Healthcare, human and animal
, The NHS is very much in the news as the government proposes a new round of welfare cuts and as I've met quite a few people from other countries lately, I've been thinking about different systems and philosophies. I do not praise Britain very often: I think there is a great deal wrong with us a country at systemic and local levels, with the bloated military (I refuse to use the Orwellian term 'defense' in reference to that department) near the top of the list. But when it comes to healthcare, the universal system I believe is right, in principle if not in execution. It isn't free healthcare. Of course we pay for it through taxation - but that's a collective 'we', we as a people, meaning that the richer you are the more you contribute, and the more you need the more you get. That's the principle, and it's a noble one.
People complain about the effects of the principle all the time. E.g.
1) My uncle complains that a serial killer received an expensive life saving operation.
2) My friend complains that she is seeing diabetics in her clinic who are soon going to require foot amputation if they do not change their diets. They are repeatedly informed of this, and fail to change their diets.
3) A woman on TV complains that an alcoholic is receiving a liver transplant before her daughter, whose condition is not caused by alcohol abuse. The alcoholic is more critically ill.
Those could all be described as unfortunate effects of a good principle (if healthcare can ever be said to be unfortunate. Perhaps less than optimal effects, depending on one's perspective). But here's the rub: if not a system based on need, there are as far as I can see two alternatives:
a) based on ability to pay
b) based on a concept of desert
A) assumes that healthcare is a commodity not a right. It's hard to think of a human right more basic than healthcare, so effectively the assertion is that there is no such thing as universal human rights, only civil ones, including right to a free market. Philosophically the position is tenable. If I assert, 'Everyone has a right to life', and you ask me, 'Why?', I have no logical answer. Basically it's a faith proposition. My real problem with this perspective is not based in a faith-assertion of human rights, but the belief a world without a concept of universal human rights would be a terrible place. You might say I believe that human rights are a 'useful fiction', in legal terms. Whether or not they exist, it is better for everyone to proceed as if they do.
B) is obviously flawed because of the impossibility of deciding 'desert', and the problem of who gets to decide. It's actually quite hard to think of a medical scenario where the patient could be said to carry *no* blame for their condition, though assault would be a candidate. When I was 10, I concussed myself by running down the stairs and skipping at the point we had an overhang, because I thought of something that delighted me. I smacked my head on the overhang and fell down the stairs. Perhaps I was to blame for not focusing solely on the task of walking sedately down the staircase. But then, I was 10. There are a million dos and don'ts to minimize one's cancer risk. Does everyone do all of them? Every day? No exceptions? I do a lot - fruit and veg, exercise, no smoking...but when we get some decent sun in Wales, you'd best believe I'm out there soaking it up on my bare skin. And, trusting my oliveness, I don't always use sunscreen.
So...need is the best system. The fallout of that is that sometimes my taxes help give murderers surgery. That's the best we can do. It also means I pay zero pennies for my 3 prescriptions of iron, Seroxat, and a specialized painkiller. Every month, for the rest of my life if needed. I have no idea how much they cost, and unless the Tories completely dismantle the welfare state, I will never need to know.
And now onto the feline portion. (My cats are privately insured, incidentally. It's a factor in my monthly budget and it certainly doesn't cover everything. This gives me an inkling of the potentially awful costs of private healthcare. But that said, they have better and faster care than I do. I've had feline blood tests back in ONE HOUR. Mine? 3 weeks minimum). My insurer ran a live Q and A with a vet on Facebook and I discussed Bibi's intermittent colitis with him. he did have one new suggestion, which was another litter tray. Even cats that are friends sometimes get aggravated sharing, and the stress can be reflected in their output. I got a hooded tray and have put it outside in their run for now, with some clingfilm covering the slats in case of rain. Seems worth a go. Of course this depends on the cats being smart enough to get *into* the hooded tray.
I'm so sleep deprived right now. The cats woke me up last night having a fight and then I couldn't go back to sleep. Well I say a fight - really it's just noise, no damage. Today they are buddies again. Mostly they get on great but sometimes Beebs likes to push Zara's buttons and then Z gets pissed. But, they've got mouthfulls of fangs and 40 razor sharp claws between them and have never harmed each other, so one must assume they don't intend to.
Well, going to see the girls tonight so best get on. Have a nice weekend all.
PS did you see Richard Speight's tweet about the possibility of the Trickster returning to SPN? I WILL FORGIVE DALLAS-LEVEL PLOTHOLES IF THIS HAPPENS
People complain about the effects of the principle all the time. E.g.
1) My uncle complains that a serial killer received an expensive life saving operation.
2) My friend complains that she is seeing diabetics in her clinic who are soon going to require foot amputation if they do not change their diets. They are repeatedly informed of this, and fail to change their diets.
3) A woman on TV complains that an alcoholic is receiving a liver transplant before her daughter, whose condition is not caused by alcohol abuse. The alcoholic is more critically ill.
Those could all be described as unfortunate effects of a good principle (if healthcare can ever be said to be unfortunate. Perhaps less than optimal effects, depending on one's perspective). But here's the rub: if not a system based on need, there are as far as I can see two alternatives:
a) based on ability to pay
b) based on a concept of desert
A) assumes that healthcare is a commodity not a right. It's hard to think of a human right more basic than healthcare, so effectively the assertion is that there is no such thing as universal human rights, only civil ones, including right to a free market. Philosophically the position is tenable. If I assert, 'Everyone has a right to life', and you ask me, 'Why?', I have no logical answer. Basically it's a faith proposition. My real problem with this perspective is not based in a faith-assertion of human rights, but the belief a world without a concept of universal human rights would be a terrible place. You might say I believe that human rights are a 'useful fiction', in legal terms. Whether or not they exist, it is better for everyone to proceed as if they do.
B) is obviously flawed because of the impossibility of deciding 'desert', and the problem of who gets to decide. It's actually quite hard to think of a medical scenario where the patient could be said to carry *no* blame for their condition, though assault would be a candidate. When I was 10, I concussed myself by running down the stairs and skipping at the point we had an overhang, because I thought of something that delighted me. I smacked my head on the overhang and fell down the stairs. Perhaps I was to blame for not focusing solely on the task of walking sedately down the staircase. But then, I was 10. There are a million dos and don'ts to minimize one's cancer risk. Does everyone do all of them? Every day? No exceptions? I do a lot - fruit and veg, exercise, no smoking...but when we get some decent sun in Wales, you'd best believe I'm out there soaking it up on my bare skin. And, trusting my oliveness, I don't always use sunscreen.
So...need is the best system. The fallout of that is that sometimes my taxes help give murderers surgery. That's the best we can do. It also means I pay zero pennies for my 3 prescriptions of iron, Seroxat, and a specialized painkiller. Every month, for the rest of my life if needed. I have no idea how much they cost, and unless the Tories completely dismantle the welfare state, I will never need to know.
And now onto the feline portion. (My cats are privately insured, incidentally. It's a factor in my monthly budget and it certainly doesn't cover everything. This gives me an inkling of the potentially awful costs of private healthcare. But that said, they have better and faster care than I do. I've had feline blood tests back in ONE HOUR. Mine? 3 weeks minimum). My insurer ran a live Q and A with a vet on Facebook and I discussed Bibi's intermittent colitis with him. he did have one new suggestion, which was another litter tray. Even cats that are friends sometimes get aggravated sharing, and the stress can be reflected in their output. I got a hooded tray and have put it outside in their run for now, with some clingfilm covering the slats in case of rain. Seems worth a go. Of course this depends on the cats being smart enough to get *into* the hooded tray.
I'm so sleep deprived right now. The cats woke me up last night having a fight and then I couldn't go back to sleep. Well I say a fight - really it's just noise, no damage. Today they are buddies again. Mostly they get on great but sometimes Beebs likes to push Zara's buttons and then Z gets pissed. But, they've got mouthfulls of fangs and 40 razor sharp claws between them and have never harmed each other, so one must assume they don't intend to.
Well, going to see the girls tonight so best get on. Have a nice weekend all.
PS did you see Richard Speight's tweet about the possibility of the Trickster returning to SPN? I WILL FORGIVE DALLAS-LEVEL PLOTHOLES IF THIS HAPPENS