ALEX COHEN, host:

This is Day to Day from NPR News. I'm Alex Cohen.

ALEX CHADWICK, host:

I'm Alex Chadwick. We've been reporting on healthcare in other countries to see what they get right and wrong. Today, NPR's Joanne Silberner has the story of a man in England and his doctor friend. The two of them took on the country's not-always-user-friendly National Health Service. Here's Joanne.

JOANNE SILBERNER: What's at stake in this fight is Jack Tagg's crystal-blue right eye, and his ability to enjoy his retirement and his lovely garden on a hill overlooking the southwest end of the English Channel.

Mr. JACK TAGG (Veteran, British Armed Forces): We have cultivated blackberries, seedless blackberries. We have green daisies, and of course, roses, begonias. We have a waterfall down here.

SILBERNER: It's a gentle sunny day. Jack Tagg, a former World War II pilot, is feeling pretty good for a man of 89.

Mr. TAGG: As well as a fellow approaching middle age can feel.

SILBERNER: But back in January...

Mr. TAGG: I discovered that my right eye was fading.

SILBERNER: Jack Tagg worried. He loves to read and drive around, and draw portraits off of photographs.

Mr. TAGG: After a few days, I was seen by the specialist, and to my surprise, he told me that I had an age-related macular degeneration.

SILBERNER: That's a disease of the retina. It hits one eye at a time, and it can progress rapidly.

Mr. TAGG: He gave me three choices. We can either let nature take its cause, in which case I should lose sight in my right eye.

SILBERNER: Or Jack Tagg could pay for the dozen or so injections of a drug called Lucentis. The cost? Fifteen thousand dollars or more.

Mr. TAGG: Or they could apply for me to receive funding.

SILBERNER: By funding, he means requesting that the National Health Service, or NHS, pay for it.

Mr. TAGG: So, naturally, I said apply for me to receive funding.

SILBERNER: Like most people in England, Jack Tagg gets his care through a tax-funded system. Doctors are paid by the government. He doesn't see a bill, so long as a local government board approves the treatment, and most things are approved. But Tagg's ophthalmologist wanted to use Lucentis.

Mr. TAGG: They rejected me for treatment.

SILBERNER: They turned him down. They'd only pay the high price of Lucentis after Jack Tagg lost sight in one eye, because after all, he still had the other eye, at least until that eye got hit by the disease.

Mr. TAGG: I would have gone blind, unless we could have sold the house and got some money.

SILBERNER: The payment policy was set by a national board that considers both effectiveness and costs. Tagg thought the board was relying too heavily on cost, and not looking enough at benefit. I asked him, what limits should there be on care?

Mr. TAGG: You tell me how much an eye is worth, and I'll answer your question.

SILBERNER: Jack Tagg decided to take action.

Mr. TAGG: My friend, the doctor, had a brilliant idea to put a message on the doctor's website asking not to send five-pound checks to the prime minister to pay for my treatment.

SILBERNER: Tagg took us to see Martin Rankin, his friend, the doctor.

Mr. TAGG: We're going out to meet my partner in crime.

SILBERNER: They settled down in front of a medieval stone fireplace. Over coffee, Rankin said the board's decision just didn't make sense.

Dr. MARTIN RANKIN (General Practitioner): Preserving binocular vision is important for people to preserve their mobility, to be able to accurately perceive depth.

SILBERNER: And it wasn't just Jack Tagg he was worried about.

Dr. RANKIN: And that's important for everyone's safety, because Jack still climbs behind the wheel of his car at the age of 88.

Mr. TAGG: Eighty-nine.

Dr. RANKIN: I'm sorry, Jack.

SILBERNER: So, Jack Tagg and Martin Rankin took the hundreds of checks they had collected to London, to the prime minister, at No. 10 Downing St.

Mr. RANKIN: So I thought, should I knock timidly on the door, or would I do the job properly? So I stepped up and grabbed the knocker and banged it as hard as I could, and there was a huge noise. The bang was just enormous, and it sort of echoed around Downing Street.

SILBERNER: With reporters and news cameras all around, an official came out and took the checks. Jack Tagg and Dr. Rankin got plenty of coverage. It's right there in the headlines, pasted in the scrapbook Tagg has brought with him.

Mr. TAGG: "Withholding Vital Treatment Beggars Belief."

Mr. RANKIN: "Hero Is Told You Can't Have Drugs Until You Go Blind."

Mr. TAGG: "War Veteran Sees Red At NHS Policy."

Mr. RANKIN: "Checks Of Shame To Be Handed To The Prime Minister."

SILBERNER: The prime minister's office returned the checks with a polite note.

Mr. RANKIN: We were like celebrities for a couple of weeks, weren't we, Jack?

Mr. TAGG: Yeah. Yeah.

Mr. RANKIN: And Jack was getting mail sent to him and it would be addressed to Jack, War Hero, Torquay.

SILBERNER: The town of Torquay can now boast of being home to Agatha Christie, the British TV show "Fawlty Towers" and Jack Tagg. But being a war hero wasn't enough for the local health board. A spokesperson refused to make anyone available to NPR to explain their action.

(Soundbite of bells ringing)

SILBERNER: But in London, at the House of Commons, Adrian Sanders is happy to talk. He's a member of Parliament who represents Torquay. He remembers how Tagg showed up at an open house he holds regularly in his home district.

Mr. ADRIAN SANDERS (Parliament Representative, Torquay): Well, he came. He and his wife just turned up unannounced, as people do. And people come along and will tell me their problems. And it can be anything, you name it.

SILBERNER: Sanders says he doesn't get many complaints about the health service. So he took Tagg's concerns to several national health officials. He suspects they have pressured the local health board, the Care Trust. Not long after, the Care Trust offered to pay for Jack Tagg's Lucentis.

Mr. TAGG: The Care Trust was clearly embarrassed by the case.

SILBERNER: Tagg was going to turn down the offer unless it was extended to everyone in his situation.

Mr. TAGG: We were fighting for liberty. Come on.

SILBERNER: Dr. Rankin convinced him to take it and continue to fight. Jack Tagg's story may seem like a failure of the British health system. An 89-year-old man had to take on the government to get the treatment he wanted. But Dr. Martin Rankin doesn't see it that way at all.

Mr. RANKIN: We see it as being a wrong that's been righted.

SILBERNER: He says the ability to fight and win is proof the system works.

Mr. RANKIN: So it shows that we expect in this country - we expect everybody's needs to be met. And when it doesn't happen, we're both outraged and astonished, and we protest and it gets fixed.

SILBERNER: And in fact, the decision-making body now says health boards shouldn't wait for the first eye to go blind, they should pay for Lucentis right away in cases where it's appropriate. Officials say it wasn't a result of Tagg's activism, but a scheduled reconsideration of the data. As for Jack Tagg, well, maybe the best way to see if the system worked for him is to climb into his little blue Renault for a ride through the green rolling hills around Torquay. He says after three treatments, he sees fine. But he asks his wife Gay for help navigating.

(Soundbite of Mr. and Mrs. Tagg navigating the car)

SILBERNER: The car is dwarfed by the ancient 8-foot tall hedges that border the narrow lane. Tagg was not only a pilot, he once ran a driving school. Still, his wife has only just started to feel comfortable driving with him since his treatment for blindness started.

Ms. GAY TAGG: I've gotten over my fright now. And he's only blind in one eye. Someone suggested we should...

Mr. TAGG: I'm not blind. I'm not blind in either eye.

Ms. TAGG: We'd put a notice in the back, Child On Board. I wanted to put one saying, Blind Driver At Wheel.

SILBERNER: He drives fast and happily, and we arrived safely back at his house.

Mr. TAGG: Like a sherry or whatever? Say when.

SILBERNER: He sits back and looks at his garden. He takes a bite of a lamb and butter sandwich, and savors his victory.

Mr. TAGG: We more than achieved our aims - more than. And we got free treatment, and we got a review in the fall. There's a review of the entire machinery of the NHS.

SILBERNER: He says if socialized medicine is going to work, sometimes people have to stand up and fight. Joanne Silberner, NPR News.

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