a spokeswoman for the Imperial College Healthcare N.H.S. Trust said that he was a leading renal clinician and that the bulk of his salary, £180,000 to £185,000, came from his clinical work. He was paid an additional £75,000 to £80,000 for his administrative duties.

Now the new government must wrestle with whether it can restrain such pay and spending and at what political cost.


http://www.nytimes.com/2010/05/25/business/global/25debt.html?src=me&ref=business