Saturday, March 25, 2017

Rationing Health Care in England

Will there be socialized medicine in our future? Who knows? As of now it seems more likely than not.

Faced with the difficult choice between opining on the debacle of Ryancare or was it Trumpcare, I prefer to offer yet another example from the wondrous British National Health System. You know, the one that looks to be coming closer by the day.

As we all know, and in despite of what Paul Krugman thinks, the NHS rations health care. If we want universal, high quality, affordable health care, the trouble, as a wise man once said, is that you can only have two. So, choose which two you prefer and you can have them: if it’s universal and high quality it will be unaffordable. If it’s affordable it will be low quality universal or high quality non-universal. Pick your poison. Just don't think that you can have it all. 

Anyway, over in England, where they even ration bariatric surgery for the morbidly obese, the word now is that if you want to jump to the front of the line for such surgery you need to become even more obese. Yes, indeed, the NHS rationing system promotes ill health… because that’s the way to get treatment when treatment is rationed.

The Daily Mail has the compelling story. One notes with some chagrin that the DM uses the utterly and totally incorrect term: "fat people." Of course, we deplore the use of such language, though we are comforted that it is gender neutered.

Anyway, the Daily Mail reports:

Rationing of surgery to treat clinically obese people means that some need to become 'super-obese' before they are allowed a weight loss operation, a new report suggests.

Some regions in England are demanding that patients must have a body mass index score of over 50 before they qualify for bariatric surgery.

Health experts are concerned that the message sent to obese patients is to get fatter so they can access surgery.

Those who have a BMI [Body Mass Index] score of over 30 are classed as obese, while those who surpass a 50 reading are clinically classed as super-obese.

The new report from the British Obesity and Metabolic Surgery Society and the Royal College of Surgeons is based on Freedom of Information requests to all clinical commissioning groups  across England.

These groups have now taken to lobbying for an end to the rationing. Which is surely a good idea. And yet, unless the government of Great Britain has limitless funds, when it stops rationing in one place it will soon be rationing somewhere else.


Sam L. said...

I have it on the sole authority of Paullie "The Beard" Krugman that YOU ARE WRONG.

(Paullie's a nutter.)

Walt said...

This is the worst case of NHS abuse I know of. This is the only link I can find now but elsewhere the guy elaborated that he was continually denied the surgery until he stopped smoking which was impossible to do since he was in constant pain from the NHS's first botch and unable to work. The system was only willing to get him hooked on opioids but not to operate or provide unemployment.

Ares Olympus said...

I don't understand why or how any can't speak of NOT rationing healthcare, and its not like this doesn't exist, at least by age. My uncle died at age 74 without a heart transplant, but of course there are limited hearts at least, so its not just a matter of money.

Anyway, that does sound like a predicament - if you set a BMI 50 as threshold for bariatric (gastric band) surgery, will that encourage more overeating for people to qualify? And it's extra strange since everyone ought to know there's nothing fair about BMI, and it'll bias tall fat people over short fat people.

The intention may be good, setting an objective standard, but this is clearly a case that it just can't work.

I have an overweight engineer coworker who has considered gastric band surgery, and apparently doctors are careful, encouraging him to increase his exercise, but actually he ended up going on anti-depressives and that helped him eat less.

But that shows another problem of healthcare - the cheapest options in the short run appear to create lifelong dependencies on drugs.

Should we also ration the "easy fixes" that have long term costs and side effects or just ration the most expensive procedures?