NHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds, a senior consultant claimed yesterday.
Professor Patrick Pullicino said doctors had turned the use of a controversial ‘death pathway’ into the equivalent of euthanasia of the elderly.
He claimed there was often a lack of clear evidence for initiating the Liverpool Care Pathway, a method of looking after terminally ill patients that is used in hospitals across the country.
It is designed to come into force when doctors believe it is impossible for a patient to recover and death is imminent.
It can include withdrawal of treatment – including the provision of water and nourishment by tube – and on average brings a patient to death in 33 hours.
There are around 450,000 deaths in Britain each year of people who are in hospital or under NHS care. Around 29 per cent – 130,000 – are of patients who were on the LCP.
Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an ‘assisted death pathway rather than a care pathway’.
He cited ‘pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients’ as factors.
Professor Pullicino revealed he had personally intervened to take a patient off the LCP who went on to be successfully treated.
[…]Professor Pullicino, a consultant neurologist for East Kent Hospitals and Professor of Clinical Neurosciences at the University of Kent, was speaking to the Royal Society of Medicine in London.
[…]He said: ‘The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway.
‘Very likely many elderly patients who could live substantially longer are being killed by the LCP.
‘Patients are frequently put on the pathway without a proper analysis of their condition.
The health service ‘looks like a supertanker heading for an iceberg’, the head of the NHS Confederation has warned.
His comment came as a survey revealed the squeeze on NHS finances is so serious that almost half of its leaders think it will reduce quality of care for patients over the next year.
The research, carried out before the confederation’s annual conference in Manchester, shows that NHS leaders fear that growing financial pressures will mean treatment rationing and longer waiting times.
Of the 252 chief executives and chairs of NHS organisations questioned, almost half believe the financial burden on the health service is ‘very serious’ and 47 per cent say this means quality of care will reduce over the next 12 months.
Mike Farrar, chief executive of the confederation which represents organisations providing NHS services, said: ‘Despite huge efforts to maintain standards of patient care in the current financial year, healthcare leaders are deeply concerned about the storm clouds that are gathering around the NHS.
‘Our survey shows that many NHS leaders see finances getting worse and that this is already having a growing impact on their patients. In response, they are cutting costs in the short term but they know that much more radical solutions are the only answer in the long run.
[…]Mr Farrar added that politicians had ‘consistently failed’ to put the long-term interests of the population’s health above their short-term electoral interests.
[…]Katherine Murphy, chief executive of the Patients Association said: ‘This survey confirms what everybody inside the health and social care system is already saying – the next decade is likely to be the most challenging one in the history of the NHS.
‘Treatments are being rationed, waiting times for elective procedures are going up and patients continue to be treated poorly on our hospital wards.
In a government-run system, whether you get treatment or not depends on a bureaucrat, whose only desire is to be re-elected. Sometimes, killing you is the best way for them to get re-elected, as seen in the euthanasia numbers. But, in a private health care system, it makes no sense to kill patients, because then the money stops coming in. Doctors actually care about you in a for profit system. They want to help you, and they want you to live.
Here is a must-read article from my friend Matt Palumbo at the American Thinker. It’s extremely high quality. (I removed the links in my excerpt – but he linked all the sources in his post)
Excerpt:
The oft-cited “46 million uninsured” is breathtakingly easy to break down to size. Keep in mind that there is overlap in the following statistics, as many people listed in them belong to multiple categories. Around 10 million of the uninsured aren’t even citizens. Another 8 million are aged 18-24, which is the group least prone to medical problems. The average salary of a person in this age group is $31,790, so affording health care would not be a problem. Seventeen million of the uninsured make over $50,000 a year, and within that group, 8 million make over $75,000. These people are usually referred to as the “voluntarily uninsured.” Another large group of these 46 million are uninsured in name only, as they are eligible for government programs that they haven’t signed up for. Estimates on how large this group is vary, the range being from 5.4 million as estimated by the Kaiser Family Foundation to as large as one third of all the uninsured, as estimated by BlueCross BlueShield. The number of people without care because they cannot afford it is around 6 million — still a large number, but a fraction of 46 million, and no reason to restructure the entire health care system.
Then comes the issue of lifespan. Of all attempts to discredit the American system, lifespan has been the worst. Although lifespan gives a good indicator of a nation’s health at a glance, it does have its problems under analysis. We get a strange paradox when examining two statistics: life expectancy and cancer survival rates. Estimates vary on how we rank exactly; the World Fact Book showing that we rank as poorly as 50th worldwide. Even the best estimates in our favor place us far behind most developed nations. Despite this, the United States excels at cancer survival. Of the 16 most common cancers, the United States has the highest survival rate for 13 of them. Overall, the five-year cancer survival rate for men in the States is 66.3%, and 47.3% in Europe. Women have an advantage too, with a survival rate of 62.9% in the States, and 55.8% in Europe. So that said, how is it that our system takes better care of us, and doesn’t grant added lifespan to boot? Quite simply, the lifespan measurement commonly cited doesn’t factor in many variables which shorten lifespan, many of which medical care cannot prevent. Among these factors are murders, suicides, obesity, and accidents.
He looks at the uninsured number, the infant mortality rate, and other interesting things in the article, showing how the statistics that impugn the US health care system have been misused. There are some good articles linked, like this post from Commentary magazine by Scott Atlas, entitled “The Worst Study Ever?”. Atlas is the same guy who listed out how the US health care system compares to others, which I blogged about before.
You can check out Matt’s blog “The Conscience of a Young Conservative“. Not sure how scalable that blog name is. Because of the “young” part, not because of the conscience or conservative part.
A story about a recent survey on Canada’s universal health care system, from the National Post.
Excerpt:
A new survey on attitudes about the health-care system reveals some interesting responses, confirming that Canadians have widespread misgivings about the system, even while not fully understanding how it works. They also favour using tax incentives to encourage healthier living and eating.
The survey of 2,300 Canadians carried out in April by the consulting firm Deloitte was part of a larger poll covering 12 countries. It is considered accurate to within two percentage points, 95% of the time.
Some of the highlights include:
– Just 5% of respondents gave the system an A grade; 45% giving it a B, 36% a C, 10% a D, and 4% a failing F.
– 33% of Canadians said they understood how the system works, down from 39% in 2009 when Deloitte did a similar survey.
– 69% feel that the system has not improved in the last two years, while there were slightly more who thought it had deteriorated, as opposed to improved, in that period.
– 36% believe that half the money spent on health care is wasted; interestingly, half of those skeptics blame the waste on people failing to take responsibility for their own health.
– 13% reported that they are caring for another person, up from 10% in 2009, a possible sign of the increasing personal burden posed by the aging population. In a third of those cases, the individual is caring for a spouse.
– 55% rated their health as excellent or very good … even though 52% report having been diagnosed with one or more chronic diseases.
– 63% favour some kind of tax-based incentive to encourage more healthy diets and lifestyles.
– About 80% favour expanding medical-school enrollments to increase the supply of doctors.
You can find some more videos describing horror stories in the Canadian system in this previous post.
Everyone agrees that the American health care system is too expensive, but do we at least get better quality outcomes? Let’s see.
Medical care in the United States is derided as miserable compared to health care systems in the rest of the developed world. Economists, government officials, insurers, and academics beat the drum for a far larger government role in health care. Much of the public assumes that their arguments are sound because the calls for change are so ubiquitous and the topic so complex. Before we turn to government as the solution, however, we should consider some unheralded facts about America’s health care system.
1. Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.
2. Americans have lower cancer mortality rates than Canadians. Breast cancer mortality in Canada is 9 percent higher than in the United States, prostate cancer is 184 percent higher, and colon cancer among men is about 10 percent higher.
3. Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit from statin drugs, which reduce cholesterol and protect against heart disease, are taking them. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them.
4. Americans have better access to preventive cancer screening than Canadians. Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate, and colon cancer:
Nine out of ten middle-aged American women (89 percent) have had a mammogram, compared to fewer than three-fourths of Canadians (72 percent).
Nearly all American women (96 percent) have had a Pap smear, compared to fewer than 90 percent of Canadians.
More than half of American men (54 percent) have had a prostatespecific antigen (PSA) test, compared to fewer than one in six Canadians (16 percent).
Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with fewer than one in twenty Canadians (5 percent).
5. Lower-income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report “excellent” health (11.7 percent) compared to Canadian seniors (5.8 percent). Conversely, white, young Canadian adults with below-median incomes are 20 percent more likely than lower-income Americans to describe their health as “fair or poor.”
6. Americans spend less time waiting for care than patients in Canada and the United Kingdom. Canadian and British patients wait about twice as long—sometimes more than a year—to see a specialist, have elective surgery such as hip replacements, or get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In Britain, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.
7. People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand, and British adults say their health system needs either “fundamental change” or “complete rebuilding.”
8. Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the “health care system,” more than half of Americans (51.3 percent) are very satisfied with their health care services, compared with only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).
9. Americans have better access to important new technologies such as medical imaging than do patients in Canada or Britain. An overwhelming majority of leading American physicians identify computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade—even as economists and policy makers unfamiliar with actual medical practice decry these techniques as wasteful. The United States has thirty-four CT scanners per million Americans, compared to twelve in Canada and eight in Britain. The United States has almost twenty-seven MRI machines per million people compared to about six per million in Canada and Britain.
10. Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States.
Despite serious challenges, such as escalating costs and care for the uninsured, the U.S. health care system compares favorably to those in other developed countries.
The author of that article is a senior fellow at the Hoover Institution and a professor of radiology and chief of neuroradiology at Stanford University Medical School.
So, we saw that the quality of the U.S. health care system is good, but how can we lower the costs? Is government controlled rationing (like Canada) the answer, or is there another way?
Choice and competition in health care
The Center for Freedom and prosperity seems to have found another way: choice and competition.
Excerpt:
In many ways, America’s health care system is the best in the world. It has state-of-the-art technology and highly-skilled medical professionals. America is also home to most of the cutting-edge medical research in the world. However, there are also important problems, such as the “third-party payer” model where consumers rarely pay the full cost of their own health care. This creates an incentive for both excessive and expensive use of health care, a problem that would be exacerbated by current proposals for greater government control of the health care system.
But the third-party payer problem is not the only reason that health care costs are high. State governments impose health insurance coverage mandates, often for “gold-plated” coverage, that drive up the cost of insurance. These regulations, which are unique to each state, are imposed at the behest of interest groups seeking to increase demand for their services. Combined with protectionist barriers that prevent consumers from buying policies from providers in other states, these mandates have severe unintended consequences:
They limit competition in the health insurance market by preventing insurance buyers from shopping across state lines, creating monopolistic and oligopolistic situations in many states;
They impose coverage mandates that force health insurance buyers to purchase coverage that they either do not want or cannot afford;
They force insurers to use community rating instead of experience rating, which means healthy people are forced to subsidize unhealthy people – to the effect that insurance premiums rise for many buyers and healthy people are driven out of the market.
The symptoms of a dysfunctional health insurance market – foremost the significant number of uninsured, but also rising costs – are recognized by many legislators. But the problem cannot be solved, as some suggest, by means of increased government regulation. Indeed, government regulation is the cause of most problems in the health insurance market, not the solution.
Restoring a free market health care system would be a daunting task, one that would involve, 1) sweeping reforms to the 45 percent of health care directly financed by government programs, and 2) a complete rewrite of the tax code to remove the distortions that exist in employer-provided health insurance. This paper focuses on the so-called third leg of the stool – policies to remove government barriers and restore competition to the market for individual health insurance.
Reforming the government-financed programs is definitely necessary because there is so much fraud and waste, as there always is with government, when compared to the private sector. Private sector businesses have to turn a profit, so they actually try to prevent fraud and waste.
Here’s a documentary featuring John Stossel that explains the health insurance problem. (And featuring Regina Hertzlinger, too)
Part 1 of 5:
Part 2 of 5:
Part 3 of 5:
Part 4 of 5:
Part 5 of 5:
Choice and competition govern the way we buy things that we want normally, especially when we buy things online. I am pretty happy buying things from online retailers, because I have so many stores to choose from, with lots of product reviews and retailer ratings. I usually like what I buy, because I know that I am buying a good product from a good seller. And if I don’t get a good outcome, I can leave a review of the product, service or seller as a warning for the next person. That helps to encourage producers to make quality products and services Seller rating helps to make sellers care for customers, and to accept returns on items that don’t perform. Maybe we should do that with health care, and just leave health insurance for catastrophic care – like car insurance is for accidents, but not for oil changes.
WINTERY KNIGHT 