As Theresa May steps down as Conservative Party leader today, one thought may occur to her. Had Donald Trump’s state visit this week come, say, six months earlier, the course of Brexit might look very different. Her rejected deal could even have succeeded.
All the president had to do was utter three letters: NHS. Trump’s statement that Britain’s state-run National Health Service and “everything else” would be on the table in any future trade talks may have been a throwaway line. But it sure got everyone’s attention.
Trump rowed back the comments the next day, saying he doesn’t consider the NHS a trade issue. Too late; and it very much is one, as Woody Johnson, the U.S. ambassador, made perfectly clear in a television interview before the president’s visit. The NHS buys medicines, devices and services, including health plan administration services, from the United States.
(Related: U.S. Carriers To Help Run U.K. Health Plans)
There is no common language between American and British conservatives on the subject. Republicans hold up Britain’s state-run health system as an example of the dangers of socialism. The Trump administration argues that single-payer systems with control over drug prices “free ride” off American innovation.
British Conservatives couldn’t disagree more. Even though the opposition Labour party introduced free health care at the point of delivery, it is nowadays politically sacrosanct for both parties. Remember that it was a highly effective (but untrue) claim that leaving the European Union would trigger a windfall for the NHS that helped to swing the referendum result. Now the future of Brexit is again tied up with the NHS, thanks to Trump’s reminder.
If it wasn’t already apparent by the presence of pharma industry reps at a closed-door breakfast with Trump this week, the U.S. Trade Representatives’ negotiating objectives leave no doubt that health care is in their sights:
That doesn’t mean that the United States would, as some have claimed, seek to privatize the NHS. The pressure would come from challenging how the service decides which drugs to approve for reimbursement and the pricing decisions it makes, a process that the Pharmaceutical Research and Manufacturers of America (PhRMA) has called a “blunt cost containment tool.”
The NHS spends about 17.4 billion pounds ($22 billion) a year on medicine. The figure has been growing roughly 5% a year, much faster than the overall health budget, but is still low by EU standards. The government controls spending by determining which drugs are made available and by influencing how doctors prescribe and pharmacists dispense drugs.
The industry has long complained that the National Institute for Health and Care Excellence, the government body that approves medicines and treatments, is too stingy and denies patients access to life-saving drugs. Since manufacturers know that NICE evaluates the cost-effectiveness of a drug, it influences their pricing strategy.