Past mistakes

Controversy of the week: what to do about the legacy of cosmetic surgery in which a key component is (retrospectively) deemed defective?  Should the offending breast implants be removed, replaced, or left alone?  Who should pay?  Different countries have reacted differently, and every reaction is sure to have outraged someone.

I find it slightly bizarre that this should be seen as a matter for governments.  Surely it should be for medical professionals to deal with: is there a medical issue, and if so what are the pros and cons of each option?  The role of politicians might be to consider how it happened in the first place and whether there are lessons to be learned for the regulatory system.  But I hesitate to say that, because the most likely outcome of politicians reviewing a hot topic like this is to make things worse.

I have one suggestion for them.  The question of who pays if corrective surgery is required can and should be dealt with by requiring all cosmetic surgery to carry insurance against the full cost of such an event arising in the lifetime of the patient.  An insurer, having its own money at stake, is better-motivated than a regulator to scrutinise the actual risks of any particular procedure.  It is also better-equipped to do so, with the budget for expert scrutiny being determined by the actual risk being taken on, rather than competing with many unrelated tasks for a fixed, politically-determined pot.

Oh, and I wonder if this’ll lead to a whole raft of similar cases being unearthed as journalists seek out new stories?

Posted on January 8, 2012, in insurance, medicine. Bookmark the permalink. 1 Comment.

  1. It’s a matter for government in the UK, at least, because if there is a health danger involved, the NHS will eventually be on the hook for treating any illnesses that may arise, and that could get expensive. It’s reasonable for the D of H to form a view on whether it’s more cost-effective to act now or wait for developments.

    (Of course this probably wasn’t a straightforward cost/benefit analysis. But once you’ve conceded they have a place in making the call, it’s pretty much impossible to restrict what criteria they’ll apply.)

    In principle I would agree with the insurance idea. But in practice, it seems to me that would lead to endless arguments between insurers and providers, and to a massive confusopoloy of policies you can choose when you go in for this kind of surgery. (In the event of this type of scare, do you want the implant removed/replaced immediately? Who makes the call as to whether there is a real risk? And so on – the possibilities are pretty much endless, and almost no-one would be qualified to read them, even if they could be bothered.) So I think the idea that there could be some sort of rational market process governing these decisions is – overoptimistic.

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