Health and Social Care Bill 2011: a legal basis for charging and providing fewer health services to people in England

BMJ 2012; 344 doi: (Published 8 March 2012)
Cite this as: BMJ 2012;344:e1729

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19 March 2012

The contrast between attempts at healthcare reform in the UK and US is disturbing. Despite President Obama's popularity and the undisputed fact that the US healthcare system is in need of reform, it has been a struggle for him to pass even the diluted version of his original bill, a version that many argue fails to address the fundamental problems that plague the system. In contrast, a UK coalition government which stumbled into power now has the audacity to push through reforms set to tear apart the very fabric of an effective, universal healthcare system. A multi-tier system already exists in the US and is difficult to change because so many groups benefit financially from the status quo- once a similar situation arises in the UK, which the current healthcare bill undeniably paves the way for, returning to an NHS which is universal in more than just name will be challenging indeed.

Competing interests: None declared

Adam M Ali, Frank Knox Fellow

Harvard University, Harvard University, Cambridge. MA 02138

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As well as legal concerns, there are issues of efficacy, and also moral issues. Much of the coalition government's rhetoric is based on Liam Fox's "Atlantic Bridge". However, the US based Commonwealth Fund report [1], has shown that the US system does not work in terms of improving longevity or health of the whole US population, and is more expensive than any other nation's. The retiring head of Medicare and Medicaid, Dr. Donald W. Berwick [2], has raised concerns about that system, citing overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud. Perhaps these are similar to the concerns of the DoH Risk Assessment of this Bill, which the government refuses to publish, despite a ruling by the Information Commissioner?

Existing private health care organisations in Britain are alleged to have avoided UK tax by offshore manipulations [3].

Recent US social psychology research may also contribute to this debate. Passing by a homeless person without an offer of help leads to less moral behaviour afterwards [4]. In general, rich people seem to behave in a less moral fashion in general [5]. If ministers and MPs lose their positions in the forthcoming 2015 election, they would be entitled, as would any of us, to apply for non-executive directorships of private health care companies, as well as companies in other sectors.

[1] The Commonwealth Fund Commission on a High Performance Health System, Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011, The Commonwealth Fund, October 2011.

[2] Health Official Takes Parting Shot at ‘Waste’. Robert Pear.The New York Times. Published: December 3, 2011

[3] Daniel Boffey, policy editor. Firms poised to take advantage of NHS shake-up 'avoid tax on their profits'.

[4] C. D. Cameron, B. K. Payne. The Cost of Callousness: Regulating Compassion Influences the Moral Self-Concept. Psychological Science, 2012; 23 (3): 225 DOI: 10.1177/0956797611430334.
Retrieved March 18, 2012, from /releases/2012/03/120315110416.htm

[5] National Science Foundation (2012, March 7). Upper class people more likely to behave unethically. ScienceDaily. Retrieved March 8, 2012, from /releases/2012/03/120307145432.htm

Competing interests: None declared

GARETH H JONES, Retired consultant psychiatrist

none, Rudry, Caerphilly, CF83 3DF

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