July 19, 2017
Charlie Gard Is the Face of Single-Payer
By Ted Noel, M.D.
I woke up very early this morning with the tortured picture of an infant running through my mind.
Charlie Gard has a tube through his nose into his lungs, connected to a machine that breathes for him. He has all the latest electronics monitoring his status. But he is unable to provide any indication of his pleasure or pain at the process. He is dying from a horrendous genetic disease that robs his body of the ability to move, breathe, or respond.
Next I saw his parents. Their expression conveyed the pain that Charlie cannot. But their pain is not physical; it is emotional. That is understandable, since their child is dying. And their anguish is magnified by an emotionless megalith against which they flail to no avail. Single-payer "health care" has taken their child from them, even while he is still alive.
Such pictures are not new to me. During my time in critical care medicine, I saw many hopeless cases. Their diseases had reached a stage where there was no medical reason to continue treatment. They had no material chance to recover to a point where they would have any meaningful life away from extensive (and expensive) medical support. And because these medical circumstances were not rare, I helped write my hospital's policy on Futility of Care. But Charlie Gard's case is different from the ones I was involved with.
When Charlie Gard entered Great Ormond Street Hospital in London, England's single-payer health system, the National Health Service, took over. At first, it seemed that this was a good thing, since his parents didn't have to pay extra for his care. But they didn't have a choice. They weren't in the small minority who are either wealthy enough or favorably employed to access private insurance. So Charlie was swallowed by the Blob.
Thus far, there didn't seem to be any difference between single-payer and private insurance. Both start with the same level of medical care. But shortly, the differences became manifest. When Charlie's rare diagnosis became clear (only 16 known cases), the NHS refused to allow any sort of alternative approach. Charlie had struck the iceberg, and theCarpathia was nowhere to be seen.
After first contact with a doctor who might be able to help, Charlie's parents set up a crowdfunding page and raised £1.3 million (about $1.7 million). That's enough for any conceivable therapy. They had become financially able to relieve the NHS of any need to care for Charlie. All the NHS had to do was say, "Yes." Instead, the NHS asserted its ownership of Charlie, and multiple courts agreed. The hospital got court orders to discontinue life support.
What would have happened in the U.S.? When there is no reasonable probability of returning a critically ill patient to meaningful life, the situation is to be presented to the patient's health care surrogate. This "Legally Authorized Person" is encouraged to recognize that further care is futile and should not be undertaken. With the LAP's consent, it would become possible to withdraw futile care.
It is critically important to note that the LAP (typically close family) has the authority to tell the medical staff to continue care or not. It is not up to the doctors or the hospital. It does not matter that continuing futile care burns out staff and consumes resources. The family is the final authority, because the family members are the ones who own all rights in this situation. It would be unethical to proceed without their consent, because they are protecting the patient's natural human rights, even if they conflict with the medical prognosis.
I know that speaking in terms of "ownership" sounds strange coming from a doctor. But this is the key fact, based in natural law. Charlie Gard's parents "own" him. They begot him. They cared for him. And when he became ill, they cared even more for him by seeking expert assistance. They are primarily responsible for Charlie. But single-payer NHS changes everything.
When Charlie Gard came through that Emergency Department door, the NHS took ownership of him. It's a classic case of the Golden Rule: "He who has the gold makes the rules." (Apologies to Saint Matthew.) In essence, the NHS said that since it is paying the freight, Charlie is now the property of the State. His parents were involuntarily dispossessed of their son. The NHS stole him by force of law. Parental rights inherent in natural law were "stripped away by strangers."
The therapy proposed by Dr. Hirano from America supposedly has about a 10% chance of success. That's significantly better than the zero the courts have offered. But let us suppose that it fails. Is it a total loss? Almost certainly not. Knowledge will be gained. It may not help kids with Charlie's condition, but it may lead to help for others. And Charlie's parents are able to afford it now. The NHS would incur no further expense.
Even at this late date, with doctors and world leaders lining up to volunteer help for Charlie, the NHS still acts on the basis that it owns the child. His parents were not allowed to appeal. Only the hospital had that right.
This conceit is at the center of the single-payer controversy, but no one is willing to actually argue it. If it were debated, it would show that the "payment" idea is a diversion. Instead, single-payer advocates have taken the position that the State owns its citizens.
Right now, I have been forced into Medicare. I don't like it, and I would happily take an alternative, but legally, I cannot. Further, if Medicare declares that I can't have a particular treatment, I can't even buy it for myself. That's exactly the same situation Charlie Gard's parents are in. The federal government owns me through Medicare.
My only alternative is to go out of the country for unauthorized care, or to find a cash-only doctor who does not accept Medicare. And how many of those are there? I've saved enough to have such an option, but how many others can do that? And suppose I'm in the hospital when the need arises. I'd have to sign out AMA (Against Medical Advice). Fortunately, I still have that small shred of personal ownership.
Every time someone proposes single-payer, throw Charlie Gard in his face. He issingle-payer – state ownership of the individual. After single-payer is instituted, will it be possible that this "government of the people, by the people, and of the people, shall perish from the face of the earth"?
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Originally Posted by MisterVeritis
