Here's a story for anyone who imagines that government-run medicine will somehow do away with gatekeepers who deny suffering patients the treatment they need based on cold-hearted financial calculations: British doctors are refusing to perform surgery on a man with a multiply fractured ankle because he's a smoker. "Doctors at the Royal Cornwall Hospital in Truro have refused to operate," reports the Daily Mail, "because they say his heavy smoking would reduce the chance of healing, and there is a risk of complications which could lead to amputation." But at least they're willing to give him morphine for the agonizing pain caused by the injury they refuse to fix.
Michael Siegel explains the reasoning behind such decisions, quoting a commentary that appeared in the British Medical Journal:
Increased use of hospital beds and associated costs mean less opportunity to treat other patients. Based on these data, five non-smokers could be operated on for the cost and bed use of four smokers and the non-smokers' surgical outcomes would be better. A well informed smoker, unwilling or unable to quit, might assume an increased risk for himself, but the decision is not his alone when it can indirectly affect others. Then, the community must involve itself.
Siegel worries about the consequences of "community" involvement in every medical decision, and so do I. But while he calls for more compassionate, tolerant, and enlightened policies by health-care-dispensing bureaucrats, I'd like to avoid the centralization of such decisions, which inevitably leads to situations like this. Last April I attended a conference at Harvard that was supposed to explore the theme of "responsibility for health," and much of the discussion revolved around the question of how central planners should allocate scarce medical resources, including the issue of how much should be spent on fat people and smokers when the government can get more bang for its buck by focusing on skinny nonsmokers.
Scarce resources always have to be allocated one way or another, of course, and Michael Moore did not have to invent stories about getting screwed over by HMO gatekeepers. But there is an important difference when patients have some choice of providers and health plans. Some might deign to repair a smoker's fractured ankle, for example. There need not be one policy for the whole country regarding what is covered for whom. Giving the government a monopoly on dispensing health care only exacerbates the problems created by medical gatekeepers.
More fundamentally, if people pay for medical care out of their own pockets, they are less likely to be viewed as public enemies when they fail to be as healthy as they can be. Those concerned about the totalitarian implications of treating every health-related decision as a matter of public policy should look for ways to expand competition and consumer choice in health care, not restrict it.