Health care in the United States was never perfect, but in the days before Medicare, it was the best the world had to offer. Whenever we begin to discuss such things as socialized medicine, we are almost immediately drawn to the United Kingdom’s National Health Service system, its baby brother in Canada, or the “single-payer” system in Japan. I think they call it managed health care —which I think is not only appropriate, but true. The questions are, who manages it, what is the effect, and at what cost?
I recently came across two analyses of the British NHS and Japan’s; it was not only interesting, but should serve as a warning bell to the American people who somehow feel as though we can trust the government to do the right thing. The problem is in determining what the right thing is, as we shall see below. But first, a summary of managed care in the United Kingdom and Japan.
According to Dr. Thane, the United Kingdom’s problems arise from two post-war measures: the NHS and National Assistance Acts (1948). The latter measure required county level governments to provide shelter for elder persons, to monitor and supervise elder care, and provide meals, home care, day care centers, and to subsidize private organizations attempting to provide similar services. Apparently, no one in the central government stopped to consider that monetary resources were limited, and they also failed to imagine that elderly populations would eventually increase. The latter would result in greater demands for funding that simply wasn’t available. Labor Government in the post war period could not fund all their ideas so they simply required county government to do this, or as Dr. Thane stated, prioritized the delivery of health and senior care. Thane argues that the relatively poor care of elderly persons living in the United Kingdom is the result of age-discrimination. She apparently ignores the fact that younger generations are also receiving relatively poor care, but on the other hand I think she is right about spending priorities: the British government is able fund outlandish foreign aid projects, but is somehow unable to address the health care of its own citizens.
Dr. Hayashi’s analysis of the health care system in Japan includes a short comparison to the way things used to be done in Japan (citing Confucian values) to those in practice today—one in which long term care is challenged by the same factors found in all industrialized societies: more people, fewer monetary resources (or that pesky prioritizing measure). “But post-war social and economic change had major implications. Japan’s economic miracle made it possible to introduce a universal healthcare system in 1961, and then free healthcare for older people in 1973. This contributed to an increased life expectancy and unprecedented numbers of older people surviving, but requiring long-term care.” Confucian ideals could no longer stand up to the expectations rooted in ancient values and this resulted in abuse and neglect in homes where the aged were being cared for by younger generations.
The Japanese government introduced universal long term care insurance for older people in the year 2000, funded by government and everyone over the age of 40; it may work now, but the program is unsustainable. By 2025, almost one-third of Japan’s population will be aged 65 and over. Included in this estimate are 7 million people suffering from dementia.
Not to worry … our governments are watching out for us. During the debate over Obama-Care, both Congressional parties raised the argument of death panels with each side accusing the other of horrific programs that would result in detached managers making decisions about whether a patient should receive medical treatment. The older the person is, the less likely they will be to receive needed medical attention. Tied to this, the federal government demanded that private doctors and hospital turn over all their patient records to the regulating agency (there are several, including the Treasury Department, if you can believe that). In this way, panels will take note whether the patient adopted a healthy life style; drinking and smoking could result in the panel deciding not to extend health services.
Now back to the United Kingdom for this case in point: The Liverpool Care Pathway (LCP), developed in the 1990s at the Royal Liverpool University Hospital in partnership with the Marie Curie Palliative Care Institute. This was not a form of treatment for sick or dying elderly; it was a methodology used to speed them along to their graves —making them as comfortable as possible, of course, but denying them nourishment and water.
In 2013, the LCP was excoriated in the press when it was revealed that the process implemented hastened death by starvation or over-prescription of pain killers. Families were kept in the dark about what was actually happening to their loved ones; seniors were placed into LCP programs without theirs or their family’s consent. What did the British government do about this intolerable situation? Why, Parliament convened a commission, of course.
In 2015, Professor Patrick Pullicino was one of the UK’s first medics to raise concerns over the pathway to death and argued that recent government proposals were worse than the LCP: they could push more patients into an early grave. Pullicino stated that new government policy encouraged hospital staff to guess at who was dying, in the absence of any clear evidence, and then to take steps that could hasten patients’ death. This means withdrawing fluids and treatment and the administration of sedation to the dying, based on no more than a reasonable guess by a healthcare manager.
If the American people were smart, and I am certainly not suggesting any such thing, they would look carefully at what is happening to Medicare and Medicaid under the so-called Patient Protection and Affordable Care Act and judge for themselves if managed care is moving dangerously close to the Liverpool Care Pathway. I only mention this because Dr. Victor J. Dzau of the Institute of Medicine once said, “The time is now for our nation to develop a modernized end-of-life care system.”
Really? What does that mean, exactly?
Do we want government or medical eggheads to have the power of life and death over us, or our parents and grandparents?
Americans might pause to consider the far-reaching implications of managed health care; they may want to remember as well: whatever goes around comes around.
 Note: the political party that gave us Medicare also gave us Obama-Care. The people who instituted the NHS were also leftists … what they have given us today in no way resembles what they promised.
 Thane, Pat and Hayashi, Mayumi, Why is our elderly care services in crisis? BBC History Magazine, February 2017