Free Markets, Free People


Those Who Refuse To Learn From History …

As the president gears up for a new push to pass health care insurance reform with a “major speech” to a joint session of Congress this coming Wednesday, it’s always instructive to peek in periodically at a system that is the practical end state he’s claimed he’s always wanted – the single payer system.

Today, as usual, we take a look at the National Health Service in the UK.

In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

What’s the criticism of the insurance industry? That a bureaucrat somewhere is making a life or death decision, correct? Of course that’s precisely the same thing that happens in a single-payer system, except it is a government bureaucrat making the decision.

In an insurance system, what are your choices? Appeal. Or tell them to stuff it and pay for the care yourself. But in such a system it is highly unlikely that any insurance company is going to try to issue “guidance” to doctors telling medical staff how to deal with dying patients like what the NHS has done. They wouldn’t presume to do it (and if they did, the option is to find an insurance carrier that doesn’t).

However, when it’s a single payer system and, as in the case of the UK, everyone works for government, such as the UK, then such guidance is completely within reason given the system. After all the basic presumption of such a system is that, in fact, bureaucrats do have a right to call the shots.

The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours.

Developed by Marie Curie, the cancer charity, in a Liverpool hospice it was initially developed for cancer patients but now includes other life threatening conditions.

It was recommended as a model by the National Institute for Health and Clinical Excellence (Nice), the Government’s health scrutiny body, in 2004

And there is no appeal as there’s really no one else to whom you can go.

A number of doctors there are concerned about the guidance. Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, is one of them:

He added that some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die.

He said: “I have been practising palliative medicine for more than 20 years and I am getting more concerned about this “death pathway” that is coming in.

It is supposed to let people die with dignity but it can become a self-fulfilling prophecy.

“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.”

He added: “What they are trying to do is stop people being overtreated as they are dying.

“It is a very laudable idea. But the concern is that it is tick box medicine that stops people thinking.”

He said that he had personally taken patients off the pathway who went on to live for “significant” amounts of time and warned that many doctors were not checking the progress of patients enough to notice improvement in their condition.

The key of course, and the reason for the “pathway” is contained in the second sentence I’ve put in bold – “overtreated”. Code for spending money on someone in the last stages of life. Obviously, it is much cheaper to put them in a drug induced coma and let them die than it is to attempt to keep them alive. Hargreaves sees that as a “self-fulfilling” process, where patients who would actually respond to more care and live “significant” amounts of time longer are condemned to death in an uncaring system more concerned about cost than life.

From the beginning one of the primary targets of health care insurance reform has been cost. The claim is that government can help lower those costs. The further claim is it can do it by introducing “competition” into the system. But there’s little in the proposals that anyone can find that actually does that. Instead it appears to most that things like the “public option” are actually designed to move us toward the eventuality of a single-payer system. The NHS provides us almost weekly examples of the cost containment strategies it implements in which extending life takes second place to cutting cost.

If cutting cost is the top priority of a system, any system, those are the types of decisions someone is going to be making. Most likely, if the patient isn’t involved in paying for the service, it isn’t going to be the patient or his family making them. It is going to be some bureaucrat with a budget line busily engaged in the priority of “cutting cost” making the decision.

~McQ

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4 Responses to Those Who Refuse To Learn From History …

  • “Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor.”

    IOW, a death panel.

  • The part that surprised me was this:

    In 2007-08 16.5 per cent of deaths in Britain came about after continuous deep sedation, according to researchers at the Barts and the London School of Medicine and Dentistry, twice as many as in Belgium and the Netherlands.

    I felt that the whole “death panels” bit was overblown, but that statistic, particularly in comparison to the rates in other countries, is startling. Those two countries may have been cherry-picked, though, so I’m wondering if this is indeed (and please pardon the pun) universal.

    Even so, 1/6th of all deaths come about after deep sedation? Is this typical, or an ominous indicator that cost-saving measures are cutting more than just costs?

  • Is anybody else thinking of “Monty Python and the Holy Grail” right now???

    McQWhat’s the criticism of the insurance industry? That a bureaucrat somewhere is making a life or death decision, correct? Of course that’s precisely the same thing that happens in a single-payer system, except it is a government bureaucrat making the decision.

    Oh, but government officials would NEVER do something like THAT! People who work in government are caring, kind, and compassionate, unlike those heartless b*stards who work for the insurance companies!

    / sarc

    • This is the point that I make to the few people I know who buy the ‘eeeeevil insurance companies’ riff. A bean counter is a bean counter is a bean counter. It doesn’t matter whether he works for a company or the government, his prime directive is finding ways to say ‘no.’ The only difference is the government kind can say no with total finality.