UK health system considers banning surgery for smokers and the obese


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Coming to a single-payer plan near you! Great Britain’s nationalized health system has proposed banning surgeries for anyone who smokes or is overweight.

In recent years, a number of areas have introduced delays for such patients – with some told operations will be put back for months, during which time they are expected to try to lose weight or stop smoking.

But the new rules, drawn up by clinical commissioning groups (CCGs) in Hertfordshire, say that obese patients “will not get non-urgent surgery until they reduce their weight” at all, unless the circumstances are exceptional. The criteria also mean smokers will only be referred for operations if they have stopped smoking for at least eight weeks, with such patients breathalysed before referral.

East and North Hertfordshire CCG and Herts Valleys said the plans aimed to encourage people “to take more responsibility for their own health and wellbeing, wherever possible, freeing up limited NHS resources for priority treatment”. Both are in financial difficulty, and between them seeking to save £68m during this financial year. [emphasis mine]

This is what happens when you centralize control of an industry into the hands of government. Rather than compete and find ways to better serve their customers while saving money, as the competitive private market does, a centralized top-down government operation rations services so that fewer people can get them.

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30 comments

  • LocalFluff

    If obese smokers were also made tax exempt, since they lose their so called welfare benefits anyway, I’d consider changing my life style for financial gains!

    In Western Europe, statistics is grossly distorted by the millions of arabs immigrating every year. They remain totally unintegrated. Islamic life style combined with free modern food leads to massive obesity among children and women, who are practically not allowed to do any healthy exercise. We all adopted the Schwarzenegger and jogging trend of the 1980s. Swedish kids don’t grow fatter. What has happened to the average is that lots of fat and careless pigs have immigrated.

  • Andy Hill

    This is what you get when the management of the NHS has been turned over to private health trusts with multilayers of management that are all being paid from the same funds that should be going to patient care, not to mention the profits that are taken by the share-holders of these trusts.

    CCGs are just another layer of management with the addition of senior medical staff, I suspect most of these people have not had to actually treat a patient in some years and normally sit behind a desk somewhere fulfilling an administrative function.

    The NHS was originally envisioned as being a safety net for those who could not afford to pay for a doctor, it is now being asked to provide a wider and wider range of procedures and support for an ever aging population, this is nothing to do with centralised government control.

  • wayne

    Andy-
    have to strongly disagree.

    Highly recommend these 2 lectures (from a series of 6, “Britain in the 20th Century.”)

    “The British Attempt to Construct a Socialist Commonwealth, 1945-1951”
    Gresham College Public Lectures
    https://youtu.be/TEgvxQ_OhcU
    1:01:24

    “To the surprise of many, the 1945 general election led to the return of Britain’s first Labour majority government. Labour’s 1945 election manifesto declared that it was a socialist party and proud of it. The Attlee government created the modern welfare state and the National Health Service, and nationalized the public utilities. It sought to construct a New Jerusalem, a socialist commonwealth.”

    Britain in the 20th Century:
    “The Collapse of the Postwar Settlement, 1964-1979.”
    Gresham College Public lecture
    https://youtu.be/qUipv0U97L8
    46:00

    “The 1960s saw a new course in British politics — the commitment of both major parties to entry into the European Community, as the European Union was then known, and a conversion to the doctrine of planning. This involved a greater degree of state intervention in the economy, together with the control of incomes and a recasting of the system of industrial relations.
    This caused problems which put the authority of government in question. In the February 1974 general election, voters were asked to resolve the issue of ‘Who Governs?’ Both Labour and Conservative administrations sought to assert themselves against the trade unions. When, in the ‘winter of discontent’ of 1979, it seemed that government had become too weak to do so, the postwar settlement collapsed.”

  • Michael Dean Miller

    First the smokers, then meat eaters, then eaters of eggs, then beer drinkers, pot smokers, then racists then native citizens ….. you get the picture.

  • Andy Hill

    Wayne

    what part do you disagree with, the origins of the NHS or that there appears to be a lot of extra management and admin sucking money out of it?

  • eddie willers

    First the smokers, then meat eaters, then eaters of eggs, then beer drinkers, pot smokers, then racists then native citizens ….. you get the picture

    “Anyone not in perfect health is exempt from all treatment”.

  • wayne

    Andy–
    Fully agree that socialized medicine inherently contains all the evils of big government operation’s.
    As to the origin’s of socialism in Britain. it goes way back (see: https://en.wikipedia.org/wiki/Poor_Law_Amendment_Act_1834) even before that period. In a more contemporary sense–they learned from the master Statist himself, and promptly started exporting it to the United States at the start of the prior century. The 1st world war delayed it a bit but the Fabian socialist’s won out.
    We just resisted longer than the British. And now it’s being imposed on us.

  • wayne

    Michael/eddie-
    good stuff!

  • Andy Hill: The extra management and administrative layers are the normal symptom of a centralized government-run top-down bureaucracy. The UK government might claim that these new layers were their attempt to privatize the NHS, but as long as ownership belongs to the government and the doctor and patient do not deal directly with each other for treatment and payment, the system has nothing to do with private enterprise and the free market.

  • Des

    There are plenty of problems in the NHS, but private health insurance is available in the UK. It is very competive in price compared to US because the NHS covers 90% of needs and so if price isn’t kept low people wouldn’t bother buying insurance. The competition between public and private provision is the free market in action. The NHS has no need of the large bureaucracy needed by private US hospitals to track billing and to chase payment.

  • wayne

    Des-
    I must disagree. (Are you a citizen of the USA?)

    Ref:
    “The competition between public and private provision is the free market in action.”
    I would respectfully put forth the proposition: that statement, is insane.

  • wayne

    “Aneurin Bevan and the Socialist Ideal ”
    Gresham College, Vernon Bogdanor
    https://youtu.be/3vgye4SvAzQ
    59:17

    “Aneurin Bevan was the leading postwar representative in Britain of the socialist ideal. He is best remembered for the creation of the National Health Service which he regarded as a symbol of applied socialism, a national service free at the point of use and available to all. But, even before he resigned from the postwar Labour government in 1951, this ideal was being eroded.”

  • Andy Hill

    Mr Z

    While you can claim that “The extra management and administrative layers are the normal symptom of a centralized government-run top-down bureaucracy” which is a perfectly true statement, it is also true that there are plenty of private companies skimming money out of the system making things worse.

    Having lived in the UK all my life (5 decades and counting) I have seen the effects first hand of turning a lot of the management of the NHS over to the private sector, its not been good for the people using the NHS.

  • Andy Hill: We agree completely. I have found that these fake schemes to “privatize” a government operation never work. They merely end up to be another way to steal from the taxpayer.

    What needs to happen is to stop asking this stuff to be regulated and controlled by the government. Let freedom be the watchword. It carries risks, but it always works better overall, making everyone wealthy and happier as a general rule.

  • wodun

    Des
    October 18, 2017 at 2:01 pm

    The competition between public and private provision is the free market in action. The NHS has no need of the large bureaucracy needed by private US hospitals to track billing and to chase payment.

    A) I don’t think you know what a free market is.

    B) The NHS has a huge bureaucracy. Although, you are right to point out how government interference drives up costs.

  • wodun

    Andy Hill
    October 18, 2017 at 4:01 pm

    it is also true that there are plenty of private companies skimming money out of the system making things worse.

    That is what happens when you have a corrupt state run system. A lot of the corruption in the American system also comes from the government.

    The best thing we could have is a system were individuals make their own health care decisions and providers are free to decide how best to meet the needs of hundreds of millions of individuals rather than a handful of politicians and their corrupt partners in the insurance industry.

    Business school teaches that most of the problems with employee performance usually stem from management incentiveizing the wrong things. These are perverse incentives. There is no single person, or even a small group of people, who possess the knowledge necessary to avoid perverse incentives when controlling the health care industry. But no one wants to admit the problem is the management, instead they call for more managers and more meddling by managers.

  • wayne

    “With a few exceptions contemporary commentators on economic problems are advocating economic intervention. This unanimity does not necessarily mean that they approve of interventionistic measures by government or other coercive powers. Authors of economics books, essays, articles, and political platforms demand interventionistic measures before they are taken, but once they have been imposed no one likes them. Then everyone—usually even the authorities responsible for them—call them insufficient and unsatisfactory. Generally the demand then arises for the replacement of unsatisfactory interventions by other, more suitable measures. And once the new demands have been met, the same scenario begins all over again.
    The universal desire for the interventionist system is matched by the rejection of all concrete measures of the interventionist policy.”
    “A Critique of Interventionism”
    1929
    Ludwig von Mises

  • Edward

    Des wrote: “[private health insurance] is very competive in price compared to US

    But it is not competitive in price compared to the NHS, which costs nothing at the time of treatment. Whether private health insurance is purchased in the UK, the patient still has already paid for NHS healthcare. Whether the citizen uses it or not, he still has already paid for NHS healthcare. Whether he is healthy and does not use it at all or is an overweight smoker whose lifestyle has caught up with him, he still has already paid for NHS healthcare. So after paying once for medical care, the patient is expected to pay again just to actually receive it?

    In fact, the overweight smoker has already paid for NHS healthcare even when the government declares that he remains at the back of the waiting list for care.

    When, in a free country, did it become acceptable to force someone to pay for something he is never allowed to use?

    From the article: “Joyce Robins, from Patient Concern, said: ‘This is absolutely disgraceful – we all pay our taxes, and the NHS should be there when we need it; we did not agree to a two-tier system.’

    Andy,
    https://www.nhs.uk/nhsengland/thenhs/about/pages/nhsstructure.aspx
    Whether the NHS contracts with private providers or with other providers, the contracts define the availability of NHS care. The NHS reports to the Department of Health, which reports to the Secretary of State, who is the central governmental leadership with the overall responsibility for the NHS and social care, at least in England.

    The NHS has everything to do with centralized government control. In this case, it is the centralized government controlling people’s lifestyles and behaviors. As should any and every freedom-loving, non-socialist, non-authoritarian, non-tyrannical, free country. [Oops, sarcasm alert for that last sentence.]

    From the article: “In a forward to the consultation outcomes paper, the CCGs’ chief executives said the region faced a £550m health and social care funding gap by 2021 unless they took action.

    Meaning that in a socialized medicine country, the citizenry’s health is dependent upon the country’s budget. In contrast, in a free market capitalist country, the citizenry’s health is dependent upon the citizenry’s willingness to pay for their health. Those who take care of themselves should be allowed to purchase the healthy-person’s insurance policy. Those who don’t should be allowed to purchase the don’t-take-care-of-myself policy. My homeowner’s policy is similar in that I pay less because I have deadbolts, a fire alarm, and fire extinguishers.

    Those who are young and healthy should be allowed to purchase a young-and-healthy policy and to save for their old age, or to not purchase any policy and save even more. Those who are old and past their golden years should be allowed to purchase an old-and-no-longer-healthy policy with the money that they saved for their old age. Those who didn’t save for their old age had a better lifestyle when they were younger than those who did save. This is what freedom looks like; you get to choose how you want to live, not the government choose for you.

    When the government chooses for you, it chooses what is best for government, not what is best for you. Only you know what is best for you. Government may think that it knows best, but it doesn’t respect you; it neither knows you nor cares about you. This is why when it has a budget shortfall that it, not you, created, it chooses to let you suffer. When government creates a problem, those who created it do not pay the consequences, you do. Thus the people who run government need not be smart and competent but can be weak and selfish.

    When government chooses for you, it chooses wrong, every single time, but it thinks it chose well and pats itself on the back.
    https://www.youtube.com/watch?v=IEDu9jVpUjI (The Giver, 16 seconds)

    No wonder the NHS’s choice is, as Joyce Robins said, “absolutely disgraceful.

  • Phill O

    If some body else pays the cost, we all will live a more risky lifestyle……….

    In Canada, the wait times are enormous. Not treating health issues which are preventable is less burdensome to the general tax payer. Why should I pay for somebody else’s excesses. This is where the user pay system has its greatest draw for me. Also, take the middle men (or women) out of the equation, then costs drop. Hospitals etc charge what they think they can get away with. With “free” health care in Canada, the dentists and optometrists-opticians raise their prices because people have “extra” money.

    The user pay system is very good. If you abuse your body, you pay the price. If the government put you in a risky situation (armed forces) they should pay the price of your health.

  • wayne

    Phill O:

    You often say some very interesting stuff & I appreciate news from Canada, but… I must challenge you on the whole “middleman” ‘thing.
    Highly recommend this to you, (and I think you would intuitively like it.)

    Prof Mike Munger on Middlemen
    Econ Talk with Russ Roberts
    http://www.econtalk.org/archives/2008/10/munger_on_middl.html

    “Mike Munger of Duke University talks with EconTalk host Russ Roberts about the often-vilified middleman–someone who “buys cheap, sells dear and does nothing to improve the product.” (or does he?) Munger explains the economic function of arbitrage using a classic article about how prices emerged in a POW camp during World War II. Munger then applies the analysis to the financial crisis.

  • Michael

    None of this will, of course, apply to members of Parliament.

  • Phill O

    wayne I am not attacking the middleman. I am saying that the medical system will charge more if they know an insurance company is paying the bill. The other part is that they have to charge more because of all the red tape required when there is an insurance company.. Put government in the place of the insurance company and this problem gets worse because of even more red tape. I preferred to consult directly with a company rather than use a government program to offset the costs. If we tried a gov. assistance program, I found quite quickly I needed to charge 3X for the paperwork etc required. The same can be said for an insurance company instead of paying the doctor etc directly.

    This is not to say that getting folk together to get better rates from an insurance company bad; it is very good. Going nationally for insurance is sure better than staying in a province or state. Being able to construct a plan to meet individual needs is better than making everyone have the same. I do not like paying for others abuse of the system (as is in Canada).

  • LocalFluff

    “- ‘We’ will pay for you health care, aren’t we very nice aren’t we? Say thank you very much.
    – Thank you very much.
    – Now, since we pay for your health, it is only fair that we decide everything that happens with you body, since we pay for it, isn’t it? Or else the system doesn’t work and you die.”

  • wodun

    Healthcare can’t be a right if the government can restrict who can access health care just because the government doesn’t like you.

  • Edward

    wodun,
    Are you saying that the UK government has taken away from the obese and the smokers their right to healthcare?

    That cannot be! Socialist systems are supposed to be compassionate. The socialist motto is: “From each according to his ability, and to each according to his need.” [Emphasis mine.] If the smokers and the obese need the healthcare, then the socialists’ obligation is to supply it to them. If the smokers and the obese are less able to be productive (perhaps because they spend so much time in ill health), then it is the socialists’ obligation to accept whatever little they can produce.

    Please do not tell me that the socialists are actually mean spirited, like the US’s Republicans. Or like the Plymouth Colony Pilgrims, when their socialist experiment failed in deadly disaster, and they converted to free market capitalism, prospering into a major world power capable of saving the world from two worldwide wars, three centuries later, complete with a Constitution guaranteeing — and providing — liberty, freedom, and justice for all.

    [Do I need a sarcasm alert? I’m pretty sure that there is sarcasm in there, somewhere.]

  • pzatchok

    Don’t count on a socialist government to provide anything.

    But count on your fellow mans greed. Mans greed is what creates and drives a free market.
    The supplier of the good or service lets his greed drive his prices up as high as possible, the consumers greed to not spend his money is what drives the prices down. Eventually coming to an equilibrium.

    At what point in this cycle did the Obama government step in and make things better?
    Did Obama care make the supply better? No it just ordered the suppliers to offer everything all the time to everyone. They are now restricted in what type of insurance they can offer each person.
    Did Obama care make it more economic for the customer? No they didn’t put a single price control in place and forced everyone to purchase the product. They now force you to buy only whats offered, at the price offered.

  • Edward

    pzatchok wrote: “Don’t count on a socialist government to provide anything. But count on your fellow mans greed. Mans greed is what creates and drives a free market.

    Adam Smith put it this way in his book “An Inquiry into the Nature and Causes of the Wealth of Nations” (I love the full name, not the shortened version): “It is not from the benevolence of the butcher, the brewer or the baker that we expect our dinner, but from their regard to their own interest.” This has been interpreted as being self-interest or even enlightened self-interest.

    The difference between that and greed is that greed expects unearned benefits, but self-interest expects a fair trade for the value of those benefits.

    A free market works on fair voluntary trades. Government-mandated purchases or taxes destroy free markets in order to favor either the greedy government or a greedy friend of the government or to punish an enemy of the government.

    An example of greed is when government takes our money then refuses to provide the promised healthcare benefit. The government becomes greedy at our expense. If an insurance company did this then everyone would be outraged at its greed, but the government does it expecting that everyone will accept the government’s greed. The Robin Hood and Zorro stories are about reactions to governmental greed.

    This is why it is so much more fair for us to be allowed to choose our own insurance policies and the benefits that go along with them. We choose which benefits we are willing to pay for and which ones we are not. The market also chooses which benefits it is willing to offer and the price for those benefits . If there is no demand at a fair price or no fair price for the demand, then that offering either changes or goes away.

    A recent posting here on Behind The Black showed that insurance rates for satellites fluctuate and have recently fallen to low levels. This is due to better responsibility for quality in the space industry. The chart at the linked article shows a dramatic drop from 20% to 5 or 20% insurance rate. This is a free market insurance system!
    https://behindtheblack.com/behind-the-black/points-of-information/higher-insurance-rates-for-proton-threaten-its-market-viability/

    For health care, better personal responsibility for quality of healthy lifestyle can likewise reduce healthcare insurance rates. Until recently, the UK health system made no such demands of its wards, so everyone was shocked to learn that they could be left without healthcare at the whim of their greedy government. It has been rightly said that this is “absolutely disgraceful.“

    Where is Robin Hood when you need him?

  • wayne

    Edward-
    Good stuff!
    Wealth of Nation’s, is a hard read. (And yeah I like those longer type of titles myself– look up the full title of the “Madness of Crowds,” and “Origin of Species.”)
    but I digress….

    Highly recommend anyone tackle Smith’s, “Theory of Moral Sentiment’s.”
    >> And do it in the form of excellent audio podcasts from the Econ-talk Library people.
    It is a very hard read (I’ve never completed it, at all) but it lays out a complete moral (and I would say psychological, as well myself) rationale underpinning Free Market Economics. And, is intertwined with the concepts in Wealth of Nations.)

    first part & info is here:
    http://www.econtalk.org/archives/2009/04/klein_on_the_th.html

    Professor Klein (George Mason U) and Prof. Russ Roberts, go through the book systematically. Great conversational analysis. (and you can safely not read the original, and still know more than almost anyone on TV or in D.C.

  • pzatchok

    Edward

    In my opinion your mistaking greed for robbery.

    In my opinion greed is just the peek of self-interest.

    The people who call it greed are normally the ones who have been on the short end of a bad deal.

    If I sold you a car for 20 thousand bucks today and you thought it was a great deal you would not be calling me greedy.
    But if a week later you found out I sold the very same car to someone else for 10 thousand bucks wouldn’t you then think I was greedy.

  • Edward

    pzatchok asked: “If I sold you a car for 20 thousand bucks today and you thought it was a great deal you would not be calling me greedy. But if a week later you found out I sold the very same car to someone else for 10 thousand bucks wouldn’t you then think I was greedy.

    If you mean that the VIN number is the same and that you sold the same car twice, then you are greedy. You are not selling something for its value, because you would not own the car to sell it.

    You are expecting unearned benefits.

    How does this differ from my earlier definition of greed?

    If, on the other hand, you sold the same type of car for half the price, then why should I not conclude that you are doing a friend a favor? The car is obviously worth at least what I had paid for it, so you are being generous in the other sale. That was very kind of you.

    If, on the third hand, the gripping hand (reference to Larry Niven and Jerry Pournelle, who passed away last month), you stole that car and sold it, we are back to you expecting unearned benefits and you are using theft in order to feed your greed.

    On the fourth hand — well, now we have to go to feet, on the right foot — if you merely overcharged me for the car, then you were not a thief or robber, because we had agreed to a price that I was happy with. It may have been an unfair price or a bad deal due to greed on your part, but it was not theft. It was not a deal made against my will or through violence or intimidation.
    http://www.dictionary.com/browse/robbery

    A person can be greedy without being a thief. Expecting unearned benefits is only one aspect of being greedy; gathering wealth or possessions for no purpose other than to possess them is a form a greed, but this should not be confused with someone who collects things as a hobby, which is not greed. If you think that a numismatist is greedy, then we have a disagreement with the meaning of greed.

    We need not have an excessive or rapacious desire for wealth or possessions in order to have self-interest. We can have a normal desire. We could merely have a desire for food, shelter, clothing, and reasonable expectation that the NHS will not short us on our healthcare after we paid our hard earned taxes for it.

    Finally, taxes are a form of theft. Despite the government’s claim that we pay them voluntarily, there are fines and jail time if we fail to pay the government what it thinks we owe to it, and people with guns will come take us away for a failure to pay. That is at least intimidation and at worst violence. That is just as voluntary as a robber with a weapon who gives us the choice of our money or our lives.

    When a government hands out that money — or goods or services from that money — to people who do not earn it (e.g. paid the taxes for it) then that is greed on the part of those who received it. If that government expects certain votes or favors from those recipients, then that is political greed. If those receivers do not thank the taxpayers for their free stuff, then that is also ingratitude on their part, especially if they also insist upon higher taxes for some or all workers.

    When a government stops health coverage to someone because it does not like him, even if they don’t like his behavior or lifestyle choices, that is corruption as well as greed.

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