Friday, August 15, 2008

Whose life is worth saving? Don't ask NHS in the UK

Sandy has a great post here that should be required reading for anyone who thinks government-provided health care is the way to go.
Basically, Nice, in the UK, is setting up guidelines for rationing health care. Their guidelines are going to put "First, Do No Harm" right into the shitter. If, in their considered opinion, you brought your ill health on yourself, you are going to be shit out of luck for getting treatment for that ill health. So, if you smoke, and get lung cancer, tough shit, no chemotherapy for you (unless, of course, you promise to quit smoking for the rest of your life). If you drink, and need a liver transplant, tough shit, nope, not happening (unless, of course, you promise to quit drinking for the rest of your life). If you're fat, and you need any kind of health care, fuggedaboutit (unless, of course, you promise to starve yourself and exercise like a hamster on speed for the rest of your life and somehow can manage to lose every one of those "excess" pounds you're carrying and keep them off for the rest of your life). And if you're poor and the quality of your life sucks, then obviously, you'd be better off dead, so why the hell should the government spend precious resources on your health, when there are so many other people out there who are so much more deserving than you?
I wonder if this is going to apply to everyone equally, or is it just going to be the working stiffs/poor people who are going to bear the brunt of these shitty-ass bioethical guidelines (do I even need to ask that question)? Is this going to apply to all the physically fat politicians, the smoking/drinking, drunk-driving politicians? After all, if Joe Schmoe who works for a living and has any of those behaviors can't get medical treatment because it's not cost effective (the cost of his medical care is more than what he will contribute to society), why should a politician who has proscribed behaviors be an exception to that rule?
If this is happening in the UK, with their National Health System, I don't even want to think about what would happen here in the good old US of A if we went to a national health care system subsidized by our taxes. Our government already wants to run our lives, for our "own good" (because everyone "knows" that big nanny government has our best interests at heart [and if you believe that, I have several bridges for sale]). I know that our health care system is a shambles now, but I have a sinking feeling that it would be so much worse if it became nationalized. Health is not a "one-size-fits-all" proposition, and trying to make it one may pave a very wide road to hell on the backs of those least able to fight for themselves, but just as deserving of life, liberty, and the pursuit of happiness. And who is any government to decide the value of a person's life? Just because the government thinks an old, fat, disabled person must have a shitty life, and would be better off dead soonest, doesn't necessarily make it so (and I know whereof I speak, I'm old, fat, and disabled, and my life is far from shitty in quality. I like my life just fine, thank you very much and do the letters FO mean anything to you, Big-ass MF Nanny-State?).
If the National Institute for Health and Clinical Excellence's (NICE) Social Value Judgements is put into practice, well, that's not a world in which I want to live (and I realize, that because I don't live in the UK, I don't have to deal with it, but I don't think the citizens of the UK should have to deal with it either).

ETA: See the post here for an even better take on this whole mess (said much better than I ever could).


  1. That makes me think a lot harder about whether or not I want to move to the UK, even if it would give me many more career options...

  2. This stuff is already happening here in the US, too, but try to find it in the news. Medicaid mothers are having to sign healthy lifestyle agreements in order to receive other government aid and get care for their special needs babies, for example. The Massachusetts universal health coverage experiment is a failure by ALL accounts: far more expensive than anticipated, taxes are going up, benefits are already being cut and rationed, and they've cut reimbursements to doctors (doctors are not happy - how many do you think will stick around to work for less while having obscene patient loads, and government paperwork regulations that require them to hire full-time staffs to keep up with). Quality of care it is not.
    It's hard to think of much of anything the government does that isn't corrupt and incompetent. What's scary, is that RWJF, pharma and insurance industries have already laid the groundwork for the U.S. universal healthcare -- and what's happening in the UK is more prophetic than people realize. [There are things going on in other European countries to control healthcare costs in those systems that would scare the eebie jeebies out of most people here, but that's a topic for another day.]
    A lot of young people seem to think that health care coverage by the government will mean everything they want for free. It SO doesn't work that way.

  3. anonymous - This is one of the scariest things happening, and it makes me so mad that people think the government can do anything well (government intelligence is an oxymoron for a reason, folks, and it applies to practically everything the government does nowadays). I don't know about anyone else, but I would rather not give up my freedom to choose who treats my medical conditions and how they are treated just because the government is going to pay for it (which is not really the government paying for it, it's the government passing out my tax dollars to pay for it, and deciding how those dollars are spent). Any time you let government have that much control over your life, you're going to get the short end of the stick crammed right up your ass, no grease, no kiss.

  4. I use to think universal heath care would be a good idea, but I have completely changed my mind after reading all these horror stories about patient care and doing more research on the topic.

    A classmate of mine was telling me how her friend's son has to wait over a year to see a specialist in Canada, even though his condition is possibly life-threatening.

    Look at how veterans get treated with their health care, and these guys and gals served our country.

    I'm against government getting involved with anything to do with my health care, because I'll most likely be tagged as a liability to society because I'm fat.

  5. While this is horribly shitty, it's not any worse than private health insurance companies in America. If your care gets too expensive they'll find any way to deny you coverage. Any way. Have one abnormal pap 10 years ago and then get cervical cancer? "Pre-existing condition", not covered.

    But, honestly, I don't have a lot of health insurance horror stories to share, because I've spent most of my life without it. Going without insurance means doing a cost/danger analysis before heading to the emergency room (and usually deciding it's too expensive), buying my asthma meds from people with insurance (because the pharmacy charges too much without prescription coverage), visiting the dentist all of twice in 15 years, and many other things that Americans who haven't been uninsured, and Canadians and others in countries with universal health care can't even imagine.

    I went to the emergency room once with my best friend, because she had severe back pain. She'd been having pains for a long time, and finally it got to be too much. The emergency room doctor said she probably had a degenerative spine disease (like her dad) but he wasn't going to do an MRI or anything to confirm it because she didn't have insurance and she certainly wasn't going to be able to pay it out of pocket. He gave her a prescription for some painkillers and sent her on her way. When she asked if he had any samples because she couldn't afford to fill the prescription, he just glared at her like he thought she was a junkie fooling with him so she could get high.

    Sarah, if you're classmate's friend's son lived in America, there's a decent chance he'd never be able to visit a specialist, not just have to wait a year.

    We can't continue to have millions of Americans go without health care. We just can't. We don't, and shouldn't, have to follow the UK's example with their crappy "Nice" guidelines. England spends half as much on health care as America does, as a percentage of each country's GDP. If we had single-payer health care, which is much more efficient than private companies (because there's no CEOs in single-payer systems making million dollar bonuses, among other reasons) and we spent the same amount as we currently do, then we could easily cover everyone, without evil rationing policies.

  6. This story is massively exaggerated. There are constant scare stories about the NHS potentially refusing to treat certain people but I have never heard of it happening at all, except one case that was on the news where a smoker was refused a treatment that does not work on smokers.

    My fat dad gets NHS diabetes treatment, my fat father-in-law got an NHS heart operation earlier this year, my fat boyfriend gets NHS physio for his bad back, and my fat self was in an NHS hospital for a week with DVT last year and nobody ever so much as suggested witholding treatment, or charging for treatment, in any of those situations.

    These stories are almost entirely propaganda against socialised healthcare, so take them with a big pinch of salt.

  7. Surly this could happen in the USA. It is not that hard to imagine insurance companies turning down, or raising cost, for fat people. I don't think that the fact that the UK has a free health care system has anything to do with it. Having lived in the US and now in New Zealand (free healthcare) I would MUCH rather have a publicly funded healthcare system. I only ever heard the term nationalised or socialised healthcare in the USA and its only to scaremonger people. USA is the only western country not to have it. This line of logic would suggest that you dont want publicly funded schools, police or fireman....No?

  8. sarah - I've read about things like that in Canada and I know what you mean about veterans' health care. Although, DH is retired after 20 years in the Navy and his care from the Veteran's Administration is pretty good, most of the time. Right now, getting appointments scheduled around his days off isn't easy because there are so many men and women coming back from Iraq/Afghanistan that need to see doctors urgently (at least here in MN, they are given priority). So it could be worse, and for some veterans, they aren't getting the level of care they deserve (and were promised when they enlisted).

    ellenf - Over the course of my lifetime, I've had periods where I didn't have insurance, was on Medical Assistance, had insurance through work and could afford to use it, or had insurance through work and couldn't afford to use it unless it was a life or death emergency (and then I'd probably have ended up doing without necessities in order to take care of the copays and what the insurance didn't cover). Right now, I have insurance through DH, that's provided by the government. So far, I haven't had to test whether they'll deny me benefits based on my size (although, if the arthritis in my knee keeps getting worse, I'll be seeing if they'll pay for a knee replacement on this fat old body, and that's definitely a pre-existing condition, since I've had arthritis for 30 years).

    missprism - I don't know that the NHS in the UK is going to implement those policies, but just the fact that they have drawn them up and are talking about using them to ration health care resources is scary enough all on its own. Nationalized/socialized health care could be a good thing, if it's managed correctly, but I don't have a lot of faith in governments anymore, especially with the crap going on now about banning all abortions and how they tried to push the new definition of abortion (which Leavitt back-pedaled on and now the wording is changed after people read it and raised a hell of a fuss). And there are fat people in the UK who have been denied health care just because of their weight (the fat priest comes to mind, he needed a knee replacement and they told him he was too fat). Those same people wouldn't be told they were too fat to have WLS, which has a much higher death rate than knee surgery. I also think the degree to which a person is fat has a lot of bearing on whether they get treatment or not (if you have a BMI of 53, like mine, I doubt very much that they would want to treat me, if I lived in the UK).

    intuitive eating - It does happen in the USA with insurance companies. They use the excuse of pre-existing conditions, which, if you change jobs and your insurance company changes, means you could be SOL for getting anything covered by the new insurance that the old one already covered.
    As long as health care is set up to make a profit, this is going to be a problem. Insurance companies didn't go into business to make sure everyone got affordable health care, they went into business because by playing the odds, they were gambling that more people who paid premiums would NOT use their insurance than people who paid premiums would. But that gamble isn't paying off anymore because of scaremongers who keep saying this, that, and the other are going to kill you and you need to have all these tests done to rule out this that and the other so the doctor can cover his ass and say he did all he could to treat you correctly and it's not his fault you had a bad outcome (in this nation of stupidity rules and I'm going to sue the ass off of you because you didn't tell me that hot coffee would burn me if I spilled it on myself, what can you expect?). Personal responsibility and common sense have gone the way of the dodo for a lot of people, so you get the government stepping in, or insurance companies mandating what doctors can/can't do in order to minimize losses. So, rationing health care and refusing to treat the ones who may have the most expensive care (or that you think will have the most expensive care, whether it's true or not) only makes financial sense to them. Do you really think insurance companies give a rat's ass about your health? I don't, I think all they care about is their bottom line.
    As far as publicly funded schools, police or fireman are concerned, police and firemen are not something I can go out and pay for myself (while if I had enough money, I could afford to pay for my health care out-of-pocket and not need insurance). Schools, on the other hand, well, there is always the option of home-schooling, and you don't have to be wealthy to afford to do that. It's been 36 years since I graduated from school, so I can't address publicly funded schooling now (I know what I had to deal with when my son was in school, he dropped out at the age of 16, and is now an electrician's apprentice). I have grandkids in school, and I can tell you that what they are taught is so far from what I was taught 50 years ago that there isn't much basis for comparison.
    Some things have to be publicly funded, but I'm just not sure that health care is one of them, unless you can insure that it's going to be fair and equitable for everyone, regardless of their situation. I just don't see that happening.

  9. "Some things have to be publicly funded, but I'm just not sure that health care is one of them, unless you can insure that it's going to be fair and equitable for everyone, regardless of their situation. I just don't see that happening."

    Without publicly funded health care, some people have no health care. It would be hard to be much more unfair and inequitable than the current health care situation in America.

  10. Ellen F - I agree that without publicly funded health care, there will be people who have no health care. But, even with it, there are going to be people who are refused health care simply because someone in the bureaucracy is going to say it isn't cost-effective, or they brought their illness on themselves and deserve to suffer for it, or that there just isn't enough money to let everyone have the same quality of care. I really don't want some bureaucrat deciding whether my life is worth living or not, and basing his decision on what level of health care I get on that basis.
    I don't know that there is any solution to this health care problem, where everyone gets decent, affordable health care regardless of income (and gets the same quality of treatment, regardless).

  11. We don't have millions of people going without healthCARE (that's been largely a sales job by the insurance industry) because the poor are cared for in America through existing programs. This is about a single-payer plan or government-mandated (and regulated) insurance, which the insurance industry is heavily promoting because they're going to make a fortune. We won't have the choice of going elsewhere, then what? That's scary. Look at what they've already put into place here in the US getting ready for nationalized healthcare or a single-payer system. It is managed care -- remember that? It was awful. We all were assigned a primary who acted as the gatekeeper whenever we wanted access to care or specialists, and we had to do what the insurance company-assigned doctor said or never get referrals we needed. Things are so corrupt and bought out I dread what's coming.

    The administrative expenses in the UK are rising exponentially and horribly wasteful, doctors and hospitals don't have money for basic things we have here and the equipment and care is dated, and doctors are forced by their contracts to prescribe stuff that would never fly here. I have several friends in the UK with cancer, and one has been denied a simple pain patch because they cost too much ($10) and he has an 18-inch deep open wound along his entire back and has lost half his body weight he is in so much pain; another girl (my age) developed ascites last year (gained massive amounts of weight in a short time as her tummy filled up with fluid) and was told she was just fat and that she couldn't have a scan to rule out ovarian cancer for 6 months.
    I hate to completely throw out the baby with the bathwater and jump into a single payer system, because they'll be no turning back. Our system could use fixing, but there's a reason why so many people in the world comes here for healthcare. I hate to think of the bozo's at our CDC deciding my care.

  12. "We don't have millions of people going without healthCARE (that's been largely a sales job by the insurance industry) because the poor are cared for in America through existing programs."

    No, we aren't. In my state, if you're not a child, have a child, or are disabled, you don't qualify for medicaid. When I was without health insurance, a lot of times the only "health care" I got was convincing my friends with insurance to sell me their extra asthma inhalers. I went for years with constant pain in my mouth until I could afford the $1000 it cost to remove my wisdom teeth. I am very lucky and privileged today to have health insurance. I know many people who don't have insurance, and if they got diagnosed with cancer or some other serious, life-threatening disease I don't know if they could even get the crappy treatment that anonymous's friends in the UK get. There are some programs to help people with cancer, but some of them are only for certain cancers, so there's no guarantee they could get any treatment. Besides, how would they even get diagnosed if they never see a doctor? I have a feeling if one of my friends showed up at the emergency room with ascites, they'd just tell her she's fat and send her home. At best they'd tell her she should go to a doctor she can't afford and get some tests she can't afford.

    I would much rather be told I could receive a test or a treatment in 6 months or however long than be told that I can't have it because I'm too poor. My health insurance now is much better than that, but I can't forget what it was like without it, and I can't say that others should continue to go without it because mine might not be as good if we had to pay for everyone's. I can't say I've got mine, so I don't care. Everyone needs health care, and a private system can't guarantee that. The US needs to join the rest of the civilized world in health care for all. We're the richest nation in the world, don't tell me we can't do it.

  13. anonymous - there are, at the least, hundreds of thousands, if not millions, of people in the US who don't have any medical insurance at all and don't qualify for Medicaid. Why don't they qualify? Probably because they're working, even if it's a minimum wage job, and they make too much money to get medical assistance. I've been there, and I know how it goes. If you're on Welfare, you can get medical assistance. If you're working, even if it's a shit-ass job with low pay and you barely have enough money to pay your bills, you don't qualify for medical assistance. And not all states have insurance funded on a sliding scale basis. If you're disabled, and get SSI or SSDI, you can get Medicaid (but I can guarantee you that SSI and SSDI don't give you enough money to live on unless you can get subsidized housing and food stamps along with that medicaid). So people who fall through the Grand Canyon-sized cracks in our system end up going to emergency rooms for care, and then not paying the bills for it because they just don't have any spare change to cover the exorbitant fees charged (give me a fucking break, $25 for a goddammed Tylenol dispensed in the ER?), which just leads to higher and higher ER charges.

  14. A bad economy is not solved by raising taxes. Minimum wage jobs will continue to be eliminated and the burdens on working people will only grow worse. Bigger government is not the solution...for anything.

  15. This is nothing to do with whether the medicine is socialised or not.

    It is to do with providing ALL treatments for EVERYONE being expensive, which is the case whatever kind of health system you have.

    Anyway, as far as the NHS goes, yes the fat guidelines suck, but it's no worse than what's in the US, for example. Here in the UK, you are not just restricted to the NHS; you can have medical insurance and go to a private hospital for treatment if you like. It's just that the NHS provides one more possibility that health-via-insurance-company systems don't.

  16. If nationalized health care is such an awful thing, then why aren't people in the UK and Canada clamoring for a totally privatized American-style system? When polled, over and over again, they say they do not want that.

    And there's a good reason for it. People in the U.S. can get to be in thousands, hundreds of thousands, millions of dollars in debt -- yes, millions -- from ONE illness in this country. Just ONE. And insurance companies deny care constantly -- it's how they stay in business -- and have lifetime caps on money they will spend on a patient, too, even if you've paid your premiums faithfully for decades. They don't care. They don't care. They don't care.

    And that's not even counting the people who can't GET insurance, or cannot afford it. Who number in the multiple millions. Including one child in every six. Don't buy the wingnut line of "most people choose not to buy insurance when they could afford it." That's true of a FEW people, not the vast majority. (And do not be fooled by the people "making more than $75,000 a year who choose not to buy insurance" line, either. That is NOT a lot of money for household income if you live in an E-ticket city like New York, Boston, San Francisco, or Los Angeles. Frequently people who live in those cities and have families will insure the kids and "go naked" themselves.)

    Besides, I cannot picture in a million years the U.S. ever going to 100% nationalized health insurance with no private insurance or private doctors allowed. Not in any of our lifetimes. There is way too much lobbying money out there and besides, any "national" coverage we have is going to be watered down by excessive moralizing, as in, "I'm not going to let people eat donuts and french fries, or have orgiastic sex, or ride motorcycles, etc., and expect to get care for that on MY DIME." (Never mind that "your dime" is not really yours in the first place thanks to privilege systems, dude, but wev.)

    Probably all we're ever going to get here is "boo-boo coverage," i.e. if you have a boo-boo and you can prove that you were 100% not responsible for said boo-boo, here's your paid-for coverage. If you had any hand whatsoever in your boo-boo, if there is a shred of evidence that you were holding your own knife, you have to pay for it yourself. IOW, there's no way on earth they'd ever be able to get rid of private insurance, because only a few people are so "perfect" that they will never have any kind of hand in their own illness or injury.

    But boo-boo coverage is still better than nothing, far as I'm concerned. Nobody should have to choose between paying for their kids' cancer treatment and having a roof over their heads.


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