The Equal Sharing of Misery

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Under current National Health Service (NHS) regulations, if a patient chooses to purchase expensive drug treatments not covered by the government, they forfeit the right to further state-funded treatment. Allowing citizens to purchase life-extending drugs not covered by the NHS would create, says Labour Health Minister Alan Johnson, a two-tiered system favoring the wealthy. Of course, Mr. Johnson's is demanding equality of grim outcomes and preventing patients from spending their after-tax income however they see fit. This would be less of a problem if the NHS actually had the money to cover £2,200 a month cancer drugs. The (London) Times fills in the details:

The National Health Service is providing dying cancer patients with drugs that are five times less effective than those available privately and is refusing to treat them if they try to buy medicines themselves.

One drug for kidney cancer, routinely available through public health systems in most European countries but not to British patients, can reduce the size of tumours in 31% of patients, compared with just 6% of those prescribed the standard NHS drug.

The growing row over "co-payments" has prompted the government to reconsider the ban. Alan Johnson, the health secretary, has promised a "fundamental rethink" of the policy.

[…]

A former fireman who developed liver cancer after 25 years' service has been told that if he pays for the only drug that can treat his disease his NHS care will be withdrawn.

Barry Humphrey, 59, from North Walsham, Norfolk, was told by NHS doctors that the drug Nexavar was the only available treatment for his advanced liver cancer.

However, consultants at Addenbrooke's hospital in Cambridge said the drug was not routinely funded by the NHS and told him that if he paid for it he would be billed for the rest of his NHS care.

reason on the crumbling NHS.

 

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  1. Universal healthcare = universal oppression.

  2. Don’t worry, the national health care Hillary creates for Obama won’t have those kinds of problems. It is just a matter of proper implementation.

    I have a bridge for sale as well…

  3. I see things haven’t changed much since I left Britain. Maybe the British public will figure out how badly they’re getting hosed before the NHS goes back to using leeches and mercury cures to save a few bucks.

  4. One drug for kidney cancer, routinely available through public health systems in most European countries but not to British patients…

    Why is it available elsewhere but not the UK?

  5. Drug reimportation will put an end to US consumers footing the bill for the rest of the world’s socialized health care.

  6. Warren,

    The U.S. already has a lot of socialized healthcare.

  7. This will, of course be seen by the Labour Party as evidence that the NHS is underfunded.

  8. Why is it available elsewhere but not the UK?

    Because the UK doesn’t want to pay for it.

    Really, once you give the accountants final say, this kind of thing is inevitable.

    The patients whose lives are extended by these treatments continue to consume public resources regardless of who payed for the wonder drug, while patients whose lives have ended are a burden on no one’s budget.

  9. Moynihan, when printing articles like this one, don’t forget to mention that the reason for policies like this is extortion – an extortion that the left openly and proudly admits to.

    Horrific injustices like this one are specifically designed to frighten voters into voting more money for the nationalized health service. Mr. Humphrey’s dead body is supposed to be an object lesson for those who would demand economy of the health scheme. “If you don’t vote for budget increases, this dead guy here will be you,” is the message.

    This is what “If they know they must participate in the system, the wealthy will make sure it’s the best system possible,” actually means.

  10. You know those old movies where the villainous psychopath threatens to destroy the priceless work of art, or kill his soon-to-be-rescued kidnap victim, and justifies this on the grounds “If *I* can’t have this/her, *nobody* can bwa ha ha ha?”

    I’m trying to pinpoint the exact moment when “If I can’t have this, nobody can” switched from “psychopathic selfishness” to “admirable commitment to justice and social equality.”

  11. Jennifer,

    I’m trying to pinpoint the exact moment when “If I can’t have this, nobody can” switched from “psychopathic selfishness” to “admirable commitment to justice and social equality.”

    30,000 BC?

  12. Fortunately, after a few high profile cases about this insanity, the rules are about to be changed.

    Top up treatments will be allowed.

    The oddity is that you have always been allowed to top up with homeopathy, ayurvedic, crytals, reiki, whatever, but not with conventional.

    That is, you weren’t allowed to buy medicine that worked, only what didn’t.

  13. I also want to note a personal anecdote about Costa Rica’s much-ballyhooed universal health care. My father-in-law was just diagnosed with prostate cancer, and he was recommended for surgery. Wait for the surgery: 6 months!

  14. Cue for joe explaining why universal healthcare is better than free-market healthcare by comparing it to our mixed public-private system in the U.S. which isn’t really free-market but not entirely socialized therefore it can be used to discredit any free-market solutions for healthcare.

  15. economist –
    so you don’t think people should be able to get health care just because they’re poor? I knew it!

  16. I don’t understand. You mean everything Polly Toynbee has been telling me in the Guardian regarding the NHS is wrong? That’s unpossible…

  17. economist,

    Since you don’t seem to have even a rudimentary knowledge of the difference between a National Health system, like they have in Britain, and universal health insurance, like in France and what is proposed by Clinton and Obama, I don’t think my answer would make much sense to you.

    I love it when people with a C- undestanding of an issue presume to talk down to me about it.

  18. Last September Hit and Run linked to that story about NHS doctors refusing to set a man’s broken ankle bone unless the man quit smoking. I wonder if he, too, would’ve been kicked out of NHS if he went to America and hired a mercenary doctor to set his broken bone for him?

  19. I’m pretty sure I actually do know the difference, joe. In a national health system the government itself is the chief provider of healthcare while in a universal coverage system it is the insurer. However, both still regulate the shit out of their healthcare sectors, both still involve rationing, both are still huge taxpayer burdens, and both are still intolerable encroachments on individual liberty. And I thought you would at least give a reason for your support for universal health insurance rather than simply imply that I am ignorant.

  20. That’s not actually true, Jennifer. The doctor refused to set his leg until his circulatory disorder – which would have caused his leg to go gangrene and either kill him or result in the amputation of the leg – cleared up.

    Your version sure does sound good, though.

  21. Proof, joe, proof! Perhaps a link?

  22. Joe, the story said, quote, “A man with a broken ankle is facing a lifetime of pain because a Health Service hospital has refused to treat him unless he gives up smoking … Doctors at the Royal Cornwall Hospital in Truro have refused to operate because they say his heavy smoking would reduce the chance of healing, and there is a risk of complications which could lead to amputation.”

    I’m still curious if this man would be kicked out of the NHS if he paid a doctor to set his broken bone for him, though.

  23. Economist, here’s the thread in question, if you’re curious.

    https://www.reason.com/blog/show/122599.html

  24. Even if joe’s version is true, the NHS might not get as many accusations of this nature were it not for stuff like the above. But then again, when all of your wealth belongs to The State and what you keep after taxes is the the generosity of The State, who’s to complain when The State tries to direct to spend it in socially beneficial ways.

  25. Actually, the doctor’s logic doesn’t sound entirely unreasonable, though I would suggest that if “the community” doesn’t want to pay for other people’s decision, it shouldn’t rope them into a system where we’re all responsible for the others’ decisions.
    Oh, yeah, and if a private insurer did that without some sort of prior agreement to that effect, their asses would get sued.

  26. Oh, yeah, and if a private insurer did that without some sort of prior agreement to that effect, their asses would get sued.

    But economist,

    If a private insurer were to do that it would be because they were only concerned with profits and not the health of teh people.

    When the government-run program does it, it’s because it’s for your own good.

    I don’t see how you can’t tell the difference

  27. dead_elvis,
    I wish with all my heart and soul for deregulated free-market health care. However, a six month wait for prostate surgery may not be that egregious. My father went through prostate surgery a couple of years ago. Among the viable options is to do nothing and just keep an eye on it. Prostate cancer can have manageable symptoms for years.

  28. Reinmoose,
    I’m waiting for joe to start sputtering a response, not to have it anticipated by someone else. Although something about “profit motive” probably would come up.

  29. How about we provide free health care 100% covered by the government – no means testing, no rationing – to everyone under 55. Those over 55 have to fend for themselves in a free market. With any luck they will reach that age in great health and with money in the bank that they saved over all those years that health care was free.

    [/possible snark, just not sure]

  30. Actually, I’ve noticed that it’s often the same people who hate it when private insurers discriminate based on health habits who love it when the government does the same thing. Probably because the private insurers are “invading your privacy for profit”. Although it’s voluntary and simply a precondition for getting them to provide you with something. Now, of course, joe will assume I’m talking about him personally, and accuse me of attacking a straw man. As a matter of fact, that was an actual letter to the editor in the print version of Reason.

  31. First Little Pig,
    Who pays for the healthcare of the people under 55? If old people have to pay taxes for this, AARP will give you hell.

  32. Since you don’t seem to have even a rudimentary knowledge of the difference between a National Health system, like they have in Britain, and universal health insurance, like in France and what is proposed by Clinton and Obama, I don’t think my answer would make much sense to you.

    I agree. The continued use on H&R of Canada and Great Britain as whipping posts in showing the evils of a nationalized health care system, while ignoring other nations, is something I find rather disappointing.

    Heck, I bet even Matt Welch finds it disappointing.

  33. I’m still curious if this man would be kicked out of the NHS if he paid a doctor to set his broken bone for him, though.

    Oddly, it appears he would have been kicked out for having a doctor set his leg, but not a vet.

    Make of that what you will.

    In a national health system the government itself is the chief provider of healthcare while in a universal coverage system it is the insurer.

    And, in the context of penalizing those who seek to “top up” their care out of their own pockets, there is no difference.

    Consider: in the US, it is prohibited for a physician who participates in Medicare to have a “private contract” with any Medicare-eligible patients for any service covered by Medicare. In a universal coverage system, this would be a rule against any physician taking payment except from universal coverage, unless the physician operated a cash-only practice and took no insurance at all. Either way, “top up” care is effectively prohibited.

  34. MP,
    That’s right. A massive tax burden and the extension of “public health” issues to mean anything that could possibly negatively impact an individual’s health are not problems at all. And there is no way to have a free market in health insurance that does not involve government subsidies. And Matt Welch never changes his rhetoric to fit the audience.

  35. MP,
    Maybe if the left didn’t use the Canadian and British systems to answer objections over the cost of socialized healthcare, they wouldn’t be the whipping post for criticisms. But if you’d like to move to France and pay higher taxes in exchange for their wonderful healthcare system, be my guest. I’ll even throw in some money for the plane ticket.

  36. Economist, I am actually not in favor of the government providing anyone (aside, perhaps, from veterans) health care (aside from battling infectious diseases, arguably an actual common good)) and would much prefer the private sector sort it out.

    But any system that does involve government largess involves a huge transfer from healthly, young, tax payers to decrepit, ill, old, gimme-gimmes retirees.

    My idea provides the benefit for those paying for it and would be fairer and cheaper than almost any system on the planet.

    As for the old who didn’t save? “Then they had better get on with it and reduce the surplus population”

  37. A massive tax burden and the extension of “public health” issues to mean anything that could possibly negatively impact an individual’s health are not problems at all. And there is no way to have a free market in health insurance that does not involve government subsidies.

    Turn down the rhetoric and turn up the hearing aid. What I said essentially was that I’d prefer that Reason make more of an effort to find examples (and not just anecdotal ones) of failures (or successes, but obviously they slant towards finding failures) in the nationalized health systems of nations other than Canada and Great Britain. Instead, they keep going to the well of Canada and the NHS.

  38. This is what Obama wants for America.

  39. First little Pig,
    I was joking. Sheesh.

    MP,
    Yeah, that’s probably a good idea. I was just pointing out the problems I could think of off the top of my head. And the fact that no one who has to pay the tax burden would actually actively choose to live in France (or most of the other countries with universal coverage). Of course, if like most immigrants to France (and other welfare-generous countries) you don’t pay taxes but live off the public dole, it’s a great system and you’d be happy to move there.

  40. That’s not actually true, Jennifer. The doctor refused to set his leg until his circulatory disorder – which would have caused his leg to go gangrene and either kill him or result in the amputation of the leg – cleared up.

    And as I pointed out in that thread, and documented with a University of Michigan Health Care System link, that same line of reasoning can be used to deny FAT people surgery until they lose weight.

    Does that work for you, joe?

  41. We hates the smokers and the fat hobbitses, yes we do! So we will implement national health care, and make sure they don’t gets any! Yes, yeeessss!

  42. Allowing citizens to purchase life-extending drugs not covered by the NHS would create, says Labour Health Minister Alan Johnson, a two-tiered system favoring the wealthy people who don’t want to die.

  43. it’s often the same people who hate it when private insurers discriminate based on health habits who love it when the government does the same thing.

    Everything the gummint does is good. We passed a law on that last year.

    Plus, we have more guns than private insurers.

  44. that same line of reasoning can be used to deny FAT people surgery until they lose weight.

    We’re also going to deny old people treatment until they’re, um, less old.

  45. Oddly, it appears he would have been kicked out for having a doctor set his leg, but not a vet.

    Sounds like a paradigm shift for our business: four legs good, two legs bad better.

  46. Maybe if the left didn’t use the Canadian and British systems to answer objections over the cost of socialized healthcare,

    Am I the only one who remembers the good old days when Britain and Canada were the countries the left pointed to in favor of socialized medicine? Now it’s France. Once the French system goes into the crapper, the same leftists using it as an example now will complain when we use it, and move on to some other shiny, new program to sing hosannas to (until it’s examined enough to discover its flaws, then they will move on again).

  47. “Even if joe’s version were true…”

    From the quote, provided for the purpose of demonstrating that my “version” isn’t true:

    Doctors at the Royal Cornwall Hospital in Truro have refused to operate because they say his heavy smoking would reduce the chance of healing, and there is a risk of complications which could lead to amputation.

    My favorite part of the thread was the half dozen or so doctors who wrote in to say that the doctor’s medical judgement was appropriate. Thanks for the link, Jennifer.

    economist,

    Oh, yeah, and if a private insurer did that without some sort of prior agreement to that effect, their asses would get sued. If a private insurer refused to pay for an operation that a patient demanded despite his doctor making a medical decision that it would likely harm or kill him, they most certainly would not get sued. The cases of insurance companies getting sued involve insurance companies that refuse to pay for treatments that doctors recommend.

  48. Although something about “profit motive” probably would come up.

    Damn, this thread is just full of people making up the nice little stories that they want to hear.

    economist, “assume” makes an ass out of you and Jennifer.

  49. And as I pointed out in that thread, and documented with a University of Michigan Health Care System link, that same line of reasoning can be used to deny FAT people surgery until they lose weight.

    Does that work for you, joe?

    If it’s a medical judgement that the surgery won’t be safe, I certainly wouldn’t let my political preferences override that judgement. We liberals are like that.

    This thread is full of straw, stupidity, and bile.

  50. Glad your back joe.

    Should obese people be required to lose weight prior to surgery? Good or bad policy?

  51. I certainly wouldn’t let my political preferences override that judgement. We some liberals are like that.

    Fixed it for you, joe.

  52. J sub D,

    I’ll say it again: only if their physical conditions makes surgery unsafe, according to the medical judgement of the doctors.

    Did you follow it this time?

  53. Art P.O.G.,

    I’m not sure we’re allowed to discuss differences in political opinions among liberals. Not on health care threads, anyway.

  54. J sub,

    Bad policy is allowing people’s political judgments to override professional medial practices.

  55. I’ll say it again: only if their physical conditions makes surgery unsafe, according to the medical judgement of the doctors.

    So you’d support it letting the fat chick do withot a bypass. Dhanks for your opinion.

  56. Let her “do” what?

    Generously assuming you meant “die,” obviously not, since the surgery would not, in such a case, increase the patient’s change of death or injury, but decrease it.

    “First, do no harm” is a really, really simple concept for people who aren’t actively trying to be confused.

    This thread is full of willful ignorance.

  57. “First, do no harm” is a really, really simple concept for people who aren’t actively trying to be confused.

    I’d say that withholding necessary medical treatment because you will get a sub-optimal outcome, and causing greater suffering in the process, is within the definition of “harm.”

    YMMV.

  58. JW,

    Death and dismemberment is not “sub-optimal.”

    Avoiding death and dismemberment is not “causing greater suffering.”

    And assuming you can make a medical judgement about the risks and likelihood of various outcomes without a medical degree from the other side of the Atlantic about a patient you’ve never laid eyes on, better than the physician who has been treating him, is not reasonable. Even if you think it can help you score a point in a political debate.

  59. joe–Is excructiating pain not harm? Shouldn’t informed consent and patient choice count for something?

    And to assume that only sound medical advice went into the decision, completely immune to documented political and budgetary considerations, not to mention the effect that a bad outcome will have on a doctor’s record, is naive.

  60. If it’s a medical judgement that the surgery won’t be safe, I certainly wouldn’t let my political preferences override that judgement…I’ll say it again: only if their physical conditions makes surgery unsafe, according to the medical judgement of the doctors.

    So, what do you think would be a reasonable, intellectually honest, and principled response to this point?

    Would you believe, “So you’d support it letting the fat chick die withot a bypass?”

    How about, “withholding necessary medical treatment because you will get a sub-optimal outcome, and causing greater suffering in the process?”

    C’mon, you people are better than this.

  61. joe–Is excructiating pain not harm? It is – both when it’s caused by a medical problem, and when it’s caused by a failed medical procedure.

    Shouldn’t informed consent and patient choice count for something? It should count for a great deal. It should not override an individual doctor’s right to decide what is, and what is not, within the bounds of responsible medical practice.

    And to assume that only sound medical advice went into the decision, completely immune to documented political and budgetary considerations, not to mention the effect that a bad outcome will have on a doctor’s record, is naive.

    Did you read the thread Jennifer linked to? Actual practicing physicians, in the comments, piping in to say that it sounded like a legit medical decision. Naivete can work in more than one direction, you know.

  62. Death and dismemberment is not “sub-optimal.”

    Quoting from the article from the heavy-smoker/bad ankle story: “because they say his heavy smoking would reduce the chance of healing, and there is a risk of complications which could lead to amputation.

    There is a risk, not a certainty. Could. Not will.

    My favorite part of the thread was the half dozen or so doctors who wrote in to say that the doctor’s medical judgement was appropriate. Thanks for the link, Jennifer.

    Michael Siegel, another physician, writes: “How can you ethically, as a physician, prescribe this patient morphine, which is quickly going to turn him into an opiate addict, yet refuse him surgery that would most likely repair the ankle, simply because he happens to be addicted to nicotine?”

    He continues:”This action by these physicians violates two tenets of the Hippocratic Oath. First, it violates the promise to do no harm to one’s patients. By refusing to fix this poor man’s broken ankle, the physicians and the hospital trust are undoubtedly doing him harm. The harm is pretty severe: he is being sentenced to chronic pain, so severe that he requires daily morphine injections.

    Second, this action violates the provision of the Hippocratic Oath whereby physicians pledge to keep the good of the patient as the highest priority. Here, the good of the patient is being sacrificed in order to save the government money.”

    A medical doctor clearly takes the complete opposite view that you do. Who’s opinion do you think should we side with?

  63. Oh, and as for the smoking: the fact that the circulatory disorder could be improved, to a high degree of certainty, in a relatively easy, non-invasive manner that would pose no other medical problems to the patient is an argument IN FAVOR of delaying the procedure until the patient is healthy enough, not against it.

  64. There is a risk, not a certainty. Could. Not will.

    The man on the scene – you know, the one who 1) has a medical degree, 2) has been treating the patient, and 3) isn’t on the other side of the Atlantic Ocean has his judgement about the risk/reward structure, and you have yours. It is not remotely difficult for a reasonable person to know where the burden of proof and benefit of the doubt lie.

    A medical doctor clearly takes the complete opposite view that you do. One sufficiently blinded by his own political preferences to write, “imply because he happens to be addicted to nicotine” when, in fact, it was not nicotine addiction that delayed the surgery, but a circulatory condition that made the operation highly risky for the patient.

    Who to believe? Once again, the doctor who is actually in a position to know something about this patient, rather than just his own political reflexes.

  65. Did you read the thread Jennifer linked to? Actual practicing physicians, in the comments, piping in to say that it sounded like a legit medical decision.

    Yeah, I went back and skimmed it. prolfeed’s wife chimed in via prol as a proxy. That was about it. That and you generally behaving like an ass.

    One sufficiently blinded by his own political preferences to write, “imply because he happens to be addicted to nicotine” when, in fact, it was not nicotine addiction that delayed the surgery, but a circulatory condition that made the operation highly risky for the patient.

    Who to believe? Once again, the doctor who is actually in a position to know something about this patient, rather than just his own political reflexes.

    You do know that Siegel is an anti-smoking activist, right?

    Let’s end this joe. I believe the actions of NHS, in the case of the smoker, are harmful. You don’t. That might be the reflex you were talking about.

  66. There’s one other point I feel like I need to make about Dr. Seigel: How can you ethically, as a physician, prescribe this patient morphine, which is quickly going to turn him into an opiate addict… is an appalling statement, either dishonest or ignorant. People who take morphine or other narcotics as directed by their physicians for the treatment of real pain have very, very low rates of addiction. This idiotic “filling your prescription will quickly turn you into an addict” belief among doctors has sentenced millions of people to lives of pain, and it needs to be called out whenever it is found. Quite the expert you found there.

    You do know that Siegel is an anti-smoking activist, right? I know he’s an anti-smoking activist who has found a nice niche railing against anti-smoking actions he deems to be coercive – explaining why he was the go-to guy for comment on this article.

    Let’s end this joe. Probably a good idea.

    I believe the actions of NHS, in the case of the smoker, are harmful. You don’t. And the person in the best position to know the specifics of the patient’s case agrees with me, (actually, I agree with him, since deference to his knowledge is the entirety of my argument) and people looking to pick fights involving publicly-funded health care and smoking agree with you.

    That might be the reflex you were talking about. Yup. You read an article with the words “NHS” and “smoking” in it, and your knee jerked in exactly the manner the writer/political activist intended.

  67. One more point: Ibelieve the actions of NHS This was not “the actions of NHS.” This was the action of his physician, the one who was treating him.

    That’s a very telling slip: the entirety of your argument about this individual case, this individual treatment and the advice of this individual doctor, comes down to your opinion about his employer, and about smoking.

  68. joe,
    I’ll actually apologize to you on the “profit motive” thing. I went back and checked the old thread, and it was geotpf that claimed that private insurers were inherently less trustworthy than the government because they were profit-driven. Yes, I actually made a mistake here, and having always been perfectly willing to point out yours, it’s only right that I admit when I was wrong.
    Everyone else,
    Maybe we should back up and look at the actual point of this story, rather than chase an apparently complicated medical question that none of us knows much about. joe, do you support the actions of the NHS in this case, withdrawing benefits from someone who pays for supplemental treatment himself. Yes or no?

  69. And as I pointed out in that thread, and documented with a University of Michigan Health Care System link, that same line of reasoning can be used to deny FAT people surgery until they lose weight.

    That’s because the morbidity of surgery on very obese people is terrible. The stitches don’t hold (can’t sew fat, and there’s too much weight pulling on the fascial and skin stitches), fluid pockets inevitably form that cause wound infection. You’re looking at 4-8 weeks in the hospital for a simple procedure, followed by home heath care and rehab.

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