A sacred cow in dire need of slaughtering

Scirocco (Almost!) 2 Morocco 2008 4 Leukaemia & Lymphoma

Sticking with the theme of taking a sledgehammer to some of Britain's most beloved institutions, it would appear that one Mike Portnoy was on the receiving end of this country's idea of "free and fair healthcare":


This is the reality of socialised medicine: long waiting times, lousy service, and a very high likelihood of being neglected if your illness isn't "serious" enough to warrant attention.

Given that Mike Portnoy had a fever of nearly 39 degrees Celsius- that's roughly 3 or 4 degrees above normal body temperature, indicating a very serious infection- and was not seen for hours after he arrived, one has to wonder just how seriously sick he would need to be in order to get an NHS doctor to see him.

When Americans are told about the wonders and virtues of "free" health care, those making these claims usually start with the British, French, or Canadian (more specifically, Quebecois) health care systems. After all, these systems are FREE for anyone who wants to use them!

Er... right?

Well... no. No, they're not.

In reality, the concept of "free at the point of use" is founded on literally Marxist economic principles. The basic idea is very simple: you make health care free, you invest in the system to ensure that everyone, no matter how rich or poor, is given the same level of service, and you remove the need for worry or choice from the patient so that he can simply worry about getting better.

This is all very well in theory. In practice, it simply does not work.

By removing the concept of "cost" from the question of health care, the linkage between price and value is immediately cut. And in so doing, resource allocation becomes simply impossible. After all, how is a hospital supposed to assign resources if it doesn't know the relative costs involved between treating someone for a relatively simple clean break of a limb, compared with treating someone for brain cancer?

I am simplifying matters dramatically, obviously, but the basic problem remains. Socialised health care is blind to the most efficient resource allocation mechanism that we have available to us- prices that respond to consumer demand and producer supply.

It is for this reason that, in socialised health care regimes, relatively cheap and simple surgery is usually preferred over more expensive, less invasive, and less dangerous targeted drug treatments. This is unsurprising when you realise that the process of developing new drugs to treat specific ailments can cost upwards of a billion dollars and ten to twenty years to bring to fruition. (I have a better understanding of this than most- my biggest investments are in drug companies, and members of my family have worked both in the pharmaceutical industry and as doctors in hospitals.)

Take, for example, the case of drug-coated stents. Now these are, quite simply, brilliant inventions- yes, I'm aware that there are quite a few questions about whether Boston Scientific's and J&J's drug-eluting stents are actually any more effective than regular wire-mesh stents, but let's leave that aside for now. A stent is basically a wire-mesh apparatus that can be inserted into an artery or large vein near the heart that is clogged with plaque due to inflammation of the arterial walls. It requires a simple, small incision in the groin, followed by a wire that pushes the stent into place. The stent, which is wrapped around a sort of "balloon", is then inflated and secured in place, rapidly increasing blood flow through the affected blood vessel.

It's an ingenious idea that basically has rendered nearly- though not entirely- obsolete the standard bypass surgery that was once commonly used to deal with patients at severe risk of heart attack due to clogged arteries.

The problem is that these stents are not cheap. Which is why the NHS's own cost-benefit guidelines dictate that they should only be used when the patient in question has at least two major risk factors for serious heart disease- and is only recommended by the Orwellian-sounding National Institute for Clinical Excellence (NICE) and its research partners in about 4% of all heart patients.

Simply put, surgery is far cheaper for the NHS to perform than more effective, but more expensive, non-surgical alternatives. The trouble is, surgery tends to be a nasty, bloody, beastly business that involves considerable trauma on the part of the patient. In some cases, surgery may well be justified over drug treatments- but in those cases, less invasive and dangerous methods are to be preferred over more invasive ones.

However, laparoscopic or "keyhole" surgery is also jolly expensive- I happen to know because I once invested in a company called Intuitive Surgical, which specialises in making machines designed specifically for keyhole surgery. (That investment returned something like 150%- and I still sold too soon!) The machines are highly advanced- and hugely expensive, though they are getting cheaper with time and expanded usage.

Now, in the US, a lot of the expense is dealt with through insurance. In the UK, such a concept is very rare- it is expected as Right and Just that the government pays for all health care, all the time. I'm not going to try to justify the American insurance system- there is a very great deal wrong with it, though most of that mess was caused by (you guessed it!) government intervention in what was once a healthy free market. The net result is that Americans have a degree of choice and freedom about their health care decisions that is truly rare among developed economies- mostly because, unlike the rest of the Western world, Americans don't yet think of health care as a "right".

Instead, it is still treated as what health care truly is- a good or service, just like any other.

Here in the UK, though, that concept has long been removed from daily discourse. The very idea of paying for health care shocks the bejeezus out of Brits- when they cross the Pond, they are often truly bewildered by what they find the moment they get the sniffles.

The end result is what Mike Portnoy experienced: a health care system that is overworked, overburdened, incapable of handling the overwhelming demands placed upon it, and quite content to neglect people. This is especially true of old people, who suffer under socialised health care systems in ways that are truly unimaginable to retired old geezers in Florida and Arizona.

(I will state, in the NHS's rather tepid defence, that they are rather good with children. The Great Ormond Street Children's Hospital, which I used to live near when I was a student, was and is one of the best children's hospitals anywhere.)

Look, no messing about and no jokes here- I wish Mike Portnoy good health and a speedy recovery. He's one of the greatest drummers in the world. But his example goes to show what the British people should have learned long ago, and will probably only learn when their much-vaunted system of "free" health care comes crashing down about their ears: this sacred cow of theirs needs to be turned into cheeseburgers, and the sooner, the better.

Cheeseburger T-shirt! Holy cow! I want to sooooo rock this shirt!!!!
Somehow I'm hungry all of a sudden

Speaking of Mike Portnoy:

(Personally I think Marco Minneman and maybe Aquiles Priestier are better drummers... but not by very much. And NO ONE beats The Professor when it comes to awesome drumming.


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