Brave New Britain: Here Comes Health Care Rationing

The UK’s National Health Care service is such a mess that some are now openly calling for explicit health care rationing. (Of course, ad hoc or sub rosa rationing already exists within the NHS.) One idea, according to this article in the Scotsman, is to make up a list of treatments that would be provided:

Alex Smallwood, from the BMA’s junior doctors’ committee, told the meeting in Torquay it needed to be accepted that rationing must take place in the NHS, but this had to be done much more openly.

“It is no longer possible to provide all the latest to absolutely everybody without notable detriment to others,” he said.

“Rationing is reduction in choice. Rationing has become a necessary evil. We need to formalise rationing to prevent an unregulated, widening, postcode-lottery of care. Government no longer has a choice.”

Dr Smallwood said that a list of acceptable treatments could be drawn up after debate and public consultation. But this might include a restriction on treating things like hernias and varicose veins - conditions with which people could live. “If somebody had a specific condition, it would be about how you could fairly say to them, ‘This is not life-threatening; there’s probably a better way we could manage this’. “When it comes to the list of conditions, it’s all about quality of life. It would be about the prioritisation of clinical need,” he added.

Well, now there’s a slippery slope. What some might say is a bad quality of life, others might say is perfectly acceptable, thank you very much for your opinion. Moreover, in the end, such approaches reward the politically powerful with complete coverage while denying those on the outskirts. We saw this in Oregon when it created its Medicaid rationing scheme that omits some life-sustaining or curative approaches for the terminally ill. The thing is: When first conceived, late stage AIDS patients were to be listed among those rationed out. But the politically potent AIDS community engaged and that exclusion was, shall we say, remedied.

I don’t blame AIDS activists, but other disease communities didn’t have the same clout, the point being that if you want to increase the politicization of medicine and turn MS patients against cancer patients, against people with profound cognitive or developmental disabilities, against people with Alzheimer’s—health care rationing based on quality of life is the way to do it.
Let’s learn from the UK and find a better way.