The Democratic candidates tell us they can provide healthcare for all
either mandated or not. It sounds utopian except they don't say how we
will pay for it or that the quality and quantity of care will go down as
costs go up.
If we think we want universal healthcare first we need to make a few reality
checks. It hasn't worked in Britain, Canada, France, Germany, and Russia.
There are some alarming health abuses going on in the United Kingdom
recently noted by the Association of American Physicians and Surgeons and
others.
To meet U.K. government targets, which require emergency department patients
to be treated within four hours, thousands of patients are kept in
ambulances outside the department for hours. Last year, more than 43,000
patients waited for more than an hour before being allowed into the
emergency room.
Ambulances that are being used as "mobile waiting rooms" are unavailable to
take fresh calls. The Labour government brought in the four-hour standard in
an effort to end the scandal of patients waiting in casualty for days (Daily
Mail 2/20/08).
British patients are being denied certain operations because of lack of
worthiness, based on smoking, obesity, heavy drinking, or age. Officials are
urging patients to turn to "self care" instead of physician visits.
Statistics from the Conservative Party show that the number of patients
released from British National Health Service (NHS) hospitals with
malnutrition has doubled in the decade since Labour came to power,
increasing from 74,431 in 1997 to 139,127. While most of the patients had
nutritional deficiencies on admission, the nutritional condition of at least
8,500 actually worsened during their hospital stay.
Last year, Health Minister Ivan Lewis admitted that patients were being
starved on the wards, with some elderly patients given little more than a
scoop of mashed potatoes for lunch. Often, elderly patients are given
non-pureed food that they cannot chew or swallow. Food trays may be placed
out of reach and simply taken away when patients are too weak to get to them
(Telegraph 1/1/08). "The threat to cut benefits to the old and the unhealthy
in Britain is a clear confirmation that healthcare can never be free," he
says. "The threat also shows that healthcare can't be truly universal, at
least not for the long term, because it becomes too costly to maintain as
such" ("Health Freezes Over," Investors Business Daily 1/29/08).
One way to relieve strains on the system is to allow patients to pay
privately for portions of their carewhile still receiving "basic" care from
the NHS. For example, patient Debbie Hirst, who has metastatic breast
cancer, attempted to raise $120,000 to pay for Avastin, a drug widely used
in the U.S. and Europe but not available to NHS patients until the cancer is
so widespread that treatment may be hopeless.
Such arrangements have tacitly been allowed before, but in this case the
doctor delivered the news that he was getting his wrists slapped by the
higher-ups. If the patient paid for Avastin, so goes the logic, she'd have
to pay for all of her treatment far more than she could afford.
Patients "hopscotch" all the time, for example paying for a timely private
consultation or MRI, then getting their surgery from the NHS. But "that way
lies the end of the founding principles of the NHS," said health secretary
Alan Johnson to parliament.
The rules for private co-payments are contradictory and confusing. The idea
of the NHS may be to assure rich and poor get equal treatment, but the
system is riddled with inequities. Drug availability, waiting lists, and per
capita spending for cancer care vary wildly from region to region.
As patient Hirst explained: "I'm a person who left school at 15 and I've
worked all my life and paid into the system, and I'm not going to live long
enough to get my old-age pension from this government" (New York Times
2/21/08).
There is no need to die while seeking universal care.
Editor's Note: This week's commentary is submitted by Michael Arnold Glueck,
M.D.
