Saturday, August 15, 2009

The NHS, life expectancy and America's health care debate.

Bureaucrats who work for the British government’s health care system are unhappy that their system of centrally planned care is being used as an example of what Americans should fear with Obamacare.

One such individual, from the Faculty of Public Health, Alan Maryon-Davis, claimed “The NHS (National Health Service does a damn fine job.” And his proof:

“We spend less on health in terms of GDP than America but if you look at health indices, especially for life expectancy, we have better figures than they do in America.”

What is interesting is how Maryon-Davis was able to include so much misinformation into one sentence. It is almost breathtaking. So let’s unpack his claim one phrase at a time.

“We spend less on health in terms of GDP than America...” This is true. But does it mean anything?

Americans spend more on cars, in terms of GDP, than do Brits. Does this mean Brits have better automobile transportation than Americans? Not at all, they have significantly less. The British government puts a lid on health care in some very simple ways: they deny it. So you can’t get the treatments in the UK that you can get in the United States.

Americans can choose to spend on these treatments, British subjects can not. If we cut the amount of health care we give out, we could cut our costs significantly. Take one example that was in the news recently, because this British woman, agreed to be interviewed by opponents to Obama’s take-over of health care.

Katie Brickell asked for a pap smear when she was 19. The NHS told her she could not have it. When she turned 20, she was told, she could ask again. She asked again, one year later. Now they told her they had changed the rules and she could only have a pap smear when she turned 25. So, once again she delayed the test. When she was 23 they told her she had cervical cancer, the very thing the test is designed to detect. She said: I gave an interview and everything I saw was truthful...” She said: “I would say to anybody in my situation now that if they had the money, they should go private.”

Luckily she was working a company that also provided private insurance. So she was immediately put on drugs that, so far, have saved her life, and appear to have put the cancer in remission. She has to take two different drugs and she acknowledges, that under NHS care “I would have had to get a lot of clearance to get that level of care. On private, that just was not an issue. If I needed a scan, it was immediate. On the NHS, it was often a two or three-week wait.”

The NHS was doing what it was designed to do: cut the costs of health care by rationing health care according to edits set by bureaucrats as their best guess as to what, is a good idea, on average. The rules are set to cut costs. In most cases a 19-year-old doesn’t need a pap smear, Katie wasn’t “most cases.” The system can’t individualize needs the way that private care can.

Thelma Nixon was told that her case of wet macular degeneration would mean she would go blind. She need injections into the eyes to prevent this. Injections, or blindness, there was no other option. The NHS told her she didn’t fit their guidelines because the cost was too great. So they decided she needed to go blind, after all NHS provides health care at a lower cost than the US and that’s a good thing.

Thelma remortgaged her home while the Royal National Institute for the Blind went to bat for her. The press caught on to the story and started campaigning for her. Since British health care is politically controlled this was causing bad publicity for the ruling party and the NHS relented—for Thelma. Those who don’t manage to create a media frenzy around themselves are not so fortunate.

But Thelma’s initial treatments were paid for by herself, from the house mortgage. And when that ran out a local businessman gave her the funds for two more treatments. Other readers of her local paper rallied to her case and provided funding. ONLY after this media frenzy was created did the NHS relent. They sent up new guidelines for assessment and will not disqualify people from care according to the new policies.

Jane Tomlinson knew that the squeeky-wheel gets the grease in the NHS system. But she didn’t want to go that route. She was an avid supporter of the NHS. She worked for the NHS as radiographer. She spent much of her time raising additional funds for the NHS. It is estimated that she raised close to $2.9 million for the NHS.

She was diagnosed with cancer. Her medical team told her that the best option for situation was treatments with Lapatinib. But that costs $11,000 for a year’s worth of care, but that’s just a fraction of the funds she raised for the NHS. Were the bureaucrats thankful? No. They told her she could not have the treatment in her region. Had she lived in other regions of the country, the bureaucrats had decided differently and she would have had the treatment. She died. The NHS Trust said: “We were deeply disappointed not to be able to offer Jane the treatment she and her consultant wanted. We support Jane and Mike’s (her husband) views that we need to debate about access to drugs that have not yet been licensed or nationally approved.” They were disappointed! Tell that to her her small son.

Remember, it is easy to cut the percentage of GDP spent on health care. Just ration it. Cut the amount of care that people are allowed to receive and you will cut the costs.

What matters, is not the percentage of GDP you spend on care, but what you get for it. We could give Americans 1950s costs on health care if we limit the care to 1950s technology. Cut out CAT scans and you can save a lot of money, and lose a lot of lives. Cut out bypass surgeries and you can lower the total amount spent on care. There is no magic in cutting health care costs. It’s easy and it is done in country after country, merely by limiting the supply of care.

We could cut the costs of education in America the same way. Just fire half the teachers and ration education. We could set up schools with waiting rooms where kids line up in the morning and the first 200 in get to go to class and the rest go home. Of course, they can try again tomorrow!

The proponent of government-run health care only whine about the costs of health care. If education is being discussed they attack America for “not spending enough.” When it comes to public transit they whine about “not spending enough.” When it comes to government programs then more. When it comes to private services then more is evil. It isn’t the cost that offends them. In the UK the same proponents of socialized care want government to spend more. Spending more is only considered evil when it is done privately.

Let’s look at the second phrase in the defense of the NHS: “if you look at health indices, especially for life expectancy, we have better figures than they do in America.”

The problem here is that life expectancy is not a measure of health. It is and it isn’t. It is a measure of life expectancy which is determined by countless other factors, of which health care, is just a small factor.

Imagine two towns, with the identical number of people, fitting precisely the same profiles. They get the exact same health care. But in one town the villages like to drive wildly, while the other town is inhabited by people afraid to drive fast then 20 mph. Which town will have a lower life expectancy?

People who smoke have a lower life expectancy than people who don’t, even if they get the identical care. A town with a higher murder rate will have a lower life expectancy than a town with few, or no murders. People who exercise and eat their vegetables will have a higher life expectancy than people who don’t. There are literally hundreds of factors which impact life expectancy which are entirely outside of the health care system.

This is widely known, but that doesn’t stop the proponents of socialized health care from using this statistic. The numbers they use are correct, but the spin they put on them isn't.

What is an objective criteria that can be used? How about survival rates for patients, suffering similar conditions, under various systems. Since the examples I used earlier, of Katie Brickell and Jane Tomlinson, involved cancer let’s explore the survival rate differences between the US and Great Britain.

The British medical journal, Lancet Oncology did just that. When it came to measuring the survival rates of cancer victims guess who came in first place: the United States, where 62.9 per cent of female patients survived. In England the rate was 52.7 per cent. For male cancer patients the news was better Americans but worse for the Brits. Sixty-six per cent of American male patients with cancer survive. In England only 44.7 per cent do.

Survival rates for cancer victims does measure health care, especially health care around the issue of cancer. Yet, the NHS apologists avoid mentioning this statistic and instead trot out life expectancy, which has little to actually do with health care. But then, what choice did Maryon-Davis have in order to make his case?

Photos: Photo #1 is of the queue outside one of the few NHS dentists in Wales taking new patients. To limit costs the NHS strictly limits the number of dentists. The results are long lines of people hoping to be allowed to see a dentist. Some pensioners have suffered so badly from tooth aches, and facing NHS restrictions on care denying them dental care, that they have resorted to pulling their own teeth. But, when they pull their teeth, instead of the NHS doing it, it lowers the percentage of health care as a part of GDP, and that's a good thing according to NHS proponents. Photo #2, Jane Tomilson and the family she left behind.

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