Beneath the transatlantic waves lies an awkward truth; one that politicians of all shapes and sizes – conservative and progressive, European and American – would prefer not to discuss. Healthcare is rationed everywhere.

Some countries, of course, choose to spend more on health than others, just as they set different priorities for education or defence. Some prefer direct state provision, others more plural arrangements – compare France’s devolved not-for-profit insurance with Britain’s monolithic NHS. But all the models, the American included, share one characteristic. They ration access, while pretending otherwise. In Britain, the state imposes the limits; in the US the market does much the same job. What separates them are questions of efficiency and equity.

The NHS stands condemned by US President Barack Obama’s opponents as an instrument of state-sponsored euthanasia. Its socialised medicine, Americans are asked to believe, would have deprived, on grounds of age, Senator Edward Kennedy of treatment for a brain tumour.

Such charges are palpable nonsense, serving only to unite British politicians in defence of the distinctly imperfect NHS. [...]

European criticism of the US model tends to focus on its inequities – the 40m-plus uninsured Americans denied access to anything but emergency care. The more startling fact is the truly enormous cost.

@94: Good point. People who buy false hope aren’t exactly making an informed decision, are they?

So you would have happily contributed to poor people starving due to shortages so you can feast as you are rich, and just because their is a war on it shouldn’t require you to make any real sacrifices?

Free Bernie Madoff!

Even the false hope is a kind of psychological opiate. I like to think that I would refuse it myself, but I haven’t been put to that test, and even if I had, that doesn’t necessarily give me the right to refuse false hope to others. I do find people who sell false hope for a profit rather disgusting, but if other people find their “product” useful, maybe I shouldn’t come between them.

(Similar remarks apply to that even bigger false hope, the afterlife.)

The question of whether it’d be better to have five months of terrible suffering and false hope, or a couple of months as many self-administered opiates as you like (no maximum cutoff) whilst being well cared for by hospice nurses, is possibly not one that NICE should be answering for people, and is what the wingnuts fear about this kind of B/CA analysis. Which is why it isn’t one that NICE answers for people and isn’t covered by this kind of B/CA analysis.

(although for me, it’d be B all the damn way, and if I ran the world I’d be sorely tempted to cut down on aggregate misery and healthcare spending by making B the only funded option…)

That’s probably the wrong criterion, and in practice NICE is much more about ensuring proven effectiveness than rationing on cost basis alone (its cost assessments are more generous than I’d use if I were in charge: £30k per QALY is higher than GDP per capita of £22k, which doesn’t seem to make sense).

The sporadic “NICE beancounters made my mum die” stories are much more about PR storms kicked up by the drug industry with the help of (understandably) statistically ignorant lifestyle journalists, and often (less understandably) statistically ignorant doctors, concerning drugs that are not proven more effective than the leading NICE-approved therapy, than they are about real cost-saving trade-offs.

(background: worked for one of the biggest pharma marketing research consultancies, then for a strategy consultancy that due diligenced pharma M&A. Or “Not A Hippy”, if you prefer.)

Just a nitpick, but this isn’t true for the Dutch case. All Dutch people are privately insured, and the 100/month is for the standard coverage, not premium. On top of the 100 a fixed portion of your income is also send to the insurance company of your choice. This is usually the larger part of the premium.

The 100 is basically a trick to remind people that they are actually paying for healthcare, and it gives insurance companies something to compete on. They are not allowed to offer a different coverage from the standard, nor to change the percentage of your income part of the premium, but a very efficient company can lower the 100 to say 90, and a company with pleasant help desks etc might be able to charge a bit more than 100. It’s mostly cosmetics.

For a doctor that has allegedly worked for the NHS you seem remarkably confused about the process.

NICE and the FDA are two completely different things. Cetuximab was approved for use in the UK, otherwise she wouldn’t have been able to take it privately.

When NICE made the original decision there was no evidence to prove that CRYSTAL was better than the existing (and cheaper) alternatives. Plenty of people thought that it was better, but then plenty of people think that crystals can cure cancer. So what?

The CRYSTAL data showing its efficacy were presented in 2007. People don’t stop dying while papers are being peer-reviewed.

Uh-huh. And plenty of papers fail to peer-review process, or have to be substantially revised. Or did you think it was some kind of rubber stamping exercise?

If it had turned out that in 2009 a paper was published showing that Cetuximab was in fact WORSE than the alternatives, what then? Doctors who had prescribed Cetuximab would, according to your somewhat hysterical logic, have been killing some of their patients.

One of the many failings of the US system is that not only are more expensive drugs often prescribed when cheaper alternatives are available; but often more expensive drugs with worse outcomes are prescribed. Most doctors (as you seem to be demonstrating on this thread) are not very good at reviewing medical data. Having a central body of experts carrying out this important task is very useful, though obviously drug companies would disagree.

No this isn’t true. At the time of the 2006 NICE overview, there was, to quote from the report, “no trials that compared cetuximab with current standard comparators”. Since the NHS is (obviously) interested in the relative effectiveness of new therapies compared to what it is currently doing, this was the relevant case.