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British Example May Sink Single Payer Idea in the US

by Scott MacStravic

As with so many political issues in this country, there tends to be a polarization between those who favor a single-payer “socialized medicine” approach, such as the UK’s National Health Service, and those who favor a “free market solution”. The trouble with such polarization, of course, is that it disguises the fact that the best answer may be some combination of the two, or at least somewhere between the poles.

A recent example of what would probably seem an outrageous policy adopted by the British National Health Service may be deemed a reason to condemn the socialized medicine idea, even though it is not essential to the single-payer idea. A woman who had metastasized breast cancer had been refused coverage by the NHS of a drug (Avastatin) that has been approved for use in Europe, though not yet in the US. She decided to pay the $120,000 costs of the drug herself, while getting the rest of necessary and covered services under the NHS.

But NHS officials decided that belonging to the national program included a “loyalty” obligation, where patients, in any single episode of care for a particular disease, cannot both get government payment and use personal or other non-governmental funds. When she was denied, the patient went to the news media, as did other patients in similar situations. It came out that patients had been routinely supplementing NHS payments with their own funds to pay for some parts of their treatment that NHS would not cover.

A physician who is a member of Doctors for Reform, a group highly critical of NHS, argued that patients switch from public to private sector healthcare all the time, e.g. if on a long waiting list to see an orthopedist, paying an extra fee to be seen immediately, then using the NHS to cover the surgery required. Patients have had to pay out-of-pocket to get a second opinions before choosing treatment for cancer. They may pay thousands out-of-pocket to get a hearing aid rather than wait a year to get one free from NHS.

Patients’ paying for some of the care they need and want is a common part of cancer care, according to another physician, when providers consider some drugs or treatments too expensive. This may require that patients go to another physician to get the drug, destroying continuity, but is essential when the NHS favors less expensive options, as governments tend to do.

There is already a great deal of variation in what patients can expect from NHS depending on where they live in the UK. Wide variations in waiting lists for seeing physicians and getting treatment are common, as are variations in which drugs will be available. Other patients at the same hospital as the breast cancer patients had been augmenting NHS treatments with self-paid options. NHS has argued that any drugs purchased by patients must be administered at a different visit from those paid for by the government, yet the particular drug in this case has to be administered together with one that is covered.

After being denied, the patients’ condition deteriorated to the point where the controversial drug could be paid for by NHS after all, so she is happy about that, but understandably unhappy at the extended wait and the possibility that her chances of cure and survival were diminished thereby. If the delay has reduced her chances, she feels the government should “be raked over the coals for it.” [S. Lyall “Paying Patients Test British Health Care System” New York Times Feb 21, 2008]

It seems unlikely to me that even a government-financed single-payer system in this country would be allowed to deprive individuals of the right to choose to pay for additional or alternative treatments, or accommodations, access, and amenities, for that matter. But those who favor a “market solution” may well use this example (which may well result in the overturning of the announced NHS policy, given the outcry that it produced) as an argument against a polar opposite “straw man, when a more pragmatic rather than political solution should probably be preferred anyway.

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