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Doctors To Breathalyse Smokers Before Allowing Them NHS Surgery (bbc.com)
Smokers in Hertfordshire, a county in southern England, are to be breathalysed to ensure they have kicked the habit before they are referred for non-urgent surgery. From a report, shared by several readers: Smokers will be breath-tested before they are considered for non-urgent surgery, two clinical commissioning groups (CCGs) have decided. Patients in Hertfordshire must stop smoking at least eight weeks before surgery or it may be delayed. Obese patients have also been told they must lose weight in order to have non-urgent surgery. The Royal College of Surgeons (RCS) said the plan seemed to be "against the principles of the NHS (the publicly funded national healthcare system for England)." A joint committee of the Hertfordshire Valleys and the East and North Hertfordshire CCGs, which made the decisions, said they had to "make best use of the money and resources available." Patients with a body mass index (BMI) of over 40 must lose 15% of their weight and those with a BMI of over 30 must lose 10%, or reduce it to under a 40 BMI or a 30 BMI - whichever is the greater amount. The lifestyle changes to reduce weight must take place over nine months.
It's not society's job to do it for you
but this is a big step towards them.
"I don't know, therefore Aliens" Wafflebox1
Obese patients have also been told they must lose weight in order to have non-urgent surgery.
Seems like this will remove the entire point of liposuction surgery. Or at least make those clinics move outside of Hertfordshire.
-- All that is necessary for the triumph of evil is that good men do nothing. -- Edmund Burke
A friend of mine was talking to a surgeon (a friend of his) about the risks of some surgery, and the doctor quoted his own success rates, so maybe he said "8% had a bad outcome" (I forget the number but it was in that range) but then he added, "but please realize every single one of those patients had serious complications such as being morbidly obese, usually with diabetes", etc. In those cases the risk of not doing the surgery was certain death, so the patient and doctor had little choice but to take the risk. However, I can see why a surgeon would want to avoid "non-urgent" surgery on a patient if they could significantly reduce the risk by losing some weight first.
"I have never let my schooling interfere with my education." - Mark Twain
Healthcare is a product with infinite demand and limited supply. There must always be a rationing system. In the US it can cost an absurd amount of money. In the UK it is "free" and therefore there will need to be another rationing method.
Halting smoking and/or losing weight when you're obese before you have major surgery means you're less likely to die on the table.
The doctor's trying to save your life, not deny you healthcare.
Where's the controversy here? I don't see it.
How long before we see this catch-22 in the Daily Mail:
Guy with bad knees can't walk. Gains weight. Needs knee replacement surgery. Ordered to loose weight before surgery can be approved. Told to get out and walk more to loose weight. "I can't walk!" Sorry, sucks to be you. BTW, I see you have a liver donor card...
Isn't the BMI measurement widely deprecated these days?
Now the big question is will this result in the patients improving their health before surgery or will surgery just get deferred until it's urgent?
When someone says, "Any fool can see
Two words: supplemental policy. The math isn't that hard, try using your brain.
However, one does have to ask whether this is a wise choice based on the evidence. If the patient is in pain, for example, forcing that patient into the traumatic experience of withdrawal may be contraindicated, and if the surgery has preventative merits, patients may delay to avoid that experience and end up burdening the system even more once the need progresses to an urgent state.
Someone had to do it.
Before everyone goes crazy about how bad the NHS is and how "we don't want that here", please bare in mind that the only reason it has reached this point is because funding for it is cut at every turn, so as to make it nearly unsustainable. Very much as Trump is trying to do by cutting the CSRs.
The UK doesn't have Single Payer. They have Socialized medicine - doctors are public employees, and the government runs the whole deal (supplemental care excepted)
Funny, Canada has had single-payer for decades, and hasn't pulled this kind of nonsense.
Are Americans such sheep that they'd put up with it? I have my doubts.
I've calculated my velocity with such exquisite precision that I have no idea where I am.
The UK government isn't refunding the taxes that these fat smokers pay for the NHS, are they?
-jcr
The only title of honor that a tyrant can grant is "Enemy of the State."
Yes, I totally want our thoroughly corrupt government deciding who lives or dies. That's clearly better than a profit-motive based implementation where an increased demand for surgeries prompts new facilities and more doctors to fulfill the need. Whereas the government would likely ration care and wait-list patients that can't survive that long, with taxpayer funded bonuses to the heartless bastards responsible.
However, one does have to ask whether this is a wise choice based on the evidence.
Agree. A much better strategy would be to require a mandatory annual checkup.
During the checkup, the patient will be checked for all the normal stuff, And in addition they will be checked for "Hazards" --- for example, checks will be made to determine if they are Obese or a Smoker.
Patients will be assessed an annual Penalty or additional charge that will append to taxes owed; E.g. $1400 fine for failing to report for an annual checkup; $400 per year fine if found to be a smoker, and up to $700 fine per year if found to be obese scaled by the level of obesity down to $200 for somewhat obese and $0 for only slightly -- the fine will be reduced to zero if this is the first year they showed in a 'Hazard' category and make a marked improvement.
That way they help compensate the system/society for the additional costs AND promote change in all citizens, not just those that already need a surgery.
Whats the Fucking Spaghetti Monster have to do with the price of rice in China?
Higher consumption of spaghetti would result in lower consumption of rice, resulting in lower demand and thus lower price.
http://spamdecoy.net - free throwaway anonymous email - avoid spam!
Yes it has. Canada has seen an explosion in the cost of providing universal healthcare. So much so that they have to ration care, have caps on the number of procedures in a given year, which leads to longer wait times. Some simple research will show you the same results. It is dying under its own weight. Choices are simple: tax more or reduce services. Either way it will get back to the same point again. Something people don't seem to get is that there will never be a time where there is "enough" for everybody. Even if everyone on the planet was a doctor, you'd still have limited supplies of equipment and medicine needed to treat everybody.
To clarify, Canada hasn't chosen to use smoking or obesity as the way to defer procedures covered under universal healthcare, but they have reduced services. They chose to make everyone wait longer. Either way, both methods are just delaying the inevitable.
Valid Point, There is this ;)
;) ATM
America does have one of the Worlds Best Health Care Systems."Money Can Buy"
FYI
Canadians Increasingly Come to U.S. For Health Care
Canadian Politician Comes to U.S. for Heart Surgery
Why Canadian premier seeks health care in U.S. - SFGate
What a wonderful world you live in. Before ACA, the insurance industry would charge you significantly more, if they would even cover you, for a litany of "pre-existing" conditions. If you go through some of those lists referenced, you'll see interesting things listed, like acid reflux. In fact, ACA came about because getting health insurance as a private citizen was basically impossible unless you were in the top 10%, and only then if you were "healthy" as defined by the insurance company. Single payer would be better for essential coverage because it would just cover everyone and knock out a large swath of basic care that's needed. Supplemental coverage (wow, does this ever sound like medicare...) could cover all those extras you'd want covered the government doesn't cover. So it's not the government deciding who lives/dies, they only cover certain basic functions. After that, it's you/your supplemental insurance that decides.
The cesspool just got a check and balance.
You don't understand how insurance works. Pre-existing condition clauses are necessary. Insurance is a risk pool. You spread out the risk by having healthy people paying in to protect themselves should they need care, and that money is used to fund care for people in need. Without the pre-existing condition clause, healthy people wouldn't buy in until they need care. They won't have paid anything in. Enough people do that and there is no pool to draw from.
Personal policies are expensive because the vast majority get their insurance through their place of employment. Like any product, if demand is low, not many companies will provide it and it will cost more.
Are they also announcing an effective weight loss program? As I understand it, outside of surgical interventions, there are basically no weight loss programs that are known to work for at least 50% of participants and are effective over a period of 2+ years. I'm not claiming there are no ways to lose weight or anything like that, merely that we don't seem to have a handle on how to reliably make it happen for the typical person in the long term.
Am I wrong? Is there something known to be reliably effective? Or is this just the health service trying to opt out of serving high-risk patients?
Those myths and deceptive half-truths have been utterly blown out of the water by this lady, a Canadian doctor testifying in front of the US Senate:
https://www.youtube.com/watch?v=xxtGepwXaes
Yes, a Canadian politician went to the US to get a minor heart operation done. He is well-known up here as a loudmouthed posturing idiot with more money than brains. He is now retired and out of our hair, mercifully. Also, you may be surprised to learn that we have more than one politician, many of them quite wealthy. Try to find others taking similar measures when they have health problems.
I've calculated my velocity with such exquisite precision that I have no idea where I am.
?????
You think that's a good way to treat others?
No wonder we have a gun problem.
I'd shoot you for that taxation with no representation.
I understand exactly how insurance is supposed to work for it to provide the type of service people want/need as healthcare. It's a general risk pool with people paying in. The thing ACA did was attempt to force everyone into the pool. It seems to have been somewhat successful at increasing the general pool. Single payer fixes it by having everyone in the pool. Your scenario would hold more water if there was a credit system for paying into the pool. But what happens with insurance is they're happy to take your money while you're healthy, but as soon as you develop something where they have to pay, they kick you out based on "pre-existing" conditions, because every year you need to sign up like you're a new person.
Now, if they couldn't kick you out, but you got a credit for every year you were in, the rate charged could be indexed to your credits. This would address the in/out scenario adequately in your scenario, and prevent exclusion for pre-existing conditions. If you stayed out during your 20s and 30s, you'd come in at a 5 or 10 fold higher rate in your 40s than someone who paid in the entire time. Now - everyone pays the same at 40, whether they were in or not. Pre ACA, you paid more at 40 than 20, unless/until you fell into the "pre-existing" condition loop hole, where you could be charged 10 times more or be kicked out entirely.
Finally, employment policies have nothing to do with personal policies at all. That's just a red-herring.
The cesspool just got a check and balance.
And yet I had coverage before the ACA. And lost it because of the ACA, only to have to buy it again, but this time with maternity coverage I can't possibly use, and now with premiums that are over 400% higher, and a deductible that's over 500% higher. Yay, ACA. Now I get essentially no benefit from my huge new premiums, and no longer have in hand the cash I'd normally have used for a routine visit to the doctor that the ACA's coverage no longer covers. Yay, thanks Democrats. You've given me essentially a catastrophic insurance plan at the cost of a premium plan that delivers exactly zero actual health care until I've dished out tens of thousands of dollars on top of what the care actually costs me. Thanks, Democrats.
Don't disappoint your bird dog. Go to the range.
We ration care too. It's just by ability to pay. If I can't afford a face-lift, I don't get one. Similarly, if I can't afford my chemo treatment, I don't get it either.
We also have socialised medicine on the cheap - our per-capita spending is much smaller than any of the major continental European countries, which might explain why the NHS is constantly overwhelmed and struggling for resources.
What will gov funded health care look like globally? .
The number of emergency patients that can be cared for over 24 hours given the services needed in tax payer hospitals will be set.
What to do when too many patients need emergency services and gov funded hospitals cant accept any more patients at that time?
Wealthy governments will start to place their tax payer covered emergency patients in private hospitals removing services from the fully insured.
Such new costs will have to be covered more rationing in the public health sector.
Longer waits to see a specialist
Rationing of service to a few main city hospitals. Not in a city? A long wait to get to any services.
New standards about what level of care will be offered for any elective surgery. Rationing on an age scale. Medications and services just don't get offered to older people.
A set number of medications. Generic medications that have less of that "new" cost to the tax payer healthcare system. Fewer new drugs get added to the tax payer supported healthcare system so governments can keep funding under control.
Domestic spying is now "Benign Information Gathering"
the fine will be reduced to zero if this is the first year they showed in a 'Hazard' category and make a marked improvement.
So they get dinged the second year if they don't remove the "hazard" despite their best efforts, right? "This year you showed up as 'obese'. You got rid of half of that weight in a controlled, lasting manner, but this year are still obese. Pay up, sucker!" Or is it better to have people yo-yoing their diets, crashing to get under the "hazard limit" and then picking it all back up, plus some?
And, pray tell, what do you do with the people who have gained weight because of the medication you've put them on to keep them alive? I heard a fascinating lecture on weight loss 101 (search for the podcast "Darthmouth Hitchcock Medical Lectures") that reported a patient who was put on a certain medication that gained 30 pounds in one month with no other changes in lifestyle. "Woopsies, we gave you a drug with known weight gain issues and now you are obese. Pay us more!"
You know, people are all about health care being a basic human right and we must have single payer to make sure that happens, and then immediately start thinking of ways to keep people from getting healthcare that is their basic human right.
the "secret boards" already exist. they just answer to the executives of the Insurance carriers instead of the Government.
we have decades of overwhelming evidence now that diets don't work
No, we have decades of evidence that people do not stick to their diets. Diets do work. If you burn fuel faster than you take it in you will lose mass. There is no way around it.
The real problem is that "health insurance" isn't insurance, it's just a means for moving money around. Unless you wander off into a forest and die or fall into a volcano or a vat of molten lead, there is a 100% chance that you will require medical care. As for pre-existing condition clauses being required, imagine if Homeowner's insurance had "fire" as a pre-existing condition that followed you for the rest of your life. You have one grease fire in the kitchen and you can never get home insurance again. Unlike a house or a car, you can't yet replace a body. Once your roof is on fire, it's on fire forever. Except that with health "insurance" we expect insurance companies to keep replacing the roof as it burns and then watch the new roof burn too.
The REAL real problem is that modern top-of-the-line healthcare is incredibly expensive, and we're losing cheaper older technology that was generally "good enough", largely because of the enormous opportunity cost of manufacturing an older generic drug versus manufacturing a new patented drug. Good luck finding a doctor under 60 with the knowledge and mix to make a plain old plaster cast, because charging a % overhead on a $1000 fiberglass epoxy cast is way more profitable than on $5 worth of plaster of paris. Plain old insulin is another one that suffers from constant improvements - each slightly more expensive than the last.
Like "any" product? Are you sure about that? Someone is at the grocery store sitting there adjusting the charges as you browse because you pay more for the exact same apple because you're self-employed than if you worked for Ford? I'm sure you imagine that a Ford employee's apple must somehow be less nutritious or valuable than a self-employed person's apple, but I'm not seeing the difference from here. Generally employer-provided insurance is cheaper because they pay some portion of the premium for you (and get a tax deduction for doing so). That's why people get sticker shock when they leave the company and sign up for the COBRA extension: It's the exact same insurance but now they have to pay 100% of the premium themselves.
If I have been able to see further than others, it is because I bought a pair of binoculars.
So they get dinged the second year if they don't remove the "hazard" despite their best efforts, right?
No fine for successive years would be based on severity and failure to improve, or severity and amount of worsening (if they backtracked), and zero'd if they remain on documented plain and continued to improve...
what do you do with the people who have gained weight because of the medication you've put them on to keep them alive?
They need to get a medical exclusion from the penalty for being on a treatment or having a metabolic issue that caused the condition outside their control; for these cases they get an exception lasting at least 10-years that can be renewed if they're still on the treatment or still have the condition.
If you ever get married, I dare you go to your wife and tell her that you would like her to pay more for the health insurance because you don't need maternity care and she does. Maybe you get lucky and she gives you a free prostate exam which of course she doesn't want to have on her health insurance because she can't possibly use it.
I am not a surgeon, but I am a doctor who recently finished residency. Testing for recent smoking is a very good policy, and it will save lives and reduce complications, as smoking interferes with recovery from surgery like you wouldn't believe. Even if a patient can't stop smoking long term, they need to at least stop for a few weeks (preferably for at least a few weeks before and a few weeks after surgery).
Cigarettes are a vasoconstrictor, meaning they cause blood vessels to clamp down, reducing blood flow. It contains carbon monoxide, which reduces oxygen carrying capacity. It suppresses the immune system -- all this interferes with wound healing, and the post-surgical period is often a race between wound-healing and breakdown/infection. Patients literally can have poorly healing surgical sites split wide open or bits of themselves turn black and necrotic, because they couldn't stop smoking at least temporarily.
Smoking is pro-coagulant, increasing tendency of blood to clot -- this is not a good thing, as it tends to do so in all the wrong places at the wrong times, and a major potential complication with bed-bound patients and patients recovering from surgery can be abnormal blood clots in the veins and lungs. It paralyzes the respiratory cilia that clean your airways, and it reduces lung function, at a time when a patient is at elevated risk for pneumonia.
You want to keep smoking after you're all done healing up? Fine, we'll tut-tut at you about the long-term risks when you're following-up in the outpatient office later, but stopping around the time of surgery can literally be a matter of life or death.
I'm having a heart attack, phone BUPA!
They need to get a medical exclusion from the penalty
In just a few years we'll have more pages of "medical exclusions and taxation" than we do IRS regulations for income taxes. We'll have replaced a costly insurance paperwork nightmare with a medical exclusion one.
You don't get a refund on your contributions to the NHS though if you do.
That's because if you develop cancer or some other long-term condition the NHS will pick up the burden when your private health care provider tells you to fuck off, sorry declines your renewal for the year.
To have a right to do a thing is not at all the same as to be right in doing it
Two words: supplemental policy. The math isn't that hard, try using your brain.
However, one does have to ask whether this is a wise choice based on the evidence. If the patient is in pain, for example, forcing that patient into the traumatic experience of withdrawal may be contraindicated, and if the surgery has preventative merits, patients may delay to avoid that experience and end up burdening the system even more once the need progresses to an urgent state.
I think they are talking about elective/cosmetic surgery where there is no immediate pain or risk to health aren't they?
To have a right to do a thing is not at all the same as to be right in doing it
My next door neighbours are both doctors. Coming from a medical family myself, and being naturally curious, I frequently chat with them about the stuff that's going on in medicine...
One of them was recently involved in a study that dealt specifically with post operative recovery rates of smokers, comparing those rates between smokers who had and had not had a cigarette in the immediate period prior to their operation.
The results were not what you'd have expected. In fact those smokers who were still smoking, even though they'd been told not to, had faster recovery rates and less complications than those smokers who had not had a cigarette from an extended period prior to their operation.
Of course we discussed possible reasons for this extremely counter-intuitive result but only two of the reasons we could come up with made any real sense: the effect was significant and real, and based on 'unknown' psychological (must get better, faster, so I can get up and have a fag...need a fag...) or physiological (for example the pre-op stress of giving up smoking weakened the 'non smokers' in some way or otherwise predisposed them to complications) factors; or the study results were a statistical fluke, exacerbated by the small sample size (the somewhat technical breath test has not been widely used on pre-op patients).
The slightly troubling aspect, I found, was that he was asked not to present the findings in any way that could be construed as suggesting that there was any positive benefit in smoking (which is a bit hard to do when that's what the results showed) at a recent conference, as there's still very much a 'war on cigarettes' going on. Don't get me wrong, I'm not advocating smoking. Any benefit demonstrated in this study is vastly outweighed by the harm that smoking does. The results are however intriguing and, in my opinion, worthy of further study; covering up inconvenient results is neither good science nor a basis for good policy.
Disclaimer: Sorry, I have no links to the study I'm talking about. I'm not even sure it has been published yet (or ever will be). You have every right to treat everything I've just said as an anecdote of dubious provenance, and be appropriately skeptical.
And the problem with health insurance as it was before ACA is it was designed to maximize profit within legal limits from those of low risk (that'd be young you, unmarried, male) and charge them some rate low enough to get you to pay it with virtually no large risk payout. They really should have been charging you 1/45th of your estimated lifetime risk (since they really only cover from 20 through 65) and that should have been a yearly charge. But if they do, no one in their 20s, and few in their 30s would take coverage, and you're a shining example of that full misunderstanding of how insurance is supposed to work.
That said, ACA didn't effectively tackle the other aspect of the insurance/provider collusion. So while the pool was increased, the insurance/provider price fixing is still in full force. Note that COBRA policies are now actually much better deals than the marketplace plans, and generally cover more as well. So the marketplace isn't all that great at this time. I have good ideas of how to fix it, but doubt politicians have the stomach to deal with the fallout from insurance providers and large swaths of health care providers if they were to do what was needed.
The cesspool just got a check and balance.
Generally employer-provided insurance is cheaper because they pay some portion of the premium for you (and get a tax deduction for doing so). That's why people get sticker shock when they leave the company and sign up for the COBRA extension: It's the exact same insurance but now they have to pay 100% of the premium themselves.
You might want to try that out some time. The sticker shock is what "private" insurance now costs, compared to COBRA, and what you get for it. Even in 2000, COBRA was no more than 50% of free market provided you were young enough. As soon as you were 40 it is a wash. Which just goes back to the health insurance industry not charging the young enough for what should be a lifetime amortized cost. (I didn't do the careful comparisons I in the past decade, where what you get on the private marketplace is absolute crap compared to employer based insurance, even the gold level plans suck compared to what I thought was a relatively mid-level employer based plan, which cost at least 30% less)
A single payer base system would remove a lot of issues. Base systems only deal with minor things, broken bones and accidents, annual checkups, prenatal care, vaccinations, basic dentistry and vision care. Things that are easily quantifiable and able to be estimated. Yes, this leaves things like cancer, large swaths of chronic diseases, etc, still in the hands of insurance. If they can be properly quantified and brought under the single payer umbrella, great. Otherwise, leave it to supplemental insurance or other organizations, which is no different than today. The reason for the split is that the goal is to get basic health care to all without breaking the budget or large new taxes, both of which wouldn't float in congress. What would happen is that insurance's revenue flow would be significantly reduced, and providers would have a much simpler billing system for 90+% of what they do.
The cesspool just got a check and balance.
While it sounds like a great way to save the NHS money by getting people to become healthier problems will arise in practice.
Anybody who smokes and doesn't want to quit can simply resume smoking after the test... Just like how drug addicts who are forced into detox usually return to using after they are released.
With obese patients the idea is even worse because if they simply diet to lose the weight they will end up losing a combination of fat and muscle, which lowers their metabolism. After surgery if they then return to the bad habits that made them obese in the first place they will gain all the weight back and probably some additional... Your just perpetuating a cycle of yo-yo dieting.
Dealing with addiction and obesity is not easy... To be effective the person has to want to change, forcing them simply won't have the long term effects you want.
Technology is most abused by the very people it was created to help
Hi I'm here for my Gastric By-pass surgery!
Loose some weight first...
What?!
I think they are talking about elective/cosmetic surgery where there is no immediate pain or risk to health aren't they?
Were it the health care system I had to go to, I would never assume such a thing. There are plenty of abstinence-only tobacco zealots available to formulate policies that have no solid scientific grounding in either overall patient welfare, or in legitimate health system financial concerns. Plenty of fatty-punchers, too. And, if previous comments have any merit, plenty of people willing to take extreme positions opposite of their actual agenda in order to discredit the system as a whole in an attempt to undermine it.
Someone had to do it.
It's only for non-urgent operations. The powers that be in the merrie old land of England just want these people to wait until their condition worsens to the point where it becomes urgent. Then its all good.
The shepherds did so well protecting the flock that the sheep no longer believed that wolves existed.
Gun owners who shoot people should be charged extra taxes for the damages and extra expenses that they cause in the health care system.
PlaynBass
My suggestion would be that Gun Owners must maintain no less than $500,000 per firearm in liability insurance, double the amount for semi-auto devices; they must pay for the insurance as permanent insurance with an upfront lump sum, and show proof during the purchase transaction --- if a firearm is stolen and misused in a crime, then the registered owner will be liable, and also create liability for compliance issues that insurance will have to cover - reporting as stolen will only reduce liabilty to 50%.
I see no reason to give the insurance companies a bonus customer base, as the ACA did for the health insurance companies. Taxes are the way to go. Put the extra money into a trust fund for trauma centers in high crime areas, or for anti-gang efforts.
PlaynBass
That's not how pre-existing clauses work at all. If you change plans, you get a statement that certifies that you had continuous coverage. With that, the pre-existing condition clause can't be invoked by the new policy.
Employment policies have everything to do with making personal policies scarce and more expensive. Sorry you don't understand supply and demand.
You have no clue - pre-existing clauses with continuous coverage only existed since 1996 via HIPAA. Again, the unbridled insurance industry was screwing people badly enough that that clause was codified into law over what I'm sure was vigorous industry objections. ACA took it a step further because the discriminations in insurance pricing and availability essentially barred almost 30% of the population from getting insurance if they needed to buy it privately. The insurance industry is not there for your benefit.
As for employer policies, some are self-funded, others are done via group bargaining with insurance companies. Ideally, insurance shouldn't be a who can cut a better deal with a company, because in a regulated market like insurance where profits are limited to a percentage of policy costs, when 1 group lowers their price (hint - the costs to the insurance don't change) another group can be increased to cover the spread, so that the final numbers work out.
The cesspool just got a check and balance.
You're referencing things that happened more than two decades ago? Get with the times.
You're referencing things that happened more than two decades ago? Get with the times.
Those that forget history are doomed to repeat it.
The cesspool just got a check and balance.