The wages of “universal health care”:
One year ago Katie Hilliard was a typical 20-something – working in the City, going out with friends from university and generally just having fun.
But the 24-year-old now has cervical cancer and despite a hysterectomy, chemotherapy and radiotherapy, the disease has spread to her lymph nodes and lungs. Doctors have given Katie at best two years; at worst 11 months.
… What makes her story even more tragic is that cervical cancer, if detected early, is a preventable disease.
In fact, Katie had actually requested a smear test – used to detect the pre-cancerous cell changes linked to the disease – twice in the four years before her diagnosis.
Yet each time she was refused, because she was ‘too young’.
In spite of the fact that HPV is well known, as are the results of it, as is the group which is vulnerable to it – young women like Claire and Katie – the NHS arbitrarily upped the guidelines to save money.
Quite what impact the decision to postpone the screening age to 25 has on cervical cancer rates won’t be known until the figures become available around 2010.
But Professor Shepherd is clear: ‘I appreciate that there is a health economics issue here – it will cost money to screen younger women – but I still think it should be a priority.
‘Cervical cancer is a preventable disease and catching it early will save lives.’
The impact to postpone screening is clear now in the lives of these two young women and countless more. But bureaucracy being what it is, they will probably continue to wait until 2010 to see what the head count of the dead is, and then decide whether or not it’s cheaper to pay for the tests or the cancer care. (At least they can’t be deported…)
When you support government-managed healthcare, you are supporting the right of the government to make decisions about what treatment you will have.
The government has no right in the UK to decide what treatment you will have, unless that treatment is in and of itself illegal (something like medical marijuana in much of the US). What it can do is decide what it will pay for, and that’s what it did here. It may well have made the wrong decision – it certainly appears so in these two cases, but no medical system in the world routinely tests for everything anybody could contract, so there is an implicit cost/benefit analysis in all systems. But both of these ladies could have chosen to have a smear done privately, and still have spent less on their health care in a year than an insured US citizen.
The reason US health care is better than the NHS (and it isn’t all the time, but at its best it is) is because so much more is spent on it. And the reason that happens, among others, is because the US has a bigger economy able to generate more of a surplus to pay for great health care.
But HPV is an STD– does this mean that, in some tiny way, the Vast, Free Health Care (you get what you pay for) is noticing that following traditional norms means lower costs?
Fat chance on them slighting OTHER STDs….but hey.
I’m sorry for the poor girl, and she’s in my prayers.
Only 8% of people in the UK have private insurance because they expect the NHS will take adequate care of them. There’s an implicit trust issue here – the NHS says I don’t need the pap smear; they’re the medical professionals so they must be right. They weren’t told, you do need this, but we’re not paying. They were told they didn’t need it yet. And it certainly wasn’t two cases; click through to read the article. The NHS didn’t just refuse pap smears for the three young women in the article – it refused to perform them for tens of thousands of young women. While it’s impossible to pay for every test out there – nor should they – this test is routine in other countries at 18, and *was* routine in Britain at 18 until they decided to cut costs by upping the age; it was a fiscal, not medical, decision.
As for still spending less on their health care than an insured US citizen – you mean “out of pocket” expenses, don’t you? Because even though British subjects don’t pay upfront for their health care, they still pay big.
I agree that there is a trust issue here, and if I could implement a single improvement to the NHS it would be to have patients stand up for their own interests rather than just going along with whatever the doctor says. But it’s refusing to give the test to tens of thousands of women each year who aren’t going on to get cancer, so they’ve made a decision that the cost of that many tests (millions of pounds) against the potential to save a small number of lives isn’t cost effective. I don’t like that sort of calculus at all, but until we invent a way to provide a health care system with limitless money they are inevitable.
On expenses – no, I meant total cost. My bill for (very good) HMO care for my family in the US was around $6,000 per year, of which I paid around 15% and my employer paid the rest. I then paid an additional $2,200 in FICA, though that varies with salary. In the UK payment is based on income, so I don’t do great – I earn almost twice the national average wage, which means that my employer and I between us pay around £7,500 per year. But that covers the NHS, unemployment benefit, disability insurance, widows/orphans death benefit, and state pension. For an average earner it would be around £4,000, again covering all those different areas.
Comparing the two directly is difficult, of course, because of the variability of exchange rates. But even today the average Brit pays less, has lower out of pocket expenses, and knows that primary care is available to everyone in the country.
I should add that I’m not a big fan of the modern NHS, and could spend an hour or two listing all the things that are wrong with it. But many of these problems are rooted not in the flaws of centralized management, but in the size of the UK economy.
FICA is social security and Medicare; government retirement taxes that we unfortunately don’t have a convenient way to get out of paying – not health insurance.
Do you know what percentage of your overall taxes is NHS? (A quick google search didn’t turn up anything useful.) I would very much like to see an apples to apples comparison, but haven’t found one anywhere.
As to the trust issue – the women in the article did stand up for their own interest and repeatedly ask for the test – and were denied with the “don’t need it yet.” If the NHS is going to cut things based on fiscal conditions – which is fair enough; private insurance companies do it all the time – they owe it to the public to tell them, yes, you need this but we’re not paying for it.
The heart of my complaint is that socialized medicine is necessarily rationed – and in practice, it’s rationed in exactly this kind of sneaky way – “you don’t need this” instead of “we won’t pay for it.”
You’re right, it’s very difficult to find the figures. One of the issues is what counts as medical care – we can both agree that a pap smear would count, but should cosmetic treatments, or alternative medicines, or even preventive care like spending on vitamins?
To give you some idea, the total cost of the NHS is around £1,750 per person, and we should round that number up to £1,800 to allow for out of pocket and other expenses (just a guess, but given that children and pensioners don’t pay anything, and most of the people in between are healthy, it seems reasonable). That’s around 7.8% of GDP, and adding in private health care spending ups it to 9.2%). Wikipedia gives a figure of around $7,000 for health care in the US, which is around £3,500, or 16% of GDP. As I mentioned before, that figure probably includes a lot of health spending that isn’t strictly ‘medical’, but even allowing for that Americans still spend a lot more per person, and a lot more of a larger GDP.
And you know what? They get better health care for it. Or at least most of them do; 40 million people at any time have no health insurance. Many of those are happily self-insured either through personal wealth or taking a reasonable bet on their youthful good health. But there are many more who don’t get any routine care, and have to rely on emergency rooms if they get any help at all. So if you can afford it, and many can, the US is undoubtedly brilliant. In contrast the NHS is OK, but it’s OK for everyone – in my lifetime nobody here has gone bankrupt because they got sick, and most Brits would find it immoral that such a thing could happen in a modern economy.
Time for a conclusion! Yes socialized medicine is rationed, as is private market medicine; until you have infinite resources it has to be rationed. But many of the NHS’s woes are because they have less to ration, not because of the rationing itself.
More on trust. I agree that the NHS should have said “Chances are this test will come back negative, because you’re so young you’re at almost no risk. That means we’re not going to pay for it, because we have greater threats to spend the money on. But as your doctor I think you should have the test, even if it costs you £100 and still comes back negative, because there is some small risk and you’re clearly worried.” That they didn’t is either a clear-cut failure of socialized medicine, or the measured approach of a doctor who can think of a dozen tests you could have today that could find something wrong with you, but almost certainly won’t. I have no idea which is the case, but respectfully I’d suggest that neither do you.