Wednesday, June 11, 2008

Nationalized health care in action.

A fundamental question about a nationalized health care system is whether its purpose is to provide a minimum basic acceptable level of health care for everyone, so nobody is deemed left without adequate basic care, or whether it provides the total of all health care provided, so nobody can use their own resources to obtain more.

The issue is coming to a legal head in Britain:
NHS scandal: dying cancer victim was forced to pay

A woman dying of cancer was denied free National Health Service treatment in her final months because she had paid privately for a drug to try to prolong her life. Linda O’Boyle was told that as she had paid for private treatment she was banned from free NHS care.

She is believed to have been the first patient to die after fighting for the right to top up NHS treatment with a privately purchased cancer medicine that the health service refused to provide.

News of her death at the age of 64 has emerged as six other patients launch a legal action to trigger a test case that they hope would force the NHS to allow them to top up their care with private drugs.

Some cancer drugs not yet available on the NHS can markedly increase the chance of survival. But Alan Johnson, the health secretary, claims that co-payment would create a two-tier NHS, with preferential treatment for patients who could afford the extra drugs. Last year he issued guidance to NHS trusts ordering them not to permit patients to pay for additional medicines...

After [Ms. O'Boyle] developed bowel cancer and began having chemotherapy, doctors told her she should boost her chances of fighting the disease by adding another drug, cetuximab. It is not routinely funded by the NHS.

When she decided to use her savings to pay for it, Southend University Hospital NHS Foundation Trust withdrew her free treatment, including the chemotherapy drug she was receiving... [ht: Tim Worstall]
A related story...
Doctors for Reform fight NHS order to halt cancer care

A group representing nearly 1,000 doctors is preparing to mount a legal action against the health service to stop care being withdrawn from patients who want to pay for their own cancer medicines ...

Last December we reported the case of Colette Mills, a breast cancer sufferer from Stokesley in North Yorkshire, who was told that if she topped up her medication with privately bought drugs she would have to pay for her entire treatment – about £10,000a month....

Doctors for Reform has teamed up with Halliwells, the law firm, to challenge the ruling. Halliwells is offering its services free as the doctors are trying to raise £35,000 in donations towards government legal fees if they lose....

Dr Christoph Lees, a steering group member, said: “Doctors are caught in a terrible dilemma: do you tell a patient about a drug that could improve their quality of life, or do you pretend it doesn’t exist?”
What say ye, Democrats? But don't answer too quickly.

The Canadian national health system that so many in the US take as their model strictly banned private health insurance until 2005, when Canada's Supreme Court struck down the ban due to deaths and other damage to health caused by long delays in the system.

Here in the US, Medicare was enacted on the promise that participants would retain "free choice", but it wasn't long before privately paid for medical services for seniors were banned. In 1997, when the Republican Congress restored some options for obtaining privately paid for service, Democrats objected that this "would start to unravel Medicare's social safety net" to benefit "the privileged few". This battle isn't over, private care options remain limited.

So if you are a proponent of national health care in the US, answer this simple question: would your program provide minimum care or maximum care? (If maximum, and one day you find yourself denied the medicine you want or at the back end of a long wait list, will you have reserved the right to go to Quebec and pay out-of-pocket there to get the treatment you desire?)