In the midst of a pandemic, here’s a friendly reminder that in the world of socialized medicine, a quality year of your life is too expensive once it costs more than $37,000.
That number comes to us from the National Health Service, the state-run health provider in the United Kingdom. The agency is now under fire for rules which critics say would discriminate against the poor and the aged amid the coronavirus pandemic.
“Denying lifesaving care to conserve public resources is nothing new for Britain’s National Health Service,” The Times reported.
“In expensive treatments for cancer and other diseases, the health service officially limits what it will spend to postpone a death: 30,000 pounds, or about $37,000, for each year of full ‘quality’ life provided to a patient.
“In the case of a pandemic, the public guidance from health officials for more than a decade has been that doctors should prepare to withhold scarce resources from the weakest patients in order to save more of the strong, especially with the use of life-sustaining ventilators,” the article continued.
“Yet now that a pandemic has finally arrived, the health authorities this week balked at spelling out exactly how to make those agonizing choices, evidently for fear of a public uproar.”
This apparently reeks of heartlessness to The Times, which is surprising because, well, this is what you get in a system where rationed health care is built into the equation.
But at least it protects the most vulnerable among us — you know, unlike free market health care. Right?
Well, not entirely. The Times reported that Prime Minister Boris Johnson’s government “has elected to avoid the political pain of disclosing its already-drafted criteria for deciding which patients should be allowed to die of the disease — even those with some chance of survival.
“The absence of official guidance could effectively force front-line doctors to improvise their own criteria, lawyers and ethicists say, potentially consigning poor, aging or disabled patients to the back of the line,” The Times said.
The outlet goes on to note how the state-run health care system in Italy is so overwhelmed they’re withholding life support to some patients — a policy that American states and other European countries are reportedly “scrambling” to put in place “in case their hospitals become overwhelmed.”
However, the British were supposed to have expertise in this sort of thing, particularly when considering how familiar they are with rationing.
“In the U.K., these are decisions by public bodies for which they are publicly accountable,” David Lock, a lawyer providing advice to the British Medical Association regarding legal and ethical issues, told The Times.
“Therefore, there is an urgent need for a clear framework for doctors to make these decisions on behalf of the public bodies that employ them.”
And therein lies the problem with the humane hand of the central planner.
Advocates for the aged argue that otherwise hearty older people might be shunted to the back of the line for resources by doctors who use age as a stand-in for health.
Advocates for the poor say the impoverished have more pre-existing health conditions like diabetes and heart disease, which means doctors might pass them over in favor of individuals with no pre-existing conditions.
The problem is that this is a feature, not a bug, of the NHS.
There are other problems with the United Kingdom’s pandemic readiness. The country has fewer than 10,000 ventilators available at the moment and one of the most broken testing regimes in the developed world.
Things don’t get much different when we aren’t in pandemic times, especially when you consider the fact that you only get £30,000 for a year of quality life. And even then, it’s (yet again) bureaucrats who determine what a”quality” life is.
According to a 2015 U.K. Independent piece, the country’s National Institute for Health and Care Excellence (or NICE, because if you drop just one letter from it the acronym seems positively Orwellian) is an agency which decides which drugs and procedures to allow and which ones to restrict due to cost.
“The drugs that Nice considers have already been licensed by the European Medicines Agency for use as safe and effective treatments,” the Independent reported. “That they work is not in doubt — the issue for Nice is: do they deliver value for money? Nice’s job is to answer the question: is the benefit they bring worth the cost, or could the money be better spent buying, for example, extra nursing care?
“To do that, it relies on what are acknowledged to be bafflingly complicated calculations based on economic models around which dispute swirls. The bottom line for Nice is that a treatment must deliver an improvement in quality and/or length of life at a reasonable price. That price is set at £20,000-£30,000 per Quality Adjusted Life Year (Qaly) — a measure of the improvement in either the quality or quantity of life that treatments can bring.”
There are innovative treatments that can go above this ceiling, but this is generally considered to be what the system is willing to countenance.
Meanwhile, absent pandemics like the current crisis, in a fully free market health care system, total premiums should always surpass total coverage costs. That way, you don’t have rationing.
Instead, in systems like the United Kingdom’s, you have a situation where the costs will always have to be tamped down and the care will always have to be rationed.
If you think it’s more egalitarian, think again.
If you can afford it, there’s also private health care in the United Kingdom — so even with a government-run system, there’s still health care mobility for the wealthy.
In the meanwhile, consider that most of the United Kingdom’s population is in the hands of a government that doesn’t think they’re worth more than $37,000 a year.
Don’t get me wrong: The people of the NHS — the doctors, nurses and other health care professionals — are doing fantastic work in one of the hardest-hit countries in all of Europe, particularly given their limited resources.
While they may be irreproachable, the system they work in is fantastically broken.
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