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Thursday, May 10th 2007

The British Medical Association Lays Reality Down

DB has a discussion over at Medical Rants on a BMA report which lays out the future of rationing in the NHS.

The BMA proposes the drawing up of a new patients’ charter specifying those health services to which every citizen across England should be entitled, regardless of the local health authority’s financial situation. They also want to see a second list of all the treatments which the sick will get only if their primary care trust has the money, and if doctors decide they are clinically worthwhile.

[Dr. Michael Wilks] told [BMA members that] the [BMA working] group had concluded that ‘while the service should remain universal, the challenges raise questions about how comprehensive the service can continue to be. This will depend on whether politicians and the taxpayer are prepared to contemplate either increasing expenditure or explicit rationing.

‘Rationing of health care in one form or another has always existed but has not been discussed. While agreeing that an open and honest debate on rationing is needed, the nature of that debate needs to be clarified. It might, for instance, address whether current inequities in care caused by pressures to balance the financial books are preferable to one alternative, which is to set a limit on the availability of some procedures.’

You should absolutely go read Dr. Centor’s thoughts on this article (here’s the link again). But, while he seems to think rationing should be a collective social choice…I don’t.

Health care is not a right. That is as simple as it can be said.

What should be a right is access to any care you can pay for.

Including say, new, yet expensive cancer drugs.

That little side jab at the NHS aside, it is true that the NHS doesn’t prove an absolute hindrance to private care (just go play medical tourist if worst comes to worst and you can afford it). But it certainly puts a hamper on it by suppressing the private health insurance market and suppressing options outside of NHS care. For instance, private medical insurance only covers acute care in the UK; you literally cannot purchase it to cover chronic diseases or preventative care. And that is because of the existence of the NHS.

And now, as a fixed budget system, it faces a future of further limiting care by extensive rationing.

That should never be a social choice. The majority should never be able to actively impede (and that is the key term here, because we’re talking about negative rights versus positive rights) an individual’s health care decisions. Which is exactly what is happening here.

In any case, this development in the British Medical Association just reiterates that opponents of single payer or socialized health care or even a two tier system in this country need to continually and unwaveringly preach on the rationing and access issue. It may be a losing battle, but I promise you the best chance of delaying or preventing a massive, disastrous alteration in the way the U.S. funds health care is to focus on rationing and access for the public. And I mean to the exclusion of all other technical or philosophical arguments against increased government funding of health care.