No Surgery for British Smokers?

This news is a couple of months old, but I stumbled across it and still think that it’s worth noting. Apparently, the National Health Service in England is considering a plan to bump patients of surgery waiting lists if they refuse to quit smoking one month prior to surgery.

SMOKERS are to be asked to give up their habit before they are put on the waiting list for routine operations such as hip replacements and heart surgery.

National Health Service managers say smokers take more time to recover from surgery, blocking beds for longer and costing more to treat.

[…]

NHS managers want patients not to have smoked any cigarettes for a full month before surgery. But as they would be expected to take about two months to stop, operations could be delayed by up to three months.

The managers do insist, however, that it is up to doctors to decide whether the surgery can still go ahead if the patient fails to give up.

Some doctors argue that the policy could deter smokers from attending appointments because they believed that they would not qualify for treatment.

I haven’t yet been able to determine if this policy will go through or not, but it’s a disturbing prospect nonetheless, and illustrates one real danger of government controlled health care. Namely, the fact that once the government controls the purse strings, they can manipulate freely chosen behavior in subtle and insidious ways. Once it’s acceptable for government to de-prioritize patients for one particular habit, how much longer until the next unhealthy habit causes an increase in your wait? Obese? To the back of the line! Enjoy beer drinking? Back of the line! Don’t exercise enough? Back of the line!

In a private health care system, I don’t have a problem with, say, smokers or obese people paying higher insurance premiums–much like driving a red Ferrari, you need to pay more as your risk goes up. But the difference between paying extra insurance for an unhealthy habit and having one’s medical needs marginalized for an unhealthy habit is enormous. If anything, what the NHS is doing is almost worse than an outright ban on unhealthy activities. In essence, what the government is doing here is punishing people for engaging in lawful activities. That’s just disgusting.

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Alex Knapp
About Alex Knapp
Alex Knapp is Associate Editor at Forbes for science and games. He was a longtime blogger elsewhere before joining the OTB team in June 2005 and contributed some 700 posts through January 2013. Follow him on Twitter @TheAlexKnapp.

Comments

  1. Anon says:

    Your commentary about the heinousness of refusing treatment to people who refuse to follow treatment protocols is crazy and clueless.

    Damage and complications resulting from being a current smoker are severe and can be easily avoided.

    Being fat is not really that comparable because that status is not as easily rectified, nor is merely being fat (as opposed to morbidly obese) as much of a risk factor for bad outcomes.

    A good parallel is alcoholics. Do you really think that alcoholics should get the same dibs on operating tables that other surgery candidates get?

    Good luck with all of the massive blood loss and organ failure you’re propagating among surgery candidates. I’m sure they’ll really appreciate the way you helped speed them to their deaths. After all, it wouldn’t be PC to favor an otherwise healthy 19-year-old over a smoking alcoholic 60-year-old with a complicated medical history.

    This isn’t a matter of denying granny a hearing aid. Next you’ll be saying that people who refuse to fast before a scheduled, non-emergency surgery also need to be coddled and catered to.

  2. davod says:

    Anon: This would be OK if it was being made on medical grounds but it is not. This is purely an economic decision being made by the bean counters.

    I read the other day that there is a six month wait for appointments relating to depression. The response – they will give you a prescription to obtain one of 37 approved books on depression from the local library. The idea of reading up on your problem is a good one. However, how many will die or become severely depressed because of the six month wait.

  3. just me says:

    This isn’t a matter of denying granny a hearing aid. Next you’ll be saying that people who refuse to fast before a scheduled, non-emergency surgery also need to be coddled and catered to.

    There is good, sound medical reason to require the fasting.

    The reasoning for requiring the sessation of smoking has no medical reason that involves the actual safety of the patient, but because smokers have a longer recovery time, thus costing the government more money.

    I agree with the original post-it is one thing if a doctor recommends something based on a medical need, but something totally different when it is the government looking for ways to save money, which is a real pitfall of the government controlling the purse strings and being the only game in town.

  4. Alex Knapp says:

    Anon,

    As the article makes clear and the other commenters have noted:

    National Health Service managers say smokers take more time to recover from surgery, blocking beds for longer and costing more to treat.

    If it was for purely medical reasons (eg fasting before surgery), I wouldn’t have a problem with this.

  5. Bandit says:

    Just keep in mind that this will be used as a rationale to regulate every activity in your life – dangerous activities – ie. motorcycle riding – massive OT – ie. pre natal detection of potential birth defects – must abort – it’s a brave new world

  6. R. Alex says:

    This would be OK if it was being made on medical grounds but it is not. This is purely an economic decision being made by the bean counters.

    When resources are finite, it’s all economic. Why waste resources on someone that is destroying their body? That money can be put to better use elsewhere.

    If anything, what the NHS is doing is almost worse than an outright ban on unhealthy activities. In essence, what the government is doing here is punishing people for engaging in lawful activities. That’s just disgusting.

    I don’t understand how any libertarian-minded guy can think this way. Applying consequences to action is much, much better than outright banning it. Something being lawful does not make it right, nor does it mean that the government should treat it as no different than other lawful behavior. The government rewards behavior it sees as productive all the time. It’s not the libertarian ideal, but it’s better than outlawing alternative behavior.

    I do agree with you, though, insofar as it relates to nationalized health care. I don’t have the problem with this specific decision that you do (even though I smoke), but I am deeply uncomfortable with the government having the power to make all of these decisions.

  7. Andy says:

    However, how many will die or become severely depressed because of the six month wait.

    You mean like the thousands of clinically depressed Americans without health insurance who wait forever to get care, or the thousands more of clinically depressed Americans who are underinsured for mental health treatment and can never afford it?

  8. Andy says:

    Oh my gosh, the NHS discriminates against smokers!

    Sort of like insurers in the U.S. discriminate against smokers. Good luck getting affordable private insurance if you’re a smoker in the U.S.

  9. davod says:

    Andy:

    Don’t change the subjecte. It looks as if you are losing the argument.

  10. floyd says:

    Go to the DMV sometime. Sit there and imagine that the arbitrary bureaucracy you are wading through is not just 2 hours to get a plate sticker,but 6 months in pain waiting for third class medical care, from indifferent medical bureaucrats.
    This is socialize medicine!

  11. davod says:

    Floyyd:
    Of course, what is lacking is the fact that once you have waited six months for your appointment with a GP, any referral to a specialist will take even longer.

    Thats why people die while waiting to get a MRI.

  12. Andy says:

    Go to the DMV sometime. Sit there and imagine that the arbitrary bureaucracy you are wading through is not just 2 hours to get a plate sticker,but 6 months in pain waiting for third class medical care, from indifferent medical bureaucrats.
    This is socialize medicine!

    You’re basically just wrong. You’re making ridiculous partisan points out of some absurd fear of socialism. Did you get mugged by socialism? Did it tease you when you were a child?

    Because this is basically also the American system. Except that ours costs 50% more for lesser results. There is rationing in any healthcare system, and the American system is particularly inefficient at distributing care.

    davod: I have no idea what you’re going on about.

  13. Andy says:

    Floyyd:
    Of course, what is lacking is the fact that once you have waited six months for your appointment with a GP, any referral to a specialist will take even longer.

    Thats why people die while waiting to get a MRI.

    You’re being plainly ridiculous now. If socialized systems are so horrible and people die so frequently, why do basically all of the countries with universal coverage have long life expectancies and better health outcomes than the U.S.?

    The numbers just aren’t on your side. You have to resort to making up anecdotes about delays, which is particularly absurd because there are equally problematic delays in the American system.

  14. just me says:

    If socialized systems are so horrible and people die so frequently, why do basically all of the countries with universal coverage have long life expectancies and better health outcomes than the U.S.?

    Because life expectancy isn’t affected solely by access to doctors. The US has a high rate of obesity, smoking/drinking/drug use, and in general we are more sedentary.

  15. TJIT says:

    Andy, fearing nationalized medicine is an entirely rational and justified stance.

    Nationalized healthcare consistently provides longer wait times and worse outcomes then the US health care system does.

    Doctors admit: NHS treatments must be rationed

    British doctors will take the historic step of admitting for the first time that many health treatments will be rationed in the future because the NHS cannot cope with spiralling demand from patients.

    James Johnson, the BMA chairman, will warn that patients face a bleak future because they will increasingly be denied treatments. He will urge the NHS to be much more explicit about what it can realistically afford to do and ask political leaders to engage in an open, honest debate about rationing.

  16. Andy says:

    Nationalized healthcare consistently provides longer wait times and worse outcomes then the US health care system does.

    This is simply false.

    Nationalized health care consistently provides longer wait times than American health care does for the well insured. Americans without healthcare or who are underinsured may never get treatment.

    As for health outcomes, socialized medicine delivers far more cost effective results. America spend 50% more per person, does not manage to cover some 45 million people, and does not produce better results even for our insured. Poor British people have better health measures than even rich Americans.

    I don’t want to see a mandatory purely universal system without any alternatives. A French-style hybrid system, with catastrophic, rationed, and preventative coverage for all, plus the option of private insurance for the better off, would solve almost all of the issues. We could do this by expanding Medicare, which has much lower overhead costs than HMO-style insurance.

  17. TJIT says:

    Andy like most nationalized healthcare programs the French system has plenty of problems.

    Hard to see how following the French system would improve US healthcare.

    French health service on verge of collapse, says commission

    A government commission has warned that without fundamental reforms France’s national health service, rated the best in the world by the World Health Organisation, will collapse within the next 15 years.

  18. Andy says:

    Gosh, you mean that the French system might be $80 billion in the red in 15 years? All first world nations face similar high rates of health care cost inflation. But because their system is much more efficient than ours, they are starting with much lower costs.

    Every problem that France has, ours are far, far worse.

    For your argument to have any legitimacy, you have to show that America’s system isn’t also on the same track to massive cost increase. You can’t, of course. Facts are so often inconvenient.

  19. TJIT says:

    Advocates of nationalizing the healthcare system have a wonderful ability to ignore the poor results produced by government run healthcare programs.

    This includes the ability to studiously ignore the poor results produced when the US government runs healthcare programs.

    US government failure in these small programs indicates a high likelihood of failure if they take over all aspects of the healthcare system.

    DEM EYES BREAST TEST ‘WAIT’ WOE

    Mammography centers in New York City are closing at an “alarming” rate, causing a 171 percent increase in wait times for the cancer-detecting procedure, according to a study by Rep. Anthony Weiner.

    Since 1999, 67 mammography sites, more than a quarter of the city’s supply, have closed, the Brooklyn Democrat found.

    The problem? Price fixing at a lower level than cost:

    The problem is that Medicare pays only $83 for a procedure that costs $125 to provide, said Weiner, who will introduce legislation to increase payments.

  20. TJIT says:

    Andy said

    Gosh, you mean that the French system might be $80 billion in the red in 15 years?

    Actually I think the relevant portion of that article was

    without fundamental reforms France’s national health service….will collapse within the next 15 years.

    The idea of emulating a collapsing healthcare system does not make sense to me. Apparently advocates for government run healthcare in the US feel differently.

    Andy also says

    Every problem that France has, ours are far, far worse.

    To which I say Got Cite?

  21. floyd says:

    Anddy:
    [1] What party is that?
    [2] Yes , I have been mugged by socialism, [as an adult.]
    [3] Socialism never came near me as a child [and neither did privilege!][lol]

    BTW; Just this week I was mugged by the present system, but I wouldn’t take a sledge hammer to an engine with an occasional miss.

  22. floyd says:

    Andy, the misspelling was mis-aimed, sorry.

  23. floyd says:

    Andy;
    “There is nothing a prudent man can do for a dollar, that government can’t do half as well for a thousand.”
    I just wanted to show that I can be charitable toward government run programs![grinz]

  24. Grewgills says:

    As long as the anecdotal evidence is flowing, I’ll add my own.
    I currently live in Western Europe under a hybrid system. Everyone is required to have health insurance. If you cannot afford it the government subsidizes it. My wife and I pay about 130 euro a month total for our health insurance. We have never had to wait more than a couple of days for an appointment. The longest wait time faced by anyone we know was a couple of weeks to find a permanent care facility for the victim of a severe stroke. During the wait he had to remain in hospital, which was paid for by his insurance.

    Advocates of nationalizing the healthcare system have a wonderful ability to ignore the poor results produced by government run healthcare programs.

    This includes the ability to studiously ignore the poor results produced when the US government runs healthcare programs.

    As you studiously ignore the failings of the American system and studiously ignore the strengths of nationalized systems.

    Because life expectancy isn’t affected solely by access to doctors. The US has a high rate of obesity, smoking/drinking/drug use, and in general we are more sedentary.

    So your argument boils down to, Americans have the least healthy lifestyles in the entire Industrialized world and that is why our health care costs are more than half again any other nations. We get worse outcomes for far more money because we are fat, lazy druggies?
    Do you really think that Americans drink more than Europeans or do more recreational drugs? Europeans smoke far more than Americans. We are among the fattest nations but Europe is getting fatter. Germany has a high rate of obesity and Germans like their beer and cigarettes, yet get better health outcomes for much less.
    European governments are able to deliver better health care to their citizens for far less money than our private system. Do you really think our government is less competent than every European government? Now who is being anti-American?

    BTW the last several times I have gone to the DMV I have been in and out within an hour. (3 different states: AL, CA, and HI) In each case I received friendly and competent service with a moderate wait. A tip for all of you who typically have negative experiences with the DMV, try being nice to them.