For those tired of the never-ending debate over Obamacare, small refuge can be taken in the fact that our U.K. brothers across the pond also are struggling with the viability and future of their National Health Service (NHS). As recently as early July, as Kate Middleton was in the final days of her pregnancy, the U.K. Parliament was debating yet again how its system will cope with the exploding 21st century demand for services.
Can the NHS survive in its current form as Prince George himself ages?
The demography of our time is profoundly different from when the U.K.’s health safety net was first created in 1947. So it’s worth projecting that by the time George of Cambridge wears the crown, Britain will have changed in ways that throw into question the viability of that old health system.
It’s hard to imagine the Brits won’t need fundamental change.
Why? A number of reasons:
First, if the little prince becomes King George VII, he’ll most likely be eligible for his pension. As the third in line of succession, George is going to have to wait around for a while. His grandfather, Prince Charles, is 64, and just two months younger than the oldest prince ever to ascend to the throne. And the longevity of his great grandmother Elizabeth is no aberration. At age 87, she is one of three million Brits over the age of 80. If longevity trends continue into the coming half-century, there’s no telling how long Baby George will have to wait while Prince William adorns the throne.
Second, if George of Cambridge becomes king, he’ll reign over a population that’s older than any this world has yet seen. If young George takes the throne by 2050 (not likely), the average British citizen will be six years his senior, or 43.3 years old. If he ascends in 2075 (more likely), the average Briton is expected to be 45 years old.
As king, he’ll have only limited influence over the economics of the pension system, of course. But it’s safe to say that, with such an aged population, there’s no chance that system can survive “as is” through the 21st century. The ratio of old-to-young will simply be too far tilted in the direction of the senior citizens.
Third, and perhaps biggest of all, the make-up of the subjects over which he’ll rule will continue to change with great impact. As is true of every other modern nation, the U.K. is producing far fewer babies, resulting in a demographic shift of more old than young. The U.K., not unlike the rest of Europe and the developed world, has been experiencing birth rates well below replacement.
While there has been a slight bump the last few years in the U.K., the trend since the early post WWII years has been a steady decrease to a low the past few decades, averaging a birth rate of roughly 1.6 children per couple.
The impact to society is huge, with consequences for the fourth fact no one’s really talking about. As a result of the demographic changes in the 21st century – namely, population aging – there will be unsustainable pressure for political, economic, and social institutional reform.
Once the pride and joy of England, the NHS is today a common punching bag for Sunday afternoon public house banter. If Baby George does ascend to the throne, this will no longer be the case. The NHS simply cannot continue to exist as it is. Already, England’s largest hospital trust, Barts Health NHS Trust in London, is losing $3.7 million a week, and 11 NHS trusts have collectively forecast a $366 million deficit for the year.
In hospitals where nearly two thirds of the people admitted are 65 and older, what will happen when the over-65 segment increases to one quarter of the total population? Should it even be surprising that an institution created in the middle of the last century might not be fit for this century’s demographics?
It’s a special time for the British, to be sure, as the nation welcomes its newest royal member. But perhaps George’s birth should trigger a different set of questions. Rather than debate the merits of his name or the color of his pram, the British media should ask tougher and more important questions – questions that we in America must also ask in our debate over how yesterday’s ideas on health care and pension systems can meet today’s demographics.
What will Britain look like if George becomes king? With a rapidly aging population, what policies can be put in place now to trigger the changes that are needed to give King George a healthy, wealthy Britain – one that is relevant for 21st century demographic realities?
If Britain and American leaders are ever to meet the demands of their citizens over the next decades, this might be a good place to start.