Starker on 24/10/2017 at 15:31
Quote Posted by heywood
In a country that believes that health care is a human right, it's surprising to me that public opinion would be in favor of treating a ground of people as second-class citizens with lesser rights.
Well, let me ask you this... In your home country, do you have counties that do things differently from the rest of the state? Why would you be surprised that there is such a county in the UK?
heywood on 24/10/2017 at 15:50
Of course there are going to be differences from locale to locale. That's not the point. The policy decision was justified based on polling and I'm surprised such a high percentage of people (85%) are in favor a policy that is blatantly discriminatory.
Starker on 24/10/2017 at 17:03
Well, I'm going with nickie's answer then that there are probably lots of smug ex-smokers and skinny people in that county that hate smokers and obese people.
nickie on 24/10/2017 at 17:30
Perhaps it's a class thing: middle class (like voting) perceiving working class and unemployed as obese chain-smokers and probably don't pay taxes towards their health care. (Massive generalisation).
Starker on 24/10/2017 at 18:51
In the UK, people in general seem to like the idea of Tory austerity and underfunding the NHS. Or at least enough to re-elect them.
nickie on 24/10/2017 at 19:56
I'm not so sure about that. I believe that a majority would prefer to see the NHS well funded. But I also think a majority believe there's a lot of wastage of resources and possibly/probably would like to see funds go to what they believe are medical necessities rather than what they see as medical choices without understanding the cost of mental health issues resulting from not being able to get IVF or sex change treatment, psychological help etc. etc.
My biases tend towards thinking Tories are of the 'be a man, pull your socks up and stop snivelling' thinking.
Edit. That is just my opinion but I have seen tremendous improvement in service since I first started seeing a doctor on my own and I do believe that the doom and gloom merchants have the loudest voice.
SubJeff on 24/10/2017 at 20:23
Quote Posted by heywood
Regardless of the headline, I can't see this as anything other than punitive.
The proposed rules mean that people are going to be denied treatment for reasons that may be completely unrelated to their ailment, which is just plain unfair and discriminatory.
Look at it this way - if an obese person has a bad knee because they are obese, and the knee replacement is more likely to fail because they are obese and smoke, it ends up costing much more money to fix this knee problem than it would in a non-obese, non-smoker.
Let's make up some figures - in potatoes P.
It costs P100 to do a knee op. In an obese smoker it lasts on average 5 years before it needs a redo. In everyone else it lasts 10 years.
For every obese smoker over 10 years you've just denied a knee op for someone who took care of themselves. So not only are they costing more money, they are affecting other people's care AND they chose to do this.
So this isn't 'completely unrelated to their ailment', is it? And to top it off it makes life harder for other people. Do those maths over 20 years. That's a lot of suffering because someone else had poor self control.
Now this isn't my opinion, but that is the argument and when you've got limited funds if you want to be 100% utilitarian/pragmatic it makes perfect cold, logical sense.
heywood on 24/10/2017 at 22:28
Like I said, if the patient's condition makes surgery risky or of limited or temporary benefit, that should be factored into the decision whether or when to operate on a case by case basis. And it shouldn't matter whether the patient's condition is a result of smoking, obesity, alcoholism, cancer, a birth defect, sports injuries, or something else. In some cases, you may put a patient in the back of the queue for surgery because of a health condition that makes them a poor candidate for surgery, and the health condition resulted from smoking or obesity. But in many other cases, there won't be any direct relationship between the person's smoking or obesity and the ailment they need surgery for. If you deny surgery to a demographic group categorically, without fair consideration of the risks and benefits in each case like you would for everyone else, that's just plain old discrimination. And pretty mean spirited too.
Starker on 25/10/2017 at 09:37
But the demographic group is characterised by bringing more risk to the (operating) table. It's not like smokers and obese people were picked arbitrarily. Smoking and obesity itself are risk factors that lead to worse outcomes. Also, they would not be denied surgery outright. It's not even as if people would be asked to quit smoking -- they could simply wear nicotine patches for 8 weeks before the surgery to reduce the risks. It would not be a blanket restriction on all non-urgent surgeries either.
Also, apparently a large percentage of people who supported this would be directly affected by the proposal and would likely have to pause their smoking or lose weight for some types of surgery.
Quote:
(
http://www.enhertsccg.nhs.uk/news/201710/east-and-north-hertfordshire-nhs-service-changes-%E2%80%93-decisions-announced) http://www.enhertsccg.nhs.uk/news/201710/east-and-north-hertfordshire-nhs-service-changes-%E2%80%93-decisions-announced
There is a significant level of public support for most of the changes that have been agreed - even from people who told us that they would be directly affected by the policy changes that we proposed. Our fitness for surgery proposal is a good example of this - 84% of those who responded thought this would mean that they themselves would need to either stop smoking or lose weight if they needed a non-urgent operation, but agreed with this policy.
heywood on 25/10/2017 at 12:59
The risk argument also applies to old people, people with heart disease, kidney disease, liver disease, cancer, asthma, diabetes, people with weak immune systems, drug abusers, and a whole host of other things. Probably the majority of people considering surgery have some risk factor. COPD is risk factor and smoking is common cause of COPD. If a doctor decides that a person with an advanced COPD is a bad candidate for surgery because of the risk, that's just prudent medicine, regardless of whether the COPD was caused by smoking or something else. But if a smoker can't get surgery even though they don't have COPD, heart disease, or any other adverse condition caused by their smoking, that's discrimination.
We can spend all day cherry picking examples where denying surgery to a smoker or obese person is justifiable or not justifiable, but that just reinforces my point that you have to consider every patient's situation on its own merits, give every patient equal consideration.
Among all the risk factors, only smoking and obesity were singled out, because their low social status makes them convenient scapegoats.
