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No health insurance premiums, no copays, no deductibles, and no coverage limits. I grew up under the care of military medicine—Balboa and Bethesda naval hospitals—and from the perspective of the pocketbook, free health care is rather nice. Then, as a college student I spent a semester in England and was much relieved to learn that I was eligible for National Health Services. No logisitics to worry about; more money for excursions and Oxfam. Maybe there’s something to socialized medicine after all.

Or maybe I’d sing a different tune if I’d actually gotten sick. A New York Times article today points out just one flaw in the system’s policy. Here’s the beginning:

Created 60 years ago as a cornerstone of the British welfare state, the National Health Service is devoted to the principle of free medical care for everyone. But recently it has been wrestling with a problem its founders never anticipated: how to handle patients with complex illnesses who want to pay for parts of their treatment while receiving the rest free from the health service.

Although the government is reluctant to discuss the issue, hopscotching back and forth between private and public care has long been standard here for those who can afford it. But a few recent cases have exposed fundamental contradictions between policy and practice in the system, and tested its founding philosophy to its very limits.

One such case was Debbie Hirst’s. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.

Only, she wasn’t allowed to—told that if she financed part of her care independently, she’d be ineligible for tax-payer funded services:

Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.

Patients “cannot, in one episode of treatment, be treated on the N.H.S. and then allowed, as part of the same episode and the same treatment, to pay money for more drugs,” the health secretary, Alan Johnson, told Parliament.

“That way lies the end of the founding principles of the N.H.S.,” Mr. Johnson said.

Perhaps, then, Debbie Hirst’s problem is not just a policy glitch. Perhaps it goes to the root of the centralized health-care philosophy. To tell the truth, Ms. Hirst is now receiving her Avastin free from the N.H.S.—not because she won the argument, but because her cancer has worsened. She’s not exactly thrilled: “It may be too bloody late.”



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