05 Mar 2009

Looking Forward to Obamacare?

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A lot of Americans were delighted to hear that, once Barack Obama was elected, absolutely everyone would be getting exactly the same kind of health care enjoyed by US senators. If you believed that, you need to talk to me about this bridge I have for sale.

Today’s Daily Mail has a story illustrating how government-provided health services really work: by rationing.

Thousands of patients with terminal cancer were dealt a blow last night after a decision was made to deny them life prolonging drugs.

The Government’s rationing body said two drugs for advanced breast cancer and a rare form of stomach cancer were too expensive for the NHS.

The National Institute for Health and Clinical Excellence is expected to confirm guidance in the next few weeks that will effectively ban their use.

The move comes despite a pledge by Nice to be more flexible in giving life-extending drugs to terminally-ill cancer patients after a public outcry last year over ‘death sentence’ decisions. Leading campaigners last night said Nice had failed the ‘acid test’ of whether it really intended to give new priority to people with just a few months to live.

One drug, Lapatinib, can halve the speed of growth of breast cancer in one in five women with an aggressive form of the disease.

Dr Gillian Leng, Nice deputy chief executive, said ‘The committee concluded that Lapatinib is not a cost-effective use of NHS resources when compared with current treatment.’

Up to 1,500 stomach cancer patients also face a ban on Sutent – the only drug that can extend their lives.

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One Feedback on "Looking Forward to Obamacare?"

sallie parker

Actually the NHS works very well for routine care. You register with the local clinic, get assigned a physician, and all is well. No five or ten thousand dollars a year of premiums just to get in the door and have the privilege of having your routine checkups partially covered.

Where the British (and Canadian, and other) health-care systems fall down is in providing anything beyond routine care. This is why they are always lauded for their primary-care facilities, and why you always hear of people queueing up for two years to get a knee replacement. Just as in America, if you want good specialized care, you have to pay for it through a private practitioner.

Twenty or so years ago America had an efficient and health-insurance system. Even if you didn’t have employeec coverage, you could buy full Major Medical for somewhere between $1200 and $1500 per year (usually covering 80% to $5000, 100% beyond, maybe $500 deductible). Whether you had employee coverage or not, the system was simple: you went to the doctor, you wrote a check and had the office fill out a claim form, you sent in your claim form, and you got some money back.

The system began to fall apart when conventional health insurance (or “PPO”) began to be replaced by HMO coverage. This was cheap when introduced in the 80s, but quickly became both expensive and drastically limited in coverage. In other words, as the private health-insurance system began to resemble the socialized healthcare in other countries, it deteriorated. How did this come about? It came about because short-sighted health-insurance companies lobbied and paid off legislators, who could not fathom the healthcare doubletalk and were happy to believe the line that healthcare “costs” were magically rocketing up every year.

Nobody has yet suggested returing to the excellent system we had 25 years ago, but that is clearly the best solution.



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