Monday, February 25, 2008

Problems From The World Of Socizlized Medicine

Meant to link to this story last week- Paying Patients Test British Health Care System.

Although the government is reluctant to discuss the issue, hopscotching back and forth between private and public care has long been standard here for those who can afford it. But a few recent cases have exposed fundamental contradictions between policy and practice in the system, and tested its founding philosophy to its very limits.

One such case was Debbie Hirst’s. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.

By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor.

“He looked at me and said: ‘I’m so sorry, Debbie. I’ve had my wrists slapped from the people upstairs, and I can no longer offer you that service,’ ” Mrs. Hirst said in an interview.

“I said, ‘Where does that leave me?’ He said, ‘If you pay for Avastin, you’ll have to pay for everything’ ” — in other words, for all her cancer treatment, far more than she could afford.

Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.

Patients “cannot, in one episode of treatment, be treated on the N.H.S. and then allowed, as part of the same episode and the same treatment, to pay money for more drugs,” the health secretary, Alan Johnson, told Parliament.

“That way lies the end of the founding principles of the N.H.S.,” Mr. Johnson said.

Sort of a damned if you do, damned if you don't. Pay for some care out of pocket and risk losing government coverage for your overall treatment. But here's the worst part- the poor aren't hurt by this rule, as they don't have the money to pay for private care in the first place. Nor are the rich hurt by it, as they could afford to pay for all of their medical expenses should the need arise. No, it's the middle class that are forced between a rock and a hard place in these sorts of situations, as they can afford some special care, but generally not the cost of an entire treatment. It's the sort of policy that strikes me as extraordinarily backward, punishing people in a twisted version of egalitarianism that keeps the vast middle class on the level of the poor, but still allows the wealthy to take advantage of their circumstances.

The point should be well taken that every health care system has it's weaknesses. As the election approaches, be wary of politicians with easy answers.


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