Denying coverage denies care
As with any public good, health care is often a strongly contested resource. Arguments in the US over who deserves access to care reached a fever pitch last year during the health care reform debate.
In the UK, a battle has ensued over whether the National Health Service should provide coverage for women to have faulty breast implants removed.
Worldwide, hundreds of thousands of women who received breast implants manufactured by the French firm Poly Implant Prothese do not know if their implants are safe.
Many implants manufactured by the company were made with industrial grade rather than medical grade silicon. Industrial grade silicon has been shown to leak or rupture at much higher rates. To make matters worse, the firm kept its records poorly, and it is unknown which or even how many implants are made of the correct material.
The French and Dutch governments have advised preventative removal of all PIP implants. British health officials have determined that removal is not necessary without evidence of rupture, but will cover the costs of removing the implants for concerned women.
Unfortunately, discussion of the NHS decision has largely devolved into character attacks against cosmetic surgery patients. Because women choose to be fitted with implants, many believe that they should be financially responsible for their removal even if necessary. However, these detractors are forgetting that a growing number of breast cancer patients get implants after a mastectomy. But even if a woman purchased implants simply to be happier with her body, her health is worth no less than that of any other person.
When insurers — public or private — deny coverage, they also withhold care by extension. Women who purchase implants often save for months or years to afford the operation. Simply because an individual was able to afford the initial procedure does not mean she can afford to have them removed.
After all, the implants were inappropriately manufactured — neither patient nor physician had reason to suspect these complications. The NHS has encouraged private clinics that placed the implants to replace them at no cost, but because the clinics purchased the implants in good faith from a reputable manufacturer, they may not be willing to take responsibility.
One large clinic, The Harley Medical Group, which fit more than 14,000 of the suspect implants in the UK, has already refused to replace the implants for free. They claim that the cost of replacing the implants would put them out of business. The manufacturer, PIP is now defunct with many a claim on the firm’s assets.
If the NHS were to refuse to pay for the replacement or removal of the implants many women would have no choice but to leave the implants in place. If these implants rupture, the trauma can cause infections and disfiguring scarring.
Breast implants may be elective, but so is eating an unhealthy diet. Many of our daily activities may not be the best decisions for our health — this is no reason to deny access to life-saving care. In truth, the societal consequences of changeable health behavior are vast.
Cigarette smoking costs the nation an average of $92 billion annually. As of 2009, costs related to obesity reached $147 billion a year and are expected to reach $344 billion by 2018. But we would not consider denying coverage of emphysema care for ex-smokers. We would not base cardiac surgery coverage on BMI.
Health care is a public good, but it is also a human right. We cannot open the door to denying coverage and care to individuals because we disagree with their decisions.
It was not the patients fitted with PIP implants that were wrong in this, but the manufacturer that knowingly endangered patients to cut costs. We cannot hold the victims responsible for the manufacturer’s crime.
Emily Brooks is an economics senior and may be reached at [email protected]