The US and the UK share a common language, a common legal tradition, and a common scourge of right-leaning political parties trying to destroy anything that the government does better than private industry. Despite over a century of evidence that many public services are natural monopolies, and therefore will provide poor quality at inflated prices whenever personal profits get involved, the electorates of both countries keep believing the lie that "industry does it better."
That's why 13 years of Conservative rule has hollowed out the UK's National Health Service (NHS), and why 25 years of Republican obstructionism has allowed corporate mergers to gut US health care.
First the NHS. As journalist Sam Freedman recently explained, NHS administration plus the Tories cutting funding to the NHS repeatedly have left the UK almost as badly off as the US in health-care outcomes:
It is well known within health policy circles that the NHS is severely undermanaged compared to other systems. The UK spends less than half the OECD average on management and administration, which is why I bang my head against the nearest wall whenever I see a newspaper splash bemoaning fat cat managers, or yet another politician promising to get more resources to the “frontline”. It is, of course, the case that if frontline staff are not properly supported they end up becoming expensive admin staff themselves (see also policing). Meanwhile the number of managers per NHS employee has fallen by over 25% since 2010 due to deliberate policy decisions from the centre of government, particularly Andrew Lansley’s disastrous “reforms”.
Meanwhile the central bureaucracy has grown to manage all this complexity. There are fewer managers but more managers managing the managers. .... The lack of clarity as to what they are supposed to be achieving is concerning, and we’ve already seen the Secretary of State slash their funding, which can hardly help.
Overall though we are drifting further into crisis due to a stubborn refusal to accept the obvious. Doctors need to be paid more. There needs to be significantly greater capital investment – in beds, equipment and IT. We need more managers, with greater autonomy. Yes this all costs money but at the moment we are wasting enormous sums on a low productivity system.
Meanwhile, the ever-more-desperate search for higher returns has led private equity to invest heavily in US health care providers, even though (a) they know nothing about health care and (b) it elevates profit-seeking behavior to actual rent-seeking, not to mention driving doctors and nurses out of practice:
E.R. doctors have found themselves at the forefront of these trends as more and more hospitals have outsourced the staffing in emergency departments in order to cut costs. A 2013 study by Robert McNamara, the chairman of the emergency-medicine department at Temple University in Philadelphia, found that 62 percent of emergency physicians in the United States could be fired without due process. Nearly 20 percent of the 389 E.R. doctors surveyed said they had been threatened for raising quality-of-care concerns, and pressured to make decisions based on financial considerations that could be detrimental to the people in their care, like being pushed to discharge Medicare and Medicaid patients or being encouraged to order more testing than necessary. In another study, more than 70 percent of emergency physicians agreed that the corporatization of their field has had a negative or strongly negative impact on the quality of care and on their own job satisfaction.
Concerns about the corporate takeover of America’s medical system are hardly new. More than half a century ago, the writers Barbara and John Ehrenreich assailed the power of pharmaceutical companies and other large corporations in what they termed the “medical-industrial complex,” which, as the phrase suggests, was anything but a charitable enterprise. In the decades that followed, the official bodies of the medical profession seemed untroubled by this. To the contrary, the American Medical Association consistently opposed efforts to broaden access to health care after World War II, undertaking aggressive lobbying campaigns against proposals for a single-payer public system, which it saw as a threat to physicians’ autonomy.
Throughout the medical system, the insistence on revenue and profits has accelerated. This can be seen in the shuttering of pediatric units at many hospitals and regional medical centers, in part because treating children is less lucrative than treating adults, who order more elective surgeries and are less likely to be on Medicaid. It can be seen in emergency rooms that were understaffed because of budgetary constraints long before the pandemic began. And it can be seen in the push by multibillion-dollar companies like CVS and Walmart to buy or invest in primary-care practices, a rapidly consolidating field attractive to investors because many of the patients who seek such care are enrolled in the Medicare Advantage program, which pays out $400 billion to insurers annually. Over the past decade, meanwhile, private-equity investment in the health care industry has surged, a wave of acquisitions that has swept up physician practices, hospitals, outpatient clinics, home health agencies. McNamara estimates that the staffing in 30 percent of all emergency rooms is now overseen by private-equity-owned firms. Once in charge, these companies “start squeezing the doctors to see more patients per hour, cutting staff,” he says.
As demonstrated repeatedly in public services as diverse as transport and drinking water, taking the profit (or rent-seeking) motivation out of the equation leads to better outcomes for everyone—except the private monopolists. But that's what governments are for.