Thursday, October 10, 2013

Are We Headed This Way? On Eve of ObamaCare, Britain's NHS Needs Political Therapy

This is from Philip Klein writing at the Washington Examiner highlighting how insignificant the individual is in the NHS's decision making.  Bureaucracy at its worst: 

... The drawback of such an approach is that because the system prides itself on creating equity by putting the needs of society as whole ahead of any given patient, it means that the needs of individuals often get lost in a sea of managers, administrative targets and rationing decisions.

“The individual is essentially a supplicant,” said Philip Booth, program director at the Institute of Economic Affairs, a free market think tank in London. “He's irrelevant to the whole system as far as the National Health Service is concerned.”

Individuals cannot get tests within the NHS if its doctors don’t approve them. The National Institute for Health and Care Excellence (whose acronym NICE is a source of irony to critics), a board of experts that recommends treatments based on cost-benefit analyses, can deny cancer patients drugs if it concludes that a short extension of life isn’t worth the expense. In a further bit of irony, NICE was created in the 1990s to foster equality within the system because certain drugs were more available in some regions of the country than others.

The NHS is rife with examples of centralized policies producing real-world results that range from tragic to absurd.

For instance, the former Labor government responded to complaints about waiting times at hospital emergency rooms by instituting a target for NHS hospitals to treat patients within four hours. Under pressure to meet these targets, the Daily Mail reported in 2008, hospital administrators let seriously ill people wait in ambulances for hours outside the hospital so that they weren’t technically counted as patients. As a result, the ambulances weren’t available to answer emergency calls.

One of the more recent scandals has its roots in the 1990s, when the NHS established a set of best practices for providing care to patients at the end of their lives. Known as the Liverpool Care Pathway, it has since been applied to hundreds of thousands of people. Last November, the Mail reported, an independent review found that 60,000 people were put on the pathway without their consent and a third of the time families weren't even informed. Thus, they had no idea that their close relatives were removed from life support equipment and were being denied nourishment. In extreme cases, nurses shouted at relatives who attempted to give their dying loved ones sips of water. According to the Mail, hospitals were given incentive payments for putting more people on the pathway - effectively, the government was providing bonuses for ending people's lives earlier. ...