A startling report from the chiefs of the British National Health Service who say without an infusion of cash, hospitals in the UK will be forced to lay off staff and implement "draconian rationing" to survive.

The Guardian:

Years of underfunding have left the service facing such “impossible” demands that without urgent extra investment in November’s autumn statement it will have to cut staff, bring in charges or introduce “draconian rationing” of treatment – all options that will provoke public disquiet, it says.

In an unprecedentedly bleak assessment of the NHS’s own health, NHS Providers, which speaks for hospital trust chairs and chief executives, tells ministers that widespread breaches of performance targets, chronic understaffing and huge overspends by hospitals mean that it is heading back to the visible decline it last experienced in the 1990s.

“Taken together this means the NHS is increasingly failing to do the job it wants to do and the public needs it to do, through no fault of its own,” Chris Hopson, the chief executive of NHS Providers, writes in the Observer.

His intervention comes days before the influential Commons health select committee decides whether to launch a special inquiry into the state of the NHS in England. After months dominated by the Brexit debate, the state of the NHS is now emerging as the key domestic challenge facing Theresa May’s government.

Recalling the NHS’s deterioration in the 1990s, which caused political problems for John Major’s government, Hopson adds: “NHS performance rarely goes off the edge of a cliff. As the 1990s showed, instead we get a long, slow decline that is only fully visible in retrospect. It’s therefore difficult to isolate a single point in that downward trajectory to sound a warning bell. But NHS trust chairs and chief executives are now ringing that bell. We face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate. They are saying it is impossible to provide the right quality of service and meet performance targets on the funding available. Something has to give.”

The future of US healthcare under Obamacare? It's certainly possible. This is especially true if the Democrats were to regain control of Congress and try to "fix" Obamacare by establishing a public option. The exact same problems bedeviling the NHS would emerge in the US because of the nature of government run insurance programs. There's never enough money to account for all who need care. The more cash that is infused in the system, the more people will use its services, leading to a cash crunch where the government will either throw more money at the problem or ration services.

Most other European countries have  a public-private mix in their national health plans. They are in better shape than the NHS but not without problems. But the British continue to resist wholesale reform of the NHS which will almost certainly lead to poorer and more expensive care.