Cancer patients fight to stop NHS withholding care

CANCER patients have launched a legal action to prevent the NHS from withdrawing care if they seek to improve their chances of recovery by paying privately for an additional drug. The patients say the NHS will be breaching their human rights if it withdraws the treatment they are receiving. Two of the patients, Colette Mills, 58, a former nurse from near Stokesley, North Yorkshire, and Debbie Hirst, 56, from St Ives, Cornwall, who both have breast cancer, have been told they will be made to foot the entire 10,000 pound monthly bill for their care if they attempt to pay privately for an additional drug, Avastin.

Ministers claim that to allow patients to pay for top-up drugs would be unfair to those who cannot afford them and lead to a two-tier NHS. The health department has issued guidance to NHS trusts warning that such co-payments are not allowed. However, the patients' solicitor, Melissa Worth of the Manchester law firm Halliwells, said NHS trusts would be breaching several articles of the 1998 Human Rights Act if they withdrew chemotherapy treatment. Worth also argued that in withdrawing treatment NHS trusts would undermine the National Health Service Act of 1977. She said: "In light of the indisputable obligations of the trusts to provide life-sustaining treatment when there is a known, real and immediate risk to life, there is no legal justification for the trust threatening to withdraw all free treatment should our clients wish to maximise their chances of survival by complementing the treatment they are receiving by receiving Avastin."

NHS chief executives, the Patients Association, Doctors for Reform and Saga, the organisation for the overfifties, have all backed Mills and Hirst since The Sunday Times highlighted their plight last month. This weekend they were joined by one of Britain's leading breast cancer consultants. Professor Ian Smith, head of the breast cancer unit at the Royal Marsden NHS Foundation Trust, said: "I am very sympathetic to the case of these patients. We are looking after patients with life-threatening diseases and it is difficult enough telling them they cannot get the drug on the NHS without needing to then say: `Even if you are prepared to pay for it, you still cannot have it.' This creates a very emotionally fraught situation and seems very harsh."

Politicians have also pledged to campaign for a change in policy. John Baron, a Conservative MP and former shadow health minister, said: "It is absolutely wrong for the NHS not to allow tax-paying patients to top up their treatment if they so wish. Why shouldn't patients make that extra payment for a drug that could be life-saving? This is unfair and the government should be ashamed."

The health department said: "It is a fundamental principle of the NHS, supported by all the main political parties, that treatment should be free at the point of need. Co-payments would undermine this."

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HillaryCare v. Obama: The Left's health-care spat

Once Hillary Clinton got roughed up in Iowa, she was bound to strike back against Barack Obama. Her first line of attack debuted at the Democratic debate over the weekend, and a big part of it concerns health care. Their differences are more political than substantive, but the debate does tell us something about current policy ambitions on the American left.

"Universal" health care is of course a major Democratic issue, and Mr. Obama laid out a proposal in May, Mrs. Clinton in September. Both plans create a public insurance option managed by the government. Both plans impose more stringent regulations on insurance companies, and both institute new taxes on business.

The main substantive difference is that Mrs. Clinton's plan would dictate that everyone have health insurance, while Mr. Obama's would only require the coverage of children. This so-called "individual mandate" has become the preferred liberal health policy tool after Mitt Romney introduced it in Massachusetts. In theory, such a law would force everyone to sign up for health insurance--either through their employers, a private plan or a government option--or otherwise pay penalties.

That Mr. Obama's mandate is limited to kids has led to a primary catfight that runs back several months, and Mrs. Clinton is pressing the issue especially hard now to attract liberals who think Mr. Obama is the better bet for "change." She said on Saturday that Mr. Obama "proposed a health-care plan that doesn't cover everybody." Mr. Obama counters that the reason many people aren't insured is because they can't afford it. Supposedly he is "echoing right-wing talking points," but he is more accurately echoing reality.

Massachusetts has exempted almost 20% of uninsured adults who don't qualify for subsidies from mandated coverage because it is too expensive. (No thanks to the state's health-care regulations, which Mr. Romney now prefers not to mention.) The logic of the individual mandate is that welfare programs will be necessary to achieve truly universal coverage. Thus it is in practice less an individual, and more a government, mandate.

In any case, these health-care plans aren't worth the white papers they're printed on, because Congress would carve them up along the way. Rather, they speak to aspirations. For "progressives," Mr. Obama's lack of a mandate is a kind of betrayal. Their political goal is to use incremental steps to gradually achieve a government-run health-care system--and Mr. Obama's steps aren't grand enough.

At least by comparison to Mrs. Clinton. Her attacks are intended to appeal to liberals because they highlight one of the few cases where her triangulating produced a policy position more ambitious, and more leftward, than Mr. Obama's. They also highlight her history as an agent of "change," if you consider Mrs. Clinton's calamitous 1994 failure with HillaryCare to be helpful experience. She's betting that Democratic primary voters will give her credit for having tried.

The new liberal consensus is that her 1994 effort got the policy right but botched the politics. Now a progressive agenda will only be ushered in by "confronting" Republicans. That's why Mrs. Clinton--and John Edwards--posits insurance and pharmaceutical companies as villains who must be vanquished for liberal reform to prevail. By contrast, Mr. Obama says a genuine health-care overhaul must be negotiated at a "big table" including industry. Such feints toward bipartisanship and reconciliation don't appeal to today's angry left.

However it turns out, this less than Grand Guignol ought to provide a warning to Republicans. Whatever the minor policy differences among Democrats, their major domestic ambition this campaign season is the government takeover of the health-care market. The Republican nominee will need a free-market alternative, and a way of explaining it that is more concise and compelling than we've heard so far.

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