kitchen table math, the sequel: compare and contrast, part 3

## Saturday, September 5, 2009

### compare and contrast, part 3

In countries where there is a single health care system -- and thus a single pool of money to pay for it -- it is somewhat easier to control costs. Britain's NHS often decides, for example, that it won't pay for kidney dialysis for a 90-year-old. That means somebody's grandmother will die, but at least Grandma and her relatives know that the money saved is going to be used to help some sick baby or some accident victim.

Q&A with Correspondent T.R. Reid

I came across this passage quite by accident; I was looking for info on the Swiss health care system, and suddenly there it was. The NHS "often" refuses to pay for dialysis for 90-year olds.

yikes

Seeing as how my own 80-year old mom needed an emergency dialysis last year, I took that amiss, and I don't see myself feeling any more friendly to such a policy 10 years from now, when she's 90. Assuming she lives to see 90, which, given her determination and the medical care she's had, she may. Unfortunately, by the time she's 90 she probably will need dialysis, so thank heavens we live here, not there.

At some point, mulling this over, I realized: the wording of this passage is odd.

The NHS often decides not to pay for dialysis for 90-year olds?

Because Britain has a lot of 90-year olds needing dialysis?

And does often mean not always? Do some 90-year olds who need dialysis  get dialysis? (And how does a person get in that queue?)

The glaring anomaly, however, and it took me a little while to notice this, is the choice of the word "grandmother." Somebody's grandmother, no less. Not your grandmother or my grandmother. Somebody's.

Of course, when somebody's grandmother dies because the NHS won't pay for dialysis, the people who are most distraught aren't the grandchildren, usually.

The people who are most distraught are the children.

So let's try it that way:
In countries where there is a single health care system -- and thus a single pool of money to pay for it -- it is somewhat easier to control costs. Britain's NHS often decides, for example, that it won't pay for kidney dialysis for a 90-year-old. That means somebody's mother will die, but at least Mom and her children know that the money saved is going to be used to help some sick baby or some accident victim.

It would be fun to put together a collection of political euphemismsfrom all realms of the political spectrum** to use teaching writing.

I wonder if anyone's done that.

* I realize that this passage is not, on the whole, what you would call euphemistic, seeing as how it states directly that the NHS withholds critical care from the elderly in order to reduce costs. Nevertheless, the use of the words "somebody's grandmother" and, later, "Grandma" avoid calling a spade a spade.

**balanced euphemisms! Balance is good.

Catherine Johnson said...

The rest of Reid's paragraph includes a qualifying comparison to having dialysis denied by Aetna in order to give money to shareholders but it didn't work at all. Once you've given people the image of a dying grandmother, there's no turning back.

Anonymous said...

When I was in grad school from 1979-81, i met a fellow student who had just moved back to the States from England, where she had worked as a public health nurse. She said that the NHS did not allow chronic dialysis for anyone over age 55 - I never researched it for myself. However, if you look at the VA and the Indian Health Service, they are rationing care now. First, because you often can't get an appointment in a reasonable amount of time and second, because some tests are simply not done on people of a certain age or medical status.

Anonymous said...

In addition to asking whether Aetna cheerfully pays for dialysis for 90-year olds with chronic renal disease (and possibly other complicating conditions), ask yourself if Medicare does so. More to the point ask yourself if Medicare will be able to do so indefinitely. The Medicare recipients who are disrupting Town Hall meetings on health care reform not only don't admit that they themselves benefit from "government" health care, they also don't realize that that system, dear though it is to them, is going to go broke if all treatments are provided for all comers.

Ari said...

With Medicare Advantage, seniors have the choice to receive their benefits from private insurance plans. It is very popular but this is the part of Medicare that is threatened.

Anonymous said...

She can still have dialysis, she just has to pay for it herself. That's not rationing.