Lives at Risk - Allegations About Accuracy

Allegations About Accuracy

The accuracy of some claims in this book are questionable. For example, the book claims that "citizens in countries with national health care systems do not have an entitlement to health care" and that only the U.S. gives an entitlement, but only cites an entitlement to kidney dialysis. In Britain, these rights come from a mixture of parliamentary legislation and a sub-set of Common law, Administrative law which is enforced by judicial review. A person's entitlement to health care under the various laws are summarised in the NHS Constitution for England. Parliament in the has U.K. has established a National Health Service to provide health care for the population but gives leeway to the NHS to determine what is and is not covered. The NHS establishes rules about how judgements are to be made about giving or denying care. Coverage denial is rare, and must always be made on reasonable grounds. This is tested from time to time in judicial review to create, a body of law without parliament having to legislate on the minutiae of details. This very flexible process confers legal rights to UK residents to a wide range free health care. Similar rights exist in most other countries with common law principles such as Canada and Ireland. Citizens in the U.S. generally only have a right to care if they can pay for it whereas U.K. citizens have a right to get most health care for free.

The article also says "elderly, minorities, and rural areas are all discriminated against in national systems. National systems do not make care available based on need." Again this is a highly questionable interpretation. The Black Report is cited as main evidence. One might be forgiven, having read the conclusions in "Lives at Risk" for thinking that the Black Report had reported that the NHS was fundamentally flawed and discriminatory. But that is not true. The authors essentially compared the situation immediately POST creation of the NHS with the situation 40 or so years later. So it only compares a national health care system at one point in time with the same system at a different point in time. It did not compare the situation immediately before the creation of the NHS with the situation later and did not conclude that public funding of heath care had been a failure. Although changing the rules of health care delivery had meant that health care delivery discrimination had been considerably reduced, it was still demonstrable that the level of improvement seen by disdvantaged groups as a result if the introduction of the NHS had reduced over time. In absolute terms the system post NHS was still better than pre-NHS. Black's recommendations were not to scrap publicly funded health care in favour of some other system, but to recommend that the positive discrimination was needed to ensure certain that minority groups did not lose out. Part of the problem was not that the system discriminates against particular groups but rather that the there are some groups better able to use the system than others. The system was not taking adequate steps to stop this from happening. The NHS Constitution for England makes it clear that discrimination on the basis of age, sex, wealth, race, or sexual orientation is forbidden in the NHS and that sanctions will apply to anyone committing any such discrimination.