Wednesday, August 12, 2009

American health debate

In an editorial in the newspaper, Investor's Business Daily, it was claimed: ' People such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.' An astonishingly ignorant thing to say since Stephen Hawking lives in the UK and survives!

Professor Hawking - who is British, and who as recently as April was treated in an NHS hospital, Addenbrooke's hospital in Cambridge - quickly rubbished the claim. 'I wouldn’t be here today if it were not for the NHS,' he told the Guardian. I have received a large amount of high-quality treatment without which I would not have survived.'

Last week Chuck Grassley, the most senior Republican on the Senate finance Committee, claimed Ted Kennedy would be left to die untreated from a brain tumour in the UK because he would supposedly be too old for treatment. However he admitted he had no evidence to back up his wild claim.

'I don't know for sure,' said Grassley. 'But I've heard several senators say that Ted Kennedy with a brain tumour, being 77 years old as opposed to being 37 years old, if he were in England, would not be treated for his disease, because end of life – when you get to be 77, your life is considered less valuable under those systems.'

Andrew Dillon, chief executive of the National Institute for Health and Clinical Excellence (NICE), told the Guardian it was utterly false that Kennedy would be left untreated in Britain: 'It is neither true nor is it anything you could extrapolate from anything we've ever recommended to the NHS.'

I respect the fact that Americans must chose their own way of paying for health care, but I wish they would do so without publishing falsehoods about the NHS. Having now received 6 months treatment from the NHS I have very little criticism of it. I may be in a more privileged position than most people using it, but my observation of fellow patients does not suggest that my treatment is exceptional. I am receiving exactly the same treatment for my cancer that I would get in the US, and should it be unsuccessful, there are second-line options available even though they are not yet NICE-approved for first line. (NICE does not hold the stranglehold over practice that its critics suggest). There are dangers in jumping in with unproven treatment options. A good example would be Bevacizumab which on the basis of early results seemed to offer improved survival in colon cancer. It was adopted in many countries including Holland, yet more recent results presented at the American Society for Oncology this year demonstrated no therapeutic benefit, just extra toxicity. I am glad I have not been given it.

My treatment has been free at the point of consumption, though I have paid enough in taxes over the years. The ward where I receive the chemo is light and airy with a fine view over the lake. The nurses are cheerful and caring. I have the Oncologist's mobile phone number. I never have to wait. I was offered a second opinion with the leading specialist in the UK for this disorder, or with whomever I would rather see, at no extra cost. I was offered a choice of hospitals to receive my treatment, though naturally I chose the one that is 5 minutes drive away since it is equipped with the latest CT and MRI scanners for which there is no waiting list. In my diagnostic work up there was no delay and I was examined with state of the art radio-scanning equipment.

When I was an in-patient having surgery there were some minor quibbles about silly rules that Health and Safety regulations had forced upon us, though it wasn't so much the rules as the over-zealous interpretation of them by junior members of staff, that was the problem.

Because there is no billing, no third-party payer, no checking on financial status, no local negotiation, no restrictions on which provider goes with what payer and for many other reasons, the cost of bureaucracy in the NHS is much less than in insurance-based systems. Government interference is always a bind, but the essence of the NHS has always been its local nature. Local people make local decisions. I spent a lot of my time in the 1980s and 1990s making those decisions for the benefit of local people. I am now benefiting from the decisions I made then.

The Labor government dislikes the unevenness of the NHS. Some areas are better or worse than others. One correspondent has suggested that Glasgow is as bad as Moscow - but that is because the people there live of whisky, cigarettes and deep-fried Mars bars. The NHS has no responsibility for that.

The idea that we would be better off being treated by vets is laughable. Anything difficult is treated by lethal injection, unless there is money in keeping the beast alive.

Normally, I would go along with Caveat Emptor, but in health care there is so much misinformation that the buyer is not qualified to know what is best for him. Even those with a medical education make wrong choices. As a result there is a huge malpractice industry in the US. My best prescription would be for everyone to have a family doctor who is concerned with the welfare of that particular patient. The NHS provides one for free to everyone. They are not always the shiniest knives in the box, but they are usually more honest than the TV ad or the specialist who sells his wares on a fee for item of service basis.

But my main point was how much the cost of the American system was to the taxpayer, When you consider the cost of Medicare, Medicaid, provision for children, the VA, NIH, CDC, health insurance for government employees, tax breaks for employers, the cost of the FDA, research grants to universities, etc the cost is more than the UK government spends for the whole of the NHS.


Burke said...


I still remember your first post here after you retired, the one in which you told us about several abuses there and then stated that you were happy not to be working for the NHS any more.

Has being a patient changed your view?

As for my opinion, every alternative to free enterprise is just some exploiting others with force.

Chonette said...

During the last 18 months I have been a regular user of the NHS and I have nothing but excellent service from all the members working there, being asistant nurses, specialist nurses or top consultants.
Having been very ill and hospitalised for 4 week last Summer and this year having been through a Reduced Intensity Stem Cell transplant, I can say with confidence that I am still alive thanks to the care of the medical profesion working on the NHS, and it has not costed me anything.
Although I am young at heart, my body is no longer young and was told people at my age do not tolarate such treatment well, yet I had great support from the consultants to go ahead and they gave me a lot of supportive care and I never had to worry about who was going to pay for all that.

David Arenson said...

Welcome to the ignorant fearmongering that is issuing from the blowholes of the right wing to scare ordinary Americans. From hearing them talk, you'd think the streets of Britain and Canada were littered with dying people unable to get "socialized" medical care. (Oh, how much better off we Americans are with insurance company bureaucrats denying us care while charging us through the nose!) There may be no such thing as a perfect health care system. The NHS is not perfect. But the American system, as currently constituted, isn't perfect, either.

Anonymous said...

One of the worst situations concerning U.S. health care is the huge amount of money spent on lawsuits against health care providers. Many doctors must pay very high insurance premiums to protect against these lawsuits and some doctors are quitting because of it. Our president and congress are doing nothing to address this problem. No wonder we have a shortage of doctors, and I know because finding a doctor for an elderly person is very difficult!

Anonymous said...

"Final Appraisal Determination endorsing treatment with MabThera - but only alongside chemotherapy with fludarabine and cyclophosphamide - in patients with chronic lymphocytic leukaemia, after concluding that the regimen offers value for money for the NHS". This is a quote from as posted on cll forum...Value for money will be the criteria...and the government will decide...could malcom on the accor list use single agent rituxin?? long has the U.S. been using FCR and just now it is approved in England?...Value for money...the government that gave us the post office, Amtrak, Korea,Vietnam, Iraq and now attaking Pakistan...using England as an example of what the United States might be...with both nations spending money that future generations will have to pay back...guess I do not see the hugs and kisses of good governance...ignorant me thinking limited government means something...I distrust business and distrust the ruling class even more...what will be will be...Was it God who said that...or
Doris Day...romanbob

Terry Hamblin said...

Touche. A change of perspective works wonders. Free enterprise unchecked gives us Al Capone. 15% of the largest GDP in the world producing te 37th best health service. Something must be wrong.

You're right. The NHS is not perfect. But it does have a lot of satisfied customers. What it can't do is change society. Unless cigarettes and alcohol are outlawed, drug enforcement becomes oppressive, exercise becomes compulsory and the Sabbath is reintroduced, people will abuse their bodies. The post-code lottery that people talk about, which means that we get better care in Bournemouth than they do in Liverpool, is not a consequence of how much money is poured into the health service, nor of whether we have better doctors down here or a better NHS management; it is down to how people live. Pregnancies at 13, broken homes, kids with guns and knives, binge drinking, cirrhosis at 22, deaths from cervical cancer at 28, fatal road accidents among teenagers too young to have a driving license, melanoma from sun-beds; there's nothing the NHS can do about that, nor will Obama be able to change society by tinkeing with health care.

There are things that I would change about the NHS. I would like to see an 'excess' as there is with household insurance or car insurance. This means that the patient agrees to pay the first £100 and only then claims for expensive health care. Something similar operates in France where you pay a small sum to see the doctor. The poor can claim it back. I also think that NICE has got the wrong economic model; mainly becauise it is peopled by statisticians and economists and not by front-line staff. Mind you the blame for the late approval of FCR for CLL patients is down to the drug companies who refused to do the necessary trials, knowing that they could bounce the American market by confusing CLL with NHL. And we could do the same in thr UK with a little dishonesty. It was only when the FDA spotted what they were doing that Big Pharma adopted the German CLL8 trial as there own. It was originally funded by the German government.

Anonymous said...

Was your tumour PET positive at presentation?
If so, wouldnt CT-PET scanning now provide reassurance . . or not?

Terry Hamblin said...

PET negative.

Burke said...

"Free enterprise unchecked gives us Al Capone."

Now, Doc.

How does having a completely free society, one in which force is outlawed as a way of men dealing with one another, lead to the opposite: crime?

And what possible reason is there for believing that people who should not be free would somehow elect governments that would compensate for their personal shortcomings?

As someone once wrote, the crimes committed by private citizens are minuscule when compare to the crimes committed by governments.

Terry Hamblin said...

In a completely free society force is not outlawed. Outlawing force involves accepting regulation. If you are regulated you are not free. If we want a civilized society we have to accept limits to our freedom. Surely all men of goodwill accept that?

Burke said...


People deal by trade or by force.

How does having a govt that acts only as a retaliatory force to outlaw the use of force as a way of dealing with one another restrict one's freedom?

Seems to me that it's doing just the opposite, as force is the only thing that, in a political context, can restrict one's freedom.

"Regulation," as the term is commonly used today, is government force directed at individuals who are using none against others. As such, it's not the same as ordinary criminal laws which are retaliatory in nature.

If I wanted to pay you to come over here and treat me and if you wanted to do so, what business would my government have disallowing it?

(And no, I don't think my political leaders know more or care more about what is good for me than I do.)

Terry Hamblin said...

All laws carry the implicit use of force. Do this or we'll arrest you and lock you up. Regulations are a form of pre-emptive retaliation. Doctors have to be licensed for fear of unqualified people harming patients. I have no doubt I could make a lot of money by offering myself as a therapist for CLL in America. But if I neglected to get a license to practice in a particular state, I would be prosecuted. Just how intrusive regulations are on interactions between two people is for individual states to decide, but all states restrict this freedom to some degree. If I set up as a radio-iritic practitioner and made a diagnoses by twiddling a knob on a black box I might find myself unregulated, but some states might feel that they have a duty of care to the vulnerable to stop me doing so. Even then I might be able to set up in the wilds of Montana and find that no-one would bother me. Modern civilization is so complex and liable to unintended consequences that it is hard to devise regulation that is both non-intrusive yet effective.

john said...


we hear a lot from republicans that reducing medical malpractice awards will solve everything I don't really believve this in fact I think it could icrease medical errors. What is the state of this in your system compared with the U.S. and how do we compare on medical errors?

John Liston

Burke said...

Doc, you write,

"Modern civilization is so complex and liable to unintended consequences that it is hard to devise regulation that is both non-intrusive yet effective."

I would say that it is not only difficult, but impossible and immoral. One can "regulate" a dangerous activity like, say, bomb making. But such activities expose others to harm that is unavoidable and irreparable. As such, it is really force itself and, therefore, retaliatory rather than preemptive.

Except in emergency situations, one is not faced with that in choosing a doctor. He can pick and choose.

The banking industry here may be the most heavily regulated of all fields, and you see what has happened. Govt practically runs the banking system, and it is largely responsible for the current economic crisis.

Socialism is the complete regulation of individuals, and it has failed. Countries like China and the former Soviet Union have been moving toward market economies because that is the only way people can live and prosper.

There are people who think, work and produce. And there are those who exploit them. Regulation today is almost completely rule of the latter.

The whole health care "debate" is just a fight over who is going to be forced to provide health care for whom and how.

Terry Hamblin said...


Medical malpractice is not really a big issue here except in a few areas. Plastic surgeons working in the 'beauty' area are likely to get sued - largely because many of them are trying to fool the public by encouraging unrealistic expectations, and obstetricians get sued because people expect perfect babies and nature won't always allow that. Cerebral palsy tends to be blamed on the doctor when it wasn't his fault.

My malpractice insurance was around $200 a year and I never got sued. Malpractice is undoubtedly an industry in the US and to some extent that is because patients are seen as customers rather than recipients of a service. There are over a million lawyers in teh US and they have to make a living somehow.

Burke, every society has some regulation that is not simply retaliatory. Each society has to judge how much - that's what politics is about. If the ruling party has too much, vote them out of office.

Anonymous said...

Dr.Hamblin...I read all your posts and respect your thought process and humanity...The bible talks about helping the poor and even sharing your coat if a man has none...I believe that is a good...would be interested in your thoughts on whether you think the act of helping others should mean that either government or individuals should be able to take from someone else and do charity...I understand the necessity of orderly society and taxes but am more interested in your thoughts from a Christian is my personal belief that capitalism fails when morality is created by man and government and not God...what will be will be...romanbob

Burke said...

One last bit on this subject, Doc:

Do you think Jesus would have approved of socialism, of a system that forces some to provide for others?

Or would he have said that charity is strictly voluntary?

Terry Hamblin said...

Should government be involved in charity?

In Israel charity was not voluntary. Various offerings to sustain the priesthood were conpulsory and it was incumbent on all Israelites to support the widow and orphan and to show hospitality. We don't live in a theocracy and even Christains seldom tithe these days, although Christians have been shown to be more generous givers to charity than secularists.

On the other hand, many well known Christians have been reformers who have pushed governments into enacting laws that effectively tax the rich to give to the poor. I'm thinking of Shaftesbury, Wilberforce, Fry, etc.

However, it is difficult to make rules for today's circumstances based on Scripture. Would we be happy with a Jubilee year, when all debts were forgiven? Who would lend money in year 49?

Taxes were originally levied to wage war, but there was a growing movement in Societies (including the US) that government should tax to provide benefits. The German model was teh one that was most comprehensive and this might have been taken up by the US had not the First World War happened.

What would Jesus have done? He said Render unto Caesar the things that are Caesar's and unto God the things that are God's. And he found a fish to help him pay his taxes. In other words I think he would have had other priorities.