Tuesday, November 10, 2009


Karyn Frist, an American, had just given birth at Princess Anne Hospital in Southampton, England. She and her husband, William H. Frist, MD, were in England, he on a seven-month assignment from Boston’s Massachusetts General Hospital.

Dr. Frist, for his chief residency in cardiothoracic surgery, would be exposed to non-heart aspects of chest surgery. He would encounter a variety of heart and lung pathologies doctors rarely see in the United States. Dr. Frist would be the senior registrar, “who assumed major responsibility and performed all of the surgical cases; he or she ran the surgical clinics, [and] made all major clinical decisions.”

After that, he would be specializing in heart transplantation at Stanford University Medical Center at Palo Alto. After that, he would be the Majority Leader of the United States Senate.

The British nationalized health care in 1948. In Southampton, Dr. Frist, assigned to the Western Thoracic Hospital, notes some striking impressions in his new (and seventh) book, A Heart to Serve, The Passion to Bring Health, Hope, and Healing (New York, Center Street, Hachette Book Group, 2009).

Dr. Frist has much to praise. “At the time of delivery, we just had to show up at the hospital. Paperwork seemed nonexistent; I don’t even recall having to sign any paperwork as we were admitted.” The care given Mrs. Frist in her pregnancy was “superb.” The general practitioner visited her at her home and they had tea.

Then the problems started. In hospital, following birth by Caesarian Section, Mrs. Frist had each day for a week to walk the corridors looking for sheets for her bed and her new-born infant’s bed. There was no one to help.

Then the problems started for Dr. Frist. “After 4:00 p.m., we were not allowed to do any more cases; the operating rooms closed, and the surgical staff went home. We started afresh on the [waiting] list the next day.” Quitting [at tea-time] is single-payer Britain’s way of rationing health care when the patients’ needs outrun the country’s supply.

Some striking similarities take me back to my own experience in a London hospital around the same time (for me, 1968). Following my operation, not one human being came into my room. It could have been because of a shortage of nurses; it could have been because I was a private patient, not being included in National Health Service. My surgeon, Mr. Wolf, appeared the following day or two days later. I asked him for a glass of water for my terrible headache, which he brushed aside. He said it was “character building” to have a headache and do without a glass of water. I asked him for the results of the surgery. He said he had not had time to consult the pathologist. (I learned later that he had not cut out anything. What had he done?) The bill, which was higher than I had been led to expect, arrived at our sublet Hyde Park flat before I got home from the hospital.

The rationing in single-payer Britain can be fatal to health. Dr. Frist as senior registrar had a list of names of over a hundred patients waiting for heart surgery during that month. Surgeons did two surgeries a day, on the patients who were highest on the list, unless there was a “clear-cut emergency.”

By the time he got down to patient number seventy or so, he noticed that some of the patients had died waiting. (No clear-cut emergency there? No way of knowing as they had not reached the top of the list.) In the United States, that procedure would never have been tolerated. “If we had one hundred patients who needed open heart surgery, we’d work around the clock and get them all done within a week.” For elective surgery, patients might have to wait a couple of weeks, “but it wasn’t because a government bureaucrat was rationing their care based on money available or some politician’s decision to cut off the money spigot.”

Rationing to kill. If during the operation, Dr. Frist noticed some minimal spread of the tumor, “that would be the end of surgery. I would tell the patient and their family that surgery was all that we had to offer and share with them the statistics showing that the patient would unfortunately not live beyond a few years because of the spread of the cancer. They accepted this. They didn’t ask what more could be done.” They didn’t ask for a second opinion. In the United States, if it looks as if the cancer is spreading, the surgeon recommends radiation and perhaps chemotherapy.

So much for single payer. On to public option. The progressive left regards public option as a down-payment on single-payer, according to an Oct. 22 Wall Street Journal editorial, which asserts that public option “will quickly blow up the private insurance market.”

Senate Leader Harry Reid is putting public option-with- an-opt-out provision into the Senate health-care bill. If so, as a “matter of conscience,” Senator Lieberman told Fox News on Sunday, “I will not allow the bill to come to a final vote.”

Is Great Britain the future for us under Speaker Pelosi’s bill passed Saturday night? Readers who support public option need to read pages 96-103 of Dr. Frist’s book to appreciate what will become of our system, the finest health-care system in the world.

By Natalie Sirkin

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