David R. Henderson  

Britain's Central Planning Death Panels

Free Market M.D.... A Sentence to Ponder...
Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.

Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

This is from "Daughter Saves Mother, 80, Left by Doctors to Starve."

Why do I use the term "Central Planning" in the title? Because that's what the policy is. Doctors use their information, along with a centrally planned protocol, to make decisions. Just as in the Soviet Union, the true customer is not the patient. The patient pays an incremental fee of zero and, therefore, has little economic clout. The true customer is the government, which is trying to conserve resources and, thus, making tradeoffs among various patients.

H/T to Ralph Raico.

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COMMENTS (18 to date)
craig writes:

Golly, doctors made a mistake. Somebody lived that they thought was going to die. How often do you see that? This really strikes me as a Terri Shiavo problem. I'm really more worried about the thousands and thousands of people that die each year because of lack of insurance. Care to look at one of those stories? I thought not.

Billy Hankins writes:

The difference, Craig, is that in a free-market system (or at least a system that isn't centrally controlled) if a doctor makes a poor diagnosis or one that you do not agree with, you can go to another doctor to get the care you want. In Britain, you get the care that someone else thinks is best for you.

Imagine going to the grocery store and being met at the front door by someone from the government who told you that there wasn't enough food for everyone and since you appeared to be close to death, you would not be able to purchase anything from any grocery store in the country. And yes, I got the idea for the analogy from Don Boudreaux's post from today.

Tom West writes:

David, surely we can do better than battle by anecdote.

No doubt that there is somebody somewhere who believes that one can have single payer health-care at the same treatment levels as the most wealthy currently get, but somehow I doubt they're reading this blog :-).

As it is, I think everyone here is aware that *every* option involves trade-offs where worthy people will suffer.

Have more respect for your readers. State your case, note what the trade-offs of both sides are, and argue why you believe your position is superior.

I'd be disappointed if you either didn't have enough confidence in the strength of your position, or even worse, didn't have enough confidence in your readers.

Z writes:

"State your case, note what the trade-offs of both sides are, and argue why you believe your position is superior."

I think he is stating his case, and outlying the tradeoffs. The tradeoffs are based on what is responsible for rationing limited resources. Maybe its money, maybe its a government policy maker.

If I tell you that Florida beat LSU yesterday, and that proves Florida is a good football team, sure, I'm 'battling be anecdote', but without citing examples, all we have is abstract arguments. Enjoy sitting in your ivory tower Tom West, ignoring real stories about the real life implications of certain policies and passing them off as avoiding the 'true argument'. Welcome to reality, it's not as safe or clear cut as debating with your friends.

keddaw writes:

How often are you guys going to mischaracterize the NHS?

I am not its biggest fan (4th biggest employer in the world!?!?) but it does not work anything like you seem to think. If a doctor mistreats a patient they, or their family sue. There is your financial incentive.

Of course the government (or local authority) are making tradeoffs between patients, resources are scarce and we try to maximise the efficiency of their allocation for the greatest good. I thought this was an economics blog?

David N. Welton writes:

Here's another vote to drop the silly anecdotes. For every one on one side, you can find one on the other - for instance, someone dying of an easily treatable disease because of lack of health insurance, or denial by the health insurance company or whatever.

What I hope for from economics blogs is a deeper look at the incentives, statistics, and possible solutions.

If I wanted anecdotes and simplistic views of things, I'd be watching Michael Moore movies rather than reading various blogs.

johnleemk writes:


I think the point is that people are rightly skeptical of a monolithic entity's ability to calculate such trade-offs.

I would also add that your example of an incentive is asymmetrical; there's a huge negative pay-off if you actively cause a patient injury, but no huge positive pay-off if you actively cause a patient to get better. In theory, this should lead to greater passivity on the part of personnel in the NHS -- in practice, this is often observed in large bureaucracies (both in the public and private sector). While I don't know about the specifics of the NHS, and agree that it's often misrepresented, I don't agree that the British healthcare system provides sufficient incentives.

RL writes:

I think some people are unclear as to what anecdotes are.

"80 year old woman left to die by her doctor" is an anecdote.

"80 year old woman left to die by her doctor in compliance with new NHS standards" is not an anecdote.

Lee Kelly writes:

Beware of government attempts to cut spending in healthcare, because it is not the same thing as cutting costs.

Yancey Ward writes:

No Death Panels here. Nothing to see, move along.

David R. Henderson writes:

RL above put it best. I could have laboriously tried to track down the British regs. Instead, I took it as given that the British newspaper reported correctly on the regs. The best way to argue against what I said is to show that the British newspaper got it wrong.

Niels writes:

I can recommend reading the following article:


The author does an outstanding job in exposing a deeper lying cause of problems (mainly high costs and limited access to care) in both centrally organized and 'free-market' healthcare systems: the fact that most healthcare expenses are covered by insurance at all.

SydB writes:

Man dies from exercising.

As you can see, people should never exercise. My anecdote demonstrates as such.

(BTW: In logic, Mr Henderson's anecdote is referred to as the fallacy of accident.)

Kurbla writes:

All our theories start with thinking about individual cases. So, why not discuss individual cases as well? Sure that J. Mat. Phys. Research wouldn't accept anything without hard numbers, but Econlog is only one blog.

David N. Welton writes:

Ok, let's explain exactly why we want real discussion/statistics/insight instead of anecdotes, since it doesn't seem to be clear.

The NHS apparently has some sort of regulation that denies care to people, and in some cases, leads to particularly unpleasant outcomes.

Well, guess what, the US has a system that leads to particularly tragic results in some cases too.

Perhaps the NHS bad outcomes occur in 1 in a million cases, whereas the US negative outcomes occur in 1 in 10. I'm just making these numbers up as an example, but in that case, the US system doesn't look so good. Or the numbers might be the other way.

Since all of these systems have their flaws, unless we actually look at data and discuss ways to improve things (Dr. Kling has been pretty good about this), we're just flailing around playing politics, which it doesn't take a trained economist to do... "Death panels" indeed. That's the province of talk radio.

David N. Welton writes:

Rereading my last comment, perhaps it appears excessively snippy, which was not my intention.

I'm not here to defend Britain's NHS, which doesn't strike me as being that great a health care system, simply to ask for a higher standard of debate. Leave the anecdotes and hyperbole to other forums, if you please.

Tom West writes:

If I tell you that Florida beat LSU yesterday, and that proves Florida is a good football team, sure, I'm 'battling be anecdote', but without citing examples, all we have is abstract arguments.

Z, if I am actually trying to make a persuasive case to people I think are informed, interested, and capable (i.e. readers of this blog) rather than simply trying to sell my cause to the uninformed, then I will *also* mention the anecdotes that don't support my case.

After all, my case should be strong enough that it will stand with every possible fact exposed, and I should have no interest in having people being uninformed of *any* aspect of the issue, including those aspects that don't support my position.

By failing to address those issues, David seems to show insufficient faith in either his position or his readers.

(I'll admit I've been pilloried by both the left and the right for demanding this level of intelligent discourse, but I am impressed with Arnold Kling's level of argument, and would encourage David to match it.)

CJ Smith writes:


So while we may conclude that a single-payor health insurance system has problems, does this in any way detract from the criticism of the present oligarchical insurance system in the United States, or the need to change that system? The death panels still exist, but the scarcity of resources problem is further exacerbated by the profit consideration.

In and of itself, allowing the government to enter into the healthcare insurance market as a participant increases, not decreases competition amongst insurers, which would act to drive prices down. It would not effect the amount of healthcare available, as those who wish to offer or purchase services not covered by the governments plans are free to go out of network and pay "non-governmental market" prices.

The problem as I understand it argued, is that the government's mere entry into the market would eliminate all other competition. Pardon the analogy, but that's like saying that the existence of the U.S. Postal Service would prevent the existence of FedEx, UPS, or other courier/delivery services.

Alternatively, I understand the argument to be that the government, as the source of laws and regulations, might have the power to dictate or require participation in programs or compel acceptance of payment schema. While this is conceivably possible, is it realistically probable given our free-market prefering economy? Consider most large insurance programs - doctors may participate, provided they accept the published schedule of charges. However, doctors are free to choose not to participate - they just lose access to that revenue source. But the Medicare program, both the largest insurer in the U.S. and an entity with exactly the power to compel partipation by doctors and patients that "death panel" proponents fear, instead uses exactly the same free market system - doctors and patients are free to participate or not participate.

The "death panel" argument is merely a red herring to avoid substantive consideration of options to make healthcare affordable and available to the public in an efficient, economical fashion.

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