Tonight I saw a GOP wanker pretending that in Britain the government comes between us and our doctors, and I started shouting at the TV about what a rectal sphincter he was.
How can they tell such stupid lies?
It's like creationists. If they know what they are talking about, then they are contemptible liars. If they have no idea what they're talking about, how do they have the effrontery to talk about it?
It's jaw-dropping. The government doesn't come between me and my doctor. The government
pays my doctor. (Very well, too, as it happens.) And I pay the government so that it can do this, by paying my taxes. I pay more tax when I'm earning well, and can afford it. If I'm not earning well, maybe because I'm too sick to work, I have no liability at that time, but I still have access to healthcare.
Wonderful, innit?
I have a large extended family. Most of my cousins are older than me. I also have a large circle of friends, including the friends of my mother, who are all, frankly, geriatric. I do not know of a single instance where someone was denied treatment his or her doctor recommended.
In contrast, simply among the American posters
on this forum, I have encountered numerous examples of insurance companies and/or HMOs refusing treatment which the patient's doctors had recommended. Not to mention the posters who didn't have access to healthcare they needed because for one reason or another they weren't insured to cover that particular requirement.
There was a very interesting programme on BBC2 last night, about NHS rationing. The whole thing can be seen online at
http://www.bbc.co.uk/iplayer/episode/b00l9dmw/Price_of_Life/, though I don't know if it's available in all locations. The question was whether or not NHS England should fund a very expensive treatment for multiple myeloma. The difficulty is that this drug is not a cure - it merely extends the patient's life for a few months.
[As an aside, the pricing of the drug was examined in detail, and the point well made that the astronomical price was not a reflection of either development or production costs, but of what the (US-based) drug company, whose commercial success was entirely dependent on this product, thought the market would bear. The CEO, who was a very enthusiastic free-marketeer, was interviewed, and said quite openly that when people's lives were at stake they were prepared to pay very high prices, so that's what they charged.]
The dilemma was that for the cost of this drug for one person, the salary of a nurse to provide palliative end-of-life care to
many patients in their own homes could be covered. Of course the extra months of life were important to the myeloma patients affected. They and their relatives were seen railing about the system, saying that the bureaucrats didn't care, and it was all about money, and a few months extra life before their inevitable deaths were worth tens of thousands of pounds. But at the same time the nurse who delivered the palliative care spoke eloquently about the difference she could make to the quality of the dying process for many patients, and her sadness that this standard of care might be curtailed if more money was allocated to the expensive drugs.
Most telling were the interviews with the committee members who made the decisions. These were hospital consultants themselves, who had the unenviable task of trying to take an unbiassed view of how the available money should be best spent. They had a high degree of compassion for all the patients involved, but they were looking at
all the patients, not just the few who were demanding very large amounts of money be spent on them merely to postpone their deaths for a few months.
Whichever way you slice this, this was not the "government" coming between anyone and their doctor. This was senior doctors themselves trying to figure out how to help the largest number of people with the money the government had made available to them.
In the end the drug company tried to cut a deal. The CEO obviously realised that there was a good chance that his pricing policy was in fact going to price him out of the NHS market completely. It wasn't a
great deal, but it was something. More agonising over conflicting priorities, and eventually the use of the drug was approved, by the chairman's casting vote. Much sobbing from the family of one patient for whom this decision had come too late. But also sorrow from the palliative care nurse, who believed that more funding for hospice and home care for the many was a better use for the eyepopping amounts of money than prolonging the lives of a few dying people for a few extra months.
So, care is rationed. It is inevitably going to be rationed in any system, as no pool of funding is infinite, and drug companies charge high prices. However, at least this system is trying to be fair about it. Decisions are open, and the aim is to be even-handed. Of
course patients and their families think a few extra months of life is worth £30,000. But the competing interests of those who don't have a vocal lobby group have to be represented as well.
And note, the government is not involved at all in this, other than as the provider of the money, and as the legislative body that has set up the doctors' committees with the instruction to be as equitable as possible and to get as good value for the taxpayers' money as possible.
And finally, one thing said by the grieving relatives of the lady who died before the drug was approved really struck me. They said that they wished that as a family they'd paid privately for the drug.
Well, why the bloody hell didn't you?????
Oh yes, demand that tens of thousands of taxpayers' money be spent to give your relative a few extra months. But don't put your hand in your pocket yourself, oh no!
Five years ago, this drug wasn't available at all. So nobody could benefit from it. Now, it is available. It's been approved for use, partly thanks to the drug company having re-evaluated just how much money it was possible to squeeze out of its potential customers.
There is
always going to be a transition period with drugs of this type. Herceptin was another example. The NHS is not just going to write a blank cheque for anything and everything that comes on the market that might delay someone's inevitable death by (say) a week. For things that are going to be approved, there will be a period while the decision-making process is ongoing when the drug exists, but is not yet available on the NHS.
Patients have options. Yes, they will almost certainly campaign to influence the decision-making process, and may sway it in their favour. And unlike an insurance-based system, one time counts for all. Nobody else is going to have to fight for that drug now, as it is approved. (We just wait to see what the next one is going to be, and it will start all over again.) But failing speedy approval, there are two things to do. One is to be philosophical about it, and realise that if you'd been in the same position five years earlier you couldn't have had the drug anyway. Many of us are likely to die of something for which a better treatment will become available in the future. The other is to pay for it yourself. Which people too hung up on their "rights", and the amount of tax they've paid over the years, are a bit reluctant to consider.
And of course the other option, for people with foresight, is to take out medical insurance to cover such an eventuality before it happens.
So there's the rationing. Very expensive drugs, priced with the aim of consolidating the finances of a drug company, are not immediately available to NHS patients, and if the cost/benefit equation is too disastrous, may never be. This tends to affect only those with fairly rare cancers, and the disadvantage they suffer is not the loss of a cure, but the loss of a few months reprieve.
And if you're in that category, you can choose to pay privately if you have or can raise the money. (Some people have done this, and then been reimbursed by the NHS when a court case was later decided in their favour.) Or if the prospect that you might some day find yourself in that position worries you, you can take out insurance against it.
I repeat, this only affects people with rare cancers. Most people will never be affected by this issue, or know anyone who is. For the rest of us, we show up needing medical attention, and we get it. How long we have to wait will depend on how urgently we need the treatment - appendicitis will be operated on immediately, gallstones will take a bit longer. And this will be decided by our doctors, and the government will not be involved at all except as the provider of the money.
Now you may say that the problem is that the government doesn't provide enough money. And you might have a point. But then, nobody likes paying taxes. Considering what we do pay, we actually get an amazing amount. If we spent as much as the USA does, our economy might be suffering in the same way. And when I look at the level at which the rationing kicks in, my suspicion is that we've probably got it about right.
Whichever way you slice it, I feel vastly privileged to have access to such a system, rather than the hit-and-miss situation in the USA. There is absolutely no doubt at all that the right-wing US commentators who say things like "the government comes between us and our doctors" are either sounding off about something they are entirely ignorant about, or are deliberately lying to further their political ends.
Rolfe.
