Times Online: Brits Need to Accept Health Care Rationing

The author is actually just telling the truth about a system based more on Utopianism than reality, but I’m betting he’s getting more than a few angry emails over this surprisingly honest assessment of National Health Care:

If you read back over ten years, especially in medical journals, the same message keeps coming through: we have rationing, but it is bad rationing because it is muddled, irrational, inconsistent, and all too often covert. Nine years ago a survey of 3,000 doctors found that one in five had known a patient die or deteriorate rapidly because treatment couldn’t be afforded. A senior BMA spokesman, Dr Hamish Meldrum, said: “We have to make choices and set priorities… people have been mucking around trying to avoid the word ‘rationing’ but we would like a whole public debate.” Geographical anomalies were also striking.

Two years later the British Medical Association said that the concept of the NHS as a service offering all treatments may have “outlived its usefulness” because some rationing is inevitable. Six years later, again, another survey found that it was already half of all doctors – not a fifth any more – who admitted they had patients suffering because of cost. Again, that call for open debate. “Rationing,” said Dr Michael Dixon of the NHS Alliance, “is the great unspoken reality… the only people who refuse to mention the R-word are the media and the politicians”.

The BMA suggested last year that we make a clear statement of “core services” available nationally, leaving local health authorities able to decide, when they had spare money, on what to offer beyond the core: fertility treatment, stomach stapling, cosmetic adjustment, removing the sort of varicose veins that present no health threat. Their report also pleaded for some mechanism to protect the NHS from day-to-day politics, with an independent board taking power away from beleaguered and media-sensitive politicians. There are problems, certainly, not least the difficulty of deciding when local discretion becomes a resented “postcode lottery”. But the calls for a proper debate go on – depressingly identical over the years – right up to this year’s BMA statement that rationing is “a fact of life” and we should be honest about it.

Governments freeze at the very idea. Who wants to be in charge – and facing the artfully heartbreaking media tales of deserving cases – at the moment when such rules are laid down? Let me pluck examples from the air, endorsing none in particular. Imagine yourself PM at the moment when it is firmly stated that IVF can’t be funded because infertility is not life-threatening whereas cancer is; that drunkards, smokers and addicts are required to get clean before any but emergency treatment; that stomach-banding is subject to co-payment in arrears since you’ll be eating less; or that life-extending (as opposed to palliative or Alzheimer’s) treatments cease at 85? Imagine being the hard-hearted monster who rules that under-50s, breadwinners and parents of young families get formal priority with new cancer drugs, or that there is an age beyond which heart surgery is not offered. My mother, who died last week at 92 (in an excellent cottage hospital), famously turned down a pig’s heart valve two years ago with the sharp observation that the idea was “unseemly’. Being from a morally robust wartime generation and reading The Times daily, she was aware of greater needs unmet.

Suddenly one plank of the new Democratic platform doesn’t sound so good does it?

One thought on “Times Online: Brits Need to Accept Health Care Rationing

  1. I blame Otto von Bismarck for being one of the first notable statemen for promoting universal health care in the West. His policies were then promoted by the Communist Party of the Soviet Union, and later the National Socialist German Workers’ Party.

    The American version is the S-CHIP, promoted with lobbying efforts from Hillary Clinton and a few U.S. Senators during her husband’s administration. The Communist Party USA has been a big supporter for increasing S-CHIP one thousand fold.

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