A: Under “Single-Payer Healthcare”, whatever the state wants to pay for it – and then, only if you don’t step out of line.
Kathy from Cake-Eater Chronicles – a cancer survivor (who quite memorably documented her struggle in one of the better bits of blogging I’ve ever read) and who thus has Absolute Moral Authority – writes about yet another atrocity of the British socialized system. She quotes the London Daily Mail:
{…}Mrs O’Boyle, 64, had been receiving state-funded treatment – including chemotherapy – for colon cancer.
But when she took cetuximab, a drug which promised to extend her life but is not available on the NHS, her health trust made her start paying for her care.
{…}Mrs O’Boyle, an NHS occupational therapist, is believed to be the first person to die after being denied free care because of ‘co-payment’, where a patient tops up treatment by paying privately for extra drugs.
Got that? She paid for a drug on her own, which was outside what the state wanted to allow her to have.
No, that’s not out-of-context paranoia; that is, indeed, exactly the government’s policy:
Co-payment was blocked last year by Health Secretary Alan Johnson because he claimed it would create a two-tier Health Service.
Bureaucracy? Sure (emphasis mine)!
However, her consultant recommended-Cetuximab, which could extend her life. But it is available on the NHS only in Scotland, not in England and Wales.
Kathy:
Nice, huh? A lifetime of taxes to pay for a health care system that actually employed this woman and her husband, only to be betrayed in the end because she was willing to pay out of pocket for a few more months on this Earth. She wasn’t looking for a cure. She knew that was beyond her. She was simply looking for a palliative treatment which could extend her life a bit. Just a bit.
She was asked, “How badly do you want to live?” And she replied that she wanted just a few more months with her family. She paid the price for a drug that wasn’t available under universal healthcare, and she did it gladly, only to be smacked with a frozen mackerel in the end. Her actions would create a “two tier” health care system, and that, apparently, cannot be allowed, because that would mean she wasn’t receiving lowest common denominator health care, like everyone else does with the NHS, and the NHS cannot stand that. She thought she had the right to choose what her healthcare was worth to her, and that she wasn’t going to be penalized for her decision. One would suspect, with universal healthcare, that that would be a reasonable assumption. Unfortunately, it wasn’t.
You could say the “good news” is that at least it’s just over there.
Well, this fall ain’t looking so good:
And yet this atrocious system is what some people would have us install here in the US. This is what some people want because their health insurance premiums are too high, and they would prefer not to have to pay them, but would rather let the government run things. It’s tidier in theory, but absolutely disgusting in practice.
Again, how badly do you want to live?
…
Governments with nationalized healthcare systems don’t want to give their citizens a choice. Patients are blackmailed, ultimately, into going with the lowest common denominator treatment if the the choice is between that or nothing at all because they don’t have spare millions on hand to pay for private care.
The political is the personal to Kathy – and many others in our country:
I know I harp on rather a lot about my cancer experience, but I don’t think I’ve ever mentioned what Dr. Academic told me one time, about what my treatment would have been if I lived in Italy. During the course of the staging controversy, we were told by my original oncologist that I would have to undergo three treatments of chemotherapy, instead of the six I’d been told originally. The reason for this was that a new study had come out, advocating three treatments for women with my stage of ovarian cancer, instead of six, because they hadn’t been able to find any added benefit, when contrasted with the risks, to the extra three treatments. However, when I was transferred over to Dr. Academic, he said, if I had to have treatment (which he wasn’t sure about at that point in time because of the evidence he had in front of him) I would have to have the dreaded six treatments, because he didn’t think the study the original oncologist had quoted was a very good study on the whole—and he would know, as he was on the board of the organization which published the study. He said that the group members had been polled and over ninety percent of them hadn’t thought it a good study, either—and weren’t going to use it as a treatment recommendation. He said that the reason for this disconnect was that to make the study’s results all the more powerful, they had let in to the statistical pool ovarian cancer diagnoses from places like Italy and Japan, for example, and Dr. Academic scoffed at their inclusion. He said their participation had ruined the study—because they hadn’t followed the protocol precisely, as in, the surgeries hadn’t been completed in the proscribed manner and as a result, had skewed the results. He said, after he’d dropped this bomb, that if I’d been living in Italy, with my cancer, all they would have done was the surgery. After all, that meant I would have a 70% survival rate for five years, which is nothing to sneeze at, particularly if you look at the statistics for things like pancreatic cancer, which has a 2% survival rate. But with a round of “precaution” chemo, just to make sure everything was cleaned out, my five year survival rate was boosted to 93%.
Which would you rather have?
Of course, when you’re talking nationalized healthcare (“Managed Care” run by the government), it’s the wrong question; “what’s it worth to the state authorities” is the first question.
Quite frankly, this is the difference between recurring and not—and if ovarian cancer recurs, well, that’s what the cause of death will be. It’s sad, but it’s true. So the goal, for women like me, is to make sure at the start that we have the best chances possible NOT to recur. That means a standardized protocol of precaution chemo. This is the standard of care here in the US. But not in Italy. How many Italian women, who were diagnosed with my stage of ovarian cancer, have recurred, and received, ultimately, a death sentence, because their government was too cheap to give them precautionary treatment in the first place?
And as we see with the O’Boyle case, the second is “does it interfere with government policy?”
Because, having worked in the industry, I can see the malthusian logic (if also the mechanistic inhumanity) behind “care management” decisions – but not the policy of forbidding people from paying for their own care, an act whose message is “not only is your life worth exactly what we say it is in terms of actual care, but it’s worth even less in terms of public policy”.
And that is inhuman.
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