Friday, December 23, 2005

Eat badly, smoke and lose your right to health care

VICTORIA - Down in the U.S. companies are getting ready to fire smokers.
Over in England, overweight people are being told they won't get knee or hip replacements.
And here in B.C., the province's chief medical health officer has just warned that diabetes - largely preventable - is already a $1-billion annual cost to the health care system. Within a decade, that will double unless we change our ways.
All three stories point to the need to start a debate on just how we're going to handle self-inflicted illness and injury when it comes to allocating scarce treatment resources.
Provincial health officer Dr. Perry Kendall focused on diabetes in his annual report. About 220,000 British Columbians have been diagnosed with the disease, and the number is expected to reach 390,000 within 10 years. Its complications can be cruel - heart and kidney disease, amputations and death.
And the problems are, Kendall reported, largely preventable. About 90 per cent of the cases are Type 2 diabetes, and people can slash their risk - and the cost to us all - if they eat healthier diets, exercise and keep their weight down.
Which raises a question about individual responsibility and the how we allocate finite health care resources.
U.S. companies, facing a health cost crisis far greater than anything we've seen in Canada, have started to make choices, with smokers the first target. Some are increasing health care premiums for smokers, or offering incentives and support for people who quit.
And some are firing people who fail tests for tobacco use. Scotts Miracle-Gro has told its 5,400 employees they have until next fall to quit, or they'll get the chop. (About 30 states have laws protecting people from being fired for smoking.)
It's not a moral judgment that smokers are flawed. The decision is based on economics. Smokers cost too much.
The British National Institute for Health and Clinical Excellence has just reported on the right of people with self-inflicted medical problems to treatment, and taken a similar approach The influential institute looked at the hard practical questions. Is it right to make a child needing a liver transplant wait in the queue behind a person whose illness is caused by years of alcohol abuse?
It's a tough question. Alcoholism is a disease too.
The institute took a cautious approach. Patients shouldn't be penalized for making themselves sick, it said. But if their behaviour reduces the chance of a successful outcome, then treatment can legitimately be delayed or denied. Why spend scarce resources on a liver transplant for someone like alcoholic former footballer George Best, who kept drinking and died within three years?
In reality health care providers have made those kinds of decisions. British National Health Managers in East Suffolk needed to save money this year, and so have stopped doing knee and hip replacements for anyone with a Body Mass Index over 30. If you're five foot nine inches and weigh 205 lbs, for example, no replacement. The surgery is riskier, outcomes poorer and artificial joints don't last as long. Joint replacements for overweight people are an inefficient use of scarce dollars.
A similar approach is take by some doctors in B.C, openly or not.
It's a difficult issue, theoretically and practically.
Type 2 diabetes, for example, is not always linked to diet and exercise. And people do not always have control over their circumstances. B.C.'s welfare rates, according to a new study from the Dietitians of Canada, don't allow a nutritious diet. Children from families on welfare are at increased risk of diabetes, and most people wouldn't argue they should be denied treatment.
But we shouldn't dodge the questions. We're already rationing surgery, often in arbitrary and unreasonable ways.
Demand and treatment options are increasing, while resources are finite. Finding the fairest, most efficient way of allocating those resources means looking at all the factors - even ones that make people uncomfortable.
Footnote: The other obvious issue is prevention. Kendall says a 25-per-cent reduction in the diabetes rate would produce annual savings of $200 million. That justifies a large upfront investment to expand existing programs aimed at increasing our health, and reducing the risk of diabetes and other illness.


RossK said...

An important topic.

Even as a waygone lefty I can see that some drawing of arbitrary lines that have been well thought out and much discussed discussed before they are implemented could help improve/preserve universality down the road.

But on the more frivolous side....would this mean I would be forced to avoid that 217th (and beyond) piece of shortbread this holiday season?

Merry Christmas Mr. Willcocks!

Anonymous said...

Now that we arn't supposed to do anyhting beyond Jog and drink water, and of course my Cuban cigars are not allowed, just how are we supposed to celebrate the festivities.

But Happy Holidays, Merry Christmas to you and yours.

But have you noticed, when governments get righteous it's because they are lecturing the masses. It's the masses who are on the waiting lists not government but it's the season to be nice and we arn't supposed to notice the person, two years down the road looking for a hip replacement or a knee job, and they all arn't overweight either.

Life in Victorola said...

Rather than engage in some kind of collective punishment for legally addictive substances like nicotine and alcohol (all of which are partially funded by sin taxes and unclaimed pension plan dividends) , I think we could recover lots of public health investment funds by refusing to fund admissions due to complications arising out of non-medically necessary third party "vanity" surgery. How many nose jobs. liposuctions and botox treatments would go ahead if consumers weren't assured that the health system would absorb the costs of predictable post-op complications such hemorrhage, septic shock and partial paralysis? Let the free marketeers pay full freight for their flights of fancy. Alternatively, they could become politicians which is after all, hollywood for ugly people :-)

Anonymous said...

Uh huh.

And who will we pass the cost of polluted (ie: PCB ridden) breast milk on to? Who's responsible for lacing most sources of meat with antibiotics and steroids and who asked (or allowed) the providers to do that? The food at my table is approved for consumption by the Canadian government. Signed off on by a largely white, largely middle class electorate.
As I get older I see each generation after that one that created the much heralded "middle class" reach back and hypocritically deny what was provided to them. From the boomer bastards that declared bankruptcy upon completion of their degrees to the UI/EI assclowns that suddenly changed the rules when they found themselves in middle management desparately amending the rules of "globalization" so they could up the returns on their precious mutual funds.
This is simply more evidence of the same middle aged jerkoffs, reaching down and pulling the plug on the folks behind them cleaning up their pile of shit.
Baby boomers will be remembered as the most selfish, most hypocritical, least foresighted, most consumptive, flat-out "sack of shit" generation that was ever spawned.
I expect nothing but the same from these ungreatful assholes.

Anonymous said...

Refer to Diabetes for
useful information