Remember when the Patient Protection and Affordable Care Act (PP ACA, also known as Obamacare) was to serve as the pathway to a single-payer healthcare system as exampled in Great Britain and a number of other European countries? At the time the supporters were quick to point out how low the cost of health care was for the average person and even the poorest would receive quality healthcare. The opponents of the law saw it as government overreach and said that it would implement “death panels” where the state would choose who would live and who would die. Of course, this idea was dismissed by those who supported central control as just outlandish foolishness. Which brings us to today’s news.
First, there was Charlie Gard an 11-month who suffered from a rare and fatal condition, and the doctors of the National Health Service told to parents to just let him die as continued treatment was not going to be supported. When they challenged this, it became apparent the NHS viewed young Gard as a ward of the state and the parents had no real say in the decision.
Now we have the second example before us, again the NHS is telling the parents of Alfie Evans they won’t offer additional treatment for what is likely a terminal illness. They took him off oxygen and when he continued to breathe they stopped feeding him. To further their position they won’t let the parents take him elsewhere where other doctors are willing to treat him. Even the Pope has weighed in on the subject.
You can say what you want about capitalism versus socialism, private insurance versus government insurance, private healthcare versus public healthcare and all the other economic comparisons but at the end of the day it comes down to someone determining a cost versus benefit. The question in health care is who should that be?
Clearly, for the British National Health Service (as supported by the courts) it is their position the nameless and faceless bureaucracy of the state is where that decision rests, it is after all the state that is paying for the care. The rights of the parent are subject to state approval and control. But is the system equal for all? If the parents were the Winsor’s would the decision of the state be the same? While I doubt it, I don’t know for sure, but I can’t imagine a bureaucrat being called before the Queen to explain his/her decision.
In our system, as flawed as it is, where does the decision lie? The answer to that, of course, depends on financial status and the compassion of the various providers, both financially and medically. There are children’s hospitals where there is sufficient financial support that the families in their care are not, as far as I know, asked to make the tough choice of what is affordable and can decide with their doctors on what is best for the child.
If we do eventually move to a “single-payer” system managed by a government bureaucracy the decision of life or death versus cost will become a part of the equation. It is inescapable when faced with a fiscal reality of budget limits. We see it in the VA today, and it is simply foolish to think it would not be there on a larger scale in a larger system.
For those who support the single-payer system be prepared to transfer your decisions on life and death to the state based on a simple algorithm of how much your life is worth to the state, versus how much will it cost to maintain it.
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