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.
RickDFL will probably weigh in on this thread at some point with a link to some WHO study showing women in Italy have a better chance of long term OC survival than those in the US (if he can find one).
Which would be beside the the point.
Health care decisions should be between a patient and a doctor. Both the patient and the doctor have the goal of giving the patient the best treatment. Under NHS the state becomes a third party in the doctor-patient relationship, one with absolute authority to determine ‘appropriate treatment’. The state has no interest in seeing a particular individual get the best treatment. The state has its own interests.
The state may determine that while a certain treatment may be effective, it costs too much or undermines some other state goal — in the case Mitch cites, the goal of social equality, which matters not at all if you are dead.
No medical system anywhere can promise to give the best treatment to every patient. Americans have the greatest choice of treatment options in the world. The price we pay for that — as a society — is that we have to accept that not everyone has equal access to medical care.
Here’s how to teach the lesson.
Take a bunch of Single Payer supporters – say, 100 of them. Make them kneel by the side of the road with their hands handcuffed behind them. One by one, shoot first one of them in the face. Then another. Then another. Then ask the rest if they want to pay for their lives. Take their money. Then shoot another in the face, saying we dont’ want to create a two teiered system. Shoot half of them as they beg for their lifes. “It’s not cost-effective to let you live and we don’t want to be unfair after all”. Let the rest go saying that it’s cost effective to let them live now. that should get the point across.
Mitch,
When you wonder why people think you righties are nuts, read ak’s comments, then read it again.
Terry – anecdotes don’t prove superiority. Further, since you need precertification, within protocols, which meet definitions of medical necessity, and perhaps require generic medication, it’s HARDLY the case that the decision on the path of treatment is between the patient and the doctor alone. The doctor is limited by the acceptible protocols, may not get pre-approval, may have the care denied as exempted from coverage, or exclued by pre-existing condition limitations.
HMO’s and Insurance companies have determined certain types of care while not officially called ‘too expensive’, are treated as well with other types of care.
Our medical system is broken, it doesn’t take Rick to point out the facts, it just takes being the slightest bit literate. Our position on the bell-weather measures has fallen consistently under the ‘free market’ system which the AMA has defended and supported. Other nations have much higher average levels of care.
I don’t agree with the idea of excluding private practice access. I think that Scotland’s position here is dead wrong – but claiming this shows the inferiority of that system, is bogus. Your last comment about choice is merely another way of saying, “if you are rich, you can get great care” – and you know, that’s absolutely true. Since when was it our society’s aim to direct it’s structure and organization to making sure the rich benefit the most – rather than the government is dedicated to the principal of doing the most good for the most people?
The problem with guys like Peev is they believe people get what they deserve but never believe it will happen to people they love.
Let’s pretend Obama gets Italian-style national health care adopted. Let’s pretend the Health Commissar decides that diabetic people are that way because they ate too much sugar and exercised too little as kids – they caused their own problem. Let’s pretend the Health Commissar decides not to pay for insulin for diabetics since it’s expensive and it’s their own fault anyway. And to make sure rich diabetics don’t get what they don’t deserve, let’s further pretend insulin becomes a restricted drug like cocaine. So millions of diabetics die.
Next, no hip replacements for old people who fall down. No bypass surgery for people who aren’t vegetarians. Then, no AIDS treatment for gays. Mandatory abortions of second children to reduce energy consumption to fight global warming. All with the same reasoning – it’s their own fault and that doesn’t justify the expense.
Any problem with any of that, Peev? ON WHAT GROUNDS?
If you concede total control to the Commissar, you give up the right to object. You take what they give and STFU about it.
Is this really where we want to be?
.
Peev, you just wrote a long comment to another post ‘splainin what a ‘strawman’ was.
Now note:
Terry – anecdotes don’t prove superiority.
I never wrote that the US system was superior. Strawman #1.
it’s HARDLY the case that the decision on the path of treatment is between the patient and the doctor alone.
I never said that in the US healthcare was determined by ‘the patient and doctor alone’. I said it should be. Strawman #2.
Our medical system is broken
I didn’t say our medical system was not broken. Strawman #3.
Your last comment about choice is merely another way of saying, “if you are rich, you can get great care”
I didn’t say that. Strawman #4.
I said that “Americans have the greatest choice of treatment options in the world. The price we pay for that — as a society — is that we have to accept that not everyone has equal access to medical care.”
What specifically in that statement do you disagree with, if anything?
We don’t have a ‘free market’ system, peevish. We haven’t had one for quite some time now. The constant blabbering and whining about the “failure of the free market” is both stupid and annoying. Proponents of “single payer health care” want to move from one government controlled system to one with significantly more government control.
When you wonder why people think you righties are nuts, read ak’s comments
Um, yeah. And when you wonder why people think “liberals” are nuts, read the comments at Democratic Underground, Democrats.com, DailyKos, Eschaton, TPM, HuffPo, the Minnesota Monitor…
Yet again, to paraphrase a famous punchline – free market capitalism gives everyone a chance to a better life for themselves; and government-is-the-solution socialism makes sure everyone is treated as poorly as possible (other than government apparatchiks, that is).
Health care decisions should be between a patient and a doctor. Both the patient and the doctor have the goal of giving the patient the best treatment. Under NHS the state becomes a third party in the doctor-patient relationship, one with absolute authority to determine ‘appropriate treatment’.
See: HMO, Insurance company
I don’t know enough about health care to know what the answer is, and I’m not advocating a single-payer system. But the claim that the government would be so much worse worse than an insurance company, which does anything to not pay a claim, could be false.
Simply put, DiscordianStooj, the government has much more power, and as difficult as changing insurance companies can be, most would agree that changing governments is harder to do. :-/
Peev:
“I don’t agree with the idea of excluding private practice access. I think that Scotland’s position here is dead wrong – but claiming this shows the inferiority of that system, is bogus.”
(Peev’s reading this right now.)
I’m not sure I get what you’re saying, Peev. I know it is simple. I know you’ll call me a Liliputian and a hater and hate-filled and all the other nonsense that comes to mind with your knee-jerk typing…
…I just need to know what you’re saying.
That’s not an invitation or a request to see seven paragraphs… just a little clarification.
“But the claim that the government would be so much worse worse than an insurance company, which does anything to not pay a claim, could be false.”
And if a company develops a reputation for that, guess what?? People stop using that HMO.
As it is I’m very happy with mine (HealthPartners). Admittedly I don’t use them often, but there was an episode a few years back where I needed lots of diagnostic work done, lots of visits to specialists, and eventually surgery and hospitalization. Bills were paid without so much as a peep from them.
Of course, others are invited to explain Peev’s comment, too.
A few thoughts on this.
One, the UK doesn’t have a single-payer system. In the UK, a patient can either use the public taxpayer-funded system (the NHS) or they can use their own money to go to a private hospital. What this woman wanted was to be able to have the taxpayers pay for most of her treatment while spending some of her own money on additional drug not covered by the taxpayers of UK. What the NHS said was in essence was if you have enough money to spend on an expensive drug that has relatively little clinical benefit, why should the taxpayers have to pay for the rest of your treatment?
Second, our sympathy for cancer patients aside, the question isn’t “how much is your life worth” but rather “how much are we the taxpayers supposed to spend on someone with a terminal condition?” I don’t agree with socialized medicine be it Canada’s single-payer system, the UK”s NHS, Obamacare, whatever but it’s no secret that the majority of health care costs are in the last couple of months of life for people like this woman. Anytime you are dealing with limited resources (and no one has proposed that we spend an unlimited amount of money on health care), there’s going to be some sort of prioritization.
You can treat the person with two months to live from terminal cancer or you can treat maybe 10 people with an 80% survival rate instead. You can keep grandma on a ventilator for six months or you can vaccinate every child in a twenty-mile radius. And that doesn’t even get into questions about whether people who have self-inflicted problems (e.g. obesity from overeating and lack of exercise, lung cancer from smoking, etc.) should be treated the same as people who suffer from problems that were beyond their control, thereby raising the question of whether a “public health” system is intended to protect people against harms that are beyond their control or whether it should include protecting them from the foreseeable consequences of their own voluntary choices.
Again, I’m not in favor of socialized medicine – not the programs that exist today like Medicare, Medicaid, SCHIPS, etc. and certainly not in favor of proposals to expand them or create new ones. But these are very real choices that providers and payers have to make on a daily basis whether we are talking about a privatized system, a socialized system, or a quasi-private/socialized system. The nature of how health care is paid for isn’t going to make these dilemmas go away.
If you really want to scare the liberals on this, suggest that if we ration health care, AIDS treatments aren’t covered as that is a 100% preventable desease.
thorleywinston said:
“The nature of how health care is paid for isn’t going to make these dilemmas go away.”
False.
The questions are only asked when you have a single authority making decisions for a group. None of the “dilemmas” come up when an individual is spending their own resources on their own health care.
Troy,
True and false. “Managed Care” – which is why HMOs exist – asks exactly those questions, applying cost/benefit ratios to treatment decisions. It’s why HMOs will rarely pay for a liver transplant for an 80 year old, for example; if their life expectancy with a new liver is the same as the life expectancy without, why spend the money?
Most “single payer” plans adopt “managed care” by one name or another. As, indeed, to most consumers when they spend their own money; people who pay their own healthcare bills (directly or via an HSA) do the same thing; they ask “do I need to go to the doctor for this sore foot, or will a heating pad do the same job?”.
Healthcare, being a finite resource, is ALWAYS rationed. The question is, who do you want doing the rationing? Government? An HMO (that is, indeed, what they do)? You and your household budget?
Mitch,
My point is that you will not ask yourself the questions:
“Did I do this to myself, and so deserve to go without care?”
“Should I have this operation, or since I am ‘over-the-hill’, should I vaccinate people instead?”
“This treatment doesn’t fit into the budget this month. Should I adjust the budget and live, or should I die a more fiscally responsible person?”
A lot of questions are not even though about until you are managing care for many people from a single pool of money.
I agree that health care is rationed (by you or somebody else), but you won’t be facing these particular dilemmas unless you are a bit odd. *shrug*
“you won’t be facing these particular dilemmas unless you are a bit odd”
If you are making the decisions for yourself by yourself, is what I mean to say.
Peev: “I think that Scotland’s position here is dead wrong – but claiming this shows the inferiority of that system, is bogus.”
Why is it bogus? From what I’ve read, single-payer systems have a tendency — and a vested interest in trying — to keep people from “escaping” the system by using a private tier. To me, that tendency makes a single-payer system inherently inferior.
“RickDFL will probably weigh in on this thread at some point”
Too much celebrating going on to worry about this.
You’re not singing that song from The Wizard of Oz, are you Rick?
Badda,
Rick is probably singing songs from the DFL hit parade, like “Happy Days Are Here Again” and the Internationale.
Pingback: How badly do you want to live?; Why we went to Iraq; Steyn and Free Speech in the dock — Shining City
Not to mention “Don’t Stop Thinking About Tomorrow” and “Don’t Stop Believing” and that song from the Rocky Horror Picture Show.
I still think he’s also singing, “The Wicked Witch is Dead”.
I dunno Badda,
When I think DFL and “Wizard of Oz,” I think Lollipop Guild.
When I think Libertarians and “Wizard of Oz”, I think of Pink Floyd.
All I can think about is what a sad, sad day it would be for U.S. citizens if we implement single payer health care.
The DFL desire for single payer isn’t about what is right for individuals but simply a power grab by the people that feel government is the source of all happiness.
I really don’t see how it can control costs. Grandma in the hospital (who has paid taxes all her life) will expect every possible medical procedure to be tried to save her life, no matter how remote the possibility for a positive
outcome. How could we as citizens (and funders) deny her that because that could be us next week.
We will all become robots, where each medical procedure will be exactly the same for every individual, totally disregarding the different rates of recovery for each person. And how can we honestly allow one person to stay in the hospital a day longer because they need a day longer to recover than another person. Everything needs to be the same.
Our right (and a true right) to freedom of speech will be severely diminished because anyone that speaks out against the system will be chastitized for denying health care to the the children, the elderly, the (name your victim group). It already happens. Then they will say if you don’t like it, you don’t have a right to collect when you need it (remember the per diem debate in the Minnesota legislature in 2007).
And how long would it take before political party affiliations or governmental dissent would lead to medical decisions that are different for some people (either better or worse) than other people.
Does the single payer healthcare eliminate the provisions that would allow trial lawyers to emerge? Doubtful since that is a key constituent in the DFL party. If that is not eliminated, then doctors will not be able to get malpractice insurance because there is no potential for income and lots of potential for lawsuits.
Does it address the lifestyle issues inherent in medical maladies? If it
doesn’t, then it soon would. People will start agitating for and demanding
people to lose weight, not drive motorcycles, not ride bicycles, etc. And
those people making the demands would be justified since they are paying for it.
Brings up the next question, would we put restrictions on the number of kids born into a family? Sounds logical to me. Why should we pay for one family to have 4 kids versus another family that only wants (or can) have two kids. That might infringe on some religious practices.
And lastly, how long before people start clamoring to shutdown the nursing
homes. Long-term care is expensive. In our culture of death (abortion on
demand, death penalties), how soon before we start aborting our elderly.
Society will also turn against our handicapped or setup rules to prevent people from having a child that has a handicap.
If the government pays for it, the government has a justifiable say in what
they will or will not pay for. We are the government. Do you really want your health care controlled by your next door neighbor?
Like I said at the beginning. It will be a sad future if we ever move to single payer health care.