Obese patients and smokers banned from routine surgery

So you not I'm not kidding about this. Hospital leaders in some cities in the UK, including London, said that patients with a body mass index (BMI) of 30 or above – as well as smokers – will be barred from most surgery for up to a year amid increasingly desperate measures to plug a funding black hole. The restrictions will apply to standard hip and knee operations.

A bit of background on this first.  The National Health Service (NHS) was launched in 1948 as a combined payer and delivery system to replace a longstanding mix of private, municipal, and charity insurance. When introducing the bill which was written by the economist William Beveridge (hence the Beveridge Model in T.R. Reid' chapter), to the House of Commons in July 1948 - almost 60 years ago! - the newly appointed Secretary of State for Health, Aneurin "Nye" Bevan argued that the NHS would “divorce the ability to get the best health and treatment from the ability to pay.”  Here is what T.R. Reid said about the NHS (pp. 104-105):

The NHS is dedicated to the proposition that nobody should ever have to pay a medical bill. In the NHS, there is no insurance premium to pay, no co-payment, no fee at all, whether you drop by the GP's office with a cold or receive a quadruple bypass from the nation's top cardiac surgeon.  The doctor's bill is paid by the government, and the patient never thinks about it.

The Brits do pay for medical care, of course.  They pay through a network of taxes that would make Americans cringe; the sales tax in the UK is 17.5% on anything you buy, while income and social security taxes are higher than America's in every income bracket.  The Brits pay by foregoing treatments and medications that the NHS won't provide.

Now you might see where this is leading.  The NHS controls its budget by controlling the range of medications, tests, and procedures it will pay for.  Should a 49-year old patient get a hip replacement?    Combining insurance and delivery of care in the NHS fostered a rational approach through the formal evaluation of therapeutic benefits against treatment costs. Yet because the NHS budget covers everybody, the money saved on one patient can be used to treat another.

Moreover, as the NHS secured annual increases averaging 6.3% during the 2000s, it grew to 20% of the government budget by 2009.  As British government debt rose from below 40% of GDP in 2007 to 72% in 2010, worries emerged that above-inflation spending had saddled the country with unsustainable commitments.

Now when you read the The Telegraph's article, it should make more sense why there is rationing - and to expect more.