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What's Wrong With National Health Care?
Ask the Brits. Well, ask those who are able to get medical care to remedy their poor hearing. It turns out a bunch of treatments are going to start getting denied, and not only the frivolous ones. The article is subheaded "Fertility, multiple sclerosis and migraine therapies at risk." Multiple sclerosis and migraine therapies? Dennis Campbell writes in The Observer/UK:

British doctors will take the historic step of admitting for the first time that many health treatments will be rationed in the future because the NHS cannot cope with spiralling demand from patients.

In a major report that will embarrass the government, the British Medical Association will say fertility treatment, plastic surgery and operations for varicose veins and minor childhood ailments, such as glue ear, are among a long list of procedures in jeopardy.

James Johnson, the BMA chairman, will warn that patients face a bleak future because they will increasingly be denied treatments. He will urge the NHS to be much more explicit about what it can realistically afford to do and ask political leaders to engage in an open, honest debate about rationing.

...Some PCTs have been bitterly criticised for refusing to pay for expensive new cancer drugs; treatment to prevent older people going blind through age-related eye degeneration and operations to help obese patients lose weight through stomach-stapling.

Each trust already has a committee of medical experts that takes decisions on whether to fund medication for complaints which are not covered in their basic contract with the Department of Health. These include treatments such as growth hormone for adults, neuro-stimulation for migraines, breast reduction and enlargement, treatments for incontinence and even some care for multiple sclerosis.

...Dr Michael Wilks, one of the BMA's senior office holders, revealed the organisation's radical thinking in a recent letter to its 139,000 members updating them on the progress of the BMA working group, headed by Johnson, which has drawn up the document. He told them the group had concluded that 'while the service should remain universal, the challenges raise questions about how comprehensive the service can continue to be. This will depend on whether politicians and the taxpayer are prepared to contemplate either increasing expenditure or explicit rationing.

I'm reminded of an American friend, married to a French woman and living in France, who bragged about his "free" health care. I reminded him that he'd just complained about paying 65% of his income in taxes. That's not free health care, that's extraordinarily expensive health care!

Posted by aalkon at May 6, 2007 9:35 AM

Comments

And THAT's why I am voting for a Democrat in next year's presidential elections. They want to institute a national plan and I just *know* for sure that they will not make the same mistakes that the other countries have. I mean, really! It's either Hillary (with that wonderful guy Bill as a bonus) or Obama (who is really smart and has like 200,000 friends on MySpace) who will be the democrat nominee and we could not get any better than them, right?

Posted by: André-Tascha at May 6, 2007 7:15 AM

Okay, I don't see any reason why a national health plan should be paying for breast enlargement, except perhaps in the case of women who have undergone mastectomies to fight breast cancer. (And I say this as a chick with an A-cup; trust me, I understand the life of the flat-chested.) Otherwise, though, AUGH.

And what's really annoying? Apparently, the NHS is paying for homeopathy and other alt-medicine "therapies." The UK even has state-sponsored homeopathic hospitals - click on my name to learn more. Talk about a waste of dollars...

Posted by: marion at May 6, 2007 12:05 PM

If they were, it's no wonder they were going broke. I don't think they should be paying for fertility treatments either. It is not your right to have a child -- certainly not on the public dime -- if your body can't get to it naturally.

Paying for bullshit therapies there's no proof work is just appalling. Why not fund witch doctor'y? Then again, I guess they are.

Posted by: Amy Alkon at May 6, 2007 12:26 PM

But Amy and Marion, it is every person's right to not only be healthy, but to feel healthy and self-confident. Society has a moral responsibility to improve the self-confidence of individuals (e.g. breast augmentation) and not discriminate against those who practice non-western medicinal treatments.

okay...that was really hard to type with a straight face...

Posted by: André-Tascha at May 6, 2007 1:38 PM

As I have posted before, we are a can’t-say-no to any procedure/drug/surgery society, or put more aptly, we are really big about getting the baby out of the well but not so big on putting caps on the well. A disproportionate amount of money is spent on the last six months of life (it varies depending on which statistics you look at, however, it is well over half of all health care expenditures). For as flawed as the American system may be, it still works: people get the care they need without the wait. You want to know how to ‘fix’ the system (i.e. stop the spiraling costs)? We as a society need to take a rational look at what we are spending the money on. Do those 14 CT scans, two months of ICU care and life-support really make a difference in the outcome of the 75 year old hypertensive, diabetic, mildly demented person who had a massive stroke? I understand it is a hard decision to make (especially if it is your family member) but it is the hard decisions that need to be made. Of course, this will lead to all manner of people who will say “that’s communism” or “you are playing God” or “that’s so cruel and heartless”, etc, etc, etc. But the current system is not sustainable and will soon lead to a France-like tax rate in order to maintain our ever increasing expenditures.

Posted by: Doc Jensen at May 6, 2007 2:24 PM

And please don't get me started on 'alternative' medicine.

Posted by: Doc Jensen at May 6, 2007 2:28 PM

Doc, your ideas make sense at an intellectual level (that we spend too much taking care of old people who will die soon anyway and don't have much to offer the world), but are impossible to implement in any practical sense, no? If I agree we shouldn't fund the interminable deaths of demented fogies, what should I do?

Posted by: justin case at May 6, 2007 6:35 PM

Doc: I think we would all LOVE to hear you get started on alternative medicine. And in the case you're talking about, don't the CAT scans/ICU stay/life support qualify as playing God? They do in my book, at least in the situation you're discussing.

"I don't think they should be paying for fertility treatments either. It is not your right to have a child -- certainly not on the public dime -- if your body can't get to it naturally."

Heart-wrenching as infertility is, I have to agree, given the scarcity-of-resources thing. The ironic thing is that, while European countries with state-sponsored health care - typically considered to be far more sophisticated and tolerant than the U.S. - do often cover at least some high-tech infertility treatment, that state involvement comes with a price - state control over what types of procedures can be done and what can be done during those procedures. The UK limits the number of embryos that can be transferred during IVF - good if you're dealing with a 29-year-old woman not willing to do selective termination, not good if you're dealing with a 40-year-old woman willing to do selective termination if necessary. It also severely restricts the ability of parents to use pre-implantation genetic diagnosis procedures on embryos that allow the selection of one that can be, say, a bone marrow donor for an already-existing child. Now, you may well think that these limitations are morally necessary...but I find it ironic that they don't exist in the U.S., land of the fundies.

Which brings up another issue that no one ever talks about when praising state-sponsored health care...if politicians are responsible for your funding, they're going to want to have something to say about the nature of care that's delivered. You think it's outrageous that the U.S. Congress has banned one abortion procedure? Imagine Congress with nigh-unlimited control over what procedures can be allowed, medications prescribed, etc. etc. No thank you.

(One note, though - one might be able to make an argument for *some* coverage of high-tech infertility treatment in the interest of lowering the risk of a high-order multiples pregnancy that leads to preemie babies who need very expensive stays in the NICU. You'd have to figure out if the one expense outweighed the other, though...)

Posted by: marion at May 6, 2007 6:51 PM

I agree what I propose is but an intellectual exercise. We as a nation have no stomach to say no to any sort of limit (on basically anything, but especially medicine). It is a thorny issue to address but I think the first and easiest step would be to plant a big boot in the ass of many doctors and teach them the difference between doing something *to* a patient and doing something *for* them. I see so many worthless surgeries performed on those at the extremes of age that do no mitigate any of the underlying problems. We perform huge and heroic operations on soon-to-be terminal cancer patients: we may extend their life by 1-2 months but they just spent their best quality month of life in the %@# hospital lying in bed instead of enjoying it with family! Good luck with that last extra month of life on the ventilator in the ICU! We perform horrendous operations on the elderly who are much more likely to die *with* their uncorrected problem than *from* it. We will perform ungodly operations on grossly premature newborns with genetic diseases and massive birth defects that otherwise would have died shortly outside the womb if it were not for all the heroics. Although everyone loves the Hallmark stories about baby Jane who underwent said heroics and is living a somewhat normal life now or the cancer patient who was written off by everyone else but had this stupendous operation and saved their life these are the miniscule minority of cases. No one wants to talk about the six month flog of keeping someone alive with tubes and wires coming from every hole (and many new holes especially created for more tubes and wires) and they still died like a dog. Again, as doctors we are great at doing things *to* patients but not so great at doing things *for* them.

Now that I have rambled on long enough on that point, I will make this next one quick: to get people to change their opinion on just what they spend their health care dollars on you need to directly expose them to the cost of doing business up close and personally with the wallet. If people saw just how much something was going to cost and the results were far from guaranteed they would think twice about saying ‘do everything’ when the risks outweigh the benefits and the costs are disproportionate to the results. In this context is sounds so cruel and heartless but these are the type of decisions we make everyday (albeit on less of a dramatic scale). You want the nice house or car but you can’t afford the payments. You want to keep a loved family pet alive but $10,000 is more than you could possibly afford. I know, comparing your loved ones to a pet, nice! If that is not a flame-worthy comment I don’t know what is. Regardless, if someone has other ways to fix the current system I am always open to consideration.

Posted by: Doc Jensen at May 6, 2007 8:57 PM

Thanks, Doc - very interesting stuff you've posted. And I think we need to set some limits -- but we can't get politicians to pass reasonable drug policy laws...reasonable death and health care policy laws are probably out of the question. And it does come down to what you're saying -- spending outrageously because it's not your money.

Posted by: Amy Alkon at May 6, 2007 10:29 PM

I used to work at a major cancer center near Detroit. We had many patients coming from Ontario so they could get MRI's and CAT scans in less than 6 months. Many were willing to pay to have surgery sooner than their national health care could schedule.

I would like all candidates favoring national health care to be required to go through an existing socialist system like that in Canada for their medical care-not the parellel system the powerful in those countries use.

Posted by: Ruth at May 7, 2007 7:25 AM

Reflections on private vs. public health care….

I pay for mine ($735.50 per month). I have a choice to write the check or not.

My father who was on Medicaid needed to be admitted to a nursing home. With assistance from Hospice, we were told the waiting list was 3 months long. After cutting through the crap we found out that there were rooms available immediately for self pay individuals. The ambulance arrived within 30 minutes; he lived for another 18 hours.

As I was made aware of after it was too late to help my family, Medicaid paid nursing homes could have been made available with political influence. Go figure.

I simply want a tax break for the $8826 per year that I pay for health insurance.

Posted by: Roger at May 8, 2007 10:14 AM

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