Tuesday, January 1, 2008

Nanny state apotheosis
Tom Smith

A loyal reader sent this astonishing link about Britain's NHS, some people's idea of a model national health care system.  The idea seems to be that if you have been bad, smoking, drinking, getting fat, well then, you go to the bottom of the queue for those who get treatment.  Too fat?  No help on fertility for you, dearie?  Smoker?  Somebody else gets the cancer care first.  When waits are long already, this is as good as saying, no care for you. 

I have no problem with insurance companies charging higher premiums or not insuring at all people who engage in risky behaviour.  But a national health plan makes it more difficult or impossible, and under some programs, illegal, for private insurers to operate.

There's something very strange going on in the UK.  It's getting to the point where it's not even funny anymore.


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Tom Smith


Maybe it's just a way to justify failure to provide health services--blame the sufferer, not the NHS.

Posted by: clarice | Jan 1, 2008 11:25:08 AM

It's just a hunch, but I'll bet that, in addition to this being a odious form of medical triage, there is an element of political correctness. I'd be interested to know if AIDS patients who picked up the disease from blood transfusions or from an unfaithful spouse to treated differently from prostitutes, homosexuals, and IV drug abusers. Somehow I doubt it.

As a physician, I have been trained to offer care based on where it can alleviate suffering. As an army officer, that can even include rendering care to enemy combatants in preference to US service members, if needed, based on medical need. I'm ashamed that the UK physicians are complicit in this.


Posted by: David | Jan 1, 2008 11:36:20 AM

"Nanny State"? why is an insistence on personal responsibility nanny state? in a pure market economy the citizen pays for the liver transplant or the oxygen tank caused by excessive drinking or smoking. If your insurance company declines to pay for treatment that compensates for willful but unhealthy habits it seems to me appropriate for a market based economy.

How they make their distinctions might be troublesome but, it seems to me, the motivation and the policy is rational. It seems hard nosed and practical so why is that "nanny state"?

Posted by: kieth Nissen | Jan 1, 2008 11:39:18 AM


Don't you know by now?

In the leftist playbook, you can screw anyone you want, but you cannot eat (i.e., consume) anything you want.

Get it? Now, to the back of the line with you!

Posted by: edh | Jan 1, 2008 11:43:36 AM

Not that I agree that "liberism is entirely about getting the power, and not about helping anybody".... you understand. I wouldn't be so absolute.

Odd though, that for people to make private "judgements" about others, including on their lifestyle, and for the state to do so, is an unmitigated outrage to the average liberal.

But once they themselves achieve the power, in this case of the NHS... well, they have no problem at all doing the exact same things, for pretty much the exact same reasons. As long as they are the ones with the power now.

As they kids put it - "I'm jus' sayin'!"

Posted by: Andrew X | Jan 1, 2008 11:44:08 AM

Taxpayers should subsidise catastophic insurance for a level of that of a healthy person (for that age and sex) then people could fund the rest (i.e the damage they have caused to their own health).

This is a much better model than the NHSs beurocrat rationed treatment.

Posted by: AntiCitizenOne | Jan 1, 2008 11:44:23 AM

Of course it's not funny, but it is logical. It's what happens when the state assumes control of resources. Resources are always limited. They just get to choose who loses out. It will be a shifting popularity contest with a high chance for different scapegoats over time. The old have no chance.

When this sort of governmental control happens it's time to overthrow the regime, not that the Brits appear to be in a fighting mood.

My friends laugh when I say this, but nationalized healthcare here in the US means more will die earlier as a result of atrophied innovation and denial of service. Pitchforks, torches and shotguns will be required if we don't wake up and prevent it's implementation.

Posted by: Greg Toombs | Jan 1, 2008 11:48:39 AM

AntiCitizenOne wrote: "Taxpayers should subsidise catastophic insurance for a level of that of a healthy person (for that age and sex)."

Why? Explain to me, please, why I am obligated to subsidise the health care of a total stranger.

And, by the way, it's spelled "bureaucrat".

Posted by: Pat Berry | Jan 1, 2008 11:49:07 AM

I read online (BBC, I think, but can't find a link now) that if you're over 55 and get diabetes in the UK, you are not treated for it. Too expensive & too many complications, ya know. If you go outside the system for treatment, you forfeit NHS coverage for anything else. This seems incredible, until you learn that a recent NHS cost-cutting policy is to not change bed sheets between patients--just turn them over for the next one coming in, as long as there's no obvious stains or whatever. Saves on those pesky laundry costs.

Lovely system they have there. Anybody who thinks national healthcare is a good thing is not paying attention.

Posted by: Denver Girl | Jan 1, 2008 11:50:42 AM

It seems hard nosed and practical so why is that "nanny state"?

Because in a supposedly democratic country, free national health care is supposed to be offered to every citizen regardless of class, ethnicity, religion, or even personal habits. That's why it's called "national" health care. When the state starts deciding that some citizens don't deserve health care even if those citizens are paying the taxes to support the system, then it's not "national" anymore, it's "special class" health care, and can be classified as excessive nanny-state coercion.

IMO, the next logical step after denying health care to people because of their habits is denying them health care because they've passed a certain age, or have developed certain intractable diseases.

Posted by: RebeccaH | Jan 1, 2008 11:50:56 AM

Homework assignment: compare denial of service by insurance providers in the United States to denial of service by the National Health Service in the United Kingdom.

Extra credit: make documentary movie.

Posted by: Moore-On | Jan 1, 2008 11:54:28 AM

Just to clarify my previous comments, I don't support a national system of health care on the UK model. It's been a disaster for that nation, and frankly, for every country where it's been implemented. The US model of health care may seem arbitrary and haphazard to outsiders, but it does provide adequate care to all citizens regardless of whether they can afford to pay or not.

Posted by: RebeccaH | Jan 1, 2008 11:57:20 AM

Once society starts down this slippery slope, how hard is it to imagine a day when the chronically or terminally ill or the mentally challenged are euthanized? Deformed or genetically undesirable babies could be aborted so that society would not have to bear the burden of caring for a potentially "inconvenient" life. It is really frightening to think where this is leading Britain and I totally agree with David's comment about Doctor's shamefully being complicit in this betrayal of their Hypocratic Oath.

Posted by: Gus | Jan 1, 2008 12:00:53 PM

There is something very wrong in the UK.

Posted by: Chaos | Jan 1, 2008 12:00:56 PM

So this is what universal healthcare will devolve to. Initially everyone will have access to "free" healthcare, but private health insurance as we now know it will cease. After several years when the true costs associated with government-provided healthcare become apparent, there will be a caste-system of patients, with those in good health retaining access to healthcare, and those in poor health or with disapproved daily activities no longer allowed to see a doctor.

Such irony. Universal healthcare will become healthcare only for those whom the government approves. And the rest? Too bad, you're out of luck. And people think too many families are are uninsured today.

Posted by: Ken | Jan 1, 2008 12:06:44 PM

Moore-on: If you are denied in the US you can still get your insurance form another provider and deal with the expense, "go into the pool" in some states, pay for your care yourself, or just show up at an emergency room- they're barred from turning you away by law; even if you can't pay they HAVE to provide services.
In England the insurer IS the law. If you're denied, you CAN'T go elsewhere- there is no elsewhere to go. Hospitals DON'T have to save your life- you're a "waste of resources". They don't even have to make a best-effort to save your life if you ARE insured, if some anonymous doctor late for his coffee break doesn't feel that you are worth the cost.

Or you could go to Cuba, and if you aren't considered valuable for propaganda purposes you get the same (horrible, filthy, terrifying) care that 99% of all Cubans get...

Anyone who takes Fat Mike seriously is welcome to have his vasectomy in the hospitals the non-politically-connected Cubans use.

Posted by: DaveP. | Jan 1, 2008 12:10:09 PM

As the economist Thomas Sowell has pointed out, there are no solutions to healthcare financing. There are only alternatives, all of which ration care. Why? Because no society is going to spend unlimited resources on healthcare. Populations have needs and interests other than healthcare, e.g., housing, education, leisure; some resources must be devoted to these other needs and interests.

In the United States, we ration healthcare on the front side, by erecting barriers to entry. In the UK, they ration care on the back side, by limiting treatment options. Under both systems, somebody gets left behind. Pick your poison, but there is no avoiding the choice.

Posted by: Paul | Jan 1, 2008 12:11:48 PM

Another, frightening note: Since the Libarals in this country have already made an issue out of their belief that holding conservative or Republican viewpoints is actually a sign of mental illness...

...how long do you think it will be in England and Canada- how long do you think it will be here- before health care is rationed based on political standing?

It already is in Cuba and most other Socialist nations (Party officials get first-grade care; Party members get second-rate care; nonParty members get little care and thoughtcriminals get a corner to die in).

Posted by: DaveP. | Jan 1, 2008 12:18:40 PM

As soon as we hand over to the government the decision-making on who gets what health care, we hand over the right to LIVE OUR LIFE AS WE CHOOSE. One person may choose to spend no money on health insurance and assume the risk to their health and well-being because they are a non-smoker with no family history of cancer or other disease, they dont' abuse drugs, and they are faithful to their partner. Another may choose to purchase top-notch insurance because they are a smoker with a family history of cancer, they abuse drugs, and are unfaithful. These are choices made by individuals who have every reason to work towards what they believe to be their best interest. There is no mechanism, none whatsoever, in any government health policy that would be equivalent to this type of choice. None required. None wanted.
Go to your local county building permit office. Watch the person behind the desk. This bureaucrat that decides whether you can build a patio deck on the back of your house is the exact same bureaucrat who will decide whether you live or die.
Only the name is different.

Posted by: Diggs | Jan 1, 2008 12:19:09 PM

"kieth Nissen" writes:

"'Nanny State'? why is an insistence on personal responsibility nanny state?"

You're trying to have it both ways, sir. If the British system truly favored personal responsibility, there wouldn't BE a National Health Service. But they have one, and so the average Brit is clearly not expected to accept responsibility for his or her own self.

Like Rebecca H said, a truly NATIONAL health service makes no distinctions as to age, gender, skin color, or personal habits. To do otherwise is to demote politically-incorrect people to the status of second-class citizens.

Choose ONE and ONLY ONE, kieth: socialized medicine, with all it implies for the care (or lack of it) for all citizens; or private contracts, to include insurance, that allow everyone to get care, either paid for out of their own pockets, or with the aid of insurance and even charity.

There is no "third way".

Posted by: Hale Adams | Jan 1, 2008 12:20:19 PM

Indeed. This proposal touches on a whole host of issues. Among them, "When does the 'right to die' morph into the 'duty to die?'"

The NHS'ers simply cannot blow off these questions since they're no longer abstract. As we all know from our 20th Century history, the "slippery slope" has already slipped in Europe not once, but multiple times:


Posted by: MarkJ | Jan 1, 2008 12:23:39 PM

It seems to me that Kieth (sp?) Nissen misses the point entirely, and even Tom Smith pulls his punch on this one. What we are seeing in the UK is the INEVITABLE consequence of entrusting the healthcare of a nation's citizens to its government: the enfeeblement of those citizens and the systematic use of healthcare rationing as a tool for 'scientific management' of the populace.

While it may have seemed rational to the Brits right after the 2nd World War and while it might seem rational to Hillary and others now to have government-run
'universal healthcare', it is actually a recipe for social disaster - - and the scope of the disaster goes well beyond the poor standards of health-care that inevitably ensue.

Governments cannot run any endeavour efficiently. So when they run healthcare, you get a lousy ratio of actual care per dollar. Politicians like to tax but they don't like to be seen to tax. Therefore, even though they throw large sums of money into the maw of the state's health-care 'system' (in the UK, the NHS), they inevitably run out of money to spend. Equally inevitably, they end up rationing the declining amount of health-care across all citizens. This shows up first in lengthy waiting times for surgery, tests, visits to specialists, etc. It doesn't take long for the technocrats to notice that there are numerous cost-benefit trade-offs available to the National Health Care system that involve denying treatment (or denying timely treatment) to patients. Of course, the quality of life for the patient need not be factored into the trade-off. Since the patient cannot make a choice, the patient is left out of the equation. "The system", either through its explicit rules, or through its culture (ultimately through the decisions of its doctors and nurses), will deny effective treatments in order to stay within budget.

You might argue that if this were so, the populace would revolt, through the political system, and elect a party and a government that would dismantle the government-run health-care system and replace it with a privately-run one. Eventually, that may be so. We must keep our fingers crossed for such an outcome in the UK - - but Mr. Cameron and the new, touchy-feely "Conservatives" don't seem to have this policy initiative very high on their agenda. More broadly, as I speak with people in Britain, I find that the privatization of healthcare (and education) just aren't on anyone's radar screen. There seems to be a blindness on this topic. Perhaps it's just an unwillingness to tackle the challenge of clearing out the Augean stables of 50 years of soft socialism.

Where Mr. Nissen has it wrong, is that in a private system a health insurer would say: "Your premium if you are 55, don't smoke and weigh 175 pounds is $400 per month; but if you do smoke and you weigh 200 pounds, then your premium will be $575 (or whatever the actuarial morbidity/mortality tables dictate) per month". In other words, a private insurance scheme will not make a moral judgment about your behaviour - - it will simply price it.

But, as I said, the real problem with governmen-run healthcare isn't simply the bad healthcare outcome. It's the diminishment and dependency of all citizens that it causes: citizens as wards of the state. The phrase 'Nanny State' sounds funny - - a bit of a joke. Such as when Mayor Bloomberg in New York furthers the ban on smoking and banishes 'trans-fats' in NYC restaurants. But the Nanny State, once empowered, will eventually have the incentive to wield overwhelming powers (ultimately, of life and death) over strictly personal behaviours. The Nanny State will smother you in your crib.

In the US, the achievement of the Nanny State is the agenda of the Democrats. Unfortunately, the Republicans are not even close to articulating the correct counter-argument and sustaining opposition to national health care. In recent years, they have even joined in the march with expanded prescription coverage for seniors.

God help us.

Posted by: Peter Carroll | Jan 1, 2008 12:24:40 PM

In a market economy, goods and services are not rationed...pricing serves to balance supply and demand. The only reason there is any health care rationing in the U.S. is precisely because the government blundered into the process. First via WWII wage and price controls that led to employers offering health care as a fringe benefit, and later outright with the Great Society's government-provided health care.

The degree to which government touches an industry is the degree to which that industry is f'ed up. Health care, airlines, schools.

Posted by: PD Quig | Jan 1, 2008 12:33:49 PM

The distinction between a national and private health care system is who gets to decide. In a private system such as in the US, employers decide, balancing cost with competition in the marketplace, i.e. what competing employers provide. In nationalized systems the government decides, with the most powerful constituents getting more say than others. It does concern me that group identity politics may determine level of care. Will we see attempts at affirmative action in medical care? I think so.

Posted by: Dan | Jan 1, 2008 12:37:58 PM

The thing Appologists of Gov't run health systems leave out is this.
If any of these folks, deemed back of the liners, ever worked for a living, they have been paying into the system that is supposed to take care of them.
Now, if your a Smoker and you have insurance and are paying for the smoker's rate, and you get cancer or other problems, your insurance is obligated to cover you to the limits of your policy. The NHS is saying essentially, "We Are Your Insurer. BUT. We are not going to honor(honour for you UK folk) our obligations to the 'Policy' you have been paying into for these however many years. If you live long enough, we may get around to dealing with you." This is a big reason Cancer survival in the UK is so dismally low. If your Insurer were to do this, John Edwards types would line up to make you put money in their wallets by suing the Insurer for you. At least the somewhat better off folks in the UK can go to a private practice. Canukistani folks are not so lucky, unless they travel here. They have only the crap run by the morons in gov't and private practice is illegal. All the UK folks I know use private dentist because if they use the NHS, the tooth will be unsalvageable by the time they get treatment.
"Free" health care is never Free and it doesn't care, nor is it worth the cost even if it truly were Free. In the case of Nationalized care, you NEVER get your money's worth.

Posted by: JP | Jan 1, 2008 1:04:29 PM