Thursday, August 20, 2009

Trade offs, difficult decisions, and "Mum"

Mike McNally, a Brit, on "Britain Dragged into ObamaCare Fight." My mother is elderly, suffers dementia, and is in assisted living — and her face still lights up when my brother or I appear, so I found his description of his mother's treatment by the NHS particularly interesting.
The simple fact is that while neither system is as terrible as their detractors claim, both have undeniable flaws. And while we can trade facts, figures, and anecdotes all day, a couple of things are clear. The first is that the poor enjoy a generally better standard of care in the UK than in the U.S. The second is that Americans with decent insurance enjoy a better standard of care than most Brits — survival rates for all the major cancers are considerably better than in the UK, and screening and treatment for heart disease and other chronic conditions is more widely available.

The most emotive areas of the U.S.-UK debate — and the issues seized on in Republican attacks on the NHS — concern rationing of care and “end of life” provisions. There’s no disputing the fact that care is rationed in Britain — mostly for the chronically-ill elderly, but increasingly too for smokers, the obese, and others whose lifestyles are deemed “unhealthy.” It’s going too far to call the entire NHS “Orwellian,” as some U.S. critics have, but the acronym for the NHS body which decides whether particular treatments are cost-effective — and thus how long certain patients can live — certainly has an Orwellian ring to it: NICE. ....

...More insidious than any group of experts are the statist mindset and the institutional heartlessness that pervade any large publicly funded body. As I discovered over the last few years while dealing with the system on behalf of my dying mother, there’s no need for anyone to “pull the plug on granny” when the system as a whole takes a dim view of providing care for those deemed not to be sufficiently productive members of society.

Mum suffered from dementia and spent the last few years of her life in nursing homes. During her illness she had several stays in the hospital, and every so often some doctor would take my brother and I aside and whisper to us about “quality of life” and “letting her go.” We politely declined the invitation, on that grounds that as long as mum wasn’t in pain, and as long as her face lit up when we arrived to visit her, then by our quaint standards she had “quality of life.”

Mum didn’t require any expensive drugs or other treatment, but the “experts” had decided that she was a burden on the system. What she did need, in addition to basic medication for various ailments, was help to make sure she got enough to eat and drink, and time after time we had to ask doctors and nurses to please, if it wasn’t too much trouble, make sure she didn’t die from dehydration.

It’s important to add that on many occasions doctors and nurses showed great skill in taking care of mum. They also showed great kindness, both to her and to my brother and me. But even with the best of intentions, staff shortages and simple incompetence meant that if we hadn’t visited mum every day, and often twice a day, to make sure she was eating and drinking enough, she would certainly have died two or three years sooner that she did.

So yes, U.S. health care needs to be reformed to reduce costs, and there must be better provision for the poorest. I’m not qualified to say how it should be done, but I do know that Americans should keep the role of the government to an absolute minimum and rely instead on solutions based on the principles of freedom of choice and personal responsibility. There will be an element of rationing under any system — the free market is itself a form of rationing — but difficult decisions should be taken by patients and their families in consultation with health providers who are responsive to the demands of their customers, rather than by government bean-counters. [emphasis added].... [more]
The picture is of Mary Elizabeth Bond Skaggs, 98, my mother.

Thanks to Gene Edward Veith for the reference.

Pajamas Media » Britain Dragged into ObamaCare Fight: NHS Under Fire
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