‘…affordable access to medical care.’

Dr Day’s statements on healthcare for the elderly were that healthcare would become burdensomely expensive, making many medical treatments out of reach of all but the richest elderly in society. He also stated that health benefits would become directly linked to work, with those unemployed or retired becoming to be seen as a burden on society – which would result in support for policies for killing the old.

Basic healthcare is already beyond the means of people in many poorer areas of the world, let alone advanced procedures or a high standard of care. Despite aid packages and medical initiatives, many countries such as Burma and Nigeria have seen little or no improvement in healthcare for decades.

According to the World Health Organisation’s ranking of healthcare systems in member states, the USA is at position number 38, the UK at number 18, and the country with the best healthcare system is France.

As the population of people over the age of 65 has increased, and is set to increase further, governments have expressed concern over the increased cost of medical treatment for the older population.

Dr Day said that free healthcare would gradually be phased out to be replaced by a medical insurance system where premiums would become increasingly expensive, especially for older people, to a point where they could only be afforded by those in work or with significant financial means.

Since the 1960s, the healthcare system in the US has gone through several significant changes and remains complex, with a mixture of state and private insurance legislation designed to cover most of the population. It has gone through periods when healthcare of the elderly came into question – mainly concerning the affordability of healthcare for those who had no independent financial means.

In the UK, since the establishment of the National Health Service in 1948 which provided free treatment to the population, it has changed from being provided as a service to being operated as a business. From a few regional health authorities, the NHS has gradually become split into hundreds of NHS ‘trusts’, each with their own board of directors and budget allocations.

When the NHS was first formed, patents had access to free treatment by hospitals, doctors, nurses, pharmacists, opticians and dentists. Charge for prescriptions were introduced in 1952 as an aid to relieve some of the high financial burden on the service, and charges were abolished in 1965 and remained free of charge until 1968.

In more recent times, the central government has required the NHS to significantly cut costs. This has resulted in higher prescription charges, less availability of treatment, longer waiting lists for important treatment, and charging of certain classes of patients, or requiring some financial contribution. Since 1999, the NHS has been required for the cost of treatment of people involved in road traffic accidents, with these charges being passed to vehicle insurers.

Hospitals have been forced to charge for some ancillary services, such as car parking at medical facilities, patient telephone and television services, charging overseas visitors, and charging for dental treatment.

The shortage of staff within the NHS means that many hospitals are unable to provide a level of service which was envisioned when the NHS was established. Many hospitals have been forced to close wards and cut spending on medical machines and equipment. There are cases where a new hospital (usually funded through a combination of private and public funds) has been unable to open most of the facility because of budget cuts.

It could seem as though health is going to be completely in the hands of private enterprises in the not too distant future, as more and more private companies are able to bit for care contracts within the structure of the NHS. This will result in only the most basic of emergency services being available to those who are unable to afford care or health insurance.

As Dr Day predicted, healthcare is rapidly moving in the direction which will mean that only those who are working or have financial means will be able to afford proper care.

A recent controversy in the UK has concerned a health initiative called the ‘Liverpool Care Pathway’ (LPC), where patients deemed by medics to be in the final days or hours of life would withdraw certain medical care under the auspice of enabling medical staff to improve end of life care for terminally ill patients.

The LPC initially received positive responses during the late 1990s when it was proposed. However, concerns were raised when in 2012 it was revealed that hospitals would receive financial rewards for hitting government targets connected to the LPC.

Some reports claimed that the LPC was being used as a form of legalised euthanasia to dispatch the elderly quickly and save costs. Reports stated that patients were often left for days without water or basic pain relief. In some instances, patients were reportedly drugged into unconsciousness.

As the LPC was adopted by more NHS trusts, so the level of people included in it increased over time, with some trusts reporting that the number of people being included in the pathway had more than doubled since the trust adopted the initiative – and all received significant government payments for hitting their government targets.

In response, the government stated that the LPC would be phased out during late 2013 into 2014, and would be replaced by a more individual approach, although (at the time of writing) we have yet to see what the alternative approach will entail.

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