Friday, December 09, 2005
The NICE (I mean come on, is it fucking Opposite Day?) report, helpfully titled Social Value Judgements: Principles for the Development of Nice Guidance, makes faint noises about not 'discriminating' against patients whose problems may be 'self-inflicted' (the whole notion of which is far from straightforward in societies like ours that structurally and definitionally promote unhealthy behaviors in lower-income groups), but of course the entire point of the communication is to establish that there are two classes of sick people: deserving and undeserving. Innocent and blameworthy.
So what, did they just want to put that out there, F.OurI.? How exactly is a provider meant to take the proposition that 'if the self-inflicted cause of the condition will influence the likely outcome of a particular treatment, then it may be appropriate to take this into account in some circumstances', if not as explicit encouragement to distinguish between patients whose conditions are 'self-inflicted' and those whose conditions may be equally intractable but who aren't to blame for them? That is discrimination, quite nakedly so, and it militates against everything the NHS was set up to represent.
The NHS 'was set up on the 5th July 1948 to provide healthcare for all citizens, based on need, not the ability to pay'. Catch that all citizens bit? Not all model citizens, not all citizens who meet certain criteria of our choosing. But of course the very notion of providing a universal, government-funded service to all, regardless of whether they've 'earned' it, is anathema to the hyperindividualist free-market ideology of neoliberalism. (Though in fact, even if we adopt for a moment their hateful predicates, one presumes the obese and others with preventable health risks pay taxes pretty comparably with the general population--certainly no claim to the contrary is being made--so in fact this report is advocating denying them a service they've already paid for.)
The NHS is being systematically gutted by underfunding, and its quality of care deliberately rotted out by the interpolation of private-funding initiatives in the name of 'competition' and 'efficiency'. These are not laws of nature. They are deliberate, ideology-driven choices made by a government that would rather spend taxpayer funds in Iraq, Afghanistan, David Blunkett's impossibly convoluted personal life, anywhere but on providing its citizens with the basic necessities of life.
British people! Do not let your government kill the NHS! I know whereof I speak; I write from the Land of Psychotic Healthcare Iniquity. Having grown up with the assurance of guaranteed healthcare (albeit, I grant you, often less-than-ideal), I think it might be hard for you to really grasp what it's like here. People die here every year in their scores of thousands from the simple fact of not having health insurance. Millions more live in poverty, pain and illness, go without food to pay for medicine, forgo the most basic preventive care to keep them alive and healthy because they simply have no money to pay for it. Millions.
And the ideological core of the argument against providing universal healthcare in America is You Can't Give Something For Nothing. Why should the Deserving, who've worked for their crust, have to foot the bill for those who Choose Not To? And that, that right there, is the wedge of which this horrific report is the thin end. First we distinguish between the Deserving and the Undeserving, and then we can justify not giving the Undeserving what they self-evidently don't deserve.
Listen to the NICE lady explaining for your reassurance what the report really means:
"We want to reassure people that in producing our guidance we are not going to take into consideration whether or not a particular condition was or is self-inflicted. The only circumstances where that may be taken into account is where that treatment may be less effective because of lifestyle choices."See the difference? Neither do I.