Saturday, September 15, 2007

National Health Service Refuses To Treat Broken Ankle

To hear some people tell the tale, if the U.S. had a national health system, like Britain, Americans would be so much better off. But as this news account from the September 14, 2007 Daily Mail reminds us, there's a cost to having the government exercising a monopoly:
A man with a broken ankle is facing a lifetime of pain because a Health Service hospital has refused to treat him unless he gives up smoking.
John Nuttall, 57, needs surgery to set the ankle which he broke in three places two years ago because it did not mend naturally with a plaster cast.
Doctors at the Royal Cornwall Hospital in Truro have refused to operate because they say his heavy smoking would reduce the chance of healing, and there is a risk of complications which could lead to amputation.

They have told him they will treat him only if he gives up smoking. But the former builder has been unable to break his habit and is now resigned to coping with the injury as he cannot afford private treatment.
He is in constant pain from the grating of the broken bones against each other and has been prescribed daily doses of morphine.
Mr Nuttall, of Newlyn, Cornwall, broke the ankle in a fall in 2005. Initially he refused surgery because he had caught MRSA at a different hospital four years earlier, and was terrified of history repeating itself.
He hoped the fractured bones would knit together with a standard plaster cast to immobilise his ankle.
But six months and three plaster casts later, it became clear that an operation to pin the bones was the only solution.
I can understand the National Health Service's concerns--Mr. Nutall is engaged in a dangerous habit, and it will make it more difficult for him to recover from this surgery. Like all health systems, it is having to make decisions about how to allocate resources. Should it spend it on someone who is behaving foolishly by continuing to smoke? Or spend it on someone else?

Now, I expect that most liberals would regard this is a wonderful thing--the NHS has told him to stop smoking, or they won't do this surgery. But imagine if President Clinton's single payer health insurance scheme gets implemented. Will they be deciding that people who continue to engage in unprotected casual sex are doing the equivalent of continuing to smoke, and refuse them treatment for future STDs (including AIDS)? What about people that are carrying an extra fifty pounds? Using this same model of allocating health care resources to those who aren't actively aggravating their health risks, that would be a rational response.

Pretty obviously, the ACLU would file suit alleging that the casual sex ban discriminated against homosexuals, and the courts would certainly agree. Those who are a little heavy, however, aren't going to be so lucky in challenging this in the courts.

I'm not saying that the current health system in America does any better of a job on this--although in my experience, the most that insurers do here is to charge different health insurance rates for smokers and non-smokers. What am I saying is that those who look to single payer health insurance or a socialized medical system need to look at how those systems actually work, not just at how they want them to work.

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