The most emotive areas of the U.S.-UK debate — and the issues seized on in Republican attacks on the NHS — concern rationing of care and “end of life” provisions. There’s no disputing the fact that care is rationed in Britain — mostly for the chronically-ill elderly, but increasingly too for smokers, the obese, and others whose lifestyles are deemed “unhealthy.” It’s going too far to call the entire NHS “Orwellian,” as some U.S. critics have, but the acronym for the NHS body which decides whether particular treatments are cost-effective — and thus how long certain patients can live — certainly has an Orwellian ring to it: NICE.
As for whether bodies such as NICE constitute “death panels” … well, my dictionary defines a panel as “a small group of people brought together to discuss, investigate, or decide on a particular issue.” If that issue is whether or not to provide certain drugs or treatment to an individual and that person’s life depends on whether or not they get that treatment, then I’m with Sarah: “death panel” isn’t that much of a stretch.
It’s a testament to the ability of leftists to make that which is true sound ridiculous (“Come on! As if the Democratic candidate for president would ever have hung out with a terrorist!”) that the term has been offered up as evidence of right-wing paranoia. But here too, lawmakers appear to be backtracking, with the Senate Finance Committee saying it will drop “end of life” provisions from its proposed bill.
Just because there’s no “panel,” however, doesn’t mean the vulnerable will be protected under a government-run system. More insidious than any group of experts are the statist mindset and the institutional heartlessness that pervade any large publicly funded body. As I discovered over the last few years while dealing with the system on behalf of my dying mother, there’s no need for anyone to “pull the plug on granny” when the system as a whole takes a dim view of providing care for those deemed not to be sufficiently productive members of society.
Mum suffered from dementia and spent the last few years of her life in nursing homes. During her illness she had several stays in the hospital, and every so often some doctor would take my brother and I aside and whisper to us about “quality of life” and “letting her go.” We politely declined the invitation, on that grounds that as long as mum wasn’t in pain, and as long as her face lit up when we arrived to visit her, then by our quaint standards she had “quality of life.”
Mum didn’t require any expensive drugs or other treatment, but the “experts” had decided that she was a burden on the system. What she did need, in addition to basic medication for various ailments, was help to make sure she got enough to eat and drink, and time after time we had to ask doctors and nurses to please, if it wasn’t too much trouble, make sure she didn’t die from dehydration.
It’s important to add that on many occasions doctors and nurses showed great skill in taking care of mum. They also showed great kindness, both to her and to my brother and me. But even with the best of intentions, staff shortages and simple incompetence meant that if we hadn’t visited mum every day, and often twice a day, to make sure she was eating and drinking enough, she would certainly have died two or three years sooner that she did.
So yes, U.S. health care needs to be reformed to reduce costs, and there must be better provision for the poorest. I’m not qualified to say how it should be done, but I do know that Americans should keep the role of the government to an absolute minimum and rely instead on solutions based on the principles of freedom of choice and personal responsibility. There will be an element of rationing under any system — the free market is itself a form of rationing — but difficult decisions should be taken by patients and their families in consultation with health providers who are responsive to the demands of their customers, rather than by government bean-counters.
And the less the government takes from its citizens, the more they’ll have to spend as they see fit. One of the biggest objections to state-run health care is that if you want anything over and above what the state is prepared to provide, then you pay twice: once through your taxes and again for private treatment. For Obama, this means “those who can afford it” paying “a little bit extra.” “Spreading the wealth,” if you will.
The U.S. should not be looking to Britain for ideas about how to run health care in the 21st century. Americans, with their resources and resourcefulness, should be able to do much better.
But that’s a task for another day — right now the priority is to pull the plug on ObamaCare.