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    The Horrors of State Run Medicine

    American Conservatives have been sounding the alarm about state run health care and what horrors await us in a government run health care plan for most of the last century. In fact, Ronald Reagan warned us what was to come several decades ago.

    Those that favor a single payer or other government run health care, continue to tell us that the problems we face are caused by the free market system, and that only government intervention is capable of solving these problems - ignoring, of course, the inconvenient truth that many of those issues are caused by governmental intrusion into the market in the first place. They also tug on our heartstrings and tell us countless stories of people without care. But what about those who get the worst type of care?

    Several stories have emerged recently from Great Britain's National Health Service - a single payer health system run by bureaucrats . These stories should lay to rest any such romantic notions that government knows best when it comes to your health, or that government has any competence in controlling free markets for a desired outcome. That the decay of care is happening not in a communist society, but rather in a democratically elected government, should give everyone pause.

    This article in the UK Daily Mail got a lot of attention last week, and rightly so. Subheadings from the article read:

    • Now sick babies go on death pathway: Doctor's haunting testimony reveals how children are put on end-of-life plan
    • Practice of withdrawing food and fluid by tube being used on young patients
    • Doctor admits starving and dehydrating ten babies to death in neonatal unit
    • Liverpool Care Pathway subject of independent inquiry ordered by ministers
    • Investigation, including child patients, will look at whether cash payments to hospitals to hit death pathway targets have influenced doctors' decisions

    The article reveals, in horrifying detail, the treatment of patients put on the Liverpool Care Pathway once it's been determined that their lives are no longer worth living.

    And how is eligibility for the 'death pathway' determined?

    Medical critics of the LCP insist it is impossible to say when a patient will die and as a result the LCP death becomes a self-fulfilling prophecy. They say it is a form of euthanasia, used to clear hospital beds and save the NHS money.

    The effects on the patient are something out of a horror movie:

    The practice of withdrawing food and fluid by tube is being used on young patients as well as severely disabled newborn babies.

    Earlier this month, an un-named doctor wrote of the agony of watching the protracted deaths of babies. The doctor described one case of a baby born with ‘a lengthy list of unexpected congenital anomalies’, whose parents agreed to put it on the pathway.

    The doctor wrote: ‘They wish for their child to die quickly once the feeding and fluids are stopped. They wish for pneumonia. They wish for no suffering. They wish for no visible changes to their precious baby.
    Their wishes, however, are not consistent with my experience. Survival is often much longer than most physicians think; reflecting on my previous patients, the median time from withdrawal of hydration to death was ten days...

    Parents and care teams are unprepared for the sometimes severe changes that they will witness in the child’s physical appearance as severe dehydration ensues.

    Horrible. Yet, this unfortunately has become all too common across the system. Another article in the Manchester Guardian detailed the grief and guilt felt by the wife of a member of parliament who died in misery in a hospital stay:

    Ann Clwyd has said her biggest regret is that she didn't "stand in the hospital corridor and scream" in protest at the "almost callous lack of care" with which nurses treated her husband as he lay dying in the University Hospital of Wales in Cardiff.

    Clwyd, the Labour MP for Cynon Valley since 1984 and Tony Blair's former human rights envoy to Iraq, told the Guardian she fears a "normalisation of cruelty" is now rife among NHS nurses. She said she had chosen to speak out because this had become "commonplace".

    Describing how her 6'2'' husband lay crushed "like a battery hen" against the bars of his hospital bed with an oxygen mask so small it cut into his face and pumped cold air into his infected eye, Clwyd said nurses treated the dying man with "coldness, resentment, indifference and even contempt".

    Owen Roberts died on Tuesday, 23rd October from hospital-acquired pneumonia. The former television director and producer had multiple sclerosis for 30 years and had been in a wheelchair for the previous two years. He had been in the flagship hospital for ten days.

    "I have had nightmares about what happened," said Clwyd, speaking to the Guardian after initially making the claims on BBC Radio 4's World at One.

    These are the death panels that the Left constantly derides. We can provide example after example of the reduction of access to care under government run health systems, and it seems they can never accept the truth.

    Or maybe they can. Could it, in fact, be intentional or are the incentives as such that it's just a matter of scarce resources and tough decisions need to be made? 

    S.R. Larson of The Liberty Bullhorn makes a compelling case toward the former in a new post, Eugenics and the welfare state:

    Eugenics is advancing in the modern welfare state as an instrument of cost containment. It is being used in health care primarily as a sorting instrument among patients in need of scarce medical resources. Disguised as advanced science, hidden behind an inconspicuous acronym called QALY, the contemporary version of the “science” of population health does its best not to tarnish the falsely compassionate reputation of the welfare state.

    The trend of killing babies to save money for a government-run health care system stretches beyond abortions. The aforementioned medical ethicists made a long and intricate case not for abortions – which they support – but for infanticide. They claim that there is no difference between aborting a disabled baby to save taxpayers money on future health care and killing that baby after it has been born.

    Larson explains the cold, calculating bureacracy that determines whether your life is still worth living or not, using the Orwellian name of Quality Adjusted Life Years:

    At the bottom of this, of course, is the fact that the British government runs the National Health Service. Their prime purpose is not to deliver health care, but to deliver health care provided that government can afford to deliver it. In order to decide whose health care government can afford to deliver, the health care system applies something called Quality Adjusted Life Years (QALY). It is a system according to which government can assess the costs and benefits of providing care to individual patients.

    .... At the heart of QALY is the question: how can a tax-paid bureaucracy compare Jack’s and Jill’s need for health care? To make this comparison the QALY model converts Jack’s and Jill’s health experiences into one common denominator. This common denominator is a utility value scale. The theoretical basis for this scale is the ethical value theory of utilitarianism, with the explicit premise that government, not Jack and Jill, assign utility values to their health care experiences. A life in perfect health is considered to have a utility value of 1, while death has a utility value of 0. In between are various health conditions that span the entire continuum between 0 and 1.

    .... Suppose Jack and Jill want treatment at the same hospital. There is not enough resources to treat both of them, so a health care bureaucrat is assigned the duty to decide who will be admitted. He asks the question: how close to 1 or 0 are Jack’s and Jill’s health experiences? Jack and Jill both suffer from the same type of cancer. It is currently curable in both cases but if left untreated it will kill them. The bureaucrat now asks four questions to determine who will be admitted. … 1. How many more years is the patient likely going to live? 2. How many of those years will the patient be affected by his/her health condition? 3. How much less worth living will his/her life be without treatment? 4. Is the patient likely to be paying enough taxes over the course of his/her life to compensate government for the treatment costs?

    Please note again that the patient is not involved in answering any of these questions.

    .... The choice is, however, not based simply on the utility calculation. There is another aspect involved as well. Suppose the health care bureaucrat finds that Jack’s utility from his remaining life years is only slightly higher than the utility that Jill will experience. At this point, the decisive variable will be – expected tax revenues. If Jill makes more money and her future expected income will produce a lot more tax revenues for government than Jack’s income, then she will get the treatment because he is more likely to pay for his treatment through taxes than Jill is.

    There is another way to look at how QALY works. Suppose Jack and Jill have the same income, are the same age and suffer from the same type of cancer. Suppose Jack was in perfectly good health before the cancer but Jill suffered from a disability. The disability means that the doctors have to provide more complex, and more costly, treatment for her cancer. The cost of surgery on her is in other words significantly higher than it is to save Jack’s life.

    In this case the QALY calculation will recommend that the government-run hospital admit Jack for treatment but let Jill go without it. Because she is less able to pay for the cost of her treatment – same income, more expensive surgery – government is less likely to recover the cost of surgery in her case.

    One eventually comes to the conclusion that, regardless of the order of cause and effect, eugenics are a vital aspect to any totalitarian society. As Larson puts it:

    There is a continuum from the most outrageous forms of oppression – Cambodia, China, The Soviet Gulag camps – to its more “lenient forms” – travel restrictions, food rationing. Everywhere within this continuum government rank themselves and their interest above the individual citizen’s needs and, in some cases, very right to exist.

    On one hand, you have command societies and economies such as Cuba and the Soviet Union that require population control to make the system work in a way that does not overburden governmental resources.  On the other hand is this concept of single payer health care that seems theoretically to solve many societal ills, but once the details of implementation and the realities of public budgeting are taken into account, turns out to require the same type of totalitarianism that we profess to want to avoid. Either way, the effect on the individual is always the same - less choice, less input into your own medical care decisions, and the need for the state to decide how much of its limited resources to spend on your care.