Coverage here has no natural stopping point, so a line has to be drawn

The argument

A second argument offered for this position concerns where coverage would end. Proponents argue that the conditions put forward as grounds for funding, chiefly distress about appearance, are not bounded. Any feature of a body can be a source of dissatisfaction, the number of features is effectively unlimited, and a successful procedure frequently shifts attention to the next thing rather than ending the concern. Proponents note that the supply of remedies also shapes the demand, since a feature becomes a problem partly because it has become fixable. The argument is that any criterion offered to contain this fails in practice. A test of severe distress requires someone to assess a report that only the patient can make, with funding attached to the answer, which makes it both unreliable and intrusive. A test of what a reasonable person would find distressing substitutes the assessor's taste for the patient's. A list of approved procedures becomes a negotiation, and the pressure runs one way, since nobody lobbies to have an item removed. Proponents argue that each of these schemes ends up either approving almost everything or making arbitrary distinctions, which is the situation the proposal was meant to correct. Holders of the view close with the comparison that decides it for them. A health budget is finite, so every procedure funded is a procedure not funded somewhere else, and the alternatives are treatments for conditions that arrived unchosen. Proponents argue that a system asked to choose between an operation someone wants and an operation someone needs has to prefer the second, and that the conventional line, for all its roughness, is the only one that can actually be held. They accept that it excludes hard cases and argue that an exception process is the right place to handle those, rather than a general entitlement.

Premises

Counter-arguments

Opponents argue that unbounded demand is managed routinely elsewhere and need not be fatal here. Physiotherapy, mental health treatment and pain management all address conditions reported by the patient with no external measure, and systems assess them with clinical thresholds, waiting lists and review rather than refusing the category. They also observe that the displacement argument applies to every new treatment ever funded and does not pick out this one. Several add that the position concedes what matters, since an exception process for hard cases is an admission that some of these procedures should be covered, which is the other position dressed as a reluctant concession.

Rejecting the premises

[Rejecting P2] Physiotherapy, mental health treatment and pain management are all assessed from patient report with no external measure, and are contained by clinical thresholds and review rather than by refusing the category. [Rejecting P3] The displacement argument applies to every treatment a system has ever added, so it does not single out this one. [Rejecting C] Allowing hard cases through an exception process concedes that some of these procedures should be funded, which is the rival position rather than this one.