Posted on 12/17/2005 2:43:07 PM PST by billorites
London—Britain's cherished universal health-care system has started denying treatment to fat people.
The first official move to refuse surgery happened last month when a local health authority in Ipswich, northeast of London, announced that obese people would not be given hip and knee replacements.
The move, which has been met with both praise and condemnation, comes amid a story all too familiar to Canadians — hospitals facing cash shortages at a time when the population is both growing and aging.
Dr. Brian Keeble, head of public health for Ipswich, acknowledged that while the added risks of hip and knee surgery on obese patients were a factor in the move, so was the reality of limited resources.
"We cannot pretend that this work wasn't stimulated by pressing financial problems," Keeble said in a statement of the list of services being reduced to save money, with joint replacements being the most controversial.
Keeble added that given the increased failure rate of the procedures on overweight people, the limited amount of money available is better spent on slimmer patients.
The Ipswich group has set a body mass index of 30 — the World Health Organization's definition of clinical obesity — as the threshold at which surgery will be denied.
Currently, one in five men and one in four women in the U.K. are obese.
Michael Summers, chair of Britain's Patients Association, a charitable advocacy group, said the move amounts to discrimination.
"Obese or large people are as entitled to these surgeries as anyone else because they pay for the NHS (National Health Service) just like everyone else does," he said of the taxpayer-funded health-care system set up in 1948. Along with social assistance, it's a key part of Britain's welfare state.
"It is meant to be available to all; that was the entire premise. And one might argue the elderly in need of hips and knees are even more deserving because they have been paying for it even longer," Summers said of the system.
The surgery limit has also ignited debate on whether or not smokers suffering from lung ailments will be the next group to be denied treatment if they refuse to kick the habit, and whether this trend amounts to an attack on the poor, who have rates of both smoking and obesity much higher than middle- and upper-class Britons.
"It's a slippery slope and it's not what doctors are supposed to be doing with their time," Summers said of putting physicians in the role of judge.
But Tony Harrison, of the independent London think tank the King's Fund, said the move amounts to a good dose of common sense given the reality of limited resources.
"Rationing is a reality when funding is limited," Harrison said, adding responsible health-service providers have an obligation to taxpayers to get the most benefit out of the money they're given.
Harrison said the lower success rates for hip and knee replacements in obese patients cannot be ignored.
"Ability to benefit is a key criteria. It is a valid point. If chances of successful outcomes go down, you are wasting money."
The move is also tacitly supported by the government body charged with giving guidance to local health authorities on what they should fund.
While stating in a new report that income, class or age should not be factors in deciding treatment, the body, known as NICE (National Institute for Health and Clinical Excellence), leaves room for doctors to deny treatment based on cost.
"If, however, self-inflicted cause/causes of the condition influence the clinical or cost effectiveness of the use of an intervention, it may be appropriate to take this into account," it states.
In a scenario mirrored in Ontario in recent years, the Labour government of Prime Minister Tony Blair has poured money — raised through a dedicated tax — into the health system amid election promises to dramatically reduce wait times for a host of procedures.
While most agree that the system has improved dramatically as a result, local hospitals say they are being forced to make cuts in some areas in order to deliver on wait time promises in others.
In Canada, federal Health Minister Ujjal Dosanjh hailed standardized wait times agreed upon last week, which sets 26 weeks as the maximum time a person should be expected to wait for a new hip or knee.
There are currently no formal weight restrictions for the procedure in Canada, although it is not unusual for a doctor to advise a patient to lose some weight before the surgery in order to reduce the risks associated with the anaesthetics used and to speed recovery.
Dr. Peter Schuringa, president of the Ontario Orthopedics Association, said Canada should not take any lessons from the British attempt to ration health care based on a patient's lifestyle.
"Before we start telling people they cannot have a procedure because of how much they weigh, we've got to find more creative ways to improve the system and to finance more procedures," he said in a telephone interview from Kitchener.
Schuringa stressed that finding new ways to fund more procedures in Ontario needs to happen without punishing patients for being overweight.
"That's a very complicated issue, in part because people's ability to exercise and lose weight is often severely compromised if they are suffering from arthritic knee or hip joints," he said. But he added that patients awaiting joint-replacement surgery are often advised to lose weight before their operations
Most doctors also believe that replacement joints last longer if patients are of normal weight. Schuringa noted that may reduce the need for future surgery, saving patients pain and stress and the health-care system money.
In Britain, the debate over how much patients can reasonably expect of a taxpayer-funded health-care system has been raging in recent weeks over both the joint-replacement issue and the death of soccer legend George Best. An alcoholic, he received a liver transplant in 2002, but fell off the wagon after his surgery and his health declined, leading to rejection of the liver.
The Europeans let them get away with this abuse. Americans would, too. If we had socialized medicine, Conservatives would be screeching that anyone who smokes, eats sweets, is fat, drinks booze, rides motorcycles, goes sky diving, sking, biking, etc. do not deserve their tax dollars becasue they are taking unnecessary risk. Liberals would be demanding we stop treating old people and people with birth defects and let them die because they have a useless life.
You should live your life whatever way you want to. Just don't expect other people to subsidize it.
ThunderThighs the Hildabeast is getting goosepumbs of delight just reading about the Socialist Healthcare Dictatorship implied in this ruling.
Yes, but she couldn't get knee or hip surgery because of her thunder thighs. Too fat.
Only if you don't really bother to do all the calculations. First of all, on average, obese people are less productive than normal weight people, have lower incomes, and therefore pay less in taxes. Furthermore, "paying" for the NHS comes in two forms: paying taxes for the system's financial inflow, and making the needed effort to take care of one's own health and avoid preventable illness, so as to minimize the system's financial outflow. Again, on average, obese people are not pulling their weight when it comes to helping minimize the financial outflow. In general, I think it's an excellent idea for both government-funded (which really shouldn't exist) and privately funded health care programs to deny or limit coverage to people with self-inflicted ailments. In the case of obesity, however, exceptions need to be made for people whose obesity is clearly the result of some other disorder that is not self-inflicted. Medical science has some work to do before that determination can be made with much confidence, but it's an avenue of research well worth pursuing.
A study a year or so ago found that about 50% of the total health care tab in the US is attributable to obesity. Stop covering that group and we'll be in for a huge tax cut. And given the incentive of stay slim or no medical care that you can't pay out of your own pocket, and quite a lot of people will find a way to lose weight or avoid obesity in the first place, and that will have a very salutary effect on both the general health of our population, and on the economy as people live longer and work more effectively due to better health.
For insurance policies I have to agree not to engage in certain high risk behaviors like cage diving, sky diving, hang gliding, etc. I don't see why it is that government should have to pay for things that certainly could have been avoided and that's one of the problems with socialized medicine, namely, they should be able to hold people accountable for the money.
Easy solution is for them not to be in the business.
I'd like to see you hold that gun steady during surgery. =)
Don't you know? The Socialst Masters never have to follow the rules they lay down to the Socialist Slaves.
Yes. Armed and legged.
You can get dental care; they just don't provide Novocain. I'm not kidding.
but in the case of the overweight person, they're being told that they can't have the procedure. They do have the honor, on the other hand, of paying for the procedure that they're denied, for the "normal weight" person.
So they get nothing and the other person gets a double helping at their expense.
Who exactly is being subsidized here?
By this logic, no one in Britain should be allowed dental care since the entire country has a penchant for sweets.
But the British military WILL pay for breast enhancement for it's soldierttes.
Go figure.
The difference is that you have the option of going with that particular insurance company or not.
in this case, the overweight person has no choice in paying the taxes that support someone else getting their replacement while the overweight person doesn't get theirs and lives in agony for the rest of their days, while still paying for someone elses hip replacement.
What the govt giveth, the govt taketh away.
NEVER TRUST GOVERNMENTS TO DO FOR YOU! DO FOR YOURSELF!
Wonder if they are denying health care to HIV positive homosexuals, because it is asinine and too expensive to extend health care to those living such an unhealthy life style?
Along the same lines. Nothing will ever cost less than the amount it is subsidized for.
i think the concept that NHS is the ONLY option for that vast majority of brits and that they are taxed VERY HIGHLY for it is escaping some of the folks here.
I look for the UK to eventually start denying certain treatments to people with certain gene characteristics, or to revoke treatments from people who violate certain behaviorial guidelines, example your genes show predisposition to liver problems, so they deny you right to drink alcohol on penalty of losing medical care. It is a perfectly logical development of the all-encompassing, ever-present State they are building.
Anyone who thinks this is the least bit far-fetched either doesn't follow domestic news and policy issues in the UK or doesn't remember that today's domestic laws and headlines were considered biting satire and parody less than a generation ago, heck 15 years ago.
Don't kid yourself. We've been doing it here for quite some time now. It was about 20 years ago when I was told that the insurance would cover physical therapy and Arthroscopic meniscus trimming, but no way were they going to cover ACL reconstruction for "someone your age unless they're an athlete."
They'd trim out part of my meniscus, to alleviate some of the pain, and maybe increase my ROM slightly, but I was gonna have to live with that streeetched ACL -- because I was not an athelete.
"Sports medicine" has juice.
"Old" (40ish) schlub getting "field-reconfigured" in a car wreck can go to the back of the bus and wait for the nurse with the pain-treatment cart.
The surgeon (a fairly prominent "big guy" in that specialty) wasn't the least bit apologetic about it. He just rattled it off... that's the way it is, tough break, you're no "athlete", you don't rate, so don't even think about it.
My mistake was breaking my knee (and wrecking my neck and spine) getting rear-ended at an intersection, rather than while playing rugby.
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