ITV: Plans to deny surgery to obese and smokers ‘put on hold’

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Will Truman

Will Truman is the Editor-in-Chief of Ordinary Times. He is also on Twitter.

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29 Responses

  1. Avatar Dark Matter says:

    Wow. Is it more expensive to operate on the heavy? …Ignoring that extreme athletes can have high BMIs.Report

    • Avatar Will Truman says:

      It can. I know (for instance) it makes c-sections more difficult and time-consuming, which means more expensive.

      But that’s not what’s going on here.Report

      • Avatar Dark Matter says:

        @will-truman

        But that’s not what’s going on here.

        I think “rationing” is probably a good word to describe it.Report

        • It seems like nothing more than just being pettily cruel. I’d be interested in knowing what type of surgery they’d consider not life-saving, and whether they’re considering that an allegedly non life-saving surgery might become horrifically expensive messes if put off a year (I’m thinking of things like putting a pin into a fractured arm or leg; if someone blows a femur I’m sure you could keep them on bedrest for a year, and if they didn’t die of a bedsore you might not kill them when you had to rebreak the bone and set the pieces properly.)

          Reading between the lines the NHS correctly rejected this stupid plan with a “OH HELL NO!”, though they appear to have neglected to strike the licenses of the idiots who thought the stupid thing up.Report

          • Avatar Will Truman says:

            I think it’s a combination of things, but mostly just two:

            1) They want to reduce costs, and chose a segment of the population with little public sympathy.
            2) A lot of physicians get very, very frustrated with their patient populations, and this is something of a reflection of that. Who should be denied non-emergent care? They should. The ones who frustrate them the most. If they want it bad enough, make them work for it. Report

          • Avatar Morat20 says:

            Given the current, incredibly depressing, research on obesity and weight loss, it’s
            not just cruel and petty — it’s pointlessly cruel.

            To lose any meaningful amount of weight in less than a year, you’d either need to quit your job and dedicate yourself full time to it….or undertake the sort of diet that is the last thing you should be doing before major surgery.

            And even if we lived in a world where weightloss was pretty easy, with motivation, given what’s considered a ‘healthy’ amount of weight loss — unless you’re on the borderline, it’d take a year or so anyways to get below it.

            “We’ll make you wait a year. Unless you lose X weight, which to lose healthily will take you 18 months. So I guess just live on juice for two months, then we’ll replace your knee! Until then, enjoy your bum knee.”

            This sounds like the sort of advice that would come from a board of surgeons who didn’t bother talking to nutritionists or doctor’s specializing in obesity.Report

            • Avatar El Muneco says:

              In light of current medical thinking, I’ve re-evaluated my own experience. Currently, pushing 50, I weigh less than I did when I was 14.
              For quite a while, I thought that this proved that it was possible that if you just applied yourself enough, and had enough discipline, you could conquer your weight demons.
              Then, years too late, I realized that I was just a fat bastard when I was a kid. Overindulged in a lot of ways, and drastically unhealthy. I was just a normal-sized kid who overate. A lot.
              I still fight my self-image, and a couple of vanity kilos. But I no longer think that anyone can really force their body to be anything other than what it was destined to be. Maybe a few percent here and there – discipline is not bad if that’s what it takes to validate – but transforming isn’t a thing.Report

              • Avatar Dave Regio says:

                @morat20
                @el-muneco

                I really don’t care for the term weight loss since weight can take the form of fat, fat-free mass, or water depending on what kind of dieting one is doing and how deep the caloric deficit.

                Due to two posts that are in the queue, one of which I hope to finish soon, I’ve taken a dive into the research and issues surrounding weight loss. It’s probably why I haven’t finished the one I really want to finish.

                I don’t take the skeptical view on weight loss and transformations, not because of my own personal experiences, but because I think the most skeptical views on weight loss are far too skeptical. There are a lot of people out there using research to back the idea that 95% of people that engage in dieting gain the weight back in 5 years. My problem with this kind of statement is that 1) it seems to lump every crappy ass diet into the dieting category and 2) there’s a lot of question on the 5% number.

                The most optimistic number I’ve seen is 20%, and if you’re using a data set that includes people that have were using heavy caloric or food-group restricted diets without any kind of plan for long-term weight management, then I think that’s a pretty good number.

                Because there have been successes, researchers have been looking into how people are able to achieve long-term weight loss. On one hand, it confirms what I’ve known and what I’ve been able to do to keep off my own weight. On the other hand, the research is pretty damn clear that there’s an irreconcilable difference between the body image ideals of society (which are pure unadulterated bullshit) and what is actually achievable long-term (I don’t know if it’s more than 15% of starting weight). Putting that in perspective, I lost 25 lbs and that put me at 12.5% of weight lost.

                That doesn’t even begin to touch on the social issues. Case in point: I lose 25 lbs, lift weights, exercise, drop my body fat to below average levels, look good with a shirt off and I’m a transformation success story.

                Imagine someone that’s 400 lbs losing 15% of his/her bodyweight. He/she drops 60 lbs of fat, mostly of the visceral variety. He/she improves him/herself in a number of different ways (improved health outcomes, reducing chronic risk, etc.). That person runs the risk of getting fat shamed despite all of the hard work (even ignoring whether or not this person is trying to meet some ideal). No one outside of the people he/she knows will see a hardworking person trying to make themselves better.

                Transformations are a whole other story (another half written post). While possible, the difficulty is ridiculously understated in most cases.Report

        • Avatar Murali says:

          I think “rationing” is probably a good word to describe it.

          You mean we shouldn’t be cost conscious when we are spending the public dime?Report

          • Avatar Dark Matter says:

            @murali

            Murali:
            Dark Matter: I think “rationing” is probably a good word to describe it.
            Murali: You mean we shouldn’t be cost conscious when we are spending the public dime?

            “Cost conscious” would be death panels. Half your lifetime use of medicine happens in your last year of life. What we’re looking at is restriction of medicine on the politically powerless or unpopular.

            This is a good example of medicine-by-politics and the political system showing it’s poorly equipped to deal with reducing medical costs.Report

            • Avatar Stillwater says:

              This is a good example of medicine-by-politics and the political system showing it’s poorly equipped to deal with reducing medical costs.

              From where I sit, the main complaint – correctly – is that our pre-ACA market system was wholly inequiped to deal with reducing medical costs. In fact, it was “designed” to inflate ’em, among other problems. Hence the ACA.Report

              • Avatar Dark Matter says:

                @stillwater

                From where I sit, the main complaint – correctly – is that our pre-ACA market system was wholly inequiped to deal with reducing medical costs. In fact, it was “designed” to inflate ’em, among other problems. Hence the ACA.

                The pre-ACA market system was also a heavily government regulated system. So we have the gov deciding that because the gov messed things up, we need more government.

                If we’re serious about using the gov to reducing medical expenses, then we need to have a long discussion on the benefits of death panels (or whatever you want to call ‘intelligent rationing’), why they’re a good thing, and how they’d work in practice.

                What we’re doing instead is pretending that we can write a blank check to everyone for all medical expenses.Report

              • Avatar Stillwater says:

                The pre-ACA market system was also a heavily government regulated system.

                Dark, I gotta say I’ve lost my patience with this argument. All the conceptually based ideologically motivated idealizations in the world won’t effect how the world actually is tho it does, conventiently, effect how certain types of people judge the world and its actors.

                If we’re serious about using the gov to reducing medical expenses, then we need to have a long discussion on the benefits of death panels

                Obama actually wanted to have that discussion, which led to Palinistas to coin the term you neutrally use to refer to it: “death panels”.

                Look, if you/we want to limit health care costs a part of that discussion is end of life care and rationing. And I mean that as a matter of logic, one which applies to the private insurance model just as much as any particular gummint program. Fact is, there is no market-based mechanism to determine price for healthcare services even in a fully “free market” private insurance model. And that’s the case irrespective of any gummint intrusion into the market via tax breaks for employers or whatever.

                The whole model is whacked. Not because markets don’t work, but because they don’t work for healthcare provision.Report

              • Avatar Dark Matter says:

                @stillwater

                Stillwater:
                DarkMatter: The pre-ACA market system was also a heavily government regulated system.

                Stillwater: Dark, I gotta say I’ve lost my patience with this argument. All the conceptually based ideologically motivated idealizations in the world won’t effect how the world actually is tho it does, conventiently, effect how certain types of people judge the world and its actors.

                Pot, meet Kettle. After the ACA fails to contain costs, will you want to see more market, or more government?

                DarkMatter: If we’re serious about using the gov to reducing medical expenses, then we need to have a long discussion on the benefits of death panels

                Stillwater: Obama actually wanted to have that discussion, which led to Palinistas to coin the term you neutrally use to refer to it: “death panels”.

                It’s a good, descriptive, term. I am trying to use it neutrally, and I fully support the idea as long as we’re going to have the gov deeply involved in paying for things.

                Stillwater: Look, if you/we want to limit health care costs a part of that discussion is end of life care and rationing. And I mean that as a matter of logic, one which applies to the private insurance model just as much as any particular gummint program.

                Agreed… but imho insurance is mechanically better suited towards dealing with this. Do you want to pay for that last year or not? If the answer is yes, then your insurance rate is ‘this’. If the answer is no, then your insurance bill is a fraction of that.

                Politicians who even try to suggest this instantly have attack ads with them throwing little old women in wheelchairs off cliffs. http://www.forbes.com/sites/kenrapoza/2012/08/12/liberal-group-throws-granny-off-cliff-again/#31518908420f

                Granted, we need to have that discussion, and badly, but I don’t expect it from the politicians.

                Report

              • Avatar Stillwater says:

                Granted, we need to have that discussion, and badly, but I don’t expect it from the politicians.

                Which exactly confirms my point, Dark. We live in a political world, commanded and controlled by politicians (even in your anti-government, free-market, non-coercive Utopia!).

                If you don’t expect that discussion from politicians (which would be a necessary pass-thru for democracy, seems to me) then what are your solutions? Obviously getting rid of democracy is on the table, but what else? Violent overthrow of gummint by peaceful technocratic libertarians?Report

              • Avatar Stillwater says:

                You also didn’t respond to what I viewed as the most important point of that comment: that the pre-ACA healthcare delivery system had no transparent “market based” mechanism by which price is determined. The whole thing was effed up, Dark. Like effed up BAR. And hopelessly so. The primary problem with the ACA is that it didn’t go far enough.Report

              • Avatar Dark Matter says:

                @Stillwater

                Stillwater:
                You also didn’t respond to what I viewed as the most important point of that comment: that the pre-ACA healthcare delivery system had no transparent “market based” mechanism by which price is determined.

                My solution, i.e. what the ACA should have done, is that it should have made pricing transparent.

                That, by itself, is probably pretty hard but imho it’s a lot more likely to do something than command and control. There are insurance structures which let consumers capture the results of savings, which put downward pressure on prices.Report

              • Avatar Murali says:

                The whole model is whacked. Not because markets don’t work, but because they don’t work for healthcare provision.

                Minor correction: markets in full cover* private insurance don’t work. Catastrophic care insurance works relatively fine. Primary care works well in a private market so long as most people pay directly (how they get subsidised is a separate issue.). It is the health insurance market specifically which is broken. And it seems like a particularly stable but bad coordination equilibrium. They key here is mechanism of payment. Is it more like a buffet or is it a la carte? Insurance for predictable medical care makes it like a buffet, which drives up costs for everyone. You’ve already paid your premiums, why not consume as much medical care as you can in your last year of life. After all your insurance will pay for it right?

                I doubt we would get into that particular equilibrium from the outside in a market system. But given that you are already in that equilibrium, I am not sure how easily you can get out of it. Especially when it is baked into your culture to have insurance as part of your employment contract. I’m not sure that even changing the law at this point will change that practice. There is too much inertia going on there.

                *By this I mean primarily the non-catastrophic stuff.Report

              • Avatar Dave Regio says:

                Stillwater:
                This is a good example of medicine-by-politics and the political system showing it’s poorly equipped to deal with reducing medical costs.

                From where I sit, the main complaint – correctly – is that our pre-ACA market system was wholly inequiped to deal with reducingmedical costs. In fact, it was “designed” to inflate ’em, among other problems. Hence the ACA.

                Absolutely positively 1,000,000,000,000,000% correct.

                I guess we could have let things go and let medical costs soar while millions of more seniors went on Medicare each year. That would have ended well I’m sure.Report

    • Avatar greginak says:

      FWIW , Very heavy people are at extra risk during surgery. Not saying anything about this proposal at all, but yeah, smoking and high weight are real issues during surgery.Report

  2. Avatar Jaybird says:

    I was worried that Obamacare wouldn’t figure out a way to deny health care to the poor!

    Whew.Report

    • Avatar Jaybird says:

      Aw, crap. This isn’t in the US.

      Yet.Report

      • Avatar Guy says:

        Honestly, this sounds like “pre-existing condition”. At least, that’s the closest I can think of.Report

        • Avatar Jaybird says:

          A pre-existing condition in a country with Socialized Medicine?

          This is something that used to only happen in banana republics that bragged about having free health care for all.Report

          • What? Those unethical scum in York were just looking back nostalgically at the pre-ACA United States.Report

          • Avatar Guy says:

            I’ve never gotten an indecipherable-Jaybird-response before. I suppose I feel proud.Report

            • Avatar Jaybird says:

              I’ll try to decipher:

              The term “pre-existing condition” used to be a term of art used by (American) insurance companies to refer to stuff that was there before you started getting their insurance.

              “Sorry, we’re not going to cover your condition. It’s pre-existing.”

              This was something that was mocked by people from more civilized countries where the medical folks would take care of your cancer or gout or whatever *NO MATTER WHAT*.

              Which was good. Because it’s not like “shopping around” was much of an option given the whole socialized medicine thing.

              So to have a country with the system that we were told that we needed to emulate suddenly discover analogues to the reasons that we shouldn’t have our system? To start pulling crap that only the US and Third World Countries did?

              That’s an indicator that things are going to get worse with the whole “socialized medicine” thing and, on top of that, it’s not like the stuff that’s part of the trade-offs is going to be getting better.

              They’re figuring out ways to deny health care to people. (Or trying to.)Report

      • Avatar greginak says:

        Yeah its disappointing you can’t use this rant about Ocare yet.

        But the good news is millions of new people, most of them poor and working class, have health insurance. And their using it.Report

        • Avatar Dark Matter says:

          But the good news is millions of new people, most of them poor and working class, have health insurance. And their using it.

          Any and every entitlement is a good thing as long as we only look at the benefits side.

          Paying for it is an issue, whether we get value for our dollar is another issue, and paying for all entitlements collectively (long term, meaning 50+ years) is a huge issue.Report