How Government Medicine Really Works - British Edition

Ronald Bailey | May 31, 2006

All hell broke out last month, when various National Health Service Trusts in Britain refused to treat women with breast cancer with the drug Herceptin arguing that is was just too costly. The National Health Service (NHS) speedily backed down in the face of public outrage.

Now the NHS wants to limit access to various drugs for Alzheimer's disease patients on the grounds that they are not cost-effective. Actually, there is a lot of research that suggests that delaying the cognitive decline that comes with Alzheimer's saves money because it delays much more costly care, such as admission to assisted living facilities. In any case, the NHS is engaged in pure and simple rationing.

Proponents of government health insurance will reply that private insurers might not cover the cost of such drugs and besides don't you know that there are 40, 50, or 60 million Americans without health insurance, so they wouldn't get the drugs anyway. So what? That response amounts to little more than that we should all get the same equally crappy care by government fiat. Just because extensive government meddling has screwed up private medicine in the United States surely doesn't mean that the solution to the problem is more government intervention.

But there is a bright side to rationing these medicines--as Britain's Alzheimer's patients succumb to their disease, they soon won't realize what their government has done to them.

Disclosure: I can't remember if I own stocks in any Alzheimer's disease drug companies, but I don't think so.

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|5.31.06 @ 10:13AM|#

The problem is that too many people are getting old. I propose that we end vaccinations for childhood diseases and chlorination of drinking water.

David|5.31.06 @ 10:19AM|#

I propose that we end vaccinations for childhood diseases and chlorination of drinking water.

We will certainly end up with a much more disease-resistant population several generations thereafter. Plus it's very cost-efficient.

|5.31.06 @ 10:26AM|#

Ron, I still don't understand what you're getting at here. Are you saying that private insurers are banned in Britain, and as a result people can only use NHS? Otherwise, what's stopping people from using NHS as baseline insurance and then purchasing private insurance for other conditions? I think I asked this same question when you blogged about the Herceptin incident and never recieved a satisfactory answer.

|5.31.06 @ 10:32AM|#

METALGRID:

You missed the point, it seems. If I understand it correctly, and I think I do, Ron was using this particular instance of state-sponsored yumminess as an example of what would happen if we went the way of the national-healthcare crowd, then this would be an example of what would happen.

In other words, while this particular example may not be "national healthcare" (whereby private insurance is prohibited) a la Canadia, it still speaks to the problem with socialized healthcare.

|5.31.06 @ 10:37AM|#

metalgrid: Basically what Evan said. However, you're right that people could purchase private insurance in Britain, but the public ideology is against it. And some people might-dangerously for their health in my opinion-reason, "If I'm paying taxes for health care, then why should I have to buy private health insurance?"

|5.31.06 @ 10:41AM|#

Ron, I have a question about journalist disclosures. I know most of the ones you make here are jokes to annoy joe, but in all seriousness, how are you supposed to handle mutual funds? For instance, I have a little money in an S&P 500 index fund, so I "own" an interest in 500 companies. Is that something you have to track and disclose (ethically speaking, of course, not legally)? Given that there are even broader funds (e.g., the Wilshire 5000) out there, that would seem to be a Red Queen's race at best.

If they really want to save money on health care, they should start a Logan's Run style program to eliminate oldies. They could raise the age from thirty (in the movie) to the current age when people start getting social security (whatever they're called in the UK) benefits. So it would save money there, too.

|5.31.06 @ 10:46AM|#

I get a kick out someone blatantly copying an entire article, and also including the copyright notice.

|5.31.06 @ 10:49AM|#

Bolek, the factor that's missing from the Times article is that the sickest Canadians always have the US healthcare system, right next door, to fall back on.

When the Canadian Prime Minister was diagnosed with prostate cancer a few years back, it seems to me that his first step was to make an appointment at a US clinic, rather than take his place in queue for Canadian care.

|5.31.06 @ 10:51AM|#

Hey we read the news to you and pretend we said it ourselves.

|5.31.06 @ 10:53AM|#

What does Canada have to do with my choice for health care anyways?

|5.31.06 @ 10:57AM|#

jf, I agree that irony abounds in such situations, but copying a work and stripping off the copyright notice is a bad thing. I can't remember all of the implications (to think I was once paid long ago to pontificate on copyright law--how the mighty have fallen!), but I think you lose your innocent infringer defense and may be subject to statutory damages.

SmokingPenguin, Carousel is our friend.

|5.31.06 @ 10:59AM|#

Do Canadians really live longer than Americans? Or does it just seem longer?

|5.31.06 @ 11:01AM|#

In other words, while this particular example may not be "national healthcare" (whereby private insurance is prohibited) a la Canadia, it still speaks to the problem with socialized healthcare.
Comment by: Evan at May 31, 2006 10:32 AM

I don't see how it speaks to a problem with socialized healthcare but at running socialized healthcare like a private insurance company. Granted, I'm not familiar with their healthcare system, and whether you can purchase tiered insurance services.

The point of the article, seems to me, that the public has expectations that a one size fits all national healthcare system provides complete coverage and has issues when the government attempts to run it just like a private system by cutting off access to more expensive procedures.

I haven't seen any banning of private insurance, pay as you go treatment or outsourced treatment, so I fail to get in a tizzy about the whole affair and wrongly associate it with being a shortcoming of socialized healthcare.

|5.31.06 @ 11:16AM|#

Facts are a fucking downer, eh?

|5.31.06 @ 11:23AM|#

Bolek, you mean like the fact that people die in Canada waiting for their "free" operation? Yeah those are a fucking downer.

|5.31.06 @ 11:48AM|#

Just FYI, folks, Ron Bailey writes from time to time for TCS, which is funded by the pharma lobbying group PhRMA, which includes Roche. Roche makes Herceptin.
Roche is currently lobbying like hell through astroturf "patient lobby groups" which it funds to get Herceptin available for early-stage cancer on the NHS, despite the fact that the UK licensing authority haven't found it actually does any good.
http://www.guardian.co.uk/science/story/0,,1742168,00.html

Bailey's generally kind to his employers: remember the CEI "CO2- Breath of Life" campaign? Our Ron was about the only journalist in the civilised world who gave it any more than a passing glance and a snigger.

The Logan's Run scenario goes a long way toward solving the Social Security problem though...

|5.31.06 @ 12:10PM|#

|5.31.06 @ 1:11PM|#

Ajay: You forgot to mention my Exxonsecrets listing too. And would you believe it that I had no idea and what's more I don't care about any alleged funding that TCSDaily may get from PHARMA. I write what I want and if they want to publish it fine, and if they don't, that's fine too. BTW, does someone pay you to lurk on websites to act as troll? Just wondering.

grylliade|5.31.06 @ 1:14PM|#

Just FYI, folks, Ron Bailey writes from time to time for TCS, which is funded by the pharma lobbying group PhRMA, which includes Roche. Roche makes Herceptin.

Thus saving you from making any arguments against him?

Look, I get the whole "Gotcha! You get money from people who benefit from your argument!" thing. But it doesn't matter. If Bailey's arguments are good, then they're good, no matter the source of his funding, and if they're bad they're bad, no matter the source of his funding. All that revealing that a website he writes for gets grants from pharmaceutical companies says is that we need to look more closely at articles he writes about pharmaceuticals, which we should be doing anyways. It doesn't mean that his arguments on the subject of pharmaceuticals are automatically wrong. Reveal these little "gotchas" if you want to; there's nothing wrong with them per se. But don't think that you've actually made an argument when you do so.

|5.31.06 @ 1:20PM|#

Oh come on, Ron.

Millions of people have private health insurance in the UK - 3.5m through their employers, more buy it individually.

And if you want a drug the NHS won't provide, you have a simple option - go and buy the drug!

|5.31.06 @ 1:27PM|#

Hey ajay, see if you can fit this theory inside your gordian pretzel logic:

The money follows the opinions.

Oh my.

|5.31.06 @ 1:36PM|#

You guys are too easy on ajay.

Just FYI, folks, Ron Bailey writes from time to time for TCS, which is funded by the pharma lobbying group PhRMA, which includes Roche. Roche makes Herceptin.

Roche is a Swiss company and isn't even a member of the Pharmaceutical Research and Manufacturers of America.

Idiot.

|5.31.06 @ 1:51PM|#

|5.31.06 @ 1:57PM|#

Well done Mr. Bailey, for noticing that the NHS engages in rationing... just like every other public or private health care provider in the world.

I can state from personal experience that there are plenty of legitimate grounds for criticizing the NHS, but an unwillingness to spend unlimited amounts of money on patients is not one of them.

|5.31.06 @ 2:00PM|#

Hey, cool. You only have to hit POST one time.

|5.31.06 @ 2:04PM|#

So to summarize: being denied expensive care by a private insurer is A-OK, but being denied expensive care by a government insurer is a sign that government-provided health care is a flawed enterprise. Got it.

|5.31.06 @ 2:14PM|#

Ted, you're ignoring the fact that the gov't-provided healthcare is forced on people, while a private insurer is always a voluntary, contractual agreement.

It's also critical to note that in many implementations of gov't-provided healthcare systems, the alternative of simply paying your own money for care you need is against the law, on the grounds that it's "unfair" to those who cannot afford to do so.

There is no equality short of the grave.

Larry A|5.31.06 @ 3:09PM|#

Ron, I have a question about journalist disclosures. I know most of the ones you make here are jokes to annoy joe, but in all seriousness, how are you supposed to handle mutual funds?

Even at a journal as prestigous as Reason the idea of increasing your net worth by writing blog entries that favor industries represented in your stock portfolio is to say the least optimistic. I'd guess the greatist possible return on a direct stock investment would be a couple of orders of magnitude lower than minimum wage. A mutual fund would be pennies/500 or 5000 or whatever. State lotteries provide a better retirement plan.

Unless the Reason staff is in a much higher tax bracket than I would suspect; in which case I want to apply for the still-vacant editorial opening.

Bailey's generally kind to his employers...

Bailey writes articles he believes in. Publications that agree with his point of view publish them. They smile at each other. Doh.

|5.31.06 @ 3:37PM|#

Larry A, I suppose I should say that I'm one of the people who doesn't think that Ron is horribly corrupted by BIG BUSINESS. In fact, I agree with him a lot, and I'm certainly not being compensated by anyone for that agreement :)

Also, my question wasn't so much about blog entries as about actual published articles. From my perspective, owning an index fund should be irrelevant--even if there's a bundle of money in the fund--as far as disclosures are concerned. Not that all mutual funds are the same. For instance, if Ron held $1 billion in the Biotechnology for Evil Renegade Terrorists fund, consisting of five companies, one would think a disclosure of that interest might be necessary if the article related to one of those companies.

|5.31.06 @ 4:05PM|#

Daniel Haszard|5.31.06 @ 4:13PM|#

Appreciate your blog,mental health consumers are the least capable of self advocacy,my doctors made me take zyprexa for 4 years which was ineffective for my symptoms.I now have a victims support page against Eli Lilly for it's Zyprexa product causing my diabetes.--Daniel Haszard www.zyprexa-victims.com

VM|5.31.06 @ 4:18PM|#

my doctors made me take zyprexa for 4 years

sorry for the med condition.

but you're ultimately responsible for what you put into your body.

responsibility is a big part of lots of mental health therapies ("talking sessions")

this doesn't minimize or take away from the pain of diabetes, tho. for that i wish you all the best.

|5.31.06 @ 7:59PM|#

I wonder what would happen if there was Government "given" auto insurance? Would people wreck their cars everytime it needed an oil change. They could get a "free" car and start over. Of course the "free" car waiting list may be years long but it's free!

|5.31.06 @ 8:07PM|#

Bolek.
In case you didn't notice, there was one reasoned response to your post (from the smart and talented Jason Ligon).

Jason.
How about the other factors mentioned... such as infant mortality etc... that are more about primary preventative care than pharma products anyway? It is easy to conflate healthcare with pills, but it is really a more complex package than your reply implies. It seems that the Times article, on its face, would provide evidence that on the whole the group taking care of those at the bottom does more for the overall health of the group than when they are left to fend for themselves. Particularly in the realm of preventible problems the logic of providing free healthcare to some seems fairly sound.

I am curious if you can go beyond your narrow pharma argument and show me how I am mistaken.

|5.31.06 @ 8:25PM|#

One of the singular pet peeves in my life is whenever people talk about free anything. We need to provide free education, free healthcare, whatever. All of the costs for these services are appropriated from the populace, and then the services are provided for them. We all pay for them.

I think it is much more appropriate to talk about government mandated services (i.e., we require everyone to buy car insurance) because it serves some public policy.

There are government provided services (i.e., it is more efficient to have one single military than a lot of smaller ones). And some services combine both, we require parents to educate their children and the government runs a school system.

In the realm of healthcare we could require citizens to purchase healthcare because we believe it has positive externalities, or we could have the government run a healthcare system because we believe that it is a more efficient supplier, but there is not such thing as free healthcare.

Of course this neglects transfers, if we take money from Bill Gates to give me healthcare that is free from my perspective but not to society as a whole.

|5.31.06 @ 9:09PM|#

lannychiu

I hate it when people talk about free stuff too. That is why I wrote "given" and "free" in quotes. Picture me holding up two bent fingers on each hand as I say "free" to get my meaning.

|6.1.06 @ 5:23AM|#

Roche is a Swiss company and isn't even a member of the Pharmaceutical Research and Manufacturers of America.
Idiot.

Go to http://www.phrma.org/about_phrma/member_company_list/members/
Scroll down until you hit Hoffman-La Roche Inc. Click through - well, well well.
http://www.rocheusa.com. Welcome to Roche Pharmaceuticals in the U.S.
No further questions.

Ron Bailey: BTW, does someone pay you to lurk on websites to act as troll?

Sorry, there's only one person on this site who's paid to espouse a certain point of view and doesn't admit it, and it's not me.

|6.1.06 @ 8:03AM|#

Sorry, there's only one person on this site who's paid to espouse a certain point of view and doesn't admit it, and it's not me.

Only one? I thought the whole Reason staff was on the take.

It must be that bastard Cavanaugh.

|6.1.06 @ 9:11AM|#

JW:

Isn't it obvious?

It's Cathy Young.

|6.1.06 @ 9:19AM|#

MainStreamMan:

Yikes. Compliments out of left field make me nervous ...

Anyway, I have sincere doubts about the overwhelming benefits of preventive care by medical practitioners, at least beyond some basic level. My skepticism lies in the fact that the vast majority of medical expenditures in the United States falls into the categories of negative effects of crappy lifestyle choices and unavoidable end of life care.

My suspicion is that the life span differences between cultures is dominated by lifestyle choices and has little to do with the method of medical delivery. Similarly, we throw a ton of cash at end of life care that has little impact on actual life span.

Overall, I have a huge fear of dissolving profitability in the US healthcare market. I am certain that the AARP will have imposed its will in the next 20 years and we will have a single payor system of some sort. What I note about a healthcare system dominated by retirees is that they don't care one bit about innovation - they care about delivery of the goods to them right now. That is the trade we will make, and no one will ever actually see the cost. Not to put too fine a point on it, but I'm likely to have untreatable altzheimers in my later years as a result.

|6.1.06 @ 4:15PM|#

Go to Link
Scroll down until you hit Hoffman-La Roche Inc. Click through - well, well well.

Point conceded.

I'd like to pull my foot out of my mouth, but I can't reach it because my head is too far up my own...

You get the picture.

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