The Covert Rationing Blog

Why the Colette Mills Dilemma Won’t Happen Here

February 20th, 2008 by DrRich

The January 27 issue of the Sunday Times of London tells the tragic story of Colette Mills, a 58 year-old British woman who lost her battle with the National Health Service (NHS), and as a consequence appears doomed to lose her battle with breast cancer.

After her initial treatment for breast cancer, Ms. Mills was placed on the drug Taxol to reduce the odds of cancer recurrence. The NHS paid for both the surgery and the Taxol. However, Ms. Mills also wanted to take the drug Avastin, which, clinical trials have shown, can reduce the chance of recurrent cancer by about 50% when it is taken in addition to Taxol. Ms. Mills, aware that the NHS will not pay for Avastin, wanted to pay for the drug herself, and asked the NHS for permission to do so. The NHS said no. Ms. Mills appealed. Unfortunately, four months into the appeal process her cancer returned and has spread to other parts of her body, making her appeal for permission to pay for Avastin moot. Her prognosis now appears grim.

According to Sarah-Kate Templeton, Health Editor of the Times, Ms. Mills is “the victim of a ruling which states that any patient who wants to pay for additional drugs not prescribed by the NHS should lose their entitlement to their basic NHS cancer care and pay for all their treatment.”

The British Department of Health holds firm to the idea that individuals paying for supplemental treatment “would ‘undermine’ the ‘fundamental principle of the NHS, now supported by all the main political parties, that treatment should be free at the point of need.” That is, you get the healthcare the government says you get, and no more, even if you’re willing to pay for it yourself.

Since the British system is often held up as an example of one we in the U.S. should emulate, we ought to ask, “Will a universal American healthcare system also prohibit individuals from purchasing their own supplemental healthcare?”

This is a question that proponents of universal healthcare, at least those proponents running for political office, assiduously avoid. But the answer to this question is almost certainly, yes. Judging from the original Clinton healthcare plan in the early 1990s, from the actions of the federal government since that time to restrict the ability of individual Medicare patients to pay for “extra” care themselves, and from more recent actions aimed at outlawing retainer practices, it is pretty clearly the (unstated) aim of the Wonkonians to ultimately prevent individuals from supplementing their government-provided universal healthcare with their own resources. One size will have to fit all.

Indeed, this very issue (whether people are to be permitted to spend their own money protecting their own health) is likely to shape up as the central battle in American healthcare reform. By DrRich’s estimate, the very reason none of today’s prominent Wonkonians are talking about a straightforward government takeover of healthcare (favoring instead a more meandering course to that end), is that they don’t think they can win the “individual autonomy” battle right now. Americans, they judge, still need 5 or 10 years of softening up. But we’re getting there. After a few more enervating years dealing with our current healthcare mess, both the Gekkonian health insurance industry and the average American will be ready to throw in the towel, and accept whatever terms the Wonkonians care to offer.

Even then, lingering notions of individual autonomy might still threaten to make things occasionally uncomfortable for government officials. But not to worry. DrRich is here to reassure nervous Wonkonian bureaucrats. After their constituents have finally drunk the government-healthcare KoolAid, American Wonkonians won’t face kind of nasty dilemma now confronting honest British bureaucrats because of disruptive patients like Ms. Mills.

The reason is straightforward.

Fundamentally, the problem imposed on the NHS by Ms. Mills was one of medical progress. As reported in the London Daily Mail, medical “specialists fear that the NHS will be ‘crippled’ by the increasing range of breakthrough treatments.” (When the chief concern of the healthcare system is controlling costs rather than optimizing healthcare, breakthrough treatments are revealed as the true threats they are.)

The good news is that once American healthcare goes to a British (or Canadian) model, the world’s great engine of medical progress (i.e., the profit-driven American healthcare system) will grind to a screeching halt. With the American profit motive out of the way there won’t be any more new therapies which the Ms. Mills of the world can selfishly demand the right to purchase. Happily, American officials will be spared the kind of regrettable discomfitures now plaguing their British counterparts. The entire problem (whose extent is sadly illustrated by some of the headlines - e.g., “Sentenced to Death By Idiocy” - to which well-meaning British bureaucrats are now being subjected), will simply disappear.

So, not to worry. It won’t happen here.

Posted in Wonkonian Rationing

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