November 10, 2011

Your Future Under ObamaCare: Pain Panels

Hatched by Dafydd

President Barack H. Obama himself has admitted that what he really wants for American health care is single-payer, one-size-fits-all socialized medicine. Well we have many examples to choose from, including Japan, Canada, and of course Great Britain's National Health Service (NHS).

We already know about the NHS's death panels; doctors and even nurses frequently write "do not resuscitate" on patients' charts -- without telling friends, family, or even the patient himself what won't happen if he has a cardiac arrest. Why bother to let patients know they've been marked for expiry? They would only intrude upon a decision that should only be made by experts!

The motive should be clear: When the government pays for all health care, it has an obvious conflict of interest; every patient allowed to die, rather than kept alive by "heroic efforts," is another load of medical outlays off the Health Minister's plate. Word is passed along to the government-controlled hospitals (typically by a nod and a wink), and doctors and nurses receive the message loudly and clearly.

But wait, we still have a problem... those wily patients who require medical treatment, including expensive painkilling medication, but who contrive to avoid having a heart attack by which they can be eased off the ministry's books and into the afterlife (where some higher ministry can pick up the tab). How can the NHS -- and the endgame for ObamaCare -- avoid all those nasty, expensive medical payments?

Very simply, and Britain's National Health Service leads the way: A government in financial trouble must foster an anti-treatment, anti-painkiller health-care culture. In clearer words, the NHS now needs pain panels to determine who gets painkillers (and how much), and who is left to suffer:

In Britain, the popular U.S. painkiller OxyContin is considered similar to morphine and used sparingly. Vicodin isn’t even licensed. And at most shops, remedies like ibuprofen are sold only in 16-pill packs.

To avoid risks including addiction, strong painkillers are often kept at arm’s length from patients -- even if that means some people will be left suffering....

For people seeking relief from everyday pains like headaches or sore muscles, painkillers like acetaminophen, sometimes sold as Tylenol, and ibuprofen are only sold in limited quantities. By law, most shops can only sell packs of 16 tablets and no one is allowed to buy more than 100 pills at once without a prescription.

The basic argument is pure utilitarianism; too many patients who require too much help, costing the ministry too much money, equals a major crackdown on expensive painkillers. Some physicians don't even bother to dissemble anymore. Here's my favorite, from "Dr. Anthony Ordman, founder of a pain clinic at London’s Royal Free Hospital":

Ordman also said British doctors may be less inclined to automatically do what their patients want. "In the U.S., doctors might wish to please their patients and prescribe them something because they’re clients," he said. "But in the U.K., the patient doesn’t pay the doctor directly so I can choose not to prescribe painkillers without the fear of suffering financially myself." [Emphasis added -- DaH]

(Which reminds me of Saturday Night Live's fake motto for Bell Telephone: "We don't care. We don't have to. We're the phone company.")

Not all doctors are on board the pain train:

"To make it harder to prescribe enough painkillers for a patient in agony is wrong and essentially a form of torture," said Dr. Michael Platt, lead clinician for pain services at St. Mary’s Hospital in London. "Either we need to treat the pain properly or we tell the patient they are just going to have to suffer."

After the next election, when ObamaCare fully kicks in, see if you can guess which of those two alternatives the administration will push. (Hint: Time to start hoarding aspirin, Motrin, and Tylenol.)

Hatched by Dafydd on this day, November 10, 2011, at the time of 3:28 PM


The following hissed in response by: Robert Dammers

I think you are confusing three different statist problems here:

Firstly, I agree that there is obviously the issue of cost to the NHS - so prescribed painkillers are subject to constraint, just like any other medication under prescription. However, there has been an increasing trend to move certain commodity medication off prescription - for example, Hydrocortisone cream is now available from a pharmacy at personal expense without a prescription. This *can* kick in the second issue:

Secondly, there is a medical/puritanical objection to over-medication - in the case of steroids, extended use can give rise to problems, so the pharmicist is supposed to "police" over-use. The second part of this is addiction: codeine and paracetamol/aspirin medications are available off prescription. Pharmacists are supposed to notice patients over-medicating, and cut them off.

Thirdly, there are crazy regulations aimed at preventing attempted suicide via overdose of Aspirin or Paracetamol (Tylenol in the US). This is why supermarkets are only allowed to sell in units of up to 16 tablets. This nonsense directly parallels the gun control fallacy but, alas, is persuasive to regulators.

Until you can get Obamacare repealed and replaced, the key thing is to ensure that provision does not become mandatory and exclusive. That was the case in Canada, until their supreme court intervened. It has never been the case in the UK, despite the wishes of the welfare-staters. All the while you have external provision and insurance schemes (even if these are non-profit or charitable), there is hope to restart an open health care system.

Good luck!

The above hissed in response by: Robert Dammers [TypeKey Profile Page] at November 14, 2011 7:17 AM

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