The Egalitarian Cruelty of the NHS

Even if you're accustomed to hearing horror stories about Britain's National Health Service, this one is really appalling. Debbie Hirst, a woman with metastasized breast cancer, wanted to take Avastin, a drug that, per The New York Times, is "widely used in the United States and Europe to keep such cancers at bay." The NHS refused to pay for it, saying it was too expensive. That much is par for the course in a system that holds down costs by rationing care according to standards set by a single central authority. But then Hirst, with the support of her oncologist, decided to raise the $120,000 she'd need to pay for the drug on her own, mainly by selling her house. The NHS said she was perfectly free to do that, but then she would have to pay for all of her care out of pocket, a financial burden that was far beyond her means. The Times does its best to explain the rationale for this position:

Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.

Patients "cannot, in one episode of treatment, be treated on the N.H.S. and then allowed, as part of the same episode and the same treatment, to pay money for more drugs," the health secretary, Alan Johnson, told Parliament.

"That way lies the end of the founding principles of the N.H.S.," Mr. Johnson said.

Yet if you are wealthy enough to pay for all of your health care out of pocket, you are allowed to do so. Doesn't that also give richer patients an unfair advantage over poorer ones? Why isn't that equally offensive to the egalitarian sensibilities of NHS bureaucrats? The fact is, it's better to be rich than poor for many reasons, and fairness doesn't really enter into it (assuming the absence of force or fraud), unless you view all resources as the government's to distribute as it sees fit. And even a collectivist would have to admit that the NHS policy that Hirst ran into makes little sense:

In fact, patients, doctors and officials across the health care system widely acknowledge that patients suffering from every imaginable complaint regularly pay for some parts of their treatment while receiving the rest free.

"Of course it's going on in the N.H.S. all the time, but a lot of it is hidden—it's not explicit," said Dr. Paul Charlson, a general practitioner in Yorkshire and a member of Doctors for Reform, a group that is highly critical of the health service. Last year, he was a co-author of a paper laying out examples of how patients with the initiative and the money dip in and out of the system, in effect buying upgrades to their basic free medical care.

"People swap from public to private sector all the time, and they're topping up for virtually everything," Dr. Charlson said in an interview. For instance, he said, a patient put on a five-month waiting list to see an orthopedic surgeon may pay $250 for a private consultation, and then switch back to the health service for the actual operation from the same doctor.

"Or they'll buy an M.R.I. scan because the wait is so long, and then take the results back to the N.H.S.," Dr. Charlson said.

In his paper, he also wrote about a 46-year-old woman with breast cancer who paid $250 for a second opinion when the health service refused to provide her with one; an elderly man who spent thousands of dollars on a new hearing aid instead of enduring a yearlong wait on the health service; and a 29-year-old woman who, with her doctor's blessing, bought a three-month supply of Tarceva, a drug to treat pancreatic cancer, for more than $6,000 on the Internet because she could not get it through the N.H.S.

In the end, after Hirst's cancer spread even further, the NHS decided the balance of costs and benefits had shifted, and it agreed to pay for her Avastin:

Mrs. Hirst is pleased, but up to a point. Avastin is not a cure, but a way to extend her life, perhaps only by several months, and she has missed valuable time. "It may be too bloody late," she said.

"I'm a person who left school at 15 and I've worked all my life and I've paid into the system, and I'm not going to live long enough to get my old-age pension from this government," she added.

She also knows that the drug can have grave side effects. "I have campaigned for this drug, and if it goes wrong and kills me, c'est la vie," she said. But, she said, speaking of the government, "If the drug doesn't have a fair chance because the cancer has advanced so much, then they should be raked over the coals for it."

Hirst had no choice about paying the taxes that support the NHS, and when she tried to supplement the limited coverage it provided out of her own pocket, it reneged on its promise to take care of her. The Michael Moores of the world surely would see injustice in a decision by an HMO or insurer not to cover a cancer patient's Avastin. Why don't they see injustice in a case like this?

Michael Moynihan on Michael Moore and the NHS here, here, and here, among other places.

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  • ||

    In his paper, he also wrote about a 46-year-old woman with breast cancer who paid $250 for a second opinion when the health service refused to provide her with one;

    We are so stupid here in America. We actually encourage people to get a second opinion if there are any doubts/unanswered questions. No wonder England kicked us out on our own.

  • jon||

    Why don't they see the injustice in this? Because people like Mssr. Moore fail to acknowledge that the cliche, "the road to hell is paved with good intentions" might have some truth to it. Or perhaps it is emotionally devastating that socialized healthcare isn't always so super duper.

  • ||

    The Michael Moores of the world surely would see injustice in a decision by an HMO or insurer not to cover a cancer patient's Avastin. Why don't they see injustice in a case like this?

    I'll take a shot at it.
    Because they're stupid socialist assholes?
    Because HMOs make a profit while NHS doesn't?
    Because they're stupid socialist assholes?
    Because "no system is perfect, but this one is the best"?
    Because they're stupid socialist assholes?
    Because the government knows best?
    Because they are stupid socialist assholes?

  • ||

    Stupid Socialist Assholes
    would be a good name for a band.

  • Paul||

    Stupid Socialist Assholes
    would be a good name for a band.


    For most bands it would be a redundancy. Or, is that why it would be a good name? Because of the irony?

  • fyodor||

    Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.

    The most retarded and vile thing about this is that if they wanted to do some sort of means testing based on income or wealth, that might make some sense and approach some semblence of "fairness". But to deny benefits based strictly on someone paying for something out of their own pocket really strains any sense of justice even allowing for collectivism. Smacks of power consolidation, don't it?

    One thing I wonder about, do US private insurers and other European socialized systems really routinely shell out the 120K for this stuff?

    Anyway, if the Times article be believed, any private payments for health care are supposed to be verbotten, and that sucks and is just stupid. Michael Moore would never tolerate such inhumanity from a private insurer!!!

    But don't worry, I'm sure nothing like that will ever happen here. Obama-care could never evolve into something so inhumane. Just like the frog thinking the water won't really get much hotter (though that frog boiling to death thing may be a myth, just proving frogs have more common sense than us!)...

  • ||

    That's socialism for you: they don't care if an individual dies.

    -jcr

  • KipEsquire||

    Not to get all "John McCain" on the New York Times, but the Times of London ran essentially the same story (same drug, different patient) over two months ago.

  • ||

    I used to live in the UK and my family and I used the NHS.

    Bloody awful! After being used to having what we have in the US, no American would put up with the NHS. The NHS is fine for the normal day to day stuff: fevers, flues, broken legs and the like, but the rest is typical British. When the Brits decide to do something right, it is top grade, but average is pretty damn mediocre.

    As I have lamented many times, my youngest son suffers from cystic fibrosis (CF). The effing brit doctors misdiagnosed and we were treating his disease as lactose intolerance for eleven effing years instead of treating him properly - assholes! The ironic thing is, the doctor in the little village I lived in was new to the position because the previous doctor's son had been diagnosed with CF and he left the village to live closer to Glasgow and specialized CF treatment.

  • ||

    jon | February 21, 2008, 5:41pm | #
    Why don't they see the injustice in this? Because people like Mssr. Moore fail to acknowledge that the cliche, "the road to hell is paved with good intentions" might have some truth to it. Or perhaps it is emotionally devastating that socialized healthcare isn't always so super duper.


    For a second i read jon as joe and about had a stroke.

  • ||

    So if I supplement my government health care with say some aspirin and band aids I buy at a store I might lose my government health care?

  • ed||

    would be a good name for a band

    No, it never is. Ever.

  • ||

    "Sorry ma'am. Those are the rules, and those are what separate us from the savages. Next!"

  • Brandybuck||

    Not to get all "John McCain" on the New York Times, but the Times of London ran essentially the same story (same drug, different patient) over two months ago.



    Yes, but two months ago it still looked like Hillary might get the Dem nomination. The NYT didn't want to earn her ire by suggesting that a centrally planned healthcare system might not be a panacea.

  • !||

    I am utterly bewildered by the constant cries of Americans for a "national health care system." The very idea of it scares me shitless.

    Hell, there was an ad in US News from the AMA telling me to keep the "47 million uninsured" in mind when I vote. WTF is that all about? The AMA actually wants Socialized Medicine?

    Of all my doctors, there is not one who wants to become a federal employee. (And they all want marijuana legalized.)

    Dying to save 'The System'

    "For defenders of Canada's government-monopoly health care system, there is only one goal that truly matters. And, no, despite their earnest insistences to the contrary, that goal is not the health of patients. It is the preservation of the public monopoly at all costs, even patients' lives."

  • ||

    That is appalling.

    One of the best things about the adoption of a single payer/private provider health care system in this country will be that its success might motivate the British and Candadians to reform their Flintstone-era universal health systems along similar lines.

  • The It Girl||

    Hunky Nick Gillespie is chatting with Pat Buchanan and Tucker Carlson right now and it's not announced here? What will the Reasonologists make of that?

  • ||

    Hunky Nick Gillespie is chatting with Pat Buchanan and Tucker Carlson right now and it's not announced here? What will the Reasonologists make of that?

    I like it when he calls McCain a war monger. Do it more.

  • ||

    Bloody awful! After being used to having what we have in the US, no American would put up with the NHS. The NHS is fine for the normal day to day stuff: fevers, flues, broken legs and the like, but the rest is typical British. When the Brits decide to do something right, it is top grade, but average is pretty damn mediocre.

    Actually, I can think of three offhand. None of the three can acquire health insurance now (two to pre-existing conditions, one due to insufficient income). All three would really like to see a doctor about some fairly significant health problems, and can't afford it.

    On the bright side, no liberal I'm aware of is pushing to implement an NHS-style system, and since the betting money is on the US having universal care within the decade, you should be happy about that at least.

  • thoreau||

    One of the best things about the adoption of a single payer/private provider health care system in this country will be that its success might motivate the British and Candadians to reform their Flintstone-era universal health systems along similar lines.



    And so joe finally learns to love Domino Theory!

    A healthy beacon in the English-speaking world will ignite a wave of reforms throughout the region....

    :)

  • Nash||

    Most socialists I encounter insist that single payer is better than the American system because it costs less money per patient. They don't care about triage or wait times. Totally irrelevant in their view. They also only think in terms of the collective. They cite life spans in countries where socialized medicine exists vs. the united states as evidence socialized medicine is better.

    I think there are unintended consequences to this type of program (like harming R&D for example or driving the cost of pharmaceuticals up even more) but it's hard to counter the less cost per patient argument or the overall life expectancy concept.

    If anyone has any counter-arguments to this I'd love to hear it. I for one have great health-care and the thought of turning my doctor's office into the DMV horrifies me.

  • ||

    Debbie Hirst, a woman with metastasized breast cancer, wanted to take Avastin, a drug that, per The New York Times, is "widely used in the United States and Europe to keep such cancers at bay."

    Oh, funny thing about this story. Debbie Hirst might not be able to get it in the US, either. As the Wall Street Journal editorial page mentioned today, Avastin has been approved in the US for colorectal cancer and lung cancer for a few years, and studies show that it's effective against metastasized breast cancer, the FDA hasn't approved it for such uses, and an advisory panel voted 5-4 against approving it a few months ago. It seems that the drug performs well on some metrics that the FDA doesn't score as highly, such as amount of time before the disease gets worse, but hasn't shown enough significant effect on mortality.

    In other words, while time_healthy improves, once it starts getting worse it gets worse faster, so time_sick is smaller, and the FDA mostly cares about t_healthy + t_sick = t_total after diagnosis.

  • ||

    Aw, you know us "socialists," thoreau. Always with the infighting.

    I heard Michael Moore yell "Long Live Humanity!" You remember that, thoreau. Don't you? DON'T YOU!?

  • ||

    Of course, off-label prescription certainly occurs all the time in the US.

  • ||

    Nash,

    The single-payer health care system is an ALTERNATIVE to "turning your doctor's office into the DMV."

    A single-payer health care system would leave your doctor's office as your doctor's office. His staff would just send bills to a different health insurance agency.

  • Nash||

    "The single-payer health care system is an ALTERNATIVE to "turning your doctor's office into the DMV."

    A single-payer health care system would leave your doctor's office as your doctor's office. His staff would just send bills to a different health insurance agency."

    Well I was mainly referring to queues. They are inevitable in socialist systems. Even the "good" systems like those in France and Canada have queue times.

  • fyodor||

    it's hard to counter the less cost per patient argument or the overall life expectancy concept.

    I guess the former is supposed to imply greater efficiency? But by itself it could just as easily imply people getting what they want rather than having what they want prohibited or impeded. After all, spending less money on food doesn't necessarily mean that the food supplying system is more efficient!

    The latter part is a harder sell. I figure it's oranges and apples, i.e., that there's other differences that account for the greater longevity in western European nations, and therefore you're just not comparing the same thing. Maybe cause we Yanks are just a crazy lot. But of course there's no proving such a thing (though maybe it could be demonstrated through a comparison of data on measurable lifestyle choices?)....

  • cgee||

    Quick save there, Mr. Thacker.

  • ||

    A single-payer health care system would leave your doctor's office as your doctor's office. His staff would just send bills to a different health insurance agency.

    Yes, essentially it would be like Medicaid or Medicare. Incidentally, that's one reason why I don't believe that it would generate cost savings in the US; neither of those hold medical costs down below private systems either, nor do they decrease paperwork. Both consumer desires and political pushes to "ensure that X is covered" would IMO mean that medical care would stay about the same percentage of GDP with a universal system. Are you suggesting that, e.g., all those pushing for bills to mandate minimal stays after childbirth, etc. would not do so under the public system?

    Denying the drug may be the correct decision, based on cost-benefit analysis. And some countries clearly have been able to hold costs down in no small part by rationing care and denying care that doesn't meet those standards. I'm skeptical, however, that suddenly voters in the US are going to be more okay with care being denied because it's a government decision instead of an insurance decision. I suppose it could happen; perhaps the effect of government paying for it would make lawmakers more hesitant to mandate. I doubt it, however.

  • !||

    Shadegg just announced he's back in:

    If I had to name one big thing, it would be the fight to oppose socialized medicine...Obama and Clinton have made it clear they want socialized medicine and they would push socialized medicine even though they don't call it socialized medicine...

    I've always believed the problems we have in health care today is that too many third parties make the decisions - your employer, your HMO, a doctor you didn't pick. A bureaucratically run government-controlled program would be even more of a mistake. On this, Clinton and Obama have it just plain wrong...

  • ||

    Avastin has been approved in the US for colorectal cancer and lung cancer for a few years, and studies show that it's effective against metastasized breast cancer, the FDA hasn't approved it for such uses

    Physicians in the U.S. have been known to presribe drugs for conditions that the FDA hasn't approved. Often.

  • ||

    Belay my last.
    I should have read ther whole thread.

  • ||

    If we ever did adopt a National Health System, we need to put Republicans in charge of it.

    Mitt Romney sent one of his buddies to clean up the Massachusetts RMV, and it runs like clockwork now. I getter better service there than at my bank.

    Srsly. If "DMV Service" was topping the most-important-issues polls, Mitt Romney would be winning this election by a landslide.

  • ||

    I don't know who this Shaddegg fellow is, but if he doesn't understand the difference between a national health system and a single payer insurance system, he probably shouldn't be lecturing people about their health care plans.

  • ||

    But of course there's no proving such a thing (though maybe it could be demonstrated through a comparison of data on measurable lifestyle choices?)....

    It's difficult to prove. There are some interesting but debatable data points. For example, Japan has the highest life expectancy in the world (the UN appears not to count Macau and Andorra, who appear first on other lists). OTOH, Japanese-Americans have
    an even higher life expectancy than Japanese in Japan
    , as do

  • Daldude||

    "But then Hirst, with the support of her oncologist, decided to raise the $120,000 she'd need to pay for the drug on her own, mainly by selling her house. The NHS said she was perfectly free to do that, but then she would have to pay for all of her care out of pocket, a financial burden that was far beyond her means."

    So, there seems to be the typical enormous blind spot here for you anti-gov healthcare folks. You know, that whole bit about her not being able to pay for all of her care out of pocket!! Isn't this exactly what would she would have had to do here with private care system? Things like long wait times or certain experimental drugs not being covered seem pretty friggin' minor in comparison to not being able pay for any of the care to begin with! Chances are, a person of her means in the US wouldn't even know she had cancer because she couldn't afford regular checkups...

  • ||

    Hmm, seems like part of my comment was eaten. Oh well.

    As do Asian-Americans as a whole.

    This is despite Japanese-Americans and Asian-Americans having higher cardiovascular disease rates than in Japan, presumably due to adopting a more Westernized diet.

    I think that leaves a lot of room for discussion.

  • ||

    I don't know who this Shaddegg fellow

    Wasn't he the guy most people around these parts wanted as minority leader?

  • ||

    You know, that whole bit about her not being able to pay for all of her care out of pocket!! Isn't this exactly what would she would have had to do here with private care system?

    I'm not particularly aware of stories where a private insurer says: "Oh, we'll cover treatment and drug A, but if you also get drug B as part of treatment we won't cover it if it's administered at the same time." It might happen, but I'm certainly familiar with the other side, cases of an insurer covering one drug but not another administered at the same time.

  • Daldude||

    I'm not particularly aware of stories where a private insurer says: "Oh, we'll cover treatment and drug A, but if you also get drug B as part of treatment we won't cover it if it's administered at the same time."

    I guess you've never been on an HMO. And, of course, that assumes that one can actually afford a private insurer - or if one can, that the coverage isn't denied altogether because it's declared a "preexisting condition".

  • economist||

    We can count on joe, of course, to defend the idea of single-payer national health care administered by the government. We're probably going to be stuck with a de facto NHS here in the US anyway, so I guess joe will get his wish. I predict it will occur some time around December 2009. Merry fucking Christmas

  • ||

    Well I was mainly referring to queues. They are inevitable in socialist systems. Even the "good" systems like those in France and Canada have queue times.

    While this is merely anecdotal, I went to an ER in Nice and waited 15 minutes, tops. There's probably no ER in a beach city that has a queue that short. Even our system has queues, most doctors won't take you same day.

  • ||

    Wait a second, wasn't Shaddegg one of the monsters in the H.P. Lovecraft stories?

  • ||

    I guess you've never been on an HMO. And, of course, that assumes that one can actually afford a private insurer - or if one can, that the coverage isn't denied altogether because it's declared a "preexisting condition".

    I have been, and I've had coverage for one part of my treatment denied after the fact but they paid for everything else. I've also been in a PPO. Right now I'm in a high-deductible HSA through my work and I enjoy the coverage they've provided so far.

  • Peter||

    "One of the best things about the adoption of a single payer/private provider health care system in this country will be that its success might motivate the British and Candadians to reform their Flintstone-era universal health systems along similar lines."

    Unfortunately attachment to the NHS is so deeply rooted in Britain, that almost nothing will shake most people's belief in it. Even stories like this will have very little impact.

    It is widely known in the UK that France and Germany have better healthcare systems, but there is no interest in emulating their approach. It appears that people just can't get over the psychological hurdle to accept that in order for healthcare to be accessible, the State doesn't need to exercise such heavy handed control as it does in Britain.

  • ||

    Peter,

    I have a theory about the British. They won't change to the successful single payer/private provider system because it's what the French do.

    If it becomes what the Americans do, it might change their minds.

    Then again, there goes Canada.

  • ||

    Chances are, a person of her means in the US wouldn't even know she had cancer because she couldn't afford regular checkups...

    What does "a person of her means" mean in this context? I assume that you're not meaning that she's poor, since she owned a house that she could sell. (And if she were poor there would be Medicaid anyway for regular checkups at least.) She was also able to hire a solicitor in order to represent herself in the case. She used to be the landlady for several pubs in Manchester, but retired in her mid 50s to live in Cornwall.

    I suspect that such a person would indeed afford private insurance in the US.

  • ||

    Funny thing about the HMO comment plus the "couldn't afford regular checkups comment":

    Studies show that being insured by a HMO decreases the chance of having to pay anything out of pocket for a mammogram among women aged 40-64.

    Even paying full cost out of pocket for a mammogram with no insurance, the national average cost was $125 in 2005.

    People are very confused about the cost of yearly screenings, as that article shows. They're not that expensive, even without insurance. They would be less than Mrs. Hirst's lawyer fees, for sure. Things like surgery and anesthetics and newly developed drugs are expensive, yes. But yearly screenings are not.

    It's a sad fact that incorrect information about the cost of yearly checkups and mammograms keeps people without insurance for getting them even if they could afford them. The same is true about regular dentist visits, which are much cheaper than getting more intensive work done later. I've had friends who didn't go to the dentist for years because they didn't have insurance.

  • ||

    "Chances are, a person of her means in the US wouldn't even know she had cancer because she couldn't afford regular checkups..."

    Nonsense. Anyone who owns a house can afford checkups. I do have to admit I know some people who don't have, and say the can't afford, health insurance. But they can afford alcohol, books from Borders, purchased DVD movies, pot, "cola", packaged foods, new clothing vs. thrift shop, cigarettes, etc. People don't want to afford certain items. I opted to go uninsured for a year while doing contract work. This was my choice and my risk.

  • ||

    OTOH, Japanese-Americans have
    an even higher life expectancy than Japanese in Japan, as do Asian-Americans as a whole.

    This is despite Japanese-Americans and Asian-Americans having higher cardiovascular disease rates than in Japan, presumably due to adopting a more Westernized diet.


    Wow! That was surprising, to say the least.

  • thoreau||

    If we ever did adopt a National Health System, we need to put Republicans in charge of it.



    Medicare prescription drug benefit. Discuss.

  • ||

    Zing!

  • ||

    One of the best things about the adoption of a single payer/private provider health care system in this country will be that its success might motivate the British and Candadians to reform their Flintstone-era universal health systems along similar lines.

    joe, when your old staws wear out, I have new ones over here that you can grasp at. Sell 'em to you cheap.

  • ||

    Medicare prescription drug benefit. Discuss.

    Extremely expensive, and not paid for in other ways. Massive new entitlement.
    OTOH, obviously inefficient to have Medicare pay for more inefficient and expensive treatments (such as surgeries) when pharmaceutical treatments existed. NBER studies show a decent amount of cross-benefit savings by decreasing Medicare expenditures in other areas.
    For the previous reason, some type of plan was probably inevitable not just politically, though I'm not sure if a better one could have passed.

    Those things have to do with proposing and passing the plan. As far as actual administering, it's been done fairly well so far, surprising some early critics who are still waiting for it to fail. Both cost from the government perspective and patient satisfaction have been better than I expected.

  • ||

    Oh, and one more thing:

    McCain opposed the benefit and participated in the filibuster against it. He continues to state on the campaign trail that it should be scaled back, yet still wins seniors and Florida. (Ron Paul, of course, wants to eliminate it.)
    According to some Reason commenters, this is because McCain hates the free market.

  • fyodor||

    I don't see why single payer per se would avoid the problem described here. It's a matter of coverage, not treatment.

  • ||

    joe sez One of the best things about the adoption of a single payer/private provider health care system in this country will be that its success might motivate the British and Candadians to reform their Flintstone-era universal health systems along similar lines.

    I read this thread fully expecting something absurd from joe, but that was a true gob-smacker.

  • ^||

    Joe says: single payer ... single payer ... single payer ... single payer ... single payer ...

    Christ, enough already. Enough with the goddamned euphemisms. You're a propagandist.

    Using "single payer" to describe a government-funded health-care system may not be inaccurate, per se, but it's akin to referring to one's house as "those bricks." It doesn't tell the whole story. It's a slippery and incomplete way to relay the information.

  • ||

    joe's right that single payer in theory is better than what the NHS puts out. But to me this story highlights a universal truth: those who pay for medical care, be it an insurance company or a gov't under a single payer system or socialized system, will always try to use some BS pretext for getting out of paying for something.

  • herodotus||

    Joe is a rejected suitor of Kerry Howley.

    C'mon, you know it makes sense.

  • Mad Max||

    "I have a theory about the British. They won't change to the successful single payer/private provider system because it's what the French do.

    "If it becomes what the Americans do, it might change their minds.

    "Then again, there goes Canada."

    Interesting theory about the Brits.

    As for the Canadians, if we want them to change their health-care system, just have the United States adopt the system *in toto.*

    Then have President Bush/McCain/Obama/Hillary go to Canada and say, "isn't it great you guys have a single-payer system just like us?"

    The Canadians will stumble over themselves to ditch their system.

  • Sean Healy||

    A dispatch from the frontier of single payer utopia:

    The Irish government, which pays for about 80% of all prescribed drugs in Ireland through various legislatively mandated reimbursement programmes, has just decided it's going to cut the retail mark-up (on the fixed prices it already negotiates with wholesalers) from 18% to a little more than 8%, to save about €100m per year on national healthcare costs. This is being presented to taxpayers as efficient management. The typical independently-owned pharmacy, however, gets about 70% of revenue from government drug payments, so these cuts will be disastrous to the (by law utterly government dependent) pharmacy sector - where margins are about 5%-6% - causing closures, especially in remote rural areas and poor city neighborhoods where front of shop sales are limited. So government gets to look like it's being responsible with healthcare costs, but it's actually reducing access to drugs for the very sectors of the population which universal healthcare is supposed to help.

    Here's the kicker: the government could achieve its savings easily if it permitted generic substitution of brand name prescription drugs, but that alas is illegal. Nine of the 10 biggest pharmaceutical manufacturers in the world have their European HQs in Ireland. None of them make generics. They bring in a lot of tax revenue and create a lot of jobs which legislators can take credit for, though.

    But that's the single payer paradise: where political concerns trump sound economics and actual healthcare outcomes. It's going to be great when the US gets a taste of that.

  • Jozef||

    Well, it should come then as no surprise that Britain is experiencing the largest brain drain in the past 50 years, highest in the world for highly qualified people and second highest (after Mexico) overall.

    Money quotes:

    Prof David Coleman, of St John's, Oxford, said the brain drain was "to do with quality of life, laws and bureaucracy, tax and all the rest of it".

    Prof Christian Dustmann, of University College London, said: "The costs of leaving a country are substantial. The rewards must be very high."

  • ||

    One of the best things about the adoption of a single payer/private provider health care system in this country will be that its success might motivate the British and Candadians to reform their Flintstone-era universal health systems along similar lines.

    Yes, because We'll Get It Right.

    Pardon me if I don't want to take that bet.

  • Jennifer||

    The British NHS has already proposed "no treatment for smokers and fatties." The American version will also withhold treatment for all drug- or alcohol-related problems (defined as "Any problem afflicting a person with any trace of drugs or alcohol in their body").

  • ||

    A single payer/private provider system in America means there will all of a sudden be 47 million people calling doctors to scheule appointments. Where are these doctors coming from? As it stands now, people already have to wait to see a doctor.

    I have ideas about how to lower costs without resorting to government financed insurance, but we need more doctors as part of the solution. One way to have more doctors is to eliminate some of the liabilities that are causing smart people to become lawyers instead of doctors. Obviously that's just a small step, but lawsuits make lots of money for lawyers and take lots of money from doctors. If your a bright college student which path might you take?

  • ||

    If we end the drug war, not only will we save a fortune that could go towards covering children's healthcare when they don't have any, but it would also allow many people to treat themselves with drugs that presently would land them in jail. Government types would also like the fact that violent criminals will be in jail and non-violent criminals will be back at work contributing to the tax collection. Ending the drug war is a win-win for everyone. Even the Prison Industrial Complex will remain because we'll be locking up all the chils molesters instead of letting them out so we have a space for potheads. No more worries by parents about sex offenders in their neighborhoods, etc.

  • Episiarch||

    One of the best things about the adoption of a single payer/private provider health care system in this country will be that its success might motivate the British and Candadians to reform their Flintstone-era universal health systems along similar lines.

    HAHAHAHAHAHA

    (wipes tears from eyes)

    Just like communism, right joe? It's a good system, it's just that the Soviets didn't do it right.

    Good stuff.

  • ||

    Physicians in the U.S. have been known to presribe drugs for conditions that the FDA hasn't approved. Often.

    "Off-label" uses are legal and will generally be paid for by insurance as long as there is support in the medical literature.

    Really, what we are looking at here is the difference between getting your health insurance via an enforceable contract and getting it from a sovereign government. It is inconceivable that a health insurance company could cancel your coverage if you pay for non-covered health care out-of-pocket, as that would violate their contract.

    But the State? It can do whatever the fuck it wants.

  • ||

    Ending the drug war is a win-win for everyone.

    No, the institutional supporters of the drug war have concluded, correctly, that it is in their self-interest to keep it going. They owe their jobs, their status, and their warm, self-righteous glow to it.

  • ||

    No, Episiarch, no, RC, the British don't have a single-payer system. The stale "like communism" quip depends on proposing the SAME system and saying it will be run better. I'm talking about a different system.

    What, were two whole seconds of thought before posting too much for you?

  • joe||

    ^,

    "Single Payer" is the straight, dry, techinical term for the system. Sorry if I didn't call it "dirty commie care" or some such politically-correct term that would make you happy, but I have this irritating habit of calling things by their proper name.

  • ||

    At least if you have problems with your insurance carrier you have recourse. You can sue them. You can shame them publicly which is sometimes just as effective. You can change insurance carriers or try to convince your employer to change carriers. (By the way, we have to stop tying it to employment, or at least convince our employers to offer multiple carriers.) You have more options. If government pays, you get one option and hope they don't screw you.

    Single payer is not the answer. In fact we need more payers. We need the government to make it easier for companies to sell insurance and we need government to allow insurance companies to offer different plans tailored to their different customers. Most states only allow a few plan options and they are all overloaded with crap people don't need, like gym memberships. If I want a bare bones, critical care plan, I shouldn't have to pay the same as some hypocondriac that goes to every specialist every week and takes 50 pills a day. If I want to add acupuncture coverage I should not be prevented by government, etc. You get the idea.

  • ||

    RC, I know you're kidding so this is not directed at you but at the pharmaceutical companies that don't want drugs legalized because it competes with them.

    OK, here goes: If more people are alive and out of jail and live longer because drugs are legal, there is a greater purchasing population for the drugs you (I'm talking to Big Pharma) produce and sell. And, your taxes will be lowered because you make lots of money and much of that goes to fighting the drug war that only stops 10% of drugs from entering the country. If marijuana makes cancer patients feel better and live longer chances are they will develop some other ailment that you CAN help them with by selling your product.

    OK, now I just want to punch a government type in the face because this really ticks me off.

  • Jennifer||

    Geez, you guys are criticizing "single payer" as though a government-run monopoly you can't opt out of is somehow a bad thing.

  • ||

    Geez, you guys are criticizing the absence of a universal system of heath coverage as if not being able to afford regular medical care is a bad thing.

  • Episiarch||

    Geez, you guys are criticizing the absence of a universal system of heath coverage as if not being able to afford regular medical care is a bad thing.

    joe wants to trade not being able to get health care because you don't have the money to not being able to get health care because it's rationed.

    Genius!

  • ||

    joe, government involvement is the primary (not only, but primary) reason for the high cost of health care and health insurance. I'm not just talking about federal government. State governments take the cake here, but they closely model each other.

  • Jennifer||

    joe wants to trade not being able to get health care because you don't have the money to not being able to get health care because it's rationed.

    Let's not forget "not being able to get health care because you smoke or drink or are fat or have any other 'lifestyle factors' on the official Unapproved List."

    Remember the thread a few months back about NHS doctors refusing to set a man's broken bone unless he quit smoking first? Joe was the one arguing that this was a good, sensible decision.

  • tarran||

    joe,

    Sweetie, if the government really wanted to make health care affordable, it wouldn't limit the number of licensed doctors so that only 1 and 3 qualified applicants who want the job can get it.

    They wouldn't then exarcebate the high prices by subsidizing the Doctors' income by in the name of making it "affordable".

    If the federal and state governments intervened in the shoe industry the way they do in the medical industry, 1 in 10 would not be able to afford shoes, and the majority of people would wear shoes that were uncomfortable and ill-fitting, and only the very rich would be able to afford nice, comfortable shoes.

    And, you'd be on this board explaining how if the government bought everyone their shoes, the system would be so much better than the "free market that fucks over the poor" system created by government intervention.

  • Geotpf||

    "John C. Randolph | February 21, 2008, 5:57pm | #

    That's socialism for you: they don't care if an individual dies.

    -jcr"

    Well, neither does a privately run insurance company.

  • ||

    If they won't treat you because you can't pay, medical care IS being rationed.

    Sure it is, Nick. Absent the federal government, MRIs could be paid for with the change in your couch.

    Remember the thread a few months back about NHS doctors refusing to set a man's broken bone unless he quit smoking first? Joe was the one arguing that this was a good, sensible decision.

    No, Jennifer, but I've learned not to bother trying to dissuade you from your beloved misrepresentations.

    tarran, dear, I'm not sure you know this, but there were a great many people who couldn't afford to go to the doctor even before the government became involved.

  • Geotpf||

    "tarran | February 22, 2008, 1:02pm | #

    joe,

    Sweetie, if the government really wanted to make health care affordable, it wouldn't limit the number of licensed doctors so that only 1 and 3 qualified applicants who want the job can get it.

    They wouldn't then exarcebate the high prices by subsidizing the Doctors' income by in the name of making it "affordable".

    If the federal and state governments intervened in the shoe industry the way they do in the medical industry, 1 in 10 would not be able to afford shoes, and the majority of people would wear shoes that were uncomfortable and ill-fitting, and only the very rich would be able to afford nice, comfortable shoes.

    And, you'd be on this board explaining how if the government bought everyone their shoes, the system would be so much better than the "free market that fucks over the poor" system created by government intervention."

    You are comparing apples and Ford F-150s.

    Shoes don't cost $100,000, and if you don't buy them today you don't die. But it's quite possible for an operation could cost $100,000, and if you didn't have it today you would die.

  • Geotpf||

    "Episiarch | February 22, 2008, 10:41am | #

    Geez, you guys are criticizing the absence of a universal system of heath coverage as if not being able to afford regular medical care is a bad thing.

    joe wants to trade not being able to get health care because you don't have the money to not being able to get health care because it's rationed.

    Genius!"

    How about a government run program where critical care isn't rationed?

    Look, the United States spends many times more on health care than socialistic countries do, yet gets (on an overall basis) the same or less care than they do. (For every horror story about socialized medicine, I could site a similar horror story about our health care system where an insurance company refuses to pay for lifesaving treatment.) We should spend the same amount of money, just do it in a different way.

  • ||

    Geotpf,

    The thing you don't realize is that patient outcomes and objective performance of the medical industry doesn't matter to these people. If they can seize on a sob story about a British patient, they're happy too, but every one of them would prefer an objectively-inferior but free-market health care system to an objectively superior subsidized one.

    You can show them all of the information about efficiency and outcomes in the world, and it won't make a dent, because they don't care about those things. They are about not having the government involved. Period.

  • Geotpf||

    "Nash | February 21, 2008, 6:57pm | #

    Well I was mainly referring to queues. They are inevitable in socialist systems. Even the "good" systems like those in France and Canada have queue times."

    And there aren't waiting lists for care in the current American system? At all?

    Bullshit.

  • ||

    Those are good queues, Geotpf. Market-based queues. Those queues are Invisible Hand queues.

  • Geotpf||

    "joe | February 22, 2008, 1:24pm | #

    Geotpf,

    The thing you don't realize is that patient outcomes and objective performance of the medical industry doesn't matter to these people. If they can seize on a sob story about a British patient, they're happy too, but every one of them would prefer an objectively-inferior but free-market health care system to an objectively superior subsidized one.

    You can show them all of the information about efficiency and outcomes in the world, and it won't make a dent, because they don't care about those things. They are about not having the government involved. Period."

    Oh, I know that. This is a libertarian blog, after all. However, libertarians also big followers of logic and, um, Reason. That is, I'm trying to point out their arguments aren't actually logical.

    Health care is different from shoes or video games or dresses or motor oil, due to the combination of wildly varying costs (that is, some people will live to be 100 without ever seeing a doctor, and some people will need constant, extremely expensive medical care all their lives) and dire consequences if you don't get it (IE, you die).

    Because of these differences, capitalistic factors (supply/demand, etc.) don't work properly. If you need an operation, and you don't get it you will die, you will pay an infinite amount of money to get it-so it will cost close to that much.

    Rich people will always have access to medical care. The question is how do you assure that poor and middle class people also have access? The best way is to, basically, take money from the rich and give it to everybody else for medical care.

    Pure libertarians perfer sick poor to die than have their taxes increase to pay for their medical care. It's just how they think.

    Even ignoring the Robin Hood aspect here, private insurance is actually less effcient than the government paying for everything. Obviously, the insurance company will try to avoid paying for as much as possible. The government may try to do the same thing, but it, at least in theory, is looking out for the citizens' welfare. The insurance company only looks out for the shareholders' welfare, not the patients'. So a private insurance company is more likely to withhold treatment than a well-funded government program. Plus, that brings another aspect-the profit motive. The company expects a return on it's investment. Let's say they expect a 5% profit. Even if the government program is 3% less effcient (in moving paperwork around-remember, we are talking about who pays for care as opposed to who actually provides it here) than the private insurer, it's still will cost less overall, because that's less than the insurer's expected profit.

  • ||

    They're "into logic and reason" purely as a brand name.

  • ||

    Of course, health care in the US is already somewhere between 1/2 and 1/3 socialized (via Medicare, Medicaid, the VA, and very heavy regulation of health insurance). Oddly, this has not resulting in progress toward any of the benefits touted by the proponents of more socialization of health care.

    Indeed, it has accompanied and arguably exacerbated at least some of the very things they decry, especially high costs and inefficiency.

    Yet somehow, despite our decades-long and unhappy experience with it, the solution is more of it!

  • economist||

    Actually, it is easier for the government to refuse you treatment than for a private insurer, because if you don't like the way they do things there's no way to get out of paying. I'm not saying that people can change insurance companies on a whim, either, but they can choose not to deal with the truly awful ones. And if the company refuses to cover something that your policy requires that it cover, you can sue them for breach of contract, while the government can get out of it by claiming it is acting in the interest of the "common good".

  • Geotpf||

    "R C Dean | February 22, 2008, 2:39pm | #

    Of course, health care in the US is already somewhere between 1/2 and 1/3 socialized (via Medicare, Medicaid, the VA, and very heavy regulation of health insurance). Oddly, this has not resulting in progress toward any of the benefits touted by the proponents of more socialization of health care."

    That is part of the problem, in a way. Hybrid systems of this nature are usually clusterfucks. Reminds me of the partial power deregulation in California.

    But the reality is that if you DON'T have at least partial government medical coverage for the old, handicapped, and poor, then those people will, well, die, because they can't afford care.

    So, since a full private system means everybody who can't afford care dies, and a hybrid system (like we have) is a clusterfuck, the correct answer is single payer health care. Basically every other first world nation has figured this out-except the United States.

  • ||

    geotpf sezHow about a government run program where critical care isn't rationed?

    Do I get a pony too?

  • economist||

    juris imprudent,
    If you get a pony, I better a pony, too, or else you're oppressing me!

  • economist||

    joe, your ignorance in declaring that government-run healthcare is more efficient because it is not motivated by profit is truly stunning. The profit made by the insurance company is the payment it gets for organizing a safety net. Put it this way, joe. Can you find 50,000 people to join you in your own non-profit associational healthcare plan on your own. If not, who finds them? Well, you'll probably have to pay someone to do it. And most insurance companies have actuaries to assess risk, lawyers to work through legal issues, and common bureaucrats to deal with the humdrum paperwork all involved in this. Any insurance organization requires these things. Also, while you might think that all insurance company safeguards against fraud are really an attempt to avoid fulfilling their agreements (as in some cases they are), there is actually a legitimate purpose to these, as insurance fraud is a fairly often-attempted crime. A government-run program would be no different, except it gets funded whether or not it's efficient, which tends to reduce incentives, encourage sloppiness, etc. There is no special reason why the insurance industry can be more efficiently run by government while practically all other commercial ventures are more efficiently run by private entities. Of course, you are right to point out that I am opposed to forced economic control by the state on principle, I just wanted to point out your ignorance in this area.

  • economist||

    Also, joe, I would like to point out that people have fairly dire consequences if they lack food or shelter, and yet most people (except for idiots who didn't read their mortgage agreements, whom you seem to think are so severely oppressed) buy these in a somewhat free market (except that the government screws around with food prices) without starving to death.

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