Darwall - Government Medicine vs. the Elderly

Rupert Darwall, a London-based strategist currently writing a book on the history of global warming, wrote an interesting Opinion in the Wall Street Journal on 14 September 2009. He noted that the Patients Association, an independent charity, had examined many end-of-life care cases of the British National Health Service (NHS) and had found "a consistent pattern of shocking standards of care." It gave examples across the NHS of "appalling treatment."

Darwall notes that the usual justification for socialized medicine is to provide access to care for the poor and disadvantaged. But this is best done by a benefits system and refundable tax credits. In reality, it is assumed that health care resources are fixed and it is necessary to prioritize their use for those who can benefit the most from them. So, Britain's NHS is the "national triage service." He notes:

It should come as no surprise that the NHS is institutionally ageist. The elderly have fewer years left to them; why then should they get health-care resources that would benefit a younger person more? An analysis by a senior U.K.-based health-care expert earlier this decade found that in the U.S. health-care spending per capita goes up steeply for the elderly, while the U.K. didn't show the same pattern. The U.K.'s pattern of health-care spending by age had more in common with the former Soviet bloc.

He notes that this assumption of limited resources lies behind Obama's claim that "We spend one-and-a-half times more per person on health care than any other country, but we aren't any healthier for it." Obama claims this threatens our economic competitiveness.

In my opinion, we would not be so tempted to view it from that angle at all except that we only offer tax breaks to companies for the purchase of employee health insurance. If we separated this cost from companies, then it would not affect their competitiveness and it would solve the problem of people losing their insurance when they lose a job or switch jobs. If the tax break for the purchase of health insurance went only to individuals, as it should, then their spending on health insurance would be viewed just like that on any other consumer spending, except that they would get a tax deduction for it. If Americans wanted to spend 1.5 times what other nations do and if they want to spend more specifically to keep granny alive another year or two or five, that would be viewed as entirely their prerogative.

Darwall questions what makes it bad to spend so much on health care? He does say that distortions such as malpractice suits and the absence of consumer price consciousness should be addressed. Putting insurance in the hands of the individual, rather than his company, and allowing high deductible plans with Health Savings Accounts is an effective answer to the issue of consumer price consciousness. Darwall observes that our greater spending on health care "incentivizes new drugs, new therapies and better ways of delivering health care. Government-administered systems are so slow and clumsy that they turn the lump of health-care fallacy into reality."

A 2002 Wanless report, which Blair's government used to justify a large tax increase to fund more NHS spending, found the NHS to be late to adopt and slow to diffuse new technology. The NHS more than doubled its spending from 1999-2000 to 2009-2010, an increase of more than 7% a year [according to Darwall, but I calculate that to be more than 10% a year], and still remains medically backward. This Wanless report examined five country's health care systems and found that only the U.S. was both an early adopter and rapid diffuser of new medical techniques. The U.S. is the world's "principal engine driving medical advance."

Indeed, which nation's scientists and doctors win almost all of the Nobel Prizes in Medicine? Those working in the U.S., of course. And it does not end with the fundamental scientific advances either, as the Wanless report confirms. Yet, Obama wants us to have the backward equivalent of the British NHS simply because he objects to the way we spend so much on granny to give her a year or two or five more years of life!

No wonder he is so sensitive on the death panel issue. It is because this really is one of the main issues, as recognized earlier by the professional publications of Dr. Ezekiel Emanuel, an adviser to Obama on health care issues and brother of Obama's Chief of Staff, Rahm Emanuel. The recent cover story in Newsweek also trod this path. As I have noted before, this path is inevitable once health care becomes a government service, rather than a personal consumer choice. This is so no many how many lies are told by socialist politicians to deceive the People, even if some of those politicians believe the lies.