T Nation

Nationalized Health Care


Great editorial from a British physician on socialized health care. Our health care system needs significant improvements, but nationalized health care will run it into the ditch.

I have a neighbor from Denmark and he also slams European health care. I've heard the same from a co-worker at work, since his wife is from England.

Now Obama is considering this. Unbelievable. Government run health care - great ready for the same experiences you receive at the DMV or Social Security office!

Danger: British health care stifles drug progress

By: Karol Sikora
Special to The Examiner | 5/15/09 4:01 PM

One of the more unproductive elements of President Barack Obamaâ??s stimulus bill is the $1.1 billion allotted for â??comparative effectiveness research,â?? to assess all new health treatments to determine whether they are cost-effective.

It sounds great, but in Britain we have had a similar system since 1999 and it has kept us in a kind of medical time-warp.

As a practicing oncologist, I am forced to give patients older, cheaper medicines. The real cost of this penny-pinching is premature death for thousands of patients â?? and higher overall health costs than if they had been treated properly. Sick people are expensive.

It is easy to see the superficial attraction, for the U.S. Health care costs are rising as an aging population consumes ever-greater quantities of new medical technologies, particularly for long-term, chronic conditions like cancer.

As the government takes increasing control of the health sector with schemes such as Medicare and the State Childrenâ??s Health Insurance Program, it is under pressure to control expenditure.

Some American health-policy experts have looked favorably at Britain, which uses its National Institute for Clinical Excellence to appraise the cost-benefit of new treatments before they can be used in the public system.

If NICE concludes that a new drug gives insufficient bang for the buck, it will not be available through our public National Health Service, which provides care for the majority of Britons.

There is a good reason NICE has attracted interest from U.S. policymakers: It has proved highly effective at keeping expensive new medicines out of the state formulary.

Recent research by Swedenâ??s Karolinska Institute shows that Britain uses far fewer innovative cancer drugs than its European neighbors. Compared with France, Britain only uses one-tenth of the drugs marketed in the last two years.

Partly as a result of these restrictions on new medicines, British patients die earlier. In Sweden,
60.3 percent of men and 61.7 percent of women survive a cancer diagnosis, while in Britain the figure ranges between 40.2 to 48.1 percent for men and 48 to 54.1 percent for women.

So we are stuck with Soviet-
quality care, in spite of the government massively increasing health spending since 2000 to bring the U.K. into line with other European

Having a centralized â??comparative effectiveness researchâ?? agency would also hand politicians inappropriate levels of control over clinical decisions, a fact which should alarm Americans as government takes ever more responsibility for delivering health care â?? already 45 cents in every health care dollar.

In Britain, NICE is nominally independent of government but politicians frequently intervene when they are faced with negative headlines generated by dissenting terminal patients.

For years, NICE tried to block the approval of the breast cancer drug Herceptin. Outraged patient groups, including many terminally ill women, took to the streets to demonstrate.

In 2006, the then-health minister suddenly announced the drug would be available to women with early stages of the disease, even though it had not fully gone through the NICE approval process.

A more recent example was the refusal to allow the use of Sutent for kidney cancer. In January, NICE made a U-turn because of pressure on politicians from patients and doctors.

Twenty-six professors of cancer medicine signed a protest letter to a national newspaper â?? a unique event. And yet this drug has been available in all Western European countries for nearly two years.

In Britain, the reality is that life-and-death decisions are driven by electoral politics rather than clinical need. Diseases with less vocal lobby groups, such as strokes and mental health, get neglected at the expense of those that can shout louder. This is a principle that could soon be exported to America.

Ironically, rationing medicines doesnâ??t help the governmentâ??s finances in the long run. We are entering a period of rapid scientific progress, which will convert previous killers such as heart disease, stroke and cancer into chronic, controllable conditions.

In cancer treatment, my specialty, the next generation of medicines could eliminate the need for time-consuming, expensive and unpleasant chemo and radiotherapy. These treatments mean less would have to be spent later on expensive hospitalization and surgery.

The risks of Americaâ??s move toward British-style drug evaluation are clear: In Britain, it has harmed patients. This is one British import Americans should refuse.

Dr. Karol Sikora, a practicing oncologist, is professor of cancer medicine at Imperial College School of Medicine, London, and former head of cancer control at the World Health Organization.


Will the world ever wake up! Preventive medicine! Not money grabbing Pharmaceutical Companies! Not over priced Hospital Care!



When they pay it themselves and do not consider it to be "free".


Wishful thinking or rank nonsense.

Preventive medicine will not prevent most or all diabetes, heart disease, and certainly not cancer.

I happen to have the acquaintance of Dr. Sikora, a few decades ago, and I can recall that he was rather fond of British National Health--then. The US was so backward in this--then. Events have overtaken that wishful thinking.

He is correct in pointing out that even with National Health and its flavor of preventive medicine, cancer survivorship in UK is repeatedly worse than in many other (European) countries. Now, as much as I dislike NICE, it may serve some purpose, but when instituted here, there will be people who suffer when they are denied access to marginally effective drugs and procedures.


The way the President has proceeded thusfar...by getting the Health Care Industry involved...it is unlikely that what will come out of all this with a "European-Style" Health Care System.

Most likely, there will be some type of "hybrid" of private/governmental system that will be unique in the delivery of Health Care.

How it will all pan out, absolutely NO one knows.

I word about us (Americans)...there is no way that we, as a people, have the patience or tolerance level for a completely Governmental Run System. When you have people who yell and scream in an office because the Physician is 20 minutes behind, they certainly are not going to patient waiting 3-6 months for a non-emergent procedure.

There is also a MAJOR problem brewing that no-one is discussing...the poor distribution of Health Care Providers, especially in 1) Primary Care and 2) High-Risk Specialties like OB-GYN.

More and more medical students simply are not choosing to go into these areas.

More people may be insured...but we'll have less and less qualified people to care for them.



Do you mean to say that most cases of diabetes, heart disease and cancer are not preventable?


..nationalized healthcare isn't evil, and it's not perfect. It's a system. If you have to make a choice between systems, you do that based on cost, availability and quality, but not on emotion...


Money grabbing? You mean every business? I find it hilarious that no one has a problem with Bmw selling a 3 series for 30K but everyone gets up in arms about the same amount of money for life saving drugs.

You realized the cost of bringing a drug to market is north of a billion dollars? I think investing that much money upfront is a good reason they should get a nice little profit.

An unintended consequence of switching to a nationalized system will be there is a lot less incentive for drug companies to develop new drugs. National Health systems bargain big time with pharma companies to get big discounts. The U.S. Health system literally pays for the world's new drugs, if all that money drys up expect less new drugs.


What do you think we are doing? It's our contention that nationalized healthcare will lead to LESS availability, LESS quality of care and LESS choice of care, along with GREATER wait times. It's not like we don't have reasons for opposing it. The cost on research is very probable and very high.


..you have healthcare available at a high level of quality with a large choice of options to those who can afford it. There are tens of millions of US citizens who don't have health insurance because they already have trouble making ends meet. Is that of concern to you?


Yes. But I do not want to emulate the British system, and I do not have any faith that Obama and the administration (least of all Congress) will provide a well thought-out plan British-like or not. They are trying to take on too many big issues at once, any ONE of which would be considered a big job for an entire term, or even two. Too many goals, to close together, spending too much money and not thinking things through. The saying "if you chase two rabbits, both will escape" applies here. Obama is chasing far more than 2 rabbits at the same time, and doing it at break-neck speed. The result is like watching a speed freak having a seizure.

I am saying "Slow down". I have zero faith that this gov't can handle so many things at once. Heck, they've all but destroyed my faith that they can handle any ONE thing effectively.

Additionally, if you got rid of the load that illegals impose on health care systems, it would alleviate a large chunk of the people who "can't" afford healthcare. They shouldn't be here in the first place; that's the definition of an illegal alien.

Following that, there are many millions who CAN afford healthcare, but choose not too because they want shiny new plasma screen tv's and cable with 1000 channels on it, with designer furniture and the latest techno gadgets. In other words, they are deliberately living outside their means and they need to stop. I don't have much sympathy for them. If they live within their means they can afford healthcare, that cuts out another large chunk.

No change on the system, and two very big chunks of uninsured population go bye-bye if these two things happen.

Note that I am not saying our system doesn't have huge, giant problems, OR that it doesn't need to be modified. I think it should be. I don't know how exactly, and this is a big complex problem that deserves a LOT OF THOUGHT, and slow DELIBERATE action. But I have no faith that the gov't will do anything but fuck it up right now.

about 17% of the population is employed in some respect that relates to healthcare. Any time you fuck with 1 in 5 Americans jobs, you'd better damn well have thought it through and asked their opinion beforehand.


Read about how the NHS bureaucrats hire doctors from 3rd world countries to save money, and how filthy the hospitals are, because they hire illegal aliens to clean them (and patients die from the filthy conditions).

Any politico who votes for this sort of evil should be tarred and feathered.


Besides, you're missing the real crux here---I said I had rational reasons. I didn't say they were YOUR reasons, or that you would even agree with my reasons. People may be getting worked up, but I (and most people on this board including at least 1 MD I know of) have good reasons they are worked up. Just because you have different priorities than them doesn't mean your priorities or perspectives are the right ones.


..i don't think it's unwise to think these things through, and i'm sure Obama pushes these changes through partly because he thinks it will win him votes or support. So are you opposing the speed with wich he wants to change the system, or do you have problems with the way he wants to change the system?


Another thing is that "we" leave "them" alone.

They can have their little hippie healthcare and be nice to everyone-

The point that they are obviously missing is that they need us to finance it against our will, that they need doctors to work for it, against their will.

That is a bit much for a system that will collapse sooner or later anyway.


It is a system that cannot be built without the threat of violence.

Of course it is evil.


..so what is the Swiss system, and how does it differ from the american and, say, the dutch one? Just in general, no need to write an article...


..then any form of government is evil?


Yes, that is why Jefferson et al described it as a "necessary evil".


Government is a necessary evil that - at least here in the US - is subject to the rule of law. The powers of the Federal Government are enumerated. Which part of the US Constitution empowers the US Government to provide a national health care system?