Should your access to medical care depend on your political or religious viewpoints, or even your criminal record?
The UK healthcare system is used as an example by members of both sides of the government-payor medicine debate in the US. These discussions prove that - like the meaning of the universe and when life begins - the definitions of justice and rationing are in the eye of the beholder(s). Some of us look at the history in the UK and the US and worry about the potential for abuse when medical access is regulated with government funds, prisons, and guns.
Kathryn Jean Lopez of the National Review Online reports (free registration required) that a 74 year-old man was sentenced to a prison term for sending pictures of the results of abortion in the mail to employees at a hospital that performs abortions.
On top of the 28 days prison time, the man in question was informed that he would be denied all but emergency, life-saving care at the (government, tax funded) hospital in question. Despite that under the National Health Service trust this hospital is his only choice, his scheduled eye exam appointment was cancelled and he has been dropped from the (government, tax funded) waiting list for evaluation (the waiting list before the waiting list) for hip replacement surgery.
I can't think of any intimate, personal matters that are managed well by committee, much less by the process of government and law making. Medical care is very intimate and personal, and my experience with the Social Security and Medicaid disability process, TriCare, Workman's Compensation, Medicaid and Medicare do not lead me to believe that the Federal government is qualified to hire me as a family doctor or to manage hospitals or other health care "providers."
(I've covered this subject before here Or, see this newspaper report about "fraud" rallies held by Secretary of Health Shalala, Attorney General Reno and FBI Director Freeh in 2000.)
Because of changes to the Social Security Act and various "Omnibus" budget bills over the last 20 years (including the newspeak-named "Health Insurance Portability and Privacy Act), the Federal government and anyone who can claim to be functioning in the name of the (Federal) Secretary of Health has a right to copy anything in your doctor's office, to open every door and drawer, and even to write their own subpoenas. Any physician or "provider" who refuses or interferes with such an action risks "exclusion" (losing the ability to bill any government medical insurance and possibly all insurances that receive payment from those government insurances.)
What may be worse, the risk of Medicare audit hangs over the head of all those who see patients who qualify for Medicare funding. The person or entity audited pays for the audit, and there have been rumors that "deals" are offered: pay $10,000 or so, and the audit will go away. In light of the fact that compliance with rules is probably impossible, can cost even small practices hundreds of thousands of dollars and carry the risk of charges of Medicare fraud and abuse with its threat of triple fines and prison time, that $10,000 can begin to look like a bargain.
In the US, we have difficulty refusing anyone virtually any medical care - far too often on the tax payers' bill. I do wish that there could be more personal responsibility and an expectation that some payment, in some form will be paid.
However, in Mr. Atkinson's case, he has paid in the form of taxes through the years. His healthcare should not be restricted, however he has offended in the past.
For more information, see the website of the Association of American Physicians and Surgeons. You can start with this article or this review from the American College of Physicians, which represents Internal Medicine docs)
Tuesday, July 11, 2006
Argument against government health care
Posted by LifeEthics.org at 9:09 AM
Labels: bioethics, government medicine, medical economics, medical finance
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2 comments:
Im in the UK. And I have some inside information on the NHS - I am a close relation of a nurse.
I get the impression that, for the most part, it isn't working terribly badly. Im not saying its perfect, of course - the wards are overloaded, and the waiting lists excessive. But this isn't due to any flaw in the concept, but a few bad decisions and poor managers over the last decade. In particular, an emphesis on targets and tables that has lead to patients being shuffled around like counters.
The service is non-discriminatory - though the more well-off often choose to go private for the speed and convenience. This particular incident I do recall hearing about when it was recent. If I remember correctly, he was suspended from treatment at one hospital out of fear of confrontation with the staff and the potential disruption. That is, noone wanted to trust him in the hospital in case he went on a leaflet-dropping spree and so upset the other patients. It wasn't his conviction itsself that lead to the baring.
It was an isolated incident though - I am not aware of any other incidents where people have been bared from hospital, other than after incidents of violence when they are judged to present a threat to the safety of staff - and that is very rarely. I doubt you would see many private hospitals taking patients they knew to be dangerous, unless they were on contract to a prison and so had suitably armed guards.
Other than that, it works. Not fantasticly, but fairly well. Patients recieve treatment. Its usually good treatment - though it may be a long time coming - and they can recieve this even if they have very little money.
I think Americans have a problem with systems like this. A leftover from the cultural cold war - an instinctive, reflexive urge to flee from anything that carries a hint of socialism, even if fleeing means traveling to the opposite extreme of unregulated, survival-of-the-richest capitalism where one's success is measured in dollars.
Siricou,
So this old man, who's paid into the system under the threat of more prison time for most of his life, can go blind or lame so no one will have to be exposed to pamplets?
I've got friends with family in the UK, and have done long distance, even telephone consults (or second opinion reassurance and interpretations) for them. I've taken care of travelers from Canada, France, Britain, and many other countries when they visit. I see the same problems that I have with unfunded or poorly-funded patients in virtually all of the NHS/government healthcare systems: long, long waits and take-what-you-can-get.
With our waste and all-or-nothing assistance, the US is still the model for the rest of the world.
As I said, I don't believe that any personal or intimate need can be taken care of by a committee, much less government.
I'll admit that Americans do have a slightly hypertrophied sense of individualism.
In addition, our secret vice - despite all the victims on TV - is a combination of a sense of personal responsibility combined with the desire to be everyone else's rescuer.
In the case of past national growth and present strength and the ability to rescue our own and other nations, these traits are healthy.
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