The supreme argument against what I propose is that it abandons the principle of everybody, whether rich or poor, having equal access to the NHS and would favour the rich. That argument is, however, based on the assumption that having free access to all treatments after 75 is a “good thing.” But it’s possible to argue that it’s not a good thing. There is ample evidence of overtreatment of people at the end of life, increasing rather than decreasing suffering. And unfortunately life expectancy has increased much more than “health life expectancy,” meaning that the period of ill health at the end of life has increased. There are, as many very elderly people will tell you, worse things than being dead.
Another problem is that it won't be easy to define what counts as symptomatic and palliative treatment, and broken bones, as with my two men, would be difficult. Sometimes surgical treatment would be needed and count as symptomatic and palliative; at other times, as now, people would be deemed too sick for surgery and treated with painkillers. The first man of my two examples would probably have had his ankle fused and no further treatment. The second man would have been left with the treatment he received overseas together with painkillers.
The main arguments for my proposal are that it will maintain the NHS for those under 75, stop the NHS bankrupting the country, allow for more expenditure on those activities that promote health, and reverse the current position that the old are exploiting the young.
As I contemplated my proposal I thought of Jonathan Swift’s “modest proposal” that the poor in Ireland sell their children as food to the English rich. My proposal seems not that outrageous to me but will, I’m sure, be seen as outrageous to many.
...
Richard Smith (A health system that is free at the point of delivery will inevitably “overtreat,” a fatal flaw in universal health coverage)
...
...