A reader of mine left an interesting comment on my post about selling your kidney. Here is an excerpt:

“I am waiting for a kidney and have been dialysising for 2 [and a] half years on hemodialysis and 5 years on capd – a gentler type of dialysis… I am…using up resources and cos[t]ing a lot of money for the UK government. My family has the money to buy a kidney but we have been advised not to go abroad by the doctors…. so…. still waiting…. still taking up resources….. still being a burden on the N.H.S… still costing the government money…. apparently it costs over £40,000 a year to keep someone on dialysis!!! in the UK”

It got me thinking about the quasi-socialized system of health care in the U.K., and how Socialism, in almost any capacity, can yield absurd results in the real world. The New York Times, despite being a decidedly “liberal” publication, sheds light on a particular example.

Sarah Lyall writes about Debbie Hirst, a British cancer patient who was denied Avastin, a common breast cancer drug. The peculiarity isn’t that the drug wasn’t covered by the British National Health Service (NHS)…it’s that Debbie was offering to pay for it herself and the British government wouldn’t allow it.

The reason wasn’t medical – her oncologist thought the drug, widely prescribed in Europe and the United States, was medically necessary.

It wasn’t based on money either – as stated above, once turned down by the socialized health care system she’d paid into her whole life, she offered to pay for the drug out of her own pocket.

It was philosophical…

British 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.”

Without question, a ridiculous outcome…

There are two strong arguments against such a position:

(1) Committing to Mr. Johnson’s position would mean preventing better overall outcomes at no additional cost to the government. In other words, a Socialist ethos demands across-the-board equality, the idea being that a socialist regime should bring everyone up to the same level of care. In economic reality, adherence to this principle doesn’t mean bringing everyone up, but rather, dragging people down to a mediocre level of care…for nothing more than the sake of the equality. The argument states that people should not be allowed to pay for life-saving care because it wouldn’t be equal. I’d be curious to see if Mr. Johnson would try to pay for a cancer drug he needed, if the government turned him down. I’d put all of my money on “yes.” You can’t substitute academic justice for natural justice… see my next point.

(2) The argument above is moot because the British health secretary can’t boast equality anyway. Here’s an excerpt for the NY Times article: “In fact, patients, doctors and officials across the health care system widely acknowledge that patients suffering from every imaginable complaint regularly pay for some parts of their treatment while receiving the rest free. ‘Of course it’s going on in the N.H.S. all the time, but a lot of it is hidden — it’s not explicit,’ said Dr. Paul Charlson, a general practitioner in Yorkshire and a member of Doctors for Reform, a group that is highly critical of the health service. Last year, he was a co-author of a paper laying out examples of how patients with the initiative and the money dip in and out of the system, in effect buying upgrades to their basic free medical care. ‘People swap from public to private sector all the time, and they’re topping up for virtually everything,’ Dr. Charlson said in an interview. For instance, he said, a patient put on a five-month waiting list to see an orthopedic surgeon may pay $250 for a private consultation, and then switch back to the health service for the actual operation from the same doctor. ‘Or they’ll buy an M.R.I. scan because the wait is so long, and then take the results back to the N.H.S.,’ Dr. Charlson said. In his paper, he also wrote about a 46-year-old woman with breast cancer who paid $250 for a second opinion when the health service refused to provide her with one; an elderly man who spent thousands of dollars on a new hearing aid instead of enduring a yearlong wait on the health service; and a 29-year-old woman who, with her doctor’s blessing, bought a three-month supply of Tarceva, a drug to treat pancreatic cancer, for more than $6,000 on the Internet because she could not get it through the N.H.S.”

The ironic bit is that Ms. Hirst’s cancer has advanced to the point that now the British government will approve Avastin, and pay for it. But she’ll probably die first. There is an economic argument in favor of Britain’s inept system – Ms. Hirst: “I’m a person who left school at 15 and I’ve worked all my life and I’ve paid into the system, and I’m not going to live long enough to get my old-age pension from this government.” Here it is: if the level of care at which everyone is equal is low enough, people won’t live long enough to collect the money they’ve paid into the system through high taxes. Ouch.

One final point – Dr. Paul Charlson’s paper (quoted above) is evidence of what common sense dictates – socialized programs DO NOT work in the real world. Even dedicated supporters of the academic notion of equal care will always secretly favor that which their means will allow. If you’re dying, and you have the money to pay for a treatment that just might save your life, you’re going to put your politics aside and pay for it – even if you have to leave the country.