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October 24, 2006

Polly Gets Nice

Quite amazing today. Polly actually seems to have some grasp of economics:

But it isn't as simple as that. Faced with patients clinging to any last straw, the big questions remain. What is a life worth? How good a quality of life should be saved, at what price, for how long? Nice has a rule of thumb using QALYs, or quality-adjusted life years. A year of life in a reasonable condition is worth £20,000-£25,000. Anything over £30,000 needs to be an exceptional case: that's not personal circumstance but a rare condition with absolutely no other treatment. Nice has to consider what better treatments could be bought for how many others for the cost of holding off death for a few more painful months? Never easy, it will always depend on how much cash there is in the pot. And politicians need to ask if an NHS pound really buys more wellbeing than other services?

Now, if we can just get her to apply that insight to everything: that there is indeed a limited pot of money, that we cannot buy everything that we want: like, for example, free high quality child care for everyone? Or rather we can, but it will be at the expense of something else: we need to calculate the trade offs, not simply state that it sounds like a very nice idea so let's go do it.

Sadly, her arguments then decline:

Professor Karol Sikora and the rightwing group Doctors for Reform call "the current socialist model" of the NHS "dogma". Instead they want patients to get basic NHS-standard treatments as approved by Nice, with the option to buy unapproved treatments by paying extra or buying top-up insurance. Sikora, writing in the Mail, compares it to private opticians letting people choose glasses to suit their purse, but the state ensuring no one goes without.

NHS provision is unequal now, but this would create an instant class divide, far greater than the 11% who currently use some private medicine. It would herald the end of a universal NHS altogether, but then perhaps it is the logical next step in the "choice" agenda. It's alarming how Tony Blair and some of his ministers listen to Sikora's market vision with intense interest.

Excuse me, but what is actually wrong with this vision? Why should people be barred from topping up with their own money their health care? Why shouldn't people 'clutching at the last straw' be able to pay £30,000 for an extra year of life? Purely because this would lead to inequality in health care treatment? Really?

I can see that a tax funded system should indeed hand out the care equitably: but why the ban on topping it up? Is it really true that people should be barred from disposing of their own property as they wish, should in fact simply roll over and die, so as to preserve equality?

Is Polly really ready to go to one of those poeple with multiple myeloma, look them in the face and say, no, you must die in the name of equality?

Update: The Tin Drummer gets a little more vehement on the subject than I did.

October 24, 2006 in Health Care | Permalink


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great post. I think she would go and say exactly that if she could; living up to her principles etc.

Lefties are always the most heartless.

Posted by: cityunslicker | Oct 24, 2006 11:28:48 AM

[ Instead they want patients to get basic NHS-standard treatments as approved by Nice, with the option to buy unapproved treatments by paying extra or buying top-up insurance. ]

this is, in fact, how things work in the UK. Private medicine is not illegal in the UK. I don't understand what Sikora's point is unless 1) by "unapproved treatments" he means things like Laetril or something, or 2) by "paying extra" he means that the NHS ought to be subsidising private medicine.

Tim adds: The situation as I understand it is that if you go private you have to go private all the way. You can't have a private diagnosis, for example, then get NHS treatment. To which I would ask, why not? You've paid the taxes, after all. Why shouldn't you be able to mix and match provision from what you've paid for?

Posted by: dsquared | Oct 24, 2006 12:02:28 PM

What are you talking about? Anyone can obtain drugs on private prescription.

It would help if you gave a link to her article and that of Prof Sikora.

Tim adds: As far as I can see there is a link to Polly's piece, first line or two. She's quoting Sikora, not me, I'm quoting her quoting him.

Posted by: james C | Oct 24, 2006 12:17:48 PM

Slightly OT but does the Guardian provide its employees with private health care benefits? I'd be very surprised if it didn't.

I assume Polly asks not to be so covered or, being possibly self-employed, she refuses to cough up personally for private medicine cover

Posted by: Umbongo | Oct 24, 2006 12:40:48 PM

She said: "11% who currently use some private medicine" and Tim said: "if you go private you have to go private all the way." Is it some or all?

Posted by: james higham | Oct 24, 2006 1:12:20 PM

The only ban on private medical top-ups should be voluntarily self-imposed by policymakers themselves in relation to their own medical treatment. Politicians currently spend 7.5% of GDP on the NHS which is supposed to provide a basic level of healthcare free at the point of delivery for all. The problem is that they are failing to make the national health service safe for the majority of the population that can't afford private medicine. It is not just the issue of a top-up to extend life in the final days of old age that is called into question but the basic service itself. It is whether the public is as safe being treated in the hands of NHS as they would be in the hands of a private practioner (Yes, I know their often the same doctors!).

I've asked MPs if they would be prepared to always use the NHS? 50 MPs indeed have to-date signed the health petition organised by OurPetiton.org that calls for 'elected representatives of all UK political parties voluntarily [to] refrain from self-paid or insurance-paid medical care treatment.' But the majority of policymakers are reluctant to sign. Even David Cameron whose family "so-often relies on the NHS" seemingly does not trust the NHS sufficiently as evidenced by his lack of response to my request to sign the petition.

The NHS will always be resource constrained. Those who can afford top-up treatments not available under the NHS should never be barred from seeking private medical care. However policymakers spending £ 90 billion per year of our money on basic healthcare provision free at the point of delivery should seriously consider backing the NHS staff and the patients they serve. There can be no greater message of support to those delivering our basic healthcare than for policymakers to always use the NHS themselves. Richard Solomon. www.ourpetiton.org

Posted by: Richard Solomon | Oct 24, 2006 1:38:34 PM

[Tim adds: The situation as I understand it is that if you go private you have to go private all the way. You can't have a private diagnosis, for example, then get NHS treatment]


not true as far as I can see

Tim adds: Fair enough, better than I had thought.

Posted by: dsquared | Oct 24, 2006 3:05:28 PM

I pay for the vet. Nowadays I have to pay for the dentist. Why is paying for the quack vicious?

Posted by: dearieme | Oct 24, 2006 7:25:15 PM

Anyone who needs treatment not provided on the NHS (the envy of the world) should get on a plane and go to one of the chains of private hospitals in India. Costs are around 30% of what private treatment in Britain would be, results are at least as good and in many cases better, and these hospitals provide a meet and greet service where they pick the patient up at the airport and get them settled into their private room.

It's also worth asking the NHS if they will pay for all or part of the treatment. Sometimes they actually kick in to get that patient off the waiting list.

Posted by: Verity | Oct 24, 2006 8:35:30 PM

"I pay for the vet. Nowadays I have to pay for the dentist. Why is paying for the quack vicious?"

But what does the c. 70 years-old pensioner do now if they believed all the New Labour stuff in the run-up to the 1997 election about "only 24 hours to save the NHS" and voted accordingly?

We've already learned from the news that new cancer drugs, such as Velcade, are available on NHS prescription in Scotland but not in England.

Presumably, in the coming New Order for England, pensioners will be be expected to pay up out of whatever savings they have to live longer and quietly note the extent of Blairite deceit and duplicity.

In the case of Herceptin for breast cancer, Patricia Hewit was very clear:

"A fortnight ago I made it clear that PCTs should not refuse to fund Herceptin solely on the grounds of its cost."

Try this on how patient access to consultants is now being rationed in the NHS:

Posted by: Bob B | Oct 24, 2006 9:43:21 PM

A bit the classical "doing a Worstall":
build up a line of argument and then retract on a few key assumptions. Fine, but the harmis already done.

Posted by: Someone At Home | Oct 25, 2006 5:23:48 AM

The Siroka piece in the Mail that PT refers to dates from April, and can be found here:

To the dsquared point, as far as I can make out what Siroka is advocating is being able to have standard NHS coverage and provision of care (e.g. the doctor, the hospital bed, the nursing) but to be able to buy your own drugs if the NHS doesn't provide what you want/need (see http://news.bbc.co.uk/1/hi/health/5413132.stm for a little more detail).

Posted by: FactcheckingPollyanna | Oct 25, 2006 10:37:57 AM

But as far as I can see, to the extent that this isn't possible already, it would involve massive second-guessing of the doctor actually treating you, wouldn't it? If the guy is prepared to prescribe something off-NICE and you're prepared to pay for it as a private patient, then that works under the current scheme. Otherwise, if he's not prepared to prescribe it, then I think it's going to be very difficult to create a system that lets you gainsay that decision without undermining the entire doctor/patient relationship.

Unless I suppose he's talking about the substantial proportion of NHS consultants who don't have private practices and therefore can't prescribe medicine privately, which would make more sense, although I see fairly substantial problems here in forcing them to - it would AFAICS involve the extension of Crown immunity to the entire private practices of all NHS doctors, which would be quite a radical step.

Posted by: dsquared | Oct 25, 2006 3:56:30 PM

I suspect (though don't know) that if the doc prescribes the drug privately, you'd have to go the whole hog and take a private room and take private nursing care, which could increase the cost significantly -- particularly in the case of cancer treatment which can involve costly isolation and extensive nursing care.

If my hypothesis is true, the Siroka proposal would help those who could afford the incremental cost of the private drug but not the incremental cost of full-on private healthcare.

Posted by: FactcheckingPollyanna | Oct 26, 2006 5:43:19 PM