Appendicitis in Nova Scotia and Single-Payer Medicine

A materials physicist friend of mine told me how his socialist sister lost her desire for a single-payer nationalized medical system.  She was on temporary business assignment in Nova Scotia, Canada and a neighbor began having severe pains.  She took her neighbor to the hospital and they entered the emergency room, where concern was expressed that her pain was caused by appendicitis.  The woman was screaming with pain.  She was told to wait for Triage and after a long wait, the examiner declared that yes, the pain was due to appendicitis.  My friend's sister assumed they would rush her to surgery.  But no, the doctor announced that she was not yet close enough to death to warrant surgery.

For 36 hours the woman screamed and writhed in pain.  My friend's sister stayed with her and helplessly listened to her screams for 36 hours.  Finally, the doctors decided she was close enough to death that they were willing to operate on her, and presumably to shove aside the many patients who had been waiting months for operations.  She did survive the operation, but my friend's sister's desire for a nationalized single-payer medical system did not.  She is now a furious opponent of single-payer nationalized health care systems.

Obama and many of his friends who want ObamaCare, really ObamaUncaringTax, to fail so it can be replaced with a fully nationalized single-payer system should have been with her.  Yes, I do understand that some of his friends are so callous that such an event would not have changed their minds, but no one can listen to a woman scream for 36 hours without at least being miserable.  At least, I cannot imagine that they would not be miserable.  But, that may be a failure of imagination on my part, because after all, they are Obama's friends.

The story above is anecdotal and scary.  Studies of larger populations are certainly useful in testing whether such stories are consistent with the Big Picture.  So, here is a Daily Mail report on the National Health Service in Great Britain:

Patients having major surgery in NHS hospitals face a much higher risk of dying than those in America, research has revealed.

Doctors found that people who have treatment here are four times more likely to die than US citizens undergoing similar operations.

The most seriously ill NHS patients were seven times more likely to die than their American counterparts.

Experts blame the British fatality figures on a shortage of specialists and lack of intensive care beds for post-operative recovery.

They also suggest that long waiting lists mean diseases are more advanced before they are treated.

Researchers from University College London and Columbia University, in New York, studied 1,000 surgery patients at the Mount Sinai Hospital, Manhattan, and compared them to nearly 1,100 people who had similar operations at the Queen Alexandra Hospital, in Portsmouth.

The results showed that just under ten per cent of British patients died in hospital afterwards compared to 2.5 per cent in America. Among the most seriously ill cases there was a seven-fold difference in the death rates.

The New York patients had paid for treatment through private medical insurance and were therefore likely to be "wealthier and healthier", whereas the NHS patients were from all social classes.

However, the study aimed to "iron out" these differences by rating each patient on their clinical status.

We Americans really must get rid of ObamaCare before it collapses and we get the almost inevitable rush by the Democrats to replace it with a fully nationalized single-payer system similar to that of Great Britain or Canada.

This is our future under ObamaCare

Dr. Smith, a young urologist in Great Britain was misdiagnosed three times for breast cancer by National Health Service General Practitioners and examined once by a Cancer Center in Oxford and told she had a benign cyst. Soon after, it was discovered the pea sized cyst was the size of a golf ball and the cancer had spread into her liver and spine.  Chemotherapy, radiotherapy, and hormone therapy have failed and she has 18 months to live.  She was months from her wedding.

Her condition is now stable and doctors believe she could potentially live for ten to 20 years with the tumours in her spine if they could operate to remove her liver cancer. It must be shrunk first, but normal chemotherapy has failed to do this.

Dr Smith has been told she needs Selective Internal Radiation Therapy (SIRT), a new treatment in which millions of tiny radioactive beads are injected into the artery which supplies the cancer, to deliver targeted radiation.

The treatment was approved in Europe in 2002 and has been used to treat 15,000 patients worldwide, including up to 300 in Britain. But Dr Smith's primary care trust in Ryde has refused to fund it because it has not been fully approved by the rationing body, the National Institute for Clinical Excellence (NICE).

The treatment costs 23,000 pounds and her regional zone in the NHS will not allow it, though other regional zones do.  Each zone has to ration the care provided to stay within their expenditure allotment.  Without the treatment, the NICE and her regional zone of the NHS have condemned her to death.  But, nice people do not talk about death panels.

Given the shortage of doctors in America, perhaps a hospital here should make her an offer.  They could offer to pay for her medical care in exchange for her agreeing to practice with them for a period of time during which she would pay the practice back.  I doubt the monolithic NHS in Great Britain has the flexibility to do the same, however much sense it would make.

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.

Government Health Care Death Panels

Obama and the Democrats are fond of saying there are no death panels in their health insurance reform bills now in Congress. Of course, there is no entity called "Death Panel" in those bills. Neither is there a panel whose stated purpose is to kill patients or to assist patients in suicide. But, the government does intend to dictate the kind of care to be paid for by acceptable insurance plans with a mind to reduce costs. With an aging population, they are specifically complaining that the costs of patients in their last year of life is especially high and the expense of such people is going to continue to drive medical costs upward. The two stated reasons for passing their bills are to bring down costs and to insure the few Americans who are not insured, though they love to greatly inflate that number.

The United Kingdom has had a National Health Service since 1948. They also have a desire to contain costs. In 2004, the National Institute for Health and Clinical Excellence (NICE), the government's health overlook agency adopted the Liverpool Care Pathway (LCP) as the protocol to reduce patient suffering in their final hours. This was developed by Marie Curie, the cancer charity, but is now used for patients who have lost consciousness or are having difficulty swallowing medication. Patients are denied sustaining fluids and put under deep sedation using automated sedation syringe drivers, if a panel of the doctors treating them, including a senior doctor, recommends this. The procedure is used in more than 300 hospitals, 130 hospices, 560 care homes, and in 800 other instances, such as in patient's homes. In 2007-2008, 16.5% of deaths in Britain followed continuous deep sedation, which is twice the percentage in the Netherlands and Belgium.

According to a letter signed by Professor Peter Millard, Emeritus Professor of Geriatrics, University of London; Dr. Peter Hargreaves, Palliative Medicine Consultant at St. Luke's Cancer Centre in Guildford; Dr. Anthony Cole, Chairman of the Medical Ethics Alliance; Dr. David Hill, anaesthetist; Dowager Lady Salisbury, Chairman of the Choose Life Campaign; and Dr. Elizabeth Negus, Lecturer in English at Barking University, some patients have been wrongly put on the Liverpool Care Pathway. Patients who are allowed to become dehydrated can become confused, especially when on pain-killing drugs, and be wrongly put on the LCP. They are concerned that tick box medicine is replacing real thinking for those following this procedure. Many doctors are not checking patients often enough for progress and the sedation makes it more difficult to see if any progress is occurring. Dr. Hargreaves says he has taken patients off the LCP and seen them live for significant time after wards.

So, Death Panels do exist in the U.K.'s National Health Service. For the same reasons that they exist in Britain, they will also come to exist in the U.S. under a government-run health care system. Under such a system, they are inevitable, no matter how much politicians may wish to deny them now.

Of course, end of life decisions do have to be made. In a private health care system, they are made by the patient, the family, and the doctors treating the patient. But, after the government takes over the delivery of health care, as with all government activities, a bureaucracy takes over. One of the primary purposes of all the Democrat bills is to set up a huge structure of such agencies and advisory panels to grow into the controlling bodies for the takeover of all medical care in the United States. They have set up panels and groups to recommend effective treatments. They will deal with end of life issues and set up procedures similar to the LCP in Britain. In time, they will minimize the consultation with patient wishes and patient's families, as all government bureaucracies do. They will deal with patients and families as though one size fits all. This is the nature of the beast.

We will definitely find that we will also develop Death Panels if we go down this road. It is inevitable! And when these bureaucracies decide whether your mother will live or die, she will surely be thought to be of much less value than you think she is. This is also inevitable.