Stanley Feld M.D.,FACP,MACE
Last year the Great British single party payer system, The National Health Service, backfired.
It occurred just at the time Americans were being suckered into instituting a single party payer system by its progressive politicians..
Winston Churchill was right when he said,“You can always count on Americans to do the right thing—after they’ve tried everything else.”
I hope some of our leaders are listening.
Dr. Don Berwick touted Britain’s National Health Serviceas the America’s ultimate healthcare role model.
Dr. Berwick had some good ideas and many very bad ideas.
President Obama had other ideas. His ideas were not about repairing the healthcare system. His goal for healthcare reform was having the federal government control the entire healthcare system.
President Obama and Dr. Berwick portrayed physicians and patients as the villains in healthcare dysfunction. It is easy to blame the physicians and the patients because both have some blame in the dysfunction.
In 2009 the new British coalition government declared the National Health Service a fiscal failure.
After 62 years, the British government’s present goal is to decentralize its healthcare system. The goal does not include decentralizing medical decision making. The system continues to put restraints on consumers’ medical spending. The government believes consumers are not smart enough to make their own medical decisions.
Baroness Hale had previously written the following for the British High Court, the U.K.’s equivalent of the U.S. Supreme Court:
“Decision-makers must look at [the patient’s] welfare … the nature of the medical treatment in question, … they [decision makers] must try and put themselves in the place of the individual patient.”
“The patient is not the decision-maker.”
The British Healthcare Service has an organization called NICE. Nice is a perfect bureaucratic name for “the National Institute for Clinical Excellence.” NICE sounds nice. Its function is not very nice.
According to the NHS Constitution, “You have the right to drugs and treatments that have been recommended by NICE.”The National Institute for Clinical Excellence is an agency that “advises” the government whether to authorize payments or withhold them for treatments deemed “not cost effective.”
Britain’s National Health Servicehas continually changed over the 62 years. Various British administrations have searched for the formula to deliver high quality care at an affordable price.
Unfortunately,Britain is making another complicated mistake.
The United States is making the same mistake as it marches toward a single party payer system. The mistake is the lack of respect for the intelligence and will of consumers. The mistake is not permitting consumers to be financially and emotionally responsible for their own medical care decisions.
The British incident is chilling. The British High Court recently ruled against parents’ wishes in defense of the National Health Services.
The high court’s decision is the result of British consumers giving total control of the healthcare system to its central government.
The British government believes that the people are not smart enough or responsible enough to figure out how to take care of themselves.
The British thinking is not dissimilar to the thinking of the Obama administration and Dr. Donald Berwick.
The basic conflict is over who is ultimately in charge of medical decision making. Government control of medical decision making is not limited to Great Britain’s single-payer structure.
In all government run health-care systems, whether in Australia, Canada, or even here in the United States under Obamacare, government increasingly makes final medical decisions, not patients in consultation with their doctors.
NICE is an agency that “advises” the government whether to authorize payments or withhold them for treatments deemed “not cost effective.”
“Consumers have the right to do what they or their doctor thinks best medically as long as your decision does not override the decision NICE decides is cost effective for the government.”
What is missing from the British system?
All government has to do is make the right rules, empower consumers with their own money, level the playing field among stakeholders and get out of the way.
Americans did not fully understand two recent single party payer events that occurred in Britain. This was partly because the American media did not cover the story’s significance adequately.
Perhaps the American media did not understand the story’s significance to the American debate in reference to a single party payer healthcare system.
“ First Charlie Gard and now Alfie Evans. These are two 23 month old babies who, though verbally silent, still gave clarion warnings to proponents of single-payer health care: The government — not my parents — is in charge of my life.”
Charlie Gard was born in August 2015 with a rare genetic disorder that carried a poor long-term prognosis.
“In July 2017, little Charlie was just 23 months of age and on a ventilator. Over the objections of his parents, British doctors decided to withdraw life-sustaining care.”
“According to British Courts, the National Health Service (NHS), the country’s single-payer system, is the ultimate medical decision maker — not the family. Ventilator support was withdrawn and Charlie died.”
Less than a year later another 23 month old child hit the British headlines. Alfie Evans was a comatose child whose NHS doctors said his condition was hopeless. His physicians felt he could not survive without ventilating life support. They wanted to terminate his life support.
His parents wanted to transfer their child to Rome’s Bambino Gesu Pediatric Hospital for further care. The Italian Hospital was willing to take him.
The British High Court ruled against the parents’ wishes, leaving Alfie’s fate to the NHS. As Justice-Baroness Hale wrote in Aintree v James: “we [referring to patients] cannot always have what we want.” On April 28, 2018,Alfie’s ventilatory support withdrawn.
Alfie did not die when artifical ventilation was withdrawn. He died because of inadaquate I.V. nutrition.He was able to breath on his own. His physicians were wrong.
NICE is the model on which the Independent Payment Advisory Board (IPAB) was created under the Affordable Care Act.The Independent Payment Advisory Board, or IPAB, was to be a fifteen member agency which was to have the explicit task of achieving specified savings in Medicare without affecting coverage or quality. The system creating IPAB granted IPAB the authority to make changes to the Medicare program with the Congress being given the power to overrule the agency’s decisions through supermajority vote.
The Bipartisan Budget Act of 2018repealed IPAB before it could take effect.[1
In my opinion it should not be the government or the court that decides about who should live or die. It should be the patient or the patient’s family who decides with the advice of the patient’s physicians and clergy.
The institution the patient is being cared in should not be responsible for the bill.
Consider the question “who’s in charge?” from two perspectives: that of the American public and that of physicians.
Americans prize their freedom above all else. When the government makes medical decisions against the patient’s wishes, it directly infringes on personal freedom. It is doubtful that Americans would support a single-payer system if they understood what they have to give up in exchange for the promise of government supplied health care. Americans would be giving up freedom of choice.
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