When Money Fails

Sometimes I'm almost persuaded that national health care is the way to go. Working in the NHS has given me some insight to how great it can be when it works, and just how completely horrific it can be when it falls short. Getting my MPH really opened me to the idea of universal health care... health care for all regardless of your social or economic status, age, sex, orientation, race, religion, etc. It seems so right and just, this free and equal access... But this world we live in, though at times fueled and inspired by such dreams and hopes, is not always this fair or merciful. It's too practical, rational, pragmatic. Universal health care cannot just be wished into existence with a light dusting of pixie dust. It comes at the price of cold, hard, unyielding cash.

In the A&E there was an elderly gentleman who came in because he had tripped, fallen, and hit his head. He was slightly dazed from the fall, but only had mild abrasions on his head to show for it. His son brought him to the A&E and on arrival he was grand, GCS 15/15. Very pleasant chap. About an hour or two after the initial incident, he started sluring and couldn't remember his last name or the date. Five minutes later, he could barely speak. An emergency CT was ordered but had to wait 30 minutes because there was another pt being scanned at the time. By this time, he was seizing and it was fairly difficult to gather a clear CT, but what came through clearly showed large bilateral subdural hematomoas. Now most even junior medical students could have told you from the just the initial history that his man most likely was at high risk of having a subdural hematoma. Many junior doctors would probably also be able to tell you that this situation could be treated and alleviated by boring a hole(s) in the pt's skull to relieve the pressure. While this procedure comes with considerable risk, not doing anything was even worse. True, 20% or so will recover without any intervention... but, come on... this is an old guy with 2 large hematomas. Really, what are his chances? No way, any moral, ethical, or humane person would just leave him as his brain slowly gets squeezed by the increasing pressure within his skull til it herniates or he suffocates, or however the end result is the same. Death.

But that's just what happened. Because of his age and the fact that he had a few comorbidities, the procedure that could have saved his life was not NHS approved. It is deemed a waste of money. Instead, his son must call the rest of the family to quickly come to the hospital because their husband/father was not long for this world even though just a few hours prior he had been fit and well. Would he also have to tell them that one of the reasons why their loved one was dying was because the NHS didn't have the money to allocate to a potentially lifesaving procedure? The doctors' hands were tied. They couldn't do anything because it wouldn't be paid for...

I was flabbergasted at this. I can't imagine that this would happen in the States. Even though our health care system had been far from perfect, we never denied life saving emergency treatment based on a person's ability to pay. Maybe I'm being naive and ignorant. And now our health care system is one step closer to maybe even the government dictating who gets to live, and who will have to die.. because frankly, you're just not worth the copper.