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31 August, 2009

The nightmare nurses of the NHS

By Minette Marrin

‘Dreadful, neglectful, demeaning, painful and sometimes downright cruel.” Those are the words used by Claire Rayner, herself a former nurse, to describe the way many nurses today treat elderly patients. Introducing a report by the Patients Association last week, she described shocking standards of nursing care in hospitals up and down the country.

The stories are horrifying — old people neglected, lying in their own faeces and urine, hungry, thirsty and afraid, while nurses chat callously at the nursing station, indifferent to the suffering around them.

Since the report was published the Patients Association has been flooded with hundreds of calls of support. “I am sickened,” Rayner said, “by what has happened to some parts of my profession, of which I was so proud.” One can only agree.

What is also particularly sickening is that none of this is remotely new. It has been a long time since anybody with any knowledge of National Health Service nurses could be that proud of them. For many years past, a significant number of them have been every bit as bad as this report now claims. I apologise, of course, to all those excellent nurses whose good name has been compromised by the bad and cruel nurses and also by those nurses who, although not bad, are badly trained and incompetent.

Recently I spent a lot of time over three weeks on a busy ward at the Gloucestershire Royal hospital, with several very sick old people, and the nursing care could not possibly have been better — highly professional, attentive and good-humoured and above all extremely kind. It can be done.

But there is no shortage of nightmare nurses. I know from many personal visits to hospitals over 20 years, and from many hundreds of heartbreaking readers’ letters over 15 years, that NHS nursing horror stories are legion. Whenever I’ve written an article about them, I get in response a collection of anecdotes that would disgrace a Third World country. And, as the Patients Association report points out, most of these stories are about old people. It is so late in the day for the country to sit up and take notice. Why has everyone been so determinedly deaf to the obvious truth?

Nearly 12 years ago I wrote an article for another newspaper headlined “The devil nurses of the health services”. I hated the sensational headline but it does make the point inescapably clearly that Britain’s quasi-religious belief that the NHS is the envy of the world and its nurses are angels was — and is — far from true.

Nurses’ personal standards would have horrified Florence Nightingale. It struck me forcibly how slovenly many nurses were, with loose hair trailing and hanging over patients’ wounds, with unkempt nails and hands all too rarely washed between patients. Many were just mean: they ignored and patronised the patients.

“They bring them to the operating table unwashed, leave them frightened and unfed, distressed by loud music, overflowing catheter bags and bed sores, by dirty sheets and filthy lavatories with blood in the sinks and excrement on the floor,” I wrote. “These are horrors caused not by shortage of money, but by personal laziness, indifference, lack of self-discipline or of any discipline at all.” And so on. There was total silence from the Royal College of Nursing and the General Nursing Council. Yet not only patients but also many nurses and doctors wrote to me in agreement, describing even worse things. So why didn’t nurses and doctors protest?

When Professor Lord Winston publicly complained about the terrible mistreatment of his elderly mother in hospital in 2000, I thought how late in the day it was for a distinguished and powerful doctor to bring this up. Surely he cannot have been the first consultant to notice the disgusting wards and vile treatment in many hospitals? Surely countless other top consultants knew about this scandalous state of affairs (or should have done), and should have brought it up?

Given the abysmal standards of nursing hygiene on many hospital wards, it is hardly surprising that we have had a growing number of scandals which no one can ignore. Poor basic hygiene was a factor in the recent disaster at the Mid Staffordshire NHS Foundation Trust hospital where at least 400 patients died needlessly; the official report of 2007 blamed “shocking and appalling” standards of care. But two years on, it emerged earlier this year that 10 NHS health trusts have even worse death rates than Mid Staffordshire had. As a spokesman for the Patients Association said at the time: “We are amazed that trusts could have these high mortality rates and yet not automatically face any action.” Quite.

To be fair, one ought to query the Patients Association’s figures in its new report. It says that its horror stories affect about 2% of patients which, it calculates, would mean 1m patients. But the total number of patients admitted to hospital each year is about 10m and 2% of 10m is 200,000. However, even 200,000 is far, far too many and I personally feel convinced that the real number — if people weren’t too terrified or exhausted or dead to complain — would be very much higher.

There are people far more knowledgeable than me, right across the health service, who know all about it, although not many of them seem to think clearly about what has caused this terrible cultural collapse in nursing. It is for them to speak out.

One of the problems is that the NHS is a monopoly — any patient knows there is nowhere else to be treated and any nurse or doctor brave enough to blow the whistle runs the risk of never working in medicine again; there is no alternative to the state medical monolith. Perversely, it is only for whistle-blowing that NHS staff are punished or dismissed; otherwise there seem to be no sanctions for bad practice. The unions have seen to that.

Another institutionalised error is the politically correct folly behind Nursing 2000, the so-called reform of nursing. In an attempt to give nurses professional status with a university degree, Nursing 2000 has all too often undermined their existing high standards of professionalism by taking students off the wards and belittling the status of old-fashioned bedside nursing care.

Yet another problem may, sadly, be a widespread fear and dislike of old people as a constant and unwelcome memento mori. But whatever the explanation, this bad and cruel nursing is completely unacceptable. Is there no one bold enough to do something?

SOURCE




NHS: Novices do nurses’ job after week’s training

HEALTHCARE assistants in the National Health Service with as little as one week’s training are performing technical nursing tasks on patients, including heart tests, blood checks and changing dripfeeding bags. The service is also relying on unqualified nursing staff to carry out basic duties such as washing patients and taking them to the toilet.

Despite being responsible for such intimate treatment, the 150,000 healthcare assistants and nursing auxiliaries working in the NHS are not registered with any professional body. The unregulated staff have been brought into hospitals partly to cut costs. However, criticism has also been levelled at ambitious nurses who perceive more menial tasks to be “beneath them”.

Peter Carter, general secretary of the Royal College of Nursing, said that supermarket shelf-stackers receive more instruction than healthcare assistants. Now he is demanding a substantial minimum training period, as well as the introduction of a code of conduct. “Hospitals take well-meaning people off the street, give them a uniform and put them on a ward,” said Carter. “Supermarkets give all of their staff training. They wouldn’t dream of taking someone on, not even someone stacking the shelves, by just saying ‘find your way around’.”

One healthcare assistant, who received only a week’s training before starting work at an Essex hospital, told The Sunday Times how unqualified nurses are being relied on to wash and feed patients. They are also used to adjust the amount of food that patients receive through a nasal tube and can even be asked to carry out echocardiograms (ECGs), which test the function of the heart.

The whistleblower, who did not want to be named, said she often felt inadequately trained for the tasks she performs. “You only get about a week’s training and that is to train you how to take blood pressure and to take blood sugar levels,” she said. “You are shown how to wash patients, how to manually handle the patients and how to use a hoist. “There are things I come up against that I am very unsure of. I did not get trained in how to carry out ECGs. “We are supposed to put the patients onto the ECG machine and get a [heart] tracing. The other day I was asked to do one and I wasn’t up to doing it because I haven’t been trained. I didn’t want to do it wrong.”

Last week the Patients Association published a report detailing the lack of basic nursing care received by NHS patients. It revealed how patients were often being left in soiled bedclothes, deprived of sufficient food and drink and having repeated falls.

Katherine Murphy, director of the association, said it had received calls from healthcare assistants and auxiliaries complaining that they are being left to carry out duties they are not qualified to perform. “Healthcare assistants are being asked to do a lot of the work that trained nurses should be doing,” she said. “We had healthcare assistants phoning us up who were put on a high-dependency unit with no introduction to the technology and no understanding of what they were meant to do.”

Unison, the public services union, claims the training of healthcare assistants and nursing auxiliaries is “patchy”. Many opt to complete national vocational qualifications, but this is not obligatory.

The union is concerned that nurses and healthcare assistants do not have standard uniforms across the NHS, leading to confusion among patients about whether or not they are being cared for by a qualified professional. One nurse, writing on the Nursing Times website, said that even she has found it difficult to distinguish between qualified and unqualified nurses. The nurse wrote: “I may be being cynical, but the reason why employers are going to resist this is so that they can continue to confuse patients and relatives about the true staffing levels on wards. “Even though I am a nurse, when I have visited relatives in hospital I have found it extremely difficult to identify the qualified from the unqualified staff.”

The healthcare assistant who spoke to The Sunday Times said qualified nurses fill out paperwork while healthcare assistants wash and feed patients. She explained that on one occasion, when a qualified nurse had been assisting with the washing of patients, she was called away to sign paperwork by another nurse who said: “Washing isn’t your job, that is not part of your job description.”

Claire Rayner, president of the Patients Association and a former nurse and newspaper agony aunt, admitted that such views were widely held by nurses. “It is an appalling attitude to say it is not your job to wash patients. I am afraid this is spreading widely and I disapprove of it strongly. Unfortunately, today’s nurses think it is too menial,” Rayner said.

Frank Field, the former Labour welfare reform minister, said: “It is a terrible indictment if the most qualified nurses on the ward are filling in the paperwork and the least qualified are doing the nursing. “Cleaning people is an essential nursing function. At the same time nurses are talking to the patients and finding out what the patients’ worries are.”

On his blog, Field recalls how he had resorted to feeding the patient in the bed next to his mother, who had had a stroke, because nurses had failed to help her. He wrote: “The woman was paralysed and unable to reach her food. It was regularly placed there at meal times and then simply taken away uneaten. The nurses commented how kind it was of me to feed the old lady. “I didn’t have the courage to tell them that it was their job; and that they had stood in a group gossiping, watching what I was doing. I was fearful that they would take it out on my mother if I did so.”

Department of Health spokesperson said: "The NHS is in a very healthy position regarding recruitment and retention, with supply broadly matching demand in most areas. Since 2007 we have seen a rise of 8,563 more qualified nurses. "Local NHS organisations need to plan and develop their workforce to deliver the right staff with the right skills to meet the needs of their local populations and ensure high quality care for patients." [Meaningless codswallop1]

SOURCE




What’s the Canadian word for ‘lousy care’?

By Jeremy Clarkson, writing from England. He thinks CanadaCare is even worse than the NHS. He regularly uses humorous exaggeration to enliven his writing but there is no mistaking his serious points. He is probably Britain's most popular TV personality

Some say America should follow Canada’s lead, where private care is effectively banned. But having experienced their procedures while on holiday in Quebec, I really don’t think that’s a good idea at all.

A friend’s 13-year-old son tripped while climbing off a speedboat and ripped his leg open. Things started well. The ambulance arrived promptly, the wound was bandaged and off he went in a big, exciting van.

Now, we are all used to a bit of a wait at the hospital. God knows, I’ve spent enough time in accident and emergency at Oxford’s John Radcliffe over the years, sitting with my sobbing children in a room full of people with swords in their eyes and their feet on back to front. But nothing can prepare you for the yawning chasm of time that passes in Canada before the healthcare system actually does any healthcare.

It didn’t seem desperately busy. One woman had lost her face somehow — probably a bear attack — and one kid appeared to have taken rather too much ecstasy, but there were no more than a dozen people in the waiting room. And no one was gouting arterial blood all over the walls.

After a couple of hours, I asked the receptionist how long it might be before a doctor came. In a Wal-Mart, it’s quite quaint to be served by a fat, gum-chewing teenager who claims not to understand what you’re saying, but in a hospital it’s annoying. Resisting the temptation to explain that the Marquis de Montcalm lost and that it’s time to get over it, I went back to the boy’s cubicle, which he was sharing with a young Muslim couple.

A doctor came in and said to them: “You’ve had a miscarriage,” and then turned to go. Understandably, the poor girl was very upset and asked if the doctor was sure. “Look, we’ve done a scan and there’s nothing in there,” she said, in perhaps the worst example of a bedside manner I’ve ever seen.

“Is anyone coming to look at my son?” asked my friend politely. “Quoi?” said the haughty doctor, who had suddenly forgotten how to speak English. “Je ne comprends pas.” And with that, she was gone.

At midnight, a young man who had been brought up on a diet of American music, American movies and very obviously American food, arrived to say, in French, that the doctors were changing shift and a new one would be along as soon as possible.

By then, it was one in the morning and my legs were becoming weary. This is because the hospital had no chairs for relatives and friends. It’s not a lack of funds, plainly. Because they had enough money to paint a yellow line on the road nine yards from the front door, beyond which you were able to smoke.

And they also had the cash to employ an army of people to slam the door in your face if you poked your head into the inner sanctum to ask how much longer the wait might be. Sixteen hours is apparently the norm. Unless you want a scan. Then it’s 22 months.

At about 1.30am a doctor arrived. Boy, he was a piece of work. He couldn’t have been more rude if I’d been General Wolfe. He removed the bandages like they were the packaging on a disposable razor, looked at the wound, which was horrific, and said to my friend: “Is it cash or credit card?”

This seemed odd in a country with no private care, but it turns out they charge non-Canadians precisely what they would charge the government if the patient were Céline Dion. The bill was C$300 (about £170).

The doctor vanished, but he hadn’t bothered to reapply the boy’s bandages, which meant the little lad was left with nothing to look at except his own thigh bone. An hour later, the painkillers arrived.

What the doctor was doing in between was going to a desk and sitting down. I watched him do it. He would go into a cubicle, be rude, cause the patient a bit of pain and then sit down again on the hospital’s only chair.

Seven hours after the accident, in a country widely touted to be the safest and best in the world, he applied 16 stitches that couldn’t have been less neat if he’d done them on a battlefield, with twigs. And then the anaesthetist arrived to wake the boy up. In French. This didn’t work, so she went away to sit on the doctor’s chair because he was in another cubicle bring rude and causing pain to someone else.

Now, I appreciate that any doctor who ends up working the night shift at a provincial hospital in Nowheresville is unlikely to be at the top of his game, and you can’t judge a country’s healthcare on his piss-poor performance. And nor should all of Canada be judged on Quebec, which is full of idealistic, language-Nazi lunatics.

But I can say this. If private treatment had been allowed, my friend would have paid for it. He would have received better service and in doing so, allowed Dr Useless to get to the woman with no face or ecstasy boy more quickly. Though I suspect he would have used our absence to spend more time sitting down.

The other thing I can say is that Britain’s National Health Service is a monster that we can barely afford. But in all the times I’ve ever used the big, flawed giant, no one has ever pretended to be French, no one has spent more time swiping my credit card than ordering painkillers and there are many chairs.

SOURCE




Australia: More public hospital negligence -- woman dies

Her dangerous condition was known but nobody cared

DAVID Cuthbertson cannot find the words to explain to his three-year-old daughter Alyssa why her mother was never able to hold her, and never will. In June 2006, having given birth by caesarean section at Nepean Hospital, Petah Kimm's blood pressure dropped suddenly. Staff failed to recognise the danger. Two hours later, at age 39, she was found dead in her hospital bed.

On Wednesday, Mr Cuthbertson will front an inquest in Sydney. ''I want this inquest to bring about change so nobody ever has to go through this again," he told The Sun-Herald. "I will not let the NSW Government sweep this under the carpet. I want them to own up."

Mr Cuthbertson and Ms Kimm were single parents when they met on the sidelines at Little Athletics near their home town of Mudgee in 2003. They became friends and gradually fell in love, creating a blended family with his son Luke and her children Steven and Nicole. "Initially I was against the idea of children because it involved IVF. But then one day I looked on as Petah nursed my brother's baby. The moment I saw the look on her face I melted. We pushed ahead with the IVF. She conceived straight away."

Alyssa was born without complication before Ms Kimm's blood pressure fell. A student midwife failed to inform senior medical staff. A Sydney West Area Health Service internal report later found that, during a changeover in nursing shifts, nobody flagged her as unwell. "Two hours passed before anyone on the next shift bothered to look. That was when Petah was found lying in bed dead," Mr Cuthbertson said.

"I've suffered with guilt. I was at the hospital until 9.30pm that night and then I went home thinking Petah was just tired. Had I stayed, maybe I could have changed this."

Last month, nurses at Nepean Hospital learnt 155 positions were being axed, including senior staff from the post-natal ward in which Ms Kimm died.

Fighting back tears, Mr Cuthbertson said: "Alyssa says 'goodnight mummy' and 'I love you' before going to bed each night." He said recently, after a family friend arrived ahead of them at their house, "I said to Alyssa, 'Guess who's going to be at our place when we get home?' She replied: 'Did you go to heaven and get mummy?' I hope one day she will understand.''

NSW Health made an out of court settlement but Mr Cuthbertson called their treatment of him during that process ''disgusting''. ''Petah and Alyssa should have been here today, playing in the park together. I want justice for them both."

SOURCE




Shattered Lives: 100 Victims of Government Health Care: Soon-to-Be Released Book Tells Dark Side of Public Health Care

A timely new book, Shattered Lives: 100 Victims of Government Health Care, abolishes the myths of public health care by telling the personal, real-life stories of 100 people who live in nations with government-run health care systems. Due to the topic's timeliness, an electronic (PDF) pre-release version of the complete book is being made available now for download to journalists, broadcast media, columnists, bloggers and the public at www.nationalcenter.org/ShatteredLives.html.

Authors Amy Ridenour, president of the National Center for Public Policy Research, and Ryan Balis, a National Center policy analyst, tell 100 agonizing, real-life stories of victims in Great Britain, Canada, Australia, New Zealand, Sweden and elsewhere who struggled to access government health services and sometimes died stuck on long government waiting lists. "Some 16 years after Washington last attempted to nationalize health care, some politicians in Washington are at it again," said co-author Amy Ridenour. "But if Americans choose to adopt a public health care system, as the stories in this book attest, they will soon regret the decision."

Shattered Lives puts a face on frustrated citizens fed up with having surgeries repeatedly cancelled, medicines ruthlessly denied and patients herded like animals onto gigantic government waiting lists. In Shattered Lives, the grim reality of what proponents falsely bill as 'free health care for all' is told through the stories of actual victims of government health care programs.

Stories include:

* Lindsay McCreith, a 66-year old Canadian, crossed the border to a Buffalo hospital for diagnosis when he was told it would take over four months for the Canadian system to do an MRI brain scan to determine if the tumor was malignant. Once U.S. doctors confirmed the tumor was cancer, McCreith was told there would be an 8 month wait for treatment in Canada. Rather than risk his life, he returned to the U.S. and paid $40,000 of his own money for treatment.

* Britain's government managed National Health Service (NHS) withheld powerful anti-cancer drugs from Barbara Moss because of their cost but willingly paid for Tanya Bainbridge's 20,000 pound (about $33,000) sex-change operation and the removal of Bainbridge's unladylike forearm tattoo.

* Dunil Almeida, 42, was suffering from colon cancer but was told he was "imagining" the pain in his stomach over the course of over 50 examinations by the British NHS, which failed to test him for cancer for nearly two years. It was only when Almeida visited Sri Lanka that doctors told him he had cancer. By then, it was too late.

Among the other 97 outrageous stories Shattered Lives documents is a woman in labor castigated by a hospital nurse for not giving birth at home; numerous elderly patients losing their sight because cataract surgery or drugs were withheld; patients resorting to do-it-yourself dentistry and much more.

"Few disagree on the need for health care reform, but imitating failing health care systems abroad by adopting a so-called "public option" will bring Americans pain, misery, fear and death," said Ridenour. "Some government treatment lists are so long, getting on one is essentially a death sentence. This is no model for politicians in Washington to emulate."

Ridenour added, "Washington should be promoting a transparent and competitive market for health care, freeing Americans at the individual level to choose the insurance and medical services most appropriate for themselves and their families. There are ways to improve our health care system, but public health care isn't one of them."

SOURCE




Gaps in Obama's Rhetoric Start to Add Up

By Rich Lowry

The Obama team is saddled with a foundering health-care strategy. But it has a fallback plan - relying on the sheer dimwitted gullibility of the American public. How stupid do they think we are?

Stupid enough to think that a new $1 trillion health-care entitlement is just the thing to restore the country to fiscal health.

Stupid enough not to know that almost every entitlement known to man has cost more than originally estimated, with a congressional committee in 1967 underestimating by a factor of ten Medicare's cost by 1990.

Stupid enough not to realize that it is through budget trickery - the taxes begin immediately, the spending is put off for a few years - that the program in the House shows "only" a $239 billion deficit over the first ten years.

Stupid enough not to focus on how the gap between the House plan's revenue and spending steadily grows after the first ten years, making it a long-term budget buster.

Stupid enough to think increased preventive care will save the government money, just because Pres. Barack Obama constantly repeats it, despite all the independent studies to the contrary.

Stupid enough to believe that a program with no cost controls that can be discerned by the Congressional Budget Office will control costs.

Stupid enough not to worry that Obama's proposed superteam of technocrats operating outside normal political controls - the so-called Independent Medicare Advisory Council - will resort to rationing when costs continue to spiral upward.

Stupid enough to consider it wise to use several billion dollars in cuts from Medicare to create a new entitlement rather than to forestall Medicare's own looming insolvency, currently projected for 2017.

Stupid enough not to notice that the "public option" was explicitly designed by the Left as a stealthy path to single-payer, even as liberals continue to talk and write about its ultimate purpose openly.

Stupid enough to believe that we'll be able to keep our current health-care arrangements if we like them, even though the public option could throw tens of millions of people out of private insurance.

Stupid enough to trust the same people who came up with the public option as stealth single-payer to craft a co-op provision that isn't a stealth public option.

Stupid enough to credit Obama's assurances that the Democrats' reform isn't about government intervention in the health-care system when - even without the public option - it all-but-nationalizes health insurance.

Stupid enough not to see through Obama's sudden insistence on calling his plan "health-insurance reform" as empty poll-tested phrase-making.

Stupid enough to consider Obama's reform a good deal when its insurance regulations would increase premiums for most healthy people.

Stupid enough to think that the very real problem of people with pre-existing conditions locked out of the insurance market can't be alleviated short of a 1,000-page bill reordering the entire health-care system.

Stupid enough to buy Obama's cockamamie stories about unnecessary tonsillectomies and amputations - undertaken by greedy doctors to pad their profits - driving health-care costs.

Stupid enough to get gulled by rhetoric attacking special interests when almost all the special interests are backing Obama's plan for cowardly and self-interested reasons.

Stupid enough to consider new taxes on employment - imposed by the so-called employer mandate - a good idea during a weak economy with a 9.4 percent unemployment rate.

Stupid enough to condemn ordinary people angry and frightened enough to show up at town-hall meetings in every corner of the country as the product of an "astroturfing" conspiracy.

Stupid enough to blame nefarious Republicans for the faltering public support for an expensive, ungainly and contradictory health-care program passed out of four congressional committees on strict party-line votes.

Stupid enough to trust the good faith and public-spiritedness of an administration operating on Chief of Staff Rahm Emanuel's ram-it-through-now credo that a crisis should never go to waste.

And stupid enough not to be offended at how contemptibly stupid they think we are.

SOURCE





30 August, 2009

More NHS negligence

"The 32-hour delay that cost my baby his life": Mother may sue over failure to examine sick child. "Rules" invoked despite urgent situation

A baby born with known health problems died at two days old after doctors waited more than 24 hours before examining him. A scan during pregnancy showed Tobias Taylor had a dilated loop in his bowel, a potentially serious condition that needed careful attention. But despite clear medical records detailing the problem, medical staff not only waited 32 hours before fully examining him, but also let his mother Marie, 36, go home soon after the birth.

When he was finally examined, he was immediately rushed to a specialist unit where he died soon after of septicaemia. Now Mrs Taylor, a police community support officer, and her husband Simon, 39, are considering legal action against the hospital, claiming Tobias was given inadequate medical attention. Mrs Taylor, who visits her son’s grave every day, also claims she was not urged to remain in hospital the night after she gave birth, a charge the hospital denies.

She said: ‘If the hospital had acted as they should have and looked at my son straight away, he would be alive. ‘His graveside is the only place I feel at peace. I sit there for hours sometimes.’

National guidelines say doctors should wait 24 hours to give newborns a routine examination because this is when any heart defects can be spotted. But in letters to the family, the chief executive of East Surrey Hospital in Redhill admitted there had been staff ‘confusion’ and medics ‘did seem to lose sight of Tobias’s particular individual needs’.

Gail Wannell conceded: ‘Tobias did not fall into the category of babies who required the routine 24- hour examination.’ She added: ‘It would have been prudent for Tobias to be examined to see if there were signs of his condition deteriorating.’

Mrs Taylor, who lives in Redhill with her husband and sons Aden, seven, and Nicholas, 12, had been trying for a third child for six years when Tobias was conceived. But she became concerned when a scan on April 17 revealed that her unborn child had an enlarged bowel loop in his intestines, which can be an indicator of cystic fibrosis, which her son Nicholas has. It can also mean the intestines are blocked and need surgery. This should have been investigated straight after birth, but when Tobias was born at 2am on May 17, a note on Mrs Taylor’s records said: ‘Baby check not due till baby is 24 hours at 2am on May 18.’

Mrs Taylor said: ‘I asked for my baby to be checked, no one would even look at him. They told me I had to wait 24 hours, it was policy. ‘They didn’t tell me not to discharge myself in the meantime. If they had, I would have stayed.’ Mrs Taylor said she went home at 5.30pm and returned the next morning at 8.55am – but Tobias was not examined until 10.25am.

Soon after he was rushed to paediatric intensive care at St George’s Hospital in Tooting, South London, but died the next day. Mr Taylor said: ‘One of the hardest things we had to do was register the birth – then register the death straight afterwards. It was awful.’

A hospital spokesman said: ‘The medical teams discussed with Tobias’s mother their preference for Tobias to remain in hospital for monitoring and observation but the family chose to take Tobias home.’

SOURCE




Dean says Obamacare Authors Don't Want to Challenge Trial Lawyers

Whatever else he said Wednesday evening at the town hall hosted by Rep. Jim Moran, D-VA, former Democratic National Committee chairman and presidential candidate Howard Dean let something incredibly candid slip out about President Obama's health-care reform bill in Congress.

Asked by an audience member why the legislation does nothing to cap medical malpractice class-action lawsuits against doctors and medical institutions (aka "Tort reform"), Dean responded by saying: "The reason tort reform is not in the [health care] bill is because the people who wrote it did not want to take on the trial lawyers in addition to everybody else they were taking on. And that's the plain and simple truth,"

Dean is a former physician, so he knows about skyrocketing medical malpractice insurance rates, and the role of the trial lawyers in fueling the "defensive medicine" approach among medical personnel who order too many tests and other sometimes unneeded procedures "just to be sure" and to protect themselves against litigation.

Texas Gov. Rick Perry recently described in an Examiner oped the medical-malpractice caps enacted by the state legislature at his urging that reversed a serious decline in the number of physicians practicing in the Lone Star state and the resulting loss of access to quality medical care available to Texas residents. Mississippi Gov. Haley Barbor also shared some of his successes in this area in a recent Examiner oped.

Credit goes to the American Tort Reform Association's Darren McKinney for catching this momentary outbreak of political honesty by Dean. McKinney has conveniently posted an audio recording of Dean speaking here, so you can listen for yourself. Mckinney has also offered more comment here, helpfully even including a link to the Examiner's recent analysis of the degree to which trial-lawyer political contributions go to Democrats in Congress.

Those contributions are why Dean knows it would be a difficult task indeed for Obama to persuade congressional Democrats to do anything that might offend the trial-lawyers lobby. The Examiner's David Freddoso and Kevin Mooney did the reporting on this link here.

SOURCE




The pot calls the electric kettle Afro-American

The article below from the Left-leaning NPR claims that opponents of Obamacare are drumming up unfounded fears. Leftist would be experts about that. With all their shrill warnings about global warming, they sure have had a lot of practice at manufacturing fear (or trying to). More of that good ol' "projection" that Leftists rely so heavily upon. They assume that other people are just as disdhonest as they are

Past efforts to overhaul the nation's health care system had different proponents, different opponents and different plans that were under consideration. But they have two things in common: They all ended in failure, and in every case, opponents used fear as a key weapon in their arsenal.

So Jonathan Oberlander, a political scientist at the University of North Carolina at Chapel Hill, says he's not at all surprised to see recent claims — all thoroughly debunked — that suggest, for example, that bills under consideration would encourage senior citizens to commit suicide when they become ill or infirm.

"It's really a case of deja vu," he says. "You hear in today's debate echoes of the past that extend all the way to the early part of the 20th century. And I think the reason that people use fear again and again is that it's effective. It's worked to stop health reform in the past. And so they're going to try and use it in the present."

Oberlander says opponents used scare tactics the very first time the idea of national health insurance was broached — around 1915 — by tying would-be reformers to the nation's then-greatest international threat. "They said that national health insurance was a plot by the German emperor to take over the United States," he says.

The next effort to remake the health system came during the late 1940s. This time the opposition, led by the American Medical Association, exploited the newest fears. "They said if we adopted national health insurance, the Red army would be marching through the streets of the U.S.; they said this was the first step toward communism," Oberlander says.

By the time the Clinton administration took on the health effort, the power of the American Medical Association was fading. But now a new opponent took its place — the health insurance industry. It ran ads using an ordinary looking couple, named Harry and Louise, to raise doubts among middle-class Americans about how the Clinton plan might hurt rather than help them.

Says Oberlander, "The opponents have changed over time; the tactic of relying on fear and scaring Americans has not."

More here




Intimidation at a Waxman health care “forum”

A genuine "Brownshirt" action -- right out of 1930's Germany

Yesterday I went to a health care “forum” featuring Henry Waxman that was definitely not a townhall. The event was a sham on so many levels, and I will deal with that soon enough.... This event was a luncheon at the Luxe hotel in Brentwood. The event was kept secret, and tickets cost $50. Supporters of Mr. Waxman were given preferential treatment. This was a tightly controlled campaign rally, not a real townhall. However, my main criticism involved a thug that works for the Luxe Hotel.

Normally people just drive up, with no issues. This time, a pair of men stopped me as I pulled up. They asked what I was coming to the hotel for. I explained to them that I was there to see the Congressman, and gave them my name. They saw I was on the list, and let me through. I figured that was it.

I took my Republican Jewish Coalition tote bag, emptied the contents, and put them in my National Football League tote bag. This was before I exited my car. I simply wanted to avoid controversy. I entered the luncheon room, began to eat my salad, and was then accosted by a Vice President of the Hotel, Seth Horowitz. I have never met Seth Horowitz before. Yet he claimed to know me. He told me that he knew who I was, and that if I had any intention of making a disturbance, I should leave immediately.

I was stunned by this. I was using my fork correctly. I told him I had no idea what he was talking about, and he emphasized that he wanted to make sure I did not cause any problems. This was mind boggling to me. There is nothing in my background to suggest I would do anything improper.

He actually threatened me, and if I was anything other than a white male, I would probably have a pretty decent civil rights claim. He told me that he would refund my money if I wanted, and that if I was not satisfied, he could have the police escort me out. I asked him flat out why he was even approaching me. He would not say. In fact, he kept saying over and over that he did explain it to me, but all he did was repeatedly say that he wanted to avoid problems. (Only after insisting that I was there for peaceful purposes did he leave me alone.)

I never got an answer to a basic fundamental question. Why did he think I would be a problem? What behavior triggered his reaction? For those wondering why this matters, think about some basic things.

Everybody who registered for this event gave their name. This Seth Horowitz fellow, based on something, “knew about me.” What did he know? Were guests investigated? Did the Valet people see the political tote bag, which I carefully turned around before giving them my car? If somebody were to google my name, it would take them several pages to find something. A jazz musician who plays saxophone and lives in San Francisco gets most of the attention. I am fine with this. So to find something about me would take some serious time and effort.

More importantly, was this mere overzealousness by a hotel employee making sure his esteemed guest was happy? If so, why all the secrecy and evasiveness by Mr. Horowitz? He did not seem to be harassing most people, and was beyond rude. Another Republican in the room had somebody looking over his shoulder the entire time, checking out what the fellow was doing with his Blackberry.

For those who think I am being paranoid, explain to me how an unassuming guy minding his own business can be targeted without explanation. Mr. Horowitz was willing to have me “taken care of,” which could mean anything from being asked to leave to something more violent. He is a physically imposing guy, and got right in my face. This was assault. I cannot imagine that Mr. Horowitz acted alone. Either Mr. Horowitz acted on direct orders, or he is a liberal activist. Yet how would he know my views?

I am going to repeat over and over again that I have never at any time in my life engaged in any political behavior that could be considered dangerous or threatening to anyone. My conversations with Congressman Waxman were cordial. He is my opponent, not my enemy.

Seth Horowitz might be the second coming of Rahm Emanuel, at least from a tactical standpoint. As for why he did what he did, he will not say. I want answers. Why was I targeted? What did he mean when he said that he “knew about me?” What does that mean? Whatever he “found out,” through what means did he find out?

I have never given a political speech at the Luxe Hotel. None of my political speeches have ever been videotaped. I have never had an event occur at the Luxe Hotel that would be considered remotely controversial.

This was not a random targeting. This man had a beef with me, and is not offering an explanation. Seth Horowitz is a bully on a power trip. The only thing bullies respect is force. I will be contacting every organization I have friends with, and plead with them to boycott the Luxe Hotel. I want answers. This is America. Every citizen has the right to peacefully assemble.

Congress Waxman’s people may have had nothing to do with this, but that theory defies logic. The whole situation stinks to high heaven. Seth Horowitz must be held accountable for his behavior. Otherwise, when he targets you, I will not be there to speak up.

Update: Seth Horowitz of the Luxe Hotel just called me and was very belligerent. He insisted that Congressman Waxman did not give the order to target me. When I asked if Congressman Waxman’s people gave the order, he clammed up. He said he did it based on my behavior. I asked him “what behavior?” He would not answer. He is hiding behind his lawyers, after accusing me of trying to sue the hotel.

I called back and emphasized to the very pleasant woman in the Executive Suite offices that I had zero interest in suing the hotel. I simply want an apology and an explanation. I also called Waxman’s office to find out more. While I suspect he may have an overzealous staffer or two, I do not have any evidence at this time that Congressman Waxman was directly involved.

SOURCE




Native Americans and the Public Option

After decades of government-run care, some Indians are finally saying enough.

Montana Sen. Max Baucus, a leading architect of national health-care reform, visited the Flathead Indian Reservation near Pablo, Mont., in May, and he was confronted with a surprising critique. "I hope any [new health-care] plan does not forget the nation's first people," Dr. LeAnne Muzquiz told the senator. Another person in the audience, according to the newspaper the Missoulian, followed up by telling the senator that the legislation pending in Congress would in fact do just that.

Native Americans have received federally funded health care for decades. A series of treaties, court cases and acts passed by Congress requires that the government provide low-cost and, in many cases, free care to American Indians. The Indian Health Service (IHS) is charged with delivering that care.

The IHS attempts to provide health care to American Indians and Alaska Natives in one of two ways. It runs 48 hospitals and 230 clinics for which it hires doctors, nurses, and staff and decides what services will be provided. Or it contracts with tribes under the Indian Self-Determination and Education Assistance Act passed in 1975. In this case, the IHS provides funding for the tribe, which delivers health care to tribal members and makes its own decisions about what services to provide.

The IHS spends about $2,100 per Native American each year, which is considerably below the $6,000 spent per capita on health care across the U.S. But IHS spending per capita is about on par with Finland, Japan, Spain and other top 20 industrialized countries—countries that the Obama administration has said demonstrate that we can spend far less on health care and get better outcomes. In addition, IHS spending will go up by about $1 billion over the next year to reach a total of $4.5 billion by 2010. That includes a $454 million increase in its budget and another $500 million earmarked for the agency in the stimulus package.

Unfortunately, Indians are not getting healthier under the federal system. In 2007, rates of infant mortality among Native Americans across the country were 1.4 times higher than non-Hispanic whites and rates of heart disease were 1.2 times higher. HIV/AIDS rates were 30% higher, and rates of liver cancer and inflammatory bowel disease were two times higher. Diabetes-related death rates were four times higher. On average, life expectancy is four years shorter for Native Americans than the population as a whole.

Rural Indians fare even worse, as data from Sen. Baucus's home state show. According to IHS statistics, in Montana and Wyoming, Indians suffer diabetes at rates 20% higher, heart disease 12% higher, and lung cancer rates 67% higher than the average across all IHS regions in the country. A recent Harvard University study found that life expectancy on a reservation in neighboring South Dakota was 58 years. The national average is 77.

Personal stories from people within the system reveal the human side of these statistics. In 2005, Ta'Shon Rain Little Light, a 5-year-old member of the Crow tribe who loved to dress in traditional clothes, stopped eating and complained that her stomach hurt. When her mother took her to the IHS clinic in south central Montana, doctors dismissed her pain as depression. They didn't perform the tests that might have revealed the terminal cancer that was discovered several months later when Ta'Shon was flown to a children's hospital in Denver. "Maybe it would have been treatable" had the cancer been discovered sooner, her great-aunt Ada White told the Associated Press.

Such horror stories are common on reservations, where the common wisdom is "don't get sick after June"—the month when the federal dollars usually run out. Late last year, the Montana Quarterly interviewed Tommy Connell, a member of the Blackfeet tribe and a worker in the IHS hospital in Browning, Mont. He didn't pull any punches in his assessment of the IHS. "They're lying to us," he said of promises over the years of more funds and better care. "You can pass just about any bill you want, but to appropriate money to that bill, that's another thing."

Dismal statistics prompted Mr. Baucus to declare a "health state of emergency" on the Fort Peck Reservation in northeastern Montana and to order an investigation of the IHS's use of funds. In July 2008, the Government Accountability Office reported that the IHS simply lost $15.8 million worth of equipment such as trucks and Jaws of Life machines between 2004 and 2007. It also found that $700,000 worth of computers were ruined by bat dung.

Tribal contracting—the alternative to IHS-run hospitals and clinics—offers some hope for improvement by giving tribes more flexibility in administering their own hospitals and clinics. Kelly Eagleman, vice-chairman of the Chippewa Cree Band on Montana's Rocky Boy's Reservation, understands the effect of a top-down bureaucracy. Of his tribe, he says, "We tend to want to blame a system, but we don't look at ourselves. We all smoke. We lay on the couch. But when something happens to us, we're the first to point and say that the clinic should have fixed us."

The Chippewa Cree Band has opted to provide its own health care with funding from the IHS. Dr. Dee Althouse, a physician at the Rocky Boy's Reservation, is still frustrated by funding constraints. She told the Montana Quarterly that she often finds herself working to save lives and limbs, deferring routine health care until there is money available. Yet even with limited funds, ongoing research by the Native Nations Institute reported earlier this year that tribal management leads to better access and better quality care than relying on the IHS-run system.

The Chippewa Cree Band runs its own hospital and has hired a registered dietician who has gotten the local grocery store to implement a shelf-labeling system to improve consumer nutritional information. They've also built a Wellness Center with a gym, track, basketball court, and pool. These are small steps that won't immediately eliminate heart disease or diabetes. But they move in the direction of local control and better health.

At a time when Americans are debating whether to give the government in Washington more control over their health care, some of the nation's first inhabitants are moving in the opposite direction.

SOURCE





28 August, 2009

'Cruel and neglectful' care of one million British public hospital patients exposed

One million NHS patients have been the victims of appalling care in hospitals across Britain, according to a major report released today. In the last six years, the Patients Association claims hundreds of thousands have suffered from poor standards of nursing, often with 'neglectful, demeaning, painful and sometimes downright cruel' treatment.

The charity has disclosed a horrifying catalogue of elderly people left in pain, in soiled bed clothes, denied adequate food and drink, and suffering from repeatedly cancelled operations, missed diagnoses and dismissive staff. The Patients Association said the dossier proves that while the scale of the scandal at Mid-Staffordshire NHS Foundation Trust - where up to 1,200 people died through failings in urgent care - was a one off, there are repeated examples they have uncovered of the same appalling standards throughout the NHS.

While the criticisms cover all aspects of hospital care, the treatment and attitude of nurses stands out as a repeated theme across almost all of the cases. They have called on Government and the Care Quality Commission to conduct an urgent review of standards of basic hospital care and to enforce stricter supervision and regulation.

Claire Rayner, President of the Patients Association and a former nurse, said:“For far too long now, the Patients Association has been receiving calls on our helpline from people wanting to talk about the dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment their elderly relatives had experienced at the hands of NHS nurses. “I am sickened by what has happened to some part of my profession of which I was so proud. "These bad, cruel nurses may be - probably are - a tiny proportion of the nursing work force, but even if they are only one or two percent of the whole they should be identified and struck off the Register.”

The charity has published a selection of personal accounts from hundreds of relatives of patients, most of whom died, following their care in NHS hospitals. They cite patient surveys which show the vast majority of patients highly rate their NHS care - but, with some ten million treated a year, even a small percentage means hundreds of thousands have suffered.

Ms Rayner said it was by "sad coincidence" that she trained as a nurse with one of the patients who had "suffered so much". She went on: "I know that she, like me, was horrified by the appalling care she had before she died. "We both came from a generation of nurses who were trained at the bedside and in whom the core values of nursing were deeply inculcated."

Katherine Murphy, Director of the Patients Association, said “Whilst Mid Staffordshire may have been an anomaly in terms of scale the PA knew the kinds of appalling treatment given there could be found across the NHS. This report removes any doubt and makes this clear to all. Two of the accounts come from Stafford, and they sadly fail to stand out from the others. “These accounts tell the story of the two percent of patients that consistently rate their care as poor (in NHS patient surveys). "If this was extrapolated to the whole of the NHS from 2002 to 2008 it would equate to over one million patients. Very often these are the most vulnerable elderly and terminally ill patients. It’s a sad indictment of the care they receive.”

The Patients Association said one hospital had threatened it with legal action if it chose to publish the material.

Pamela Goddard, a piano teacher from Bletchingley, in Surrey, was 82 and suffering with cancer but was left in her own excrement and her condition deteriorated due to her bed sores. Florence Weston, from Sedgley in the West Midlands, died aged 85 and had to remain without food or water for several days as her hip operation was repeated cancelled.

The charity released the dossier to highlight the poor care which a minority of patients in the NHS are subjected to. Ms Murphy said the numbers rating care as poor came despite investment in the NHS doubling and the number of frontline nurses increasing by more than a quarter since 1996.

The personal stories were revealed to prevent their cases being ignored as only representing a small portion of patients. The report said: "These are patients, not numbers. These are people, not statistics."

Dr Peter Carter, Chief Executive of the Royal College of Nursing, said he was concerned that public confidence in the NHS could be undermined by the examples cited and it would affect morale in hardworking staff. He said: “The level of care described by these families is completely unacceptable, and we will not condone nurses who behave in ways that are contrary to the principles and ethics of the profession. "However we believe that the vast majority of nurses are decent, highly skilled individuals. “This report is based on the two per cent of patients who feel that their care was unacceptable. Two per cent is too many but we are concerned that this might undermine the public’s confidence in the world-class care they can expect to receive from the NHS."

Barbara Young, Chairman of the Care Quality Commission, the super-regulator, said: “It is absolutely right to highlight that standards of hospital care can vary from very good to poor. “Many people are happy with the care they receive, but we also know that there are problems. “I am in no doubt that many hospitals need to raise their game in this area. “Where NHS trusts fail to meet the mark, we have tough new enforcement powers, ranging from warnings and fines to closure in extreme cases. We will not hesitate to use these powers when necessary to bring improvement. "We will be asking NHS trusts and primary care trusts how they are ensuring that the needs of patients and their safety and dignity are kept at the heart of care.” [Blah, blah, blah!]

Chris Beasley, Chief Nursing Officer at the Department of Health said the care in the cases highlighted by the PA was “simply unacceptable”. She added: "It is important to note this is not representative of the picture across the NHS. "The NHS treats millions of people every day and the vast majority of patients experience good quality, safe and effective care - the Care Quality Commission's recent patient experience survey shows that 93 percent of patients rate their overall care as good or excellent.

"We will shortly be publishing complaints data on the NHS Choices website and expect trusts to publish the number of complaints they receive, setting out how these are successfully resolved."

SOURCE




Australia: More revelations about a rotten government-run ambulance service

Paramedics operate in 'culture of fear' because management behavior in unaccountable

THE State Government will establish a panel [A "panel" three bureaucrats! Three dedicated coverup artists, no doubt. How about a judicial enquiry?] to investigate bullying and harassment amid concerns paramedics and emergency workers operate in a "culture of fear".

The Courier-Mail can reveal an internal investigation found an Emergency Management Queensland boss guilty of victimisation, harassment and inappropriate comments, which included very harsh, sexist and intimidatory language. Documents obtained under Right to Information laws show six of 10 allegations made against the manager were substantiated and he was aggressive towards EMQ office staff.

Another EMQ officer was found guilty of swearing at Emergency Service cadets during a camp exercise last year. He referred to them as "little bastards" and told them they were "full of s--- and wouldn't survive in the bush".

Recommendations made as a result included staff training in the department's code of conduct and dealing with conflict in the workplace but it is not known whether the culprits were reprimanded.

Emergency Medical Service Protection Association president Prebs Sathiaseelan said he had received numerous complaints from his members. "EMPSA on a regular basis receives calls from our membership about some form of harassment and bullying – it isn't improving," he said. Mr Sathiaseelan said it was a "culture of fear".

In another case, a Brisbane senior officer was investigated after he "dropped his trousers, exposed his genitalia and simulated oral sex" with another employee against her will. He also made offensive comments against two colleagues in relation to race and sexuality. While at least one recipient of his comments has left the QAS, his language was deemed to be "part of his character" and "generally non-offensive". [????] But a spokesman for QAS Commissioner David Melville this week said the officer concerned was asked to "show cause" at a formal disciplinary hearing. "This officer was not counselled as the Regional Assistant Commissioner determined that the matter was of such a serious nature that this officer should be formally reprimanded." The officer was warned if his behaviour deteriorated again over 12-months he would also be docked two weeks pay.

Another senior officer, who didn't want to be named, contacted The Courier-Mail concerned the organisation was cutting corners trying to keep up with patient demand. "When you stick your hand up and say anything nowadays, you just get smashed and told to shut up," he said.

Emergency Services Minister Neil Roberts said yesterday after discussions with the Director-General, ambulance officers, firefighters, and staff in EMQ and the Department of Community Safety would be able to make complaints to a dedicated phone line and email service, which would then be referred to the panel. "It is my hope that this panel will be utilised by personnel who feel that they cannot confidently report instances of bullying, harassment or intimidation through existing channels," he said.

The panel will comprise Ministerial, Information and Legal Services branch executive director Fiona Rafter, Ethical Standards director Terry Christensen and Legal Services director Tracey Davern. "It is important that employees feel confident that their allegations will be taken seriously, properly investigated and dealt with without any personal ramifications," Mr Roberts said.

SOURCE




Liberal lies about national health care

By Ann Coulter

With the Democrats getting slaughtered – or should I say, "receiving mandatory end-of-life counseling" – in the debate over national health care, the Obama administration has decided to change the subject by indicting CIA interrogators for talking tough to three of the world's leading Muslim terrorists.

Had I been asked, I would have advised them against reinforcing the idea that Democrats are hysterical bed-wetters who can't be trusted with national defense while also reminding people of the one thing everyone still admires about President George W. Bush. But I guess the Democrats really want to change the subject. Thus, here is Part 2 in our series of liberal lies about national health care.

6) There will be no rationing under national health care.

Anyone who says that is a liar. And all Democrats are saying it. (Hey, look – I have two-thirds of a syllogism!). Apparently, promising to cut costs by having a panel of Washington bureaucrats (for short, "The Death Panel") deny medical treatment wasn't a popular idea with most Americans. So liberals started claiming that they are going to cover an additional 47 million uninsured Americans and cut costs ... without ever denying a single medical treatment!

Also on the agenda is a delicious all-you-can-eat chocolate cake that will actually help you lose weight! But first, let's go over the specs for my perpetual motion machine – and it uses no energy, so it's totally green! For you newcomers to planet Earth, everything that does not exist in infinite supply is rationed. In a free society, people are allowed to make their own rationing choices.

Some people get new computers every year; some every five years. Some White House employees get new computers and then vandalize them on the way out the door when their candidate loses. (These are the same people who will be making decisions about your health care.)

Similarly, one person might say, "I want to live it up and spend freely now! No one lives forever." (That person is a Democrat.) And another might say, "I don't go to restaurants, I don't go to the theater, and I don't buy expensive designer clothes because I've decided to pour all my money into my health."

Under national health care, you'll have no choice about how to ration your own health care. If your neighbor isn't entitled to a hip replacement, then neither are you. At least that's how the plan was explained to me by our next surgeon general, Dr. Conrad Murray.

7) National health care will reduce costs.

This claim comes from the same government that gave us the $500 hammer, the $1,200 toilet seat and postage stamps that increase in price every three weeks. The last time liberals decided an industry was so important that the government needed to step in and contain costs was when they set their sights on the oil industry. Liberals in both the U.S. and Canada – presidents Richard Nixon and Jimmy Carter and Canadian P.M. Pierre Trudeau – imposed price controls on oil. As night leads to day, price controls led to reduced oil production, which led to oil shortages, skyrocketing prices for gasoline, rationing schemes and long angry lines at gas stations. You may recall this era as "the Carter years."

Then, the white knight Ronald Reagan became president and immediately deregulated oil prices. The magic of the free market – aka the "profit motive" – produced surges in oil exploration and development, causing prices to plummet. Prices collapsed and remained low for the next 20 years, helping to fuel the greatest economic expansion in our nation's history. You may recall this era as "the Reagan years."

Freedom not only allows you to make your own rationing choices, but also produces vastly more products and services at cheap prices, so less rationing is necessary.

8) National health care won't cover abortions.

There are three certainties in life: a) death, b) taxes, and c) no health-care bill supported by Nita Lowey and Rosa DeLauro and signed by Barack Obama could possibly fail to cover abortions. I don't think that requires elaboration, but here it is:

Despite being a thousand pages long, the health-care bills passing through Congress are strikingly nonspecific. (Also, in a thousand pages, Democrats weren't able to squeeze in one paragraph on tort reform. Perhaps they were trying to save paper.)

These are Trojan Horse bills. Of course, they don't include the words "abortion," "death panels" or "three-year waits for hip-replacement surgery." That proves nothing – the bills set up unaccountable, unelected federal commissions to fill in the horrible details. Notably, the Democrats rejected an amendment to the bill that would specifically deny coverage for abortions.

After the bill is passed, the Federal Health Commission will find that abortion is covered, pro-lifers will sue, and a court will say it's within the regulatory authority of the health commission to require coverage for abortions. Then we'll watch a parade of senators and congressmen indignantly announcing, "Well, I'm pro-life, and if I had had any idea this bill would cover abortions, I never would have voted for it!"

No wonder Democrats want to remind us that they can't be trusted with foreign policy. They want us to forget that they can't be trusted with domestic policy.

SOURCE




Health Insurance and the Lure of Someone Else

By Jon N. Hall

Insurance is all about "someone else" paying your bills. However, if everyone's healthcare bills were the same, if our bodies failed and expired in the same way and on the same schedule, if our little lives were as predictable as those of the adult mayfly, we wouldn't have a health insurance industry. Insurance makes sense only if it's for the unpredictable.

But we are not a uniform species like the mayfly. Our bodies differ dramatically. Some folks are rarely sick; one day their bodies simply stop, incurring little if any cost to the insurance industry and government treasuries. Healthy people are all alike, perhaps a bit like the mayfly. Sick folks are all different. And the variety of ailments they suffer from beggar the imagination. Some have multiple degenerative diseases, all at the same time. Some are basket cases from birth.

If everyone had absolutely wretched health, would Congress be so intent on insuring us all? It is because there are only a few of us who have truly wretched health that health insurance is feasible. Insurance makes sense only if claims vary.

And those who make the fewest insurance claims get the worst deal from insurance. If everyone were to pay the same in health insurance premiums, the healthier half would be better off to "go it alone", i.e. be self-insured. Betsy McCaughey reports that in America "about 5 percent of the populace uses 50 percent of treatment dollars", citing the Congressional Budget Office. Could that possibly mean that 94+ percent of us would be better off financially if self-insured? (Check out Ms. McCaughey's more detailed critique of the healthcare debate here, at The American Spectator.)

Some say: "healthcare is a right". But where in the Constitution is this right conferred? Perhaps these folks are confusing "is" for "should be". The Constitution doesn't even say we have a right to be fed by the feds. If they want healthcare to be a right, there's a way to bring that about: amend the Constitution. It would be interesting to see if such an amendment could ever be ratified; I have my doubts. (During last year's campaign, I expressed my doubts about the constitutionality of the individual mandate, which is still under consideration.)

In her blog for Fox Business, Elizabeth MacDonald quotes economist Ed Yardeni: "Ask doctors and hospital administrators about Medicare and Medicaid and they will tell you that it amounts to a theft of their services because the government doesn't pay them enough to cover their expenses for the care they provide. So they pass those costs on to patients covered by private health insurance."

If the "reformers" in Congress want to create a real market for healthcare, they would enact a law that demands this: No individual nor private health insurance company can be billed more for a medical expense than what government programs pay. This would help end price discrimination, which Uwe Reinhardt describes as "the practice of charging different payers different prices for identical health care goods or services". The same should be done for drugs: No co-op, foreign government, nor bargaining bloc could be given special prices. Let's put the kibosh on the "cost shifting" that has sent the price of private insurance soaring and distorted the market.

If the "reformers" in Congress weren't in the hip pocket of trial lawyers, they would put a cap on malpractice torts. Recently, columnist Charles Krauthammer, who happens to be an MD, provided an elegant solution for malpractice: "The penalty would be losing your medical license. There is no more serious deterrent than forfeiting a decade of intensive medical training and the livelihood that comes with it."

The "reformers" in Congress claim they want to bring competition, choice and cost savings to healthcare. If so, they should enact a law that allows workers to direct their employers to drop them from company-provided health insurance and then add to their paychecks whatever their employers were paying for them in health insurance. And if these workers then elect to buy health insurance on their own, they would get the same tax break as their employers get. Or, they could pocket the money and "go it alone" -- if they're diligent about their health regimens (and lucky), they'll save money.

If the "reformers" in Congress want to overhaul America's healthcare system and erect some "comprehensive" new system, then Congress should first demonstrate to the American People that they are competent at holding down healthcare inflation. But they can't do that.

That's because Congress itself is responsible for healthcare inflation. Congress caused healthcare inflation by mandates (e.g. Medicare) that it refused to fully pay for, thus shifting costs to "someone else", i.e. the private sector; by disallowing the purchase of insurance across state lines, thereby quashing competition; by mandating that emergency rooms take everyone and then not paying for it (shifting those costs to "someone else"); by mandating that illegal aliens be treated in emergency rooms; by disallowing the purchase of drugs from Canada; by cordoning off vast chunks of the economy which they reserve for healthcare; etc; etc; etc.

Despite having run up the deficit by a factor of 10 in just 2 years, despite the recently revealed $2 Trillion bump up in the projected deficits over the next decade, despite an unemployment trend that continues to worsen, despite being in 2 wars, and despite an Iran that gets ever closer to the bomb, our brilliant Congress wants to create the largest entitlement of all...now! This is the most irresponsible Congress in modern history. And that's a pity, because just as for the mayfly, our time is running out.

SOURCE




Under the Cover of a Backroom Deal

Excuse me, but weren't we just talking about health care? After scanning news this week, one might notice a startling dearth of health care stories making headlines. Surprisingly, for most media outlets--be they liberal, conservative, a major news network or a basement blog--stories regarding public options, death panels, Obama's waning support, insurance companies, and the like were nowhere to be found.

Their absence might make the average news junkie feel like he's entered a non-parallel universe. But please don't be alarmed: it is entirely calculated. Simply put, it's not that health care is no longer newsworthy; it's just that Barack Obama is deliberately making his news bigger to block it out.

As a self-described "gifted" orator, Mr. Obama has demonstrated a clear understanding and flawless execution of one of the most crucial strategies of effectively dominating the conversation: changing the subject when the discussion gets too uncomfortable. Health care, it seems, was becoming too difficult of a conversation for the gifted one to stomach. Something had to be done. So, in the past two days alone, the President and/or White House officials have announced:

* That he will appoint a special prosecutor to investigate CIA interrogation abuses.
* That he will nominate Ben Bernanke to a second term as chairman of the Federal Reserve.
* That he demands the media leave him and his daughters alone while on vacation.
* That 90,000 Americans could die from swine flu this fall (and most of them will be kids).
* That the budget deficit this year will skyrocket to an unexpected record of $1.6 trillion.
* That he will soon part the waters of the Nantucket Sound (okay, not yet – but just wait).

With such an onslaught of manufactured news fodder—all “breaking” in two days, mind you—it is no wonder the health care debate got pushed off the front page. And that’s exactly what Barack Obama intended. Some schemes are best hatched undercover.

The fact is: the national health care debate had become far too politically damaging for the Obama Administration. Ever since kicking his government-run healthcare plan into high-gear at the beginning of the summer, Mr. Obama’s poll numbers have plummeted as a direct result. According to Rasmussen Reports, Barack Obama had a +7 approval index on June 1st. As of August 25th, the President scored a -11 on the approval index. That’s an 18-point swing in three months.

What Obama clearly intended to be the sparkling set-piece of his “transformational” Administration has quickly become a burgeoning blight destroying his lofty approval rating – and already threatening his all-important legacy as well.

Moreover, Barack Obama’s minions—the multitudes of Democrat representatives, senators, and White House officials scattered across the nation during the August recess—have likewise felt the burn from hordes upon hordes of Americans upset with the Democrats’ plans for government-run health care. Despite the best—no, make that worst—efforts of the Administration and Obamaton media to paint the concerned American people as “angry racist mobs,” the embarrassment and sinking poll numbers are as plain as the lengthening nose on Obama’s face.

Their embarrassment is Obama’s embarrassment. And all of the Administration’s prevarications about “misunderstandings” aren’t going to change the hardscrabble facts. So, for Obama and Co., now is the perfect time to avert attention by changing the subject.

Abandoning their health care agenda, however, is far from the goal. Displacing health care with a barrage of other news stories needs to be seen for what it is—a cynical cover up for a backroom deal.

With both the media and the public looking the other way, the President can quietly take the health care debate off the front page and return to the kind of backroom, bare-knuckle politics he truly enjoys —those that don’t involve the American people. After all, it’s become increasingly evident that if Mr. Obama involves the American people, his sweeping government-run health care scheme would never be carried out.

So while the politically-damaging health care chaos may have been pushed from the front page, it won’t end up on the obit page—buried and forgotten. If Barack Obama has his way, it will next appear as a “Second-Coming Headline” proclaiming, “Obamacare Passed Without Debate” as America’s healthcare industry is scrapped under the obscene cover of a backroom deal.

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27 August, 2009

The babies born in British hospital corridors: Bed shortage forces 4,000 mothers to give birth in lifts, offices and hospital toilets

Thousands of women are having to give birth outside maternity wards because of a lack of midwives and hospital beds. The lives of mothers and babies are being put at risk as births in locations ranging from lifts to toilets - even a caravan - went up 15 per cent last year to almost 4,000.

Health chiefs admit a lack of maternity beds is partly to blame for the crisis, with hundreds of women in labour being turned away from hospitals because they are full. Additionally, overstretched maternity units shut their doors to any more women in labour on 553 occasions last year.

Babies were born in offices, lifts, toilets and a caravan, according to the Freedom of Information data for 2007 and 2008 from 117 out of 147 trusts which provide maternity services. One woman gave birth in a lift while being transferred to a labour ward from A&E while another gave birth in a corridor, said East Cheshire NHS Trust. Others said women had to give birth on the wards - rather than in their own maternity room - because the delivery suites were full.

Tory health spokesman Andrew Lansley, who obtained the figures, said Labour had cut maternity beds by 2,340, or 22 per cent, since 1997. At the same time birth rates have been rising sharply - up 20 per cent in some areas. Mr Lansley said: 'New mothers should not be being put through the trauma of having to give birth in such inappropriate places. 'While some will be unavoidable emergencies, it is extremely distressing for them and their families to be denied a labour bed because their maternity unit is full. 'It shows the incredible waste that has taken place that mothers are getting this sort of sub-standard treatment despite Gordon Brown's tripling of spending on the NHS. 'Labour have let down mothers by cutting the number of maternity beds and by shutting down maternity units.'

The NHS employs the equivalent of around 25,000 full-time midwives in England, but the Government has promised to recruit 3,400 more. However, the Royal College of Midwives estimates at least 5,000 more are needed to provide the quality of service pledged in the Government's blueprint for maternity services, Maternity Matters. At the same time almost half of all midwives are set to retire in the next decade.

Jon Skewes, a director at the Royal College of Midwives, said: 'The rise in the number of births in other than a designated labour bed is a concern. We would want to see the detail behind these figures to look at why this is happening. 'There is no doubt that maternity services are stretched, and that midwives are working harder and harder to provide good quality care. However, we know the Government is putting more money into the service. 'The key now is to make sure this money is spent by the people controlling the purse strings at a local level.'

Care services minister Phil Hope said: 'The number of maternity beds in the NHS reflects the number of women wanting to give birth in hospital. Giving birth can be unpredictable and it is difficult to plan for the exact time and place of every birth. 'Local health services have plans to ensure high quality, personal care with greater choice over place of birth and care provided by a named midwife. 'We recognise that some parts of the country face particular challenges due to the rising birth rate and that is why last year we pledged to increase funding for maternity by £330million over three years. 'We now have more maternity staff than ever before and we have already met our target to recruit 1,000 extra midwives by September.' [Blah, blah, blah!]

Pregnant Linda Corbett, 33, was turned away from one hospital and gave birth in a car as she dashed to another. Her husband Chris, 39, delivered their daughter Iona in the back seat while her father raced to the hospital at 70mph. 'I was really scared but I had to hold it together as I was the only one who knew the way to the hospital,' she said. 'The baby was born just as we entered the car park.'

Mrs Corbett was due to give birth at her Brighton home in June last year but when she phoned the Royal Sussex County Hospital after her contractions started she was told the maternity unit was too busy to send a midwife to her. When she phoned back later, she was told the unit was full and she would have to go to another hospital. Fifteen minutes later she gave birth. She said: 'We had such a happy ending but it could have been a disaster.'

SOURCE




Man collapses with ruptured appendix... three weeks after NHS doctors 'took it out'

This could well have been fatal

After weeks of excruciating pain, Mark Wattson was understandably relieved to have his appendix taken out. Doctors told him the operation was a success and he was sent home. But only a month later the 35-year-old collapsed in agony and had to be taken back to Great Western Hospital in Swindon by ambulance.

To his shock, surgeons from the same team told him that not only was his appendix still inside him, but it had ruptured - a potentially fatal complication. In a second operation it was finally removed, leaving Mr Wattson fearing another organ might have been taken out during the first procedure.

The blunder has left Mr Wattson jobless, as bosses at the shop where he worked did not believe his story and sacked him.

Mr Wattson told of the moment he realised there had been a serious mistake. 'I was lying on a stretcher in terrible pain and a doctor came up to me and said that my appendix had burst,' he said. 'I couldn't believe what I was hearing. I told these people I had my appendix out just four weeks earlier but there it was on the scanner screen for all to see. 'I thought, "What the hell did they slice me open for in the first place?" 'I feel that if the surgery had been done correctly in the first place I wouldn't be in the mess I am today. I'm disgusted by the whole experience.'

Mr Wattson first went under the knife on July 7 after experiencing severe abdominal pain for several weeks. He was discharged but exactly a month later he had to dial 999 after collapsing in agony.

Following the second operation his incision became infected and he was admitted to hospital for a third time for treatment.

He said: 'I had a temporary job at a sports shop but when I took in two medical certificates saying I had my appendix out twice they didn't believe me. 'Now I'm helpless. I can't go out and find a job, I can't go to interviews, I can barely walk and am in constant pain. Before the first operation they told me I had to have my appendix removed and when I woke up afterwards they said it had been a complete success. 'But then I keeled over in agony one month later and when they did some tests at the hospital we could see the appendix was still there on the scans. 'As far as I was aware they took my appendix out and no one told me any different. 'I have no idea what they did take out, but I want to find out what went wrong.'

A spokesman for Great Western Hospital confirmed that a representative had met Mr Wattson and that an investigation had been started. He was unable to confirm what, if anything, was removed in the first operation. Paul Gearing, deputy general manager for general surgery at Great Western Hospital NHS Trust, said: 'We are unable to comment on individual cases. 'However, we would like to apologise if Mr Wattson felt dissatisfied with the care he received at Great Western Hospital.' [IF he felt dissatisfied??? What a bureaucratic sh*t!]

SOURCE




Australia: A public hospital for possums??



THIS photograph was taken in the intensive care unit at the ailing Hornsby Ku-ring-gai Hospital. Staff found the brush-tailed possum sitting among open boxes of face masks, gloves and surgical sponges, its faeces scattered across the counter. It was sent to the Herald only days after one of the state's most senior health bureaucrats denied claims the hospital had a big problem with possums, known to spread deadly golden staph and e.coli infections. The photo was taken in 2005 but staff say possums have been plaguing the hospital for more than a decade and are removed weekly from wards and offices.

Desperate for help, they sent the picture to the Health Department at the time it was taken but the warning went unheeded. And one senior official used it as a point of laughter to show visitors to his office. After the possum was found, staff in the intensive care unit locked up medical supplies but say maintenance workers regularly move the animals to boxes in trees within the grounds. ''The one in the intensive care unit is not an isolated case. It's par for the course around here,'' one doctor said.

Possums, which have a lifespan of 15 years, can carry deadly diseases easily transmitted to humans, including Lyme disease, leptospirosis, rickettsia and mycobacteriosis, which can cause abscesses, fistulas, headaches, vomiting and renal failure. Their faeces can carry the gut parasite cryptosporidium and their urine can cause breathing problems for asthmatics.

Any animal in a hospital was a health risk but some, such as possums, were known to spread superbugs such as methicillin-resistant staphylococcus aureus, said an infectious diseases expert at Canberra Hospital, Peter Collignon. ''Allowing a wild animal, which scavenges far and wide, to contaminate gloves and surgical equipment is obviously a real problem.''

The chief executive of the Northern Sydney Central Coast Area Health Service, Matthew Daly, last week rejected allegations that the hospital had been neglected but did not deny continuing possum problems. All reports of possum urine had been addressed, he said. ''Possum nests were in a derelict buildings and were subsequently removed,'' he said.

Up to six possums might live in the roof space of a family home, but more than 25 would probably be found in a hospital, said David Bennett, the owner of a possum removal service in Adelaide. ''You definitely wouldn't want them in a hospital. And unless you get an expert in, there is no way to keep them out. They are highly territorial and will immediately return to where they were.''

A spokeswoman for the area health service said yesterday the present management was not aware of the photo and an inspection of the hospital last week found no evidence of possums in wards or patient areas. ''All such reports are taken seriously and are dealt with at the time,'' she said. [What utter bulldust! A problem known since 2005 has still not been dealt with]

SOURCE




Australia: One reason why dental bills are so high

Official regulations make dentists pay sky-high prices for the equipment and supplies that they use

DENTISTS are allegedly being shown how to access unregulated overseas markets to obtain cut-price dental equipment which is not being scrutinised by the Therapeutic Goods Administration.

The Port Macquarie dentist Jeremy Rourke conducted a series of capital city seminars in May, titled ''Work SMART = Grow RICH: Profiting from every minute''.

He charged dentists $770 each for the one-day course, promising to show participants ''how it is possible to 'DOUBLE production and TRIPLE profitability''.

Although the Herald is not suggesting Dr Rourke is acting illegally, one professional who attended a Sydney seminar on May 18 told the Herald she became angry and walked out when he began showing participants how to access sites such as Made in China.com and eBay, where dentists could directly import dental equipment and materials for a fraction of the price of Australian-made goods.

Under TGA regulations, all dental products and materials, local or imported, must be listed on its register before they can be used on patients. But concerns have been raised by the dental supplies industry that the practice of dentists accessing unregistered products from unregulated Asian markets has become widespread.

Raymond Shroot, the NSW president of the Australian Dental Industry Association, which represents suppliers of dental equipment, said anyone seeking to import a medical device could easily bypass the TGA's scrutiny, because there was no requirement for the importer to quote an Australian Register of Therapeutic Goods listing number.

''To get anything that is listed with the TGA through customs you should have to quote that number on the customs clearance form, but that hasn't been the case,'' Mr Shroot said. ''We've been told the TGA is unwilling to changes its practices.''

Dr Rourke told the Herald he had done nothing illegal. ''I simply tell dentists there are websites where there are items available but I make them aware that anything used in patient treatment has to go past the TGA.''

Dr Rourke denied that by showing dentists how to access cut-price unregulated equipment, he was educating them on how to avoid TGA regulations. ''You can show someone where the murder section of a library is, but that doesn't make you a murderer because you've shown them where to get the information, does it?''

The Australian Dental Association has dismissed concerns raised by the local dental supplies industry, accusing it of scaremongering to protect its business. When asked last week if he was aware of any dentists importing equipment not listed with the TGA, the national president of the association, Dr Neil Hewson, said: ''I've got no idea, how would anyone know they're doing it … we can't monitor everything our 10,000 members do.''

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Democrats fall over themselves to whitewash Cuba but how would they like Cuba's socialized medicine?

And as tourists with hard currency to spend these people would have got top notch treatment by Cuban standards

A top Manchester cop and his young daughter were held in a `diabolical' Cuban hospital for FOUR days - because airport officials thought she had swine flu.

Det Chief Insp Pete Marsh, 47, spent £4,000 treating his wife and two children to a dream holiday. But it became a nightmare when a thermal camera showed daughter Bethany, 12, had a high temperature. She was rushed to a ramshackle hospital - with Pete insisting he went along too. They were put in a room with bars on the windows and no running water - and forbidden to leave. They only got out when Pete, of the Wythenshawe major incident team, told staff they would have to arrest him to make them stay. Now they are back at their hotel with the rest of the family - but claim the holiday has been ruined.

"The conditions were absolutely diabolical," Pete, from Stockport, said from Cuba. "It has been a terrible experience. Bethany was really frightened the first night because of the way they responded even though there was nothing wrong with her. She kept asking: ‘Am I going to die?’ We weren’t ill when we came but we could have been as a result of the conditions in there.”

The drama began when the family landed at Holguin airport and Bethany was detained. Pete said: “Everyone who met our flight was wearing green face masks. Doctors rushed over and said she would have to be taken to hospital for tests. She’d just had a bad flight and wrapped herself up in a blanket. We were quarantined in a ward which looked like it was from the 1950s.”

Pete says Bethany’s temperature was back to normal the following day. But they were told to stay until doctors could rule out swine flu – which could take days. Yesterday, Pete decided enough was enough. He said: “I said they’d have to arrest me to keep us there because my daughter had hardly eaten anything for days and I was worried about her health deteriorating.”

They went to the Playa Pesquero hotel in Holguin, where wife Marian and daughter Sarah, seven, were waiting. But they have been warned Bethany, a Stockport Academy pupil, will have to go back to the hospital if the swine flu tests prove positive.

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The SCHIP of State

Just how far will the politicians in Washington go to distort and pervert America's health care system? If their dubious manipulation of the SCHIP children's health insurance bill is any indication, the answer may be "to the ends of the earth." Even if they have to redraw the earth's boundaries to do so.

In 2007, shortly after seizing the Senate and House, the Democrats declared that they had to rush through a coercive bill mandating taxpayer-funded health insurance to "low-income children" throughout the land. So, they passed their bill (which George W. Bush later vetoed), and declared it would cure the ills of the ailing young. Well, not quite. In the first place -- as those who pushed the bill through well knew -- SCHIP was not really aimed at “low-income children” at all. The truth is that 77% of the targeted beneficiaries came from homes with incomes in excess of $60,000 a year. And they already had private health insurance.

So, what was the real purpose of SCHIP if it wasn’t actually to help “low-income children”? Quite simply, it was to expand the federal government’s reach over the health care industry and drive private health insurance programs out of existence. In short, it was a power grab. Sound familiar? Well, it should, because that is also the precise purpose of what is now known as “Obamacare” -- and should be known as the most massive redistribution of the wealth and health in human history. From the private sector to the public domain. From those who work hard to those who hardly work.

The second revealing codicil in the SCHIP scam was that in order to implement the federal power grab, the bill actually went so far as to redefine the latitude and longitude of the entire country and all of the states therein. Sound preposterous? Well, it was. For example, according to New York Times reporter Robert Pear writing in 2007, the Bay Area Medical Center (BAMC), located on the border between Wisconsin and Michigan, received SCHIP funding because Congress decided that it was in Chicago. That’s right, in the “Windy City,” that “toddling town” – in Illinois.

Here’s the actual wording from the SCHIP legislation: “Any hospital that is co-located in Marinette, Wisconsin, and Menominee, Michigan, is deemed to be located in Chicago.” There is only one hospital in America fitting that description. You guessed it, the BAMC – which is more than 250 miles from Chicago, Illinois.

The fact is, in their SCHIP deception, the members of Congress redrew the map of the United States to make 40 different hospitals parts of metropolitan areas that were nowhere near the institutions’ actual locations. It was a sinister and cynical effort to take advantage of little children in order to get Big Government’s piercing tentacles into health insurance programs all over America. To the politicians in Washington, that might be known as “hope” and “change.” To the rest of the world, it is known as a lie.

And now, those same politicians are preparing to plunge their tentacles in even deeper with a socialized medicine power grab that would put the government in charge of every breath Americans take – and put private health insurance out of business altogether.

In short: in 2007, they attempted to redraw the boundaries of the entire nation. Now, they’re getting ready to redefine the boundaries of life and death. And that’s why patriotic Americans are vowing to go “to the ends of the earth” to stop them in their tracks. More power to them.

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Why health insurers are optimistic about Obamacare

Lashed by liberals and threatened with more government regulation, the insurance industry nevertheless rallied its lobbying and grass-roots resources so successfully in the early stages of the healthcare overhaul deliberations that it is poised to reap a financial windfall. The half-dozen leading overhaul proposals circulating in Congress would require all citizens to have health insurance, which would guarantee insurers tens of millions of new customers -- many of whom would get government subsidies to help pay the companies' premiums.

"It's a bonanza," said Robert Laszewski, a health insurance executive for 20 years who now tracks reform legislation as president of the consulting firm Health Policy and Strategy Associates Inc.

Some insurance company leaders continue to profess concern about the unpredictable course of President Obama's massive healthcare initiative, and they vigorously oppose elements of his agenda. But Laszewski said the industry's reaction to early negotiations boiled down to a single word: "Hallelujah!"

The insurers' success so far can be explained in part by their lobbying efforts in the nation's capital and the districts of key lawmakers. The bills vary in the degree to which they would empower government to be a competitor and a regulator of private insurance. But analysts said that based on the way things stand now, insurers would come out ahead.

"The insurers are going to do quite well," said Linda Blumberg, a health policy analyst at the nonpartisan Urban Institute, a Washington think tank. "They are going to have this very stable pool, they're going to have people getting subsidies to help them buy coverage and . . . they will be paid the full costs of the benefits that they provide -- plus their administrative costs."

One of the Democratic proposals that most concerns insurers is the creation of a "public option" insurance plan. The industry launched a campaign on Capitol Hill against it, grounded in a study published by the Lewin Group, a health policy consulting firm that is owned by UnitedHealth Group. The lobbyists contended that a government-run plan, which would have favorable tax and regulatory treatment, would undermine private insurers.

Opposition increased this month when boisterous critics mobilized at town hall meetings held by members of Congress home for the August recess. The attacks, supplemented by conservative critics on talk radio and other forums, drew national attention.

Leading insurers, including UnitedHealth, urged their employees around the country to speak out. Company "advocacy hot line" operations and sample letters and statements were made available to an army of insurance industry employees in nearly every congressional district. Some insurers supplemented the effort with local advertising, often designed to put pressure on specific members of Congress. Late in the spring, Blue Cross Blue Shield of North Carolina -- the home state of several conservative Blue Dog Democrats -- prepared ads attacking the public option.

Leading Democrats have fought back, with House Speaker Nancy Pelosi (D-San Francisco) last month calling the industry "immoral" for its past treatment of customers and suggesting insurers were "the villains" in the healthcare debate. Still, recent support for the public option has declined, and the stock prices of health insurance firms have been rising.

Undermining support for the public option wasn't the only gain scored by insurance lobbyists. In May, the Senate Finance Committee discussed requiring that insurers reimburse at least 76% of policyholders' medical costs under their most affordable plans. Now the committee is considering setting that rate as low as 65%, meaning insurers would be required to cover just about two-thirds of patients' healthcare bills. According to a committee aide, the change was being considered so that companies could hold down premiums for the policies.

Most group health plans cover 80% to 90% or more of a policyholder's medical bills, according to a report by the Congressional Research Service. Industry officials urged that the government set the floor lower so insurers could provide flexible, more affordable plans. "It is vital that individuals, families and small-business owners have the flexibility to choose an affordable coverage option that best meets their needs," said Robert Zirkelbach, spokesman for America's Health Insurance Plans, the industry's Washington-based lobbying shop.

Consumer advocates argue that a lower government minimum might quickly become the industry standard, placing a greater financial burden on patients and their families. "These are a bad deal for consumers," said J. Robert Hunter, a former Texas insurance commissioner who works with the Consumer Federation of America. Meanwhile, companies would probably see a benefit by providing less insurance "per premium dollar," Hunter said. "It would be quite a windfall," said Wendell Potter, a former executive at Cigna insurance company who has become an industry whistle-blower.

Consumer and labor advocates acknowledged the industry's lobbying success. In the first half of 2009, the health service and HMO sector spent nearly $35 million lobbying Congress, the White House and federal healthcare offices, according to data from the Center for Responsive Politics. With more than 900 lobbyists, that sector -- whose top spenders are insurance giants UnitedHealth, Blue Cross Blue Shield and Aetna -- was poised to spend more than in 2008, a record lobbying year.

UnitedHealth spent the most, $2.5 million in the first half of 2009, and hired some of Washington's most prominent political players, including Tom Daschle, the former Senate majority leader who served as an informal health policy advisor to Obama. "They have beaten us six ways to Sunday," said Gerald Shea of the AFL-CIO. "Any time we want to make a small change to provide cost relief, they find a way to make it more profitable."

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26 August, 2009

Big midwife shortage in Britain

There are lots of qualified midwives no longer working in the NHS after becoming fed up with the chaos, bureaucracy and mismanagement there

A lack of maternity staff and poor communication within the NHS are significant barriers to improving the safety of care for mothers and babies, an independent report suggests today. The Government has promised choice in where and how all women in Britain give birth, and one-to-one care from a named midwife by the end of this year.

Despite the best efforts of doctors and midwives, pledges to improve care for mothers and newborn babies could be threatened by a shortage of staff and poor NHS management, the report by the King’s Fund, the health think-tank, suggests.

Problems recruiting and keeping doctors and midwives were the biggest concern among frontline NHS staff who gathered at four regional events held in London and the North of England, according to the report.

Participants from London pointed out that 25 per cent of births in Britain take place within the boundaries of the M25 and the number is rising. They added that often midwives in the capital, who have a full-time job at one trust, work shifts at a second, leading to concerns that many staff are exhausted. The report quoted one midwife in London as saying: “There is a relentless need for beds day and night.” Another added: “We have a workforce who do an awful lot of overtime and it is uncontrolled.”

Teams from Yorkshire and the Humber and the North East argued that safety was compromised by staff shortages, a problem that was made worse by the introduction of the European working time directive, which limits doctors to a 48-hour working week from this month. In one unit in Wigan, 17 out of 112 midwives had taken maternity leave at the same time and in other areas trusts were forced to use agency staff to address shortfalls, or had difficulty replacing experienced staff when they retired or left.

The number of births in Britain has increased by 16 per cent since 2001, meaning that the NHS cannot offer women a choice of a home birth or promise continuity of care from midwives in many areas, medical leaders said.

The report added that according to local trusts the solution was to make better use of existing resources, stronger leadership and more effective teamworking.

The Royal College of Midwives said that 5,000 extra midwives are needed but the Government has promised only 3,400 extra full-time posts by 2012. Frances Day-Stirk, the director of learning at the college, said that she was not surprised by the findings in the report. “There is no doubt that midwifery numbers need to increase, because the stress of working ever harder to provide good quality services has a major impact on retaining midwives and bringing new ones into the profession,” she said. “The problems in the system are apparent and it is encouraging to see solutions emerging from the report.”

Professor Sir Sabaratnam Arulkumaran, the president of the Royal College of Obstetricians & Gynaecologists, said: “Careful resource allocation is important and, as the King’s Fund report demonstrates, in a time of financial difficulty, many trusts are looking at innovative ways to ensure that money is well spent. “You can pour money into the system, however, what is fundamental is not what you buy but how you go about planning your services when funds are tight.”

SOURCE




The NHS "forgot" to train enough doctors

Foreign GPs who commute to Britain: £100-an-hour Poles and Lithuanians fly in for shifts Britain's doctors won't do. Great continuity of care!

The huge extent to which the NHS needs foreign doctors to treat patients out of hours is revealed today. A third of primary care trusts are flying in GPs from as far away as Lithuania, Poland, Germany, Hungary, Italy and Switzerland because of a shortage of doctors in Britain willing to work in the evenings and at weekends. The stand-ins earn up to £100 an hour, and one trust paid Polish and German doctors a total of £267,000 in a year, a Daily Mail investigation has found.

It raises fresh concerns that British patients are being treated by exhausted doctors without a perfect command of English.

Yesterday the Royal College of GPs and the General Medical Council called for a 'radical review' of out-of-hours care so that the NHS no longer has to rely on help from abroad.

The figures come months after an investigation was launched into the conduct of a German doctor after two patients died on his first shift in Britain. Daniel Ubani had just three hours sleep after travelling from Germany before he went on duty in Cambridgeshire. The Nigerian-born doctor injected 70-year-old kidney patient David Gray with ten times the maximum recommended dose of morphine, and an 86-year-old woman died of a heart attack after Ubani failed to send her to hospital.

The NHS is having to rely on doctors from overseas because a lucrative new contract for British GPs has resulted in more than 90 per cent opting out of responsibility for their patients in the evenings and at weekends. Despite doing less, their pay has soared by 50 per cent to an average of almost £108,000. Responsibility for out-of-hours cover has now passed to primary care trusts.

The rules state that foreign doctors need to have basic GP training, but recent experience is not always necessary. Their qualifications are checked by the General Medical Council and the local PCT, but no checks are in place to ensure that they are not exhausted after working long hours in their home country.

Our investigation revealed that more than a third of the 152 primary care trusts (PCTs) in England have flown in foreign GPs in the last year. Of the 146 trusts who responded, 51 have used overseas GPs in the last 12 months. The figure has trebled since 2008 when just one in ten primary care trusts were flying in GPs from abroad. However, it is impossible to know the exact number of GPs travelling to the UK as many primary care trusts do not keep a record of their nationality.

Halton and St Helens PCT spent the most on foreign GPs for the second year running. Between 2008-9, it paid nine Polish and two German doctors a total of £267,000 for shifts in the UK.

South Western Ambulance Service, which arranges out- of-hours cover in Bournemouth, Dorset and Somerset, spent £163,760 in the same period employing four German GPs - more than twice the sum spent the previous year.

South Staffordshire PCT spent £13,585 on three foreign GPs who provided more than 205 hours of cover between 2008-9 on an hourly rate of £66.10, and Medway PCT spent £12,000 on foreign cover.

Many of the trusts employ the same European locums regularly. East of England Ambulance Trust, which covers Norfolk, Suffolk and parts of Essex, employs two Italian and three German GPs for five shifts a month on average, while Leicestershire and Rutland PCT regularly employs three EU doctors.

Campaigners fear the use of foreign doctors is putting patients' lives at risk. Michael Summers of the Patients' Association said: 'The problem is that these PCTs send the work to agencies saying we need this number of doctors, we don't really care where you get them, and they get any old Tom, Dick or Harry to do the job for £1,000 a weekend. 'Patients' lives are likely to be put at risk if we do not establish the level of expertise and medical training of these doctors arriving from all over the world.'

Liberal Democrat health spokesman Norman Lamb said: 'The Government completely botched reform of the GP contract and failed to develop an adequate out-of-hours care system. 'Relying on doctors being flown in for a weekend shift is not a sustainable way to cover up ministers' mistakes.'

Calling for a 'radical review' of out-of-hours care, Professor Steve Field, chairman of the Royal College of GPs, said: 'I am particularly worried about the use of doctors from Europe flying in to provide out-of-hours care and then flying back to their home countries to provide services there. 'It's not good for patients here or in their home countries. 'Doctors from Europe who come to the UK to work in out of hours services must prove they are of the same quality as our home-grown doctors. We are not convinced there are appropriate checks in place to ensure they are.'

Finlay Scott, chief executive of the General Medical Council, which regulates doctors, said the current system 'does not guarantee the level of patient safety that we want'.

A spokesman for the Department of Health said: 'The NHS has always used professionals trained abroad because until recently we did not train enough for our own needs. 'Now the need to use overseas doctors is declining.'

SOURCE




Australia: Yet another Queensland ambulance meltdown

Ambulance officers 'on grog run' ignore seizure patient. These stories have never stopped coming since the State government took it over. And they will keep coming while nobody is being penalized for negligence and misbehaviour

A MAN having a seizure waited for an ambulance while a paramedic went to the pub to pick up alcohol for an office party that degenerated into a racial brawl, The Courier-Mail reports. The ambulance officer, who was only new to the job in Queensland, was pressured into ignoring a callout which became a top priority Code 1 emergency while she was driving a senior colleague to pick up more "grog". Paramedics say the incident added to stress on workers stretched trying to keep pace with a system swamped by demand.

Documents obtained by The Courier-Mail under Right to Information laws reveal that off-duty ambulance workers were holding a party at an unnamed Queensland station when they ran out of alcohol. The documents show that all paramedics involved in the booze run from the party at the station on July 13, 2007, knew that a call had been made to dispatch an ambulance to a man having an epileptic fit.

The two senior off-duty officers drinking at the party were later involved in a fight with four "indigenous males" outside the station. The officers tried to get an on-duty paramedic, who was treating a patient, to drop them home. One officer admitted he "just went out and got hammered" and the night was a "blur". The two officers were "counselled" over their bender after the allegations against them and the junior officer were substantiated.

But a clinical assessment by witnesses determined the man who had the seizure suffered "no detrimental outcome whatsoever" from the ambulance's delay of up to 30 minutes and that any emotional injury was "impossible to calculate".

Premier Anna Bligh yesterday said reports of life-threatening bungles by the QAS had occurred before the Government "made various substantial changes" to the service in 2007. The changes have been underpinned by a $105 annual levy collected from Queenslanders via electricity bills.

The response to the Code 1 call during the booze run was not met within the standard time because the dispatched officer was driving her off-duty colleague to the pub. The on-duty paramedic's partner was ready to attend the job but was told by another officer that the woman "had gone to the (name deleted) Hotel to get some more grog", according to the RTI documents.

Later, police were called to the ambulance station "to attend an altercation involving the same two off-duty ambulance officers". "It was alleged that the officers caused a conflict with a group of indigenous males and that they swore and used racist taunts during the incident," the report said. The fight was allegedly over a taxi, with one witness describing "full-on fisticuffs".

Four police cars arrived but the documents show no one was taken into custody. The two officers also repeatedly called a working paramedic to try to get a lift home after their attempt to wave her down as she attended a case was unsuccessful.

The advanced care paramedic denied he had used racist taunts but admitted he was unable to remember much of the night's events. He said he had been "put through the wringer" with a QAS internal investigation and now that the incident was being dragged up again, he was concerned for the health of one of the other officers. The report concluded the officers had breached the Code of Conduct, but made no recommendations concerning the offending officers or their managers.

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Queensland ambulance service rotten at the top

ONE man who has watched the Queensland Ambulance Service more closely than most regards it as a dysfunctional bureaucracy that is jeopardising lives. Ted Malone, the opposition's emergency services spokesman, said he received calls every week about serious QAS problems and nothing had improved despite regular changes at the top.

"In any other organisation, you'd say the management is corrupt because they are not supporting the people who are actually delivering the service. This organisation works from the top-down, and it obviously doesn't work," Mr Malone said.

He accused Emergency Services Minister Neil Roberts of not treating seriously problems raised by the LNP. "It's amazing that some of the cases I've talked to the minister about, he's actually abused me for raising the issue," Mr Malone said.

He argued QAS should be focused only on outcomes for residents. "The bureaucracy almost has a life of its own, the poor buggers on the front line are left out there to cop it," Mr Malone said. QAS was "top-heavy in its management" with people who seemed willing to defend their jobs "to the nth degree", he said. Fixing the system was complicated – "you almost have to go in and strip it" – to change the organisation's culture, he said.

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No Maine Miracle Cure

Another state 'public option' that failed

Want a preview of ObamaCare in action? Sneak a look at what has happened in Maine. In 2003, the state to great fanfare enacted its own version of universal health care. Democratic Governor John Baldacci signed the plan into law with a bevy of familiar promises. By 2009, it would cover all of Maine's approximately 128,000 uninsured citizens. System-wide controls on hospital and physician costs would hold down insurance premiums. There would be no tax increases. The program was going to provide insurance for everyone and save businesses and patients money at the same time.

After five years, fiscal realities as brutal as the waves that crash along Maine's famous coastline have hit the insurance plan. The system that was supposed to save money has cost taxpayers $155 million and is still rising.

Here's how the program was supposed to work. Two government programs would cover the uninsured. First the legislature greatly expanded MaineCare, the state's Medicaid program. Today Maine families with incomes of up to $44,000 a year are eligible; 22% of the population is now in Medicaid, roughly twice the national average.

Then the state created a "public option" known as DirigoChoice. (Dirigo is the state motto, meaning "I Lead.") This plan would compete with private plans such as Blue Cross. To entice lower income Mainers to enroll, it offered taxpayer-subsidized premiums. The plan's original funding source was $50 million of federal stimulus money the state got in 2003. Over time, the plan was to be "paid for by savings in the health-care system." This is precisely the promise of ObamaCare. Maine saved by squeezing payments to hospitals and physicians.

The program flew off track fast. At its peak in 2006, only about 15,000 people had enrolled in the DirigoChoice program. That number has dropped to below 10,000, according to the state's own reporting. About two-thirds of those who enrolled already had insurance, which they dropped in favor of the public option and its subsidies. Instead of 128,000 uninsured in the program today, the actual number is just 3,400. Despite the giant expansions in Maine's Medicaid program and the new, subsidized public choice option, the number of uninsured in the state today is only slightly lower that in 2004 when the program began.

Why did this happen? Among the biggest reasons is a severe adverse selection problem: The sickest, most expensive patients crowded into DirigoChoice, unbalancing its insurance pool and raising costs. That made it unattractive for healthier and lower-risk enrollees. And as a result, few low-income Mainers have been able to afford the premiums, even at subsidized rates.

This problem was exacerbated because since the early 1990s Maine has required insurers to adhere to community rating and guaranteed issue, which requires that insurers cover anyone who applies, regardless of their health condition and at a uniform premium. These rules—which are in the Obama plan—have relentlessly driven up insurance costs in Maine, especially for healthy people.

The Maine Heritage Policy Center, which has tracked the plan closely, points out that largely because of these insurance rules, a healthy male in Maine who is 30 and single pays a monthly premium of $762 in the individual market; next door in New Hampshire he pays $222 a month. The Granite State doesn't have community rating and guaranteed issue.

One proposal to get people into the DirigoChoice system is to reduce the premiums, presumably to give the uninsured a larger incentive to join. But that would explode the program's costs when it already can't pay its bills. A program that was supposed to save money by reducing health-care waste and inefficiencies has seen a 74% increase in premiums. But even those inflated payments can't keep the program out of the red.

Last year, DirigoCare was so desperate for cash that the legislature broke its original promise of no tax hikes and proposed an infusion of funds through a beer, wine and soda tax, similar to what has been floated to pay for the Obama plan. Maine voters rejected these taxes by two to one. Then this year the legislature passed a 2% tax on paid health insurance claims. Taxing paid insurance claims sounds a tad churlish, but the previous funding formula was so complicated that it was costing the state $1 million a year in lawsuits.

Unlike the federal government, Maine has a balanced budget requirement. So out of fiscal necessity, the state has now capped the enrollment in the program and allowed no new entrants. Now there is a waiting list. DirigoChoice has become yet another expensive, failed experiment in government-run health care, alongside similar fiascoes in Massachusetts and Tennessee.

Not everyone sees it this way. Noting the similarities between the Maine program and the Congressional initiative, Karynlee Harrington, the executive director of the Dirigo Health Agency, boasted recently: "DirigoChoice is consistent with what we think the definition of a public health option is." It certainly is.

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Why the Health-Care Bill Is Unacceptable in Any Form

Facing a broad public rejection of President Obama's health-care bill, our Kamikaze Congress is contemplating the political suicide of ramming the bill through against the people's loudly expressed wishes, using the brute power of a Democratic majority without even the window dressing of support from moderate Republicans.

But these congressional leaders are just whistling Dixie—an apt metaphor, since their real problem is their inability to convince Southern "Blue Dog" Democrats. The health-care bill was never held up because moderate Republicans refused their support. It was held up because moderate Democrats refused to support it.

More likely, the Democrats will attempt to water down the bill and offer fake compromises such as the substitution of government-backed health-insurance "co-ops" for the "public option"—a distinction without much of a difference. Over the weekend, the White House briefly indicated its support for this tactical retreat, only to backtrack when faced with opposition from far left congressmen in the House. That reversal actually makes the dropping of the "public option" more likely. The administration's flip-flop tells every wavering congressman that the White House is in disarray and cannot be trusted to take a position and stick to it—so why should anyone in Congress stick their necks out? A lot of them will say what Florida Democrat Allen Boyd told a town hall meeting over the weekend: that he is willing to "scrap everything," in the words of one of his questioners, and start over from scratch on the health-care bill.

But don't be fooled by attempts to compromise and water down this bill, because the fundamental issue is not any one specific provision in it. The issue is the very existence of the new government health-care bureaucracy it would create.

An amusing "live-blogging" of the health-care bill—a blogger sharing his observations as he reads through all 1,017 pages of HR 3200—has been making the rounds on the Web, and what I found most interesting about it was his description of the first 100 pages of the bill.

As you begin reading the actual text of the bill, you begin to notice a pattern. Roles and responsibilities of the Secretary of Health and Human Services. Commissioners. Ombudsmen. Auditors. Assistants. Departments. Commissions. You begin to realize you are reading a verbal description of a corporate organizational chart, with lengthy discussions of how these people will be staffed, compensated, replaced, and so on. A lot of the sections, like 2714 and 2754, purport to discuss ensuring lower premiums. But I found nothing that described specifics. Instead, there were blanket statements that it will be someone's responsibility to find a way to lower premiums. There's no discussion of how this will save money; but there are concepts thrown around about how the Sec HHS will review a bunch of different options to find the best ones representative for each type of group member. Same as before: we will make healthcare affordable for all Americans by finding a way.

This blogger is looking at the bill from the perspective of someone trying to evaluate the Democrats' promise that the bill will reduce health-care spending. But let's look at this from the perspective of simply trying to figure out exactly what the bill will do. In effect, the bill sets up an enormous bureaucracy for the purpose of regulating health-insurance in a way that will reduce health-care costs—but leaves to a future bureaucracy all of the actual, specific decisions about how this is to be done.

In short, the fundamental purpose of this bill is not to establish a "public option" or "end-of-life planning" or any other specific outcome. Its purpose is to establish a functioning bureaucracy with the legal authority to regulate all aspects of health insurance and health-care spending. What that bureaucracy will actually do is a detail to be worked out later by the Secretary of Health and Human Services, or the Health Choices Commissioner, or some other executive-branch functionary.

Is it any wonder we're afraid that our private health-insurance will be taken away because the Health Choices Commissioner decides to impose regulations that hound private insurers out of the market? Or that we're terrified of "death panels"? What do you expect, when you create an unelected bureaucracy charged with cutting health-care costs—without ever specifying exactly what they are empowered to cut?

This is why the American people simply do not trust this bill—and it is why it must be defeated in any form. It does not matter much whether the Democrats strip out one obnoxious provision or another. Once the government takes on this newly expanded role as regulator plenipotentiary of the health-insurance industry, the power to achieve the left's entire wish list will be shifted from Congress to a new, unelected health-care bureaucracy.

Historically, this is how Congress has given away its power, and our freedom. Congress passes a law declaring some vague and laudatory goal—"environmental protection," say, or "clean air," or "occupational safety," or the relief of troubled assets—then Congress creates a vast new bureaucracy and leaves it to them to fill the Federal Register with tens of thousands of pages, year after year, specifying exactly how those goals are to be achieved.

That's why it's impossible to say exactly what any of this legislation actually does. It is impossible to predict whether the Clean Air Act will be used to regulate carbon dioxide, or whether the Troubled Asset Relief Program will do any of the half-dozen things it ended up doing after Hank Paulson decided that it wouldn't actually relieve us from any troubled assets.

So it's a mistake to think of the current legislation as a health-care reform bill. It is actually a bill for the formation of a massive health-care bureaucracy charged with the task of scheming endlessly to expand its own power.

The only way to prevent this kind of free-floating grant of power to the bureaucracy is to prevent it from forming in the first place, by keeping government out of medicine. It's far too late to keep the government out of medicine altogether, of course; the government has been "reforming" health-care for 60 years, and it has already taken over roughly half of the industry. If we want government out of health care, we'll need reform, all right—but in the opposite direction from the current bill. But for now, we can at least stop the government from encroaching any further.

If we don't, we can expect that every political battle over health-care from now on will be a rear-guard action to stop the new health-care bureaucracy from taking on an ever wider role, imposing new regulations and controls that were never specified or even dreamed of when the legislation was passed.

Advocates of liberty have been winning the current battle over health-care. The administration is making concessions, Blue Dogs are trying to mollify us, and some congressmen are so terrified that they can only be found on milk cartons this August.

It is time to press our advantage, keep up the pressure, and make it clear to our congressmen that we don't want a modified or watered down version of this health-care bill. We want no version of this health-care bill and no new health-care bureaucracy.

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Socialism By Any Other Name Still Stinks

A piece in the current Reader's Digest purports to clear up all the confusion over health-care reform. In a WashingtonPost.com excerpt, Ezra Klein laments that the terms 'socialized medicine' and 'single-payer health care’ have been distorted beyond all meaning. He states that no one is proposing that government should employ doctors or own hospitals, which would be socialistic. He goes on to define a single-payer system as simply one entity paying for health care without owning the doctors or hospitals. "What we're actually getting," he concludes, "is not socialized medicine or single-payer health care. It's a hybrid. Private insurers, hopefully competing with a public option. Private doctors and hospitals. Government regulations and subsidies. . . A mix of corporate preferences and public compassion. . . A uniquely American system."

Of course, socialists will never identify themselves by that name. Merely because government doesn't own doctor's offices or the wares of their trade matters little if, in their stated quest to control costs, they hold the purse strings for millions of Americans.

Mr. Klein's reasoning -- and in one of America's best-read publications -- illustrates the advantage leftists wield in furthering their agenda. Conservatives tend to argue in terms of absolutes, i.e. right versus wrong. Leftists follow the adage, 'if you can convince 'em with brains, baffle 'em with bull malarkey.' They are patient, willing to enact their agendas incrementally. In fact, they are not overly concerned with the specifics because once health-care reform is enacted, it can be modified over time. They have succeeded in the past, wearing down the passions of the American people with time and tedious details.

To health-care reformers, the notion of a 'hybrid' solution is the epitome of deep, enlightened thinking. But if President Obama's goal is to reduce costs, then the best way is to promote competition, which thrives best in a free market. Author and columnist Mark Steyn said it brilliantly, if crudely (and I'm paraphrasing): if you mix ice cream with horse manure, there's no question which taste will stand out. The same principle applies to mixing freedom and statism.

Government controls rarely if ever enhance competition and choice, they merely breed more controls. Free markets, unencumbered by restraints (some of which we live with), weed out the weak and inefficient, government enshrines them. Reform proponents claim they are merely seeking to fund health care for the uninsured, but clearly, he who holds the purse strings controls how the money is -- and is not -- spent. The Congressional Budget Office and the Heritage Foundation agree that the numbers of people accepting the public option will be massive -- a permanent class and voting bloc dependent on the federal government.

America is an exceptional nation because of its exceptional regard for freedom -- an unwavering devotion born of principle and not practicality. A ‘hybrid’ mix is a vague, all-encompassing concept that could mean any amount of coercion the mob of the moment demanded. Because ideals such as freedom and constitutional government are much easier to define does not make them any less effective. A distinctly American health-care system would offer all the benefits of the other capitalist enterprises we take for granted. Ideally, Americans would see doctor's offices on every corner, national chains would pop up, with sharp, shiny logos, animal mascots and bubbly spokesmodels. Dinner time would bring annoying phone calls from telemarketers hawking cheap care and insurance, and health clinics opening up would offer balloons and tote bags to the first 100 patients.

One could argue that the benefits of capitalism, with its acquisitive spirit and cheesy excesses, don't extend to the dire realm of health-care. In fact, it is the limitations of government that don't carry over. Just recall President Obama's recent contrast of Fed Ex and UPS to the near bankrupt postal service. Government has proven itself effective at protecting us from foreign invaders and violent criminals and maybe a small list of other things, but skepticism over massive intervention in our lives, by whatever name you wish to call it, is the uniquely American concept that Mr. Klein is missing.

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25 August, 2009

Authoritarian State medicine in Britain

You have no choice!! Our bureaucratic rules are supreme!! Mother dies a year after being denied her daughter's kidney

A mother who was denied a kidney transplant from her dying daughter because of rules banning donor requests has died. Rachel Leake, 41, had been in hospital for three months with septicemia. Her 21-year-old daughter Laura Ashworth had wanted to give her a kidney, but died in April last year before starting the process of becoming a 'living donor'. Doctors then insisted her organs go to strangers at the top of the waiting list.

Mrs Leake spoke out to condemn the rules and the Government announced a change to the law in March, allowing donors to choose who gets their organs after they die if there is no critical need for them nationally.

Mrs Leake first underwent a kidney-transplant in 2003, but the organ failed. Her daughter regularly spoke to friends and family about donating one of hers, but Mrs Leake refused to take her up on the offer because of her young age. Miss Ashworth then collapsed in her mother's arms after suffering an asthma attack and died because her brain was starved of oxygen.

When a friend of the family asked if a kidney could be used to help Mrs Leake she was told: 'There's a law which prevents directed donorship'. Miss Ashworth was carrying a donor card and her kidneys were given to men in Sheffield and London and her liver to a 15-year-old girl.

Mrs Leake hoped instead to get a kidney from her sister Carole Saunders, 52, but her continuing health problems meant the operation wasn't able to go ahead. Her health deteriorated further and she died at Bradford Royal Infirmary.

Mrs Leake, who was a diabetic, had been admitted for treatment because of an infection in her feet due to poor circulation. Relatives said the circulation problem would have been eased if she had received her daughter's kidney last year. But it is not known if or to what extent her death was related to her need for a transplant.

Mrs Saunders said: 'She had no fight left in her, to be honest, when she lost her daughter. We are all devastated, absolutely devastated. 'Rachel was a lovely, lovely person, a beautiful woman and a friend to so many people. She had a big heart. She was very caring and even though she had a lot of problems herself and suffered an awful lot of pain she still had time to listen to other people.' When her daughter died Mrs Leake took over the job of caring for her granddaughter Macie, despite her own poor health.

She lobbied her local MP and said: 'I am angry, really angry. I am not finding comfort at the moment in the fact that she helped three people. 'All I wanted to do was carry out her wishes. She would have been so upset that she was able to help other people and not her own mum. 'Everyone has gone mad and everyone is disgusted. The thing that hurts the most is how Laura would feel. She would be devastated that she was not able to help me.'

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British Heart patients missing out on life-saving care after surgery

Two thirds of heart-attack survivors are not getting promised follow-up advice and treatment that could help them to live longer, a charity’s report says today

A national audit commissioned by the British Heart Foundation found that only 34 per cent of 83,500 heart attack victims took part in a cardiac rehabilitation programme after coming out of hospital.

The Government pledged to offer it to 85 per cent of heart patients by 2002 but seven years on, the audit for England, Wales and Northern Ireland, found that overall only 38 per cent of heart patients attended cardiac rehabilitation. The figure was only 30 per cent of those who underwent an angioplasty and 68 per cent for those who had heart bypass surgery.

A shortage of cardiac nurses and other therapists means that those who do receive the care get only one third of the recommended hours of physiotherapy. Women were found to be significantly underrepresented in the programme, accounting for only 28 per cent of those who received follow-up treatment.

Every year about 270,000 people in Britain suffer a heart attack. Coronary disease remains the country’s biggest killer.

Previous studies have shown that rehabilitation — typically a 6 to 12-week programme involving nurses, physiotherapists, dieticians, psychologists and occupational therapists — gives heart-attack patients a 26 per cent greater chance of surviving after five years.

The £600-per-patient treatment has also been shown to improve quality of life, decrease anxiety and reduce future hospital admissions. Mike Knapton, associate medical director at the foundation, said that the NHS was falling short of the goals outlined in the National Service Framework for treating heart disease in 2000. There has been no significant increase in the proportion of patients referred to the services, despite the 85 per cent target set by the framework.

“Recovery from a heart attack isn’t over when a patient leaves hospital and heart patients should be receiving the ongoing support they need,” Dr Knapton added. “Referral to cardiac rehabilitation should be a routine part of treating heart patients.”

The report’s author, Professor Bob Lewin, from the University of York, said that many people were simply not aware that rehabilitation services exist. He added that a third of patients who were offered the service turned it down, but said this was worrying.

“Why wouldn’t you be interested in a service that could prolong and improve your life? It is important that all of the staff within the NHS understand the benefits of cardiac rehabilitation and communicate how important it is to their patients.”

The Department of Health said that cardiac rehabilitation services were a matter for local trusts, adding: “We have made substantial progress in treatment ... and have already met our target to reduce deaths from cardiovascular disease by 40 per cent in people under 75 by 2010.”

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Australia: Huge Queensland ambulance foulup (1) -- one of three such reported in one day

Girl, 8, died after life-saving defibrillator removed from ambulance. Since the Leftist Queensland State government took over the ambulance service some years ago and made it "free" for all, serious problems have never stopped coming, despite various "reforms" and "overhauls". Some of the problems stem from a typically Leftist love of centralization, with local call centres being abolished and operators in the newly centralized locations being made responsible for distant cities that they know nothing about. That is the exact opposite of what is actually needed. Another example of how disastrous government involvement in medical services can be. There are similar reports from other Australian States -- particularly Victoria

An eight year-old Gold Coast girl in cardiac arrest died after life-saving equipment was removed from the ambulance sent to treat her. Documents obtained by The Courier Mail under Right to Information laws show that the ambulance arrived without a defibrillator – a device used to restore the heart beat – because it had been taken out at the station for training purposes.

A report into the incident, which occurred on December 2, 2007, said the address was less than 3km from the station and an advanced care and student paramedic reached the scene within three minutes. "On arrival the officers identified that they had left the portable resuscitation kit and defibrillator at the station after it had been removed for the purposes of undertaking training," the report said.

"The officers reported that during CPR, copious amounts of vomit was 'flowing from the airway during cardiac compressions'. "Normally the airway would have been suctioned using the suction device in the portable resuscitation kit, however this was not available."

Two more crews were sent and arrived four and seven minutes later, but the girl's pulse was already "unrecordable" and "skin cold". "The patient was transported to hospital and was pronounced deceased a short time after," the report stated. "The officer who removed the equipment was under the impression that they would be the last crew out.

"The officer-in-charge confirmed that it was normal practice (to) remove equipment for training from the spare unit . . . when a spare vehicle was not available equipment would be removed from an operational vehicle."

The investigation concluded that it was "beyond the scope of this investigation to determine if the absence of the oxygen resuscitation kit and defibrillator contributed to the inability to successfully resuscitate the child". However, the absence was "unlikely to have had a significant bearing on the outcome of the patient".

Emergency Services Minister Neil Roberts said the defibrillator should have been there, but evidence suggested the girl would have died anyway. "The Coroner actually investigated that matter as well and there were no adverse findings to the QAS," he said. However, neither his office, nor the Coroner would provide a copy of the report.

Australasian College for Emergency Medicine Queensland chairman David Rosengren said defibrillators were the key to preventing death in this instance, but cardiac arrests were generally a life-ending event. "Everybody knows somebody who's had a cardiac arrest and been resuscitated and survived but they are clearly in the minority," he said.

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Australia: Huge Queensland ambulance foulup (2) -- one of three such reported in one day

LORRAINE Silman watched her husband die while a misdirected ambulance took 45 minutes to find their Mackay home. Bob Silman, 63, a wedding photographer and sugar mill groundskeeper, was stricken with a heart attack on November 2 last year and could not be revived. A dispatcher in another city ignored Mrs Silman's directions and sent paramedics to an address that didn't exist.

"The ambulance officer can't be blamed. The system failed us," Mrs Silman said. "If they'd got there in the time frame they should have, he would have stood a chance." Mrs Silman kept her husband alive at their Pleystowe home for 15 minutes using CPR while the ambulance was lost.

Mr Silman left behind his wife of 40 years, three children and three grandchildren. He didn't live to see a fourth grandchild born. Neighbours knew him as the generous man who gave away the vegies he loved to grow and entertained their children in a Santa suit at Christmas

Daughter Alison Silman said it was "an absolute joke" that ambulances didn't have GPS devices and couldn't find homes in well-established areas close to urban areas. "In this day and age, they should be able to know where to respond," Ms Silman said. "This is happening too often. It's not good enough. People's lives are on the line."

The ambulance centre had never corrected a typographical error showing the Silmans lived at No. 2 Griffiths St, when no such address existed. The family lived at No. 20. The family called twice to have the address corrected. Mrs Silman said the ambulance was also told by the family not to cross a landmark bridge and did not send a vehicle from the closest station. "They kept asking me if I was in Miriam Vale. That's nowhere near here," Mrs Silman said. "My husband was dying in front of me. I told the woman I had to get off the phone." Although the station was only 13 minutes away, it took 40-45 minutes, she said. "When they got there, he'd passed away," she said.

Stress after her husband's death took such a toll on Mrs Silman she needed to be hospitalised two weeks later. Her daughter said the family drove her to the hospital rather than risk another ambulance miscue. "I wouldn't trust them," Alison said. "I just lost my dad. I wasn't going to lose my mother too."

The family said they were frustrated to learn a cadet officer in Rockhampton took their emergency call and a mentor supervisor didn't listen to the call.

Mrs Silman has difficulty dealing with the experience and still doesn't sleep well. "It's hard to get through the trauma of that day. I don't think I'll ever get over it. I don't wish any other family to have to go through it," she said. She was frustrated ambulance staff were not more knowledgeable about places they were responsible for.

The Member for Mirani, Ted Malone, the shadow minister for emergency services, raised concerns about the Silman death in Parliament in December.

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Australia: Huge Queensland ambulance foulup (3) -- one of three such reported in one day

Paramedic quits after being sent to the wrong city. Once again it's the management, not the men on the frontline who are at fault

PARAMEDICS were ready to break into a Mackay home to treat a suspected heart attack victim when they learned the emergency was actually in Brisbane. Eric Fleissig who later quit the Queensland Ambulance Service in disgust at its management and working conditions, said he was met by a startled and confused person when he attended a Code 1 emergency call. He said he went to an address provided by ambulance dispatchers where the resident told him he knew nothing about an emergency.

The paramedics queried the communication centre, which then realised that the street name was correct but the emergency was in the Brisbane suburb of Ashgrove and not the Mackay suburb of Andergrove. "It happens all the time," Mr Fleissig said. Paramedics say the QAS hasn't done enough to make sure the best maps and direction-finding equipment are available, or to train communications staff who know their areas.

QAS Commissioner David Melville said dispatch systems were not perfect but Queenslanders were given the best possible service regardless of where they lived. "I'd like to think we will get it perfect, but I can't give you a 100 per cent guarantee on it," he said. "We try to give the best possible service no matter where people are." [But HOW HARD do you try? Not very, given the frequency of stupid and dangerous foulups. As well as the three reported today, there was another one reported just a couple of days ago]

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What Soviet Medicine Teaches Us

In 1918, the Soviet Union became the first country to promise universal "cradle-to-grave" healthcare coverage, to be accomplished through the complete socialization of medicine. The "right to health" became a "constitutional right" of Soviet citizens. The proclaimed advantages of this system were that it would "reduce costs" and eliminate the "waste" that stemmed from "unnecessary duplication and parallelism" — i.e., competition. These goals were similar to the ones declared by Mr. Obama and Ms. Pelosi — attractive and humane goals of universal coverage and low costs. What's not to like?

The system had many decades to work, but widespread apathy and low quality of work paralyzed the healthcare system. In the depths of the socialist experiment, healthcare institutions in Russia were at least a hundred years behind the average US level. Moreover, the filth, odors, cats roaming the halls, drunken medical personnel, and absence of soap and cleaning supplies added to an overall impression of hopelessness and frustration that paralyzed the system. According to official Russian estimates, 78 percent of all AIDS victims in Russia contracted the virus through dirty needles or HIV-tainted blood in the state-run hospitals.

Irresponsibility, expressed by the popular Russian saying "They pretend they are paying us and we pretend we are working," resulted in appalling quality of service, widespread corruption, and extensive loss of life. My friend, a famous neurosurgeon in today's Russia, received a monthly salary of 150 rubles — one third of the average bus driver's salary.

In order to receive minimal attention by doctors and nursing personnel, patients had to pay bribes. I even witnessed a case of a "nonpaying" patient who died trying to reach a lavatory at the end of the long corridor after brain surgery. Anesthesia was usually "not available" for abortions or minor ear, nose, throat, and skin surgeries. This was used as a means of extortion by unscrupulous medical bureaucrats.

To improve the statistics concerning the numbers of people dying within the system, patients were routinely shoved out the door before taking their last breath.

Being a People's Deputy in the Moscow region from 1987 to 1989, I received many complaints about criminal negligence, bribes taken by medical apparatchiks, drunken ambulance crews, and food poisoning in hospitals and child-care facilities. I recall the case of a fourteen-year-old girl from my district who died of acute nephritis in a Moscow hospital. She died because a doctor decided that it was better to save "precious" X-ray film (imported by the Soviets for hard currency) instead of double-checking his diagnosis. These X-rays would have disproven his diagnosis of neuropathic pain.

Instead, the doctor treated the teenager with a heat compress, which killed her almost instantly. There was no legal remedy for the girl's parents and grandparents. By definition, a single-payer system cannot allow any such remedy. The girl's grandparents could not cope with this loss and they both died within six months. The doctor received no official reprimand.

Not surprisingly, government bureaucrats and Communist Party officials, as early as 1921 (three years after Lenin's socialization of medicine), realized that the egalitarian system of healthcare was good only for their personal interest as providers, managers, and rationers — but not as private users of the system.

So, as in all countries with socialized medicine, a two-tier system was created: one for the "gray masses" and the other, with a completely different level of service, for the bureaucrats and their intellectual servants. In the USSR, it was often the case that while workers and peasants were dying in the state hospitals, the medicine and equipment that could save their lives was sitting unused in the nomenklatura system.

At the end of the socialist experiment, the official infant-mortality rate in Russia was more than 2.5 times as high as in the United States and more than five times that of Japan. The rate of 24.5 deaths per 1,000 live births was questioned recently by several deputies to the Russian Parliament, who claim that it is seven times higher than in the United States. This would make the Russian death rate 55 compared to the US rate of 8.1 per 1,000 live births.

Having said that, I should make it clear that the United States has one of the highest rates of the industrialized world only because it counts all dead infants, including premature babies, which is where most of the fatalities occur.

Most countries do not count premature-infant deaths. Some don't count any deaths that occur in the first 72 hours. Some countries don't even count any deaths from the first two weeks of life. In Cuba, which boasts a very low infant-mortality rate, infants are only registered when they are several months old, thereby leaving out of the official statistics all infant deaths that take place within the first several months of life.

In the rural regions of Karakalpakia, Sakha, Chechnya, Kalmykia, and Ingushetia, the infant mortality rate is close to 100 per 1,000 births, putting these regions in the same category as Angola, Chad, and Bangladesh. Tens of thousands of infants fall victim to influenza every year, and the proportion of children dying from pneumonia and tuberculosis is on the increase. Rickets, caused by a lack of vitamin D, and unknown in the rest of the modern world, is killing many young people.

Uterine damage is widespread, thanks to the 7.3 abortions the average Russian woman undergoes during childbearing years. Keeping in mind that many women avoid abortions altogether, the 7.3 average means that many women have a dozen or more abortions in their lifetime.

Even today, according to the State Statistics Committee, the average life expectancy for Russian men is less than 59 years — 58 years and 11 months — while that for Russian women is 72 years. The combined figure is 65 years and three months.[1] By comparison, the average life span for men in the United States is 73 years and for women 79 years. In the United States, life expectancy at birth for the total population has reached an all-time American high of 77.5 years, up from 49.2 years just a century ago. The Russian life expectancy at birth is 12 years lower.[2]

After seventy years of socialism, 57 percent of all Russian hospitals did not have running hot water, and 36 percent of hospitals located in rural areas of Russia did not have water or sewage at all. Isn't it amazing that socialist government, while developing space exploration and sophisticated weapons, would completely ignore the basic human needs of its citizens?

More here




Sen. Lieberman: Postpone Universal Healthcare

One of the Senate's most powerful Democrats said Sunday that President Obama should take an "incremental" approach to fixing health care and argued that the country should postpone adding nearly 50 million new patients to the government system until after the recession is over.

"We morally, every one of us, would like to cover every American with health insurance," Sen. Joseph Lieberman of Connecticut, told CNN's John King on the "State of the Union" program.

"But that's where you spend most of the $1 trillion plus, a little less that is estimated, the estimate said this healthcare plan will cost," he said.

"I'm afraid we've got to think about putting a lot of that off until the economy's out of recession," he added.

"There's no reason we have to do it all now, but we do have to get started. And I think the place to start is health delivery reform and insurance market reforms."

John King asked Lieberman if it was "time for the president to hit the reset button? Forget sweeping healthcare reform this year, do three or four incremental things that are less costly?"

Lieberman responded: "In a word, yes. I don't think -- I give the president tremendous credit for taking on the healthcare problem. And it really is a problem that we've got to deal with. But he took it on at a very difficult time that was not of his making.

"In other words, we're in a recession. People are very worried about their jobs, about the economic future. They've watched us add to the debt of this country. We're projected to run a $1.8 trillion deficit this year, September 30th, more than $1 trillion next year. You mentioned the 10-year numbers. People are nervous, I think the protests coming out at the public meetings around the country this month are as much to do with that larger environment as they are with questions about healthcare reform. I think great changes in our country often have come in steps. The civil rights movement occurred — changes occurred in steps. Let's focus now on how to reduce costs. That's been a central theme of the president.

"Let's talk about how to change the way health care is delivered. Let's talk about protecting people from not getting insurance because of pre-existing illness. Let's take off the caps on the amount of insurance coverage you can get over the years. Let's pay for preventive services for health from the first dollar. Here's the tough one. We morally, every one of us, would like to cover every American with health insurance. But that's where you spend most of the $1 trillion plus, a little less that is estimated, the estimate said this healthcare plan will cost."

Lieberman also said he oppose any attempt his colleagues to use a Senate maneuver called "reconciliation," in which only 51 votes — rather than 60 — would be needed to overcome opposition to a health care bill.

"I think it's a real mistake to try to jam through the total health insurance reform, healthcare reform plan that the public is either opposed to or of very, very passionate mixed minds about," he said. "It's just not good for the system, frankly, it won't be good for the Obama presidency."

SOURCE





24 August, 2009

America’s lesson for the NHS

Comment from Britain. He says that Brits think US healthcare favours those who can pay for it, but that’s a serious misdiagnosis of a smart system

The political class in the United Kingdom has taken a good deal of umbrage at the unkind comments about the National Health Service made in the context of the American healthcare debate. Please accept my apologies on behalf of my countrymen, who are looking at the NHS through the prism of the American experience and without the historical context of British health before the NHS.

That said, there is also a tremendous amount of misinformation in Britain about the American healthcare system. The fact is, both America and Britain are going to have to change the way they provide healthcare but through evolution, not sudden or drastic reform.

The root of the misunderstanding on both sides of the Atlantic involves the way that healthcare is rationed. “Rationed” is a dirty word in some quarters, but we economists have it drilled into our thinking from the first week of our freshman year in college. Goods are scarce. Societies can ration scarce goods by price, or by regulation, or by queueing, or can choose not to ration by making them almost free and thereby drive ever increasing amounts of resources into massive consumption of the free goods.

The negative view of the NHS being circulated by some in America highlights the adverse effects of rationing by regulation and queueing that occurs in Britain without giving the whole picture. It also ignores the enormous benefits the NHS has brought to British healthcare in the six decades of its existence and just how scarce access to even basic healthcare was in Britain before the NHS.

The negative view of American healthcare held in Britain also comes from a misperception of the American choice on rationing. It is widely assumed that America rations healthcare by price and that to be uninsured means not to have access to healthcare. The fact is that of all the options mentioned above, America has by and large chosen not to ration healthcare by either price or regulation or queueing, thereby driving enormous resources into the basically unrationed healthcare sector.

The contrast is clear in the numbers. America spends 16% of its GDP on healthcare. Britain spends 8%. >The difference springs from the historical contexts in which each system evolved. The NHS grew up in an atmosphere of severe scarcity. Britain had been historically underserved in a whole variety of medical measures: doctors, hospital beds, technology and the country itself faced a severe budget constraint, rationing of a wide variety of goods and destruction of much of the industrial base.

Making do was the watchword of the NHS in the beginning and, as a competitor for the scarce resources of the state, still is today.

By contrast, additional healthcare spending in America was always viewed as a way around scarcity. The initial provision of health insurance occurred during the second world war to avoid wage and price controls. Firms found they could abide by the government-imposed wage limits and still attract the workers they wanted by offering health insurance on the side as a “fringe benefit” that for some unknown reason the wage control bureaucracy didn’t count as pay.

Lyndon Johnson added Medicare — government health insurance for those over 65. Today Medicare is an entitlement. This means it isn’t subject to an appropriation by Congress — the spending is automatic and unconstrained. Whatever bills Medicare’s beneficiaries run up, the government will pay without so much as a by-your-leave by Congress.

We have now added Medicaid — which covers medical insurance for those who are classified as poor or near poor. The scheme covers a family of four with an income of up to $65,000 (£39,000), depending on the state. That is roughly twice the median family income in the UK. There is also SCHIP, the State Children’s Health Insurance Program, which has grown eightfold since its inception 12 years ago, covering children in families earning up to $65,000 who have no family-based insurance.

All told, 85% of the American population has medical insurance coverage and often it is quite generous. For example, the average health insurance premium for a state employee with a family is $10,000 per year to cover relatively healthy middle-aged workers and their children. Average spending for all Americans is roughly $8,000 per year per person. By contrast, per capita spending in the United Kingdom is about $3,500 per year.

Moreover, being uninsured does not close the door to receiving healthcare. The Washington Post recently estimated that the average healthcare spending by the uninsured was 50%-70% of that of the insured population, meaning the average uninsured person in America consumes more healthcare spending than the average resident of the UK, especially when one adjusts for age.

Some of the uninsured simply pay out of pocket. But, if you are uninsured and indigent, you show up at the emergency room. It is illegal to refuse treatment in all 50 states. This creates an enormous crosssubsidy issue as hospitals and other medical service providers must push this unreimbursed cost onto their insured customers.

Ending this cross-subsidy is one reason why doctors, drug companies, hospitals and the insurance industry are all advocates of “universal coverage”. Cross-subsidisation is inefficient, but it also means that everyone in America gets cared for, whether insured or not.

So the real issue in America is not that we ration by price — by and large we do not. Our bigger long-term problem is that we effectively do not ration at all. Healthcare spending in America is growing between two and four percentage points faster than GDP. Washington views this as a long-term political challenge. As an economist, I view it as a long-term mathematical impossibility. One cannot have a component of GDP growing faster than GDP indefinitely.

With this as a backdrop, the basic idea for Obama-Care was like the adage of the businessman who was losing money on every unit he produced and proposed making it up on volume. Sure, providing insurance for the uninsured would probably improve their health outcomes and it would help eliminate all the cross-subsidisation. But bringing the 15% of the population who now consume 50%-70% as much as the rest of us up to par means adding 6% to the national health bill. The official scorekeepers for the government’s share at the Congressional Budget Office came in at over 8%, since there would also be some shifting of people who now get private insurance to the government.

This is where all that talk about the NHS came in. To cut costs, the administration and its congressional supporters proposed doing some real, but fairly modest, non-price rationing. The biggest losers, since they are also the biggest consumers, were the elderly. And, relative to America, the NHS does quite a bit of queueing and regulatory denial of healthcare procedures for the elderly. So it became a natural target.

This does not mean the NHS is not “cost-effective”. That is a judgment call, to be discussed below. But, if you have grown up in a system that in effect has no rationing and you are told that some non-price rationing is on its way, it really doesn’t matter whether it is cost-effective or not for the government budget. It means you are going to get less late-in-life care than you thought, whether you like it or not.

A fair question is what we Americans get by spending twice the share of GDP on healthcare than does the United Kingdom. Your politicians, your NHS and American politicians who admire your system would like us to believe that the answer is “nothing at all”. That may provide political comfort, but it is simply not credible. Nor does it comport with the facts. Again, that is different from saying: “We’ve made the right choice and you haven’t.” An 8% of GDP gap in spending is a huge sum, the equivalent of 10 Iraq wars, if you like, or roughly the total collections from the personal income tax. So we ought to get quite a bit of extra healthcare for that kind of money. In many areas the systems are equivalent but there are three standouts.

First, there is much less queueing. Any insured American can get an appointment with his or her physician at a mutually agreed time with almost no waiting. Perhaps not on Sunday or at 3am (then you have to go to the emergency room). But you don’t spend hours sitting around a waiting room and we Americans are a very impatient people. In addition there is no bending of the rules by keeping ambulances outside hospitals to meet the average wait time between being admitted and getting service or running a “waiting time” version of triage to meet bureaucratic goals. Again, the value of this is a matter of judgment and we may have culturally different answers. Contrast getting a cab at busy times in Manhattan with the nice neat queues you have in London.

Second, and this is going to be painful for the NHS’s supporters to admit, we Americans have much better cancer survival rates. A study of cancer survival rates in 31 countries published last year in The Lancet bears this out. America was consistently in the top three for both men and women in the four different kinds of cancer studied. Britain tended to rank about 20th.

For example, a woman with breast cancer is 88% more likely to die within five years of diagnosis in Britain than in America. A man with prostate cancer is six times as likely to die within five years in Britain than in America. For various types of colon and rectal cancers, both men and women are 40% more likely to die in Britain than in America within five years of diagnosis.

The reason for this difference is twofold. First, Americans are more likely to get tested, thanks to the lack of rationing, and therefore the cancers are likely to be diagnosed sooner. This naturally makes them more curable. Second, unrationed American healthcare throws a ton of money at cancer, relative to Britain. If one uses a linear programming-style health resources rationing system as the NHS does, cancer is a very poor use of resources.

This is therefore not a criticism of the NHS. The NHS is actually fulfilling its mission — which is to make maximum cost-effective use of the resources at its disposal — and not failing at its mission as some in the United States have been suggesting. But the NHS is failing in terms of the American medical mission, which is to maximise life regardless of cost, something only a system developed in the virtual absence of rationing can accomplish. The reason cancer diagnoses are the main example that American critics of the NHS bring up is that this is where the difference in mission statements is likely to produce the most disparate results. As diseases go, cancer is a very expensive one to fight in terms of extra years of life.

The third main service obtained from the higher cost of the American system is “extra spending at the end of life”. President Obama has noted that half of all American healthcare spending occurs in the last year of life. As an admirer of the NHS-type system, he gives that as an example of the wastefulness of the current arrangement. The corollary of his observation, which he is too astute a politician to say, is that if we simply all agreed to die a year earlier, we could cut our healthcare costs in half. Of course, that would also require an unattainable omniscience on the part of the medical community about whether we really were in that last year or not.

American medical practice does tend to prolong life at its end in a way that would strike anyone operating in a system with resource constraints (such as the NHS) as somewhat bizarre. Unless otherwise instructed, medical personnel will resuscitate a terminally ill person who has stopped breathing, defibrillate them if their heart has stopped and even operate on an individual who is infirm if it might “help”.

We are developing legal means in America of having the elderly and their families make decisions about these issues before the need arises. Because America has shown that a healthcare system left to its own devices in the absence of rationing will do almost everything it can to extend life.

Again, these three “advantages” to the American healthcare system may or may not meet the reader’s idea of being sensible, but they are real. Far from being “cruel” in rationing by price, the lack of rationing in the American system is arguably almost too kind. It will not be that way for ever. We in America will have to find a way of doing more rationing of healthcare in a politically acceptable way. It will not be easy and, as of this writing, it is highly unlikely that whatever passes of Obama-Care will be a significant step in that direction.

On the other hand, my suspicion is that Britain is on its way in the opposite direction. Avoidance of the NHS is beginning to catch on by those who can afford it. One cannot blame folk for avoiding the queues or taking advantage of life-prolonging medicines when they are ill or near the end of their days.

Politicians in both parties in Britain have chosen to make the NHS sacrosanct lest it become “American”. For budgetary reasons they are probably wise to perpetuate the delusion in the media about people not getting care on my side of the Atlantic.

The irony is that this will lead to less equal provision of health services in Britain than in America. When nearly everyone gets generous coverage through insurance as in America, the extra “buying power” available to the rich or well connected is quite small. But when the public gets a highly rationed set of services determined by bureaucratic rules, the ability for the elite to buy their way around the queue or obtain a lifesaving medicine that the NHS does not provide is enormously valuable.

One of the big questions angry constituents have been asking their congressmen about the new “government option” that will substitute for many people’s private insurance under Obama-Care is whether the congressmen will put themselves on the government plan. So far there have been no takers.

SOURCE




I am finally scared of a White House administration

By Nat Hentoff

I was not intimidated during J. Edgar Hoover's FBI hunt for reporters like me who criticized him. I railed against the Bush-Cheney war on the Bill of Rights without blinking. But now I am finally scared of a White House administration. President Obama's desired health care reform intends that a federal board (similar to the British model) — as in the Center for Health Outcomes Research and Evaluation in a current Democratic bill — decides whether your quality of life, regardless of your political party, merits government-controlled funds to keep you alive. Watch for that life-decider in the final bill. It's already in the stimulus bill signed into law.

The members of that ultimate federal board will themselves not have examined or seen the patient in question. For another example of the growing, tumultuous resistance to "Dr. Obama," particularly among seniors, there is a July 29 Washington Times editorial citing a line from a report written by a key adviser to Obama on cost-efficient health care, prominent bioethicist Dr. Ezekiel Emanuel (brother of White House Chief of Staff Rahm Emanuel).

Emanuel writes about rationing health care for older Americans that "allocation (of medical care) by age is not invidious discrimination." (The Lancet, January 2009) He calls this form of rationing — which is fundamental to Obamacare goals — "the complete lives system." You see, at 65 or older, you've had more life years than a 25-year-old. As such, the latter can be more deserving of cost-efficient health care than older folks.

No matter what Congress does when it returns from its recess, rationing is a basic part of Obama's eventual master health care plan. Here is what Obama said in an April 28 New York Times interview (quoted in Washington Times July 9 editorial) in which he describes a government end-of-life services guide for the citizenry as we get to a certain age, or are in a certain grave condition. Our government will undertake, he says, a "very difficult democratic conversation" about how "the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care" costs.

This end-of-life consultation has been stripped from the Senate Finance Committee bill because of democracy-in-action town-hall outcries but remains in three House bills. A specific end-of-life proposal is in draft Section 1233 of H.R. 3200, a House Democratic health care bill that is echoed in two others that also call for versions of "advance care planning consultation" every five years — or sooner if the patient is diagnosed with a progressive or terminal illness. As the Washington Post's Charles Lane penetratingly explains (Undue influence," Aug. 8): the government would pay doctors to discuss with Medicare patients explanations of "living wills and durable powers of attorney … and (provide) a list of national and state-specific resources to assist consumers and their families" on making advance-care planning (read end-of-life) decisions. Significantly, Lane adds that, "The doctor 'shall' (that's an order) explain that Medicare pays for hospice care (hint, hint)."

But the Obama administration claims these fateful consultations are "purely voluntary." In response, Lane — who learned a lot about reading between the lines while the Washington Post's Supreme Court reporter — advises us: "To me, 'purely voluntary' means 'not unless the patient requests one.'"

But Obama's doctors will initiate these chats. "Patients," notes Lane, "may refuse without penalty, but many will bow to white-coated authority." And who will these doctors be? What criteria will such Obama advisers as Dr. Ezekiel Emanuel set for conductors of end-of-life services?

I was alerted to Lanes' crucial cautionary advice — for those of use who may be influenced to attend the Obamacare twilight consultations — by Wesley J. Smith, a continually invaluable reporter and analyst of, as he calls his most recent book, the "Culture of Death: The Assault on Medical Ethics in America" (Encounter Books).

As more Americans became increasingly troubled by this and other fearful elements of Dr. Obama's cost-efficient health care regimen, Smith adds this vital advice, no matter what legislation Obama finally signs into law: "Remember that legislation itself is only half the problem with Obamacare. Whatever bill passes, hundreds of bureaucrats in the federal agencies will have years to promulgate scores of regulations to govern the details of the law.

"This is where the real mischief could be done because most regulatory actions are effectuated beneath the public radar. It is thus essential, as just one example, that any end-of-life counseling provision in the final bill be specified to be purely voluntary … and that the counseling be required by law to be neutral as to outcome. Otherwise, even if the legislation doesn't push in a specific direction — for instance, THE GOVERNMENT REFUSING TREATMENT — the regulations could."

Who'll let us know what's really being decided about our lives — and what is set into law? To begin with, Charles Lane, Wesley Smith and others whom I'll cite and add to as this chilling climax of the Obama presidency comes closer.

Condemning the furor at town-hall meetings around the country as "un-American," Harry Reid and Nancy Pelosi are blind to truly participatory democracy — as many individual Americans believe they are fighting, quite literally, for their lives. I wonder whether Obama would be so willing to promote such health care initiatives if, say, it were 60 years from now, when his children will — as some of the current bills seem to imply — have lived their fill of life years, and the health care resources will then be going to the younger Americans?

SOURCE




Army of the Lord? Obama Seeks Health Care Push From Pulpit

Thousands of religious leaders got a call from on high Wednesday as President Obama reached out to Jewish and Christian clergy, asking some to sermonize in favor of health care reform

If President Obama has his way, you'll soon be hearing about his health care package when you go to your church or synagogue to pray. Thousands of religious leaders got a call from on high Wednesday when Obama reached out to Jewish and Christian clergy, urging them to push health care reform from the pulpit. Obama spoke to about 140,000 people of faith in a conference call and webcast Wednesday evening. He and a White House official discussed the moral dimension of health care, telling the mostly Christian audience that "this debate over health care goes to the heart of who we are as a people."

But earlier that day, Obama went much further, asking about 1,000 rabbis to preach his political agenda in their sermons on Rosh Hashanah, the Jewish New Year -- one of the holiest days of the year. The conversation was supposed to be off the record but was captured on the Twitter feeds and blogs of some rabbis who took part in the call, which was organized by the Union of Reform Judaism and included rabbis from other denominations. "I am going to need your help in accomplishing necessary reform," Obama said, according to Rabbi Jack Moline of Virginia, whose Twitter feed has since been scrubbed of the information.

Obama told the rabbis that "we are God's partners in matters of life and death" and asked them to "tell the stories of health care dilemmas to illustrate what is a stake" in their sermons, Moline wrote.

Critics say Obama's message seemed to "cross a line" and imply a kind of "scriptural or holy support for the program." "I can't imagine why it would be appropriate for a president even to suggest a partnership with God somehow was connected to his ideas for health care," said the Rev. Barry Lynn, executive director of Americans United for the Separation of Church and State. "Whenever politicians give a message that implies that God is on their side on an issue ... this always troubles me."

A White House official told FOX News that Obama spoke at the invitation of the rabbis, who had many questions about health care. Current events often come up in sermons, the official said, and during the highly attended holidays many rabbis and congregants are likely to be interested in discussing the topic. "We are not asking Rabbis to give a political lecture -- we don't expect everybody will want to hear sermons on health care," the official said.

Mark Pelavin, who organized the call from the Reform movement's Washington office, said the president talked about why the health care system needed to be fixed, but Pelavin declined to discuss Obama's specific remarks. Pelavin, the associate director of the Religious Action Center of Reform Judaism, said his office organizes one or two such calls a year with experts and politicians to discuss issues of great interest to Jewish leaders, and health care was a natural topic. Rabbis may choose to discuss health care in their sermons but will "stay away from partisan politics, but certainly they'll talk about issues that are facing the country," he told FOXNews.com.

But other rabbis present noted their discomfort with the president's message, and said they believed he was "using religious organizations to promote policy." "I find the blurring of church and state to be disconcerting, not only on political grounds ... but also for competency," wrote Rabbi Josh Yuter of Manhattan, who was also on the call. "Rabbis have enough difficulty understanding the nuances and intricacies of their own religion to be promoting specific policies in areas for which they have no expertise."

Lynn, of Americans United for Separation of Church and State, said that although Obama is a religious man, he generally avoids emphasizing the religious basis for his decisions, adding he was disappointed that the president had "clouded this debate" with an underlying religious emphasis. "This seems to, unfortunately, cross a line," he said.

SOURCE




ObamaCare Gets Religion

Once the Obama Administration completed their goal of passing an enormous spending bill with the promise of stimulating our economy, they immediately set their sights on passing legislation to control the health care system throughout the nation. The Democrats are seeking to replicate the socialized medicine systems of other industrialized nations such as Britain, Canada and Japan, but they are using the tactics of misinformation and stealth to achieve their goal.

"The mainstream news media and liberal politicians are always praising the health care systems in other countries, but they never discuss the nightmare stories emanating from these countries' medical professionals," said political strategist Mike Baker. "I believe individuals should have the opportunity to select the health insurance policy that best meets his or her needs, which is why I am an original co-sponsor of the Health Care Choice Act. The Health Care Choice Act would enable consumers to choose and purchase affordable health insurance policies that offer a range of benefits," said Representative Pete Hoekstra (R-MI).

Hoekstra and other conservative congressmen want Americans to receive medical care, but they say they don't want the government dictating what care is given and when it is given. Unfortunately for President Barack Obama, Speaker of the House Nancy Pelosi, and the usual suspects on the far-left, a majority of the American people aren't buying the idea of ObamaCare, resulting in a grassroots uprising similar to the one President Bill Clinton faced in 1993 when his wife attempted a government takeover of medicine.

So Barack Obama, after exhausting his usual tactics of vilifying his opposition, decided to embark on a new project: a teleconference with religious leaders and other Americans of faith. According to estimates, more than 140,000 people participated as President Obama waxed elegant. He even threw in a few Bible verses (and took them out of context).

What President Obama did not mention to those religious participants was that he favors the killing of unborn babies and voted for partial-birth abortion. He also failed to mention that one of his main advisors, Rahm Emanuel's brother Ezekial, had made radical statements regarding abortion including the statement that a baby wasn't a human being until he or she were able to understand the concept of "tomorrow."

Whenever the subject of abortion or euthanasia is brought up regarding the far-left health care plan, President Obama and the Democrats respond that there is nothing in their health care bill regarding those procedures. However, the truth is that there is nothing in the health care bills being circulated that would prevent taxpayer money being used for abortions, and euthanasia will naturally result from the rationing of health care. If an elderly patient is denied medical treatment for cancer, for example, that is euthanasia -- you are indirectly killing a human being by withholding live saving threatment.

One Biblical reference used President Obama during his "health care sermon" was a part of the Ten Commandments that reads, "Thou shalt not bear false witness." Those who oppose a government health care system are bearing false witness, according to the man who sat in a pew listening to a pastor who said, "God damn, America" and other anti-American utterances, but did not leave that church until Americans found out about the real Rev. Jeremiah Wright.

During his religious teleconference, Obama, like Hillary Clinton before him, used the Ninth Commandment to condemn his detractors and opponents of the Democrat's idea of health care reform. Of course, no one in the media mentioned how many times Obama bore false witness against others such as when he claimed there were physicians amputating patients' arms and legs solely to make more money. Of course, no one in the news media pushed the President to provide even one example of his assertion. And President Obama did not volunteer that information, either. Can I get an Amen?

SOURCE




The Oregon example shows what lies ahead under Obamacare

The Oregon Health Plan is a government run health insurance option that, like some current health plans being pushed in Washington, is designed to increase access to health care and contain health care costs. The cost of the OHP far outstripped original estimates so new enrollment in the program was closed from mid-2004 until early 2008, when a lottery-based system was introduced to limit new enrollments. As this June 2008 local news story from KATU in Portland shows, the Oregon Health Plan also found other ways to limit costs as well:

Here is the text of KATU’s report:

Barbara Wagner has one wish - for more time. “I’m not ready, I’m not ready to die,” the Springfield woman said. “I’ve got things I’d still like to do.”

Her doctor offered hope in the new chemotherapy drug Tarceva, but the Oregon Health Plan sent her a letter telling her the cancer treatment was not approved. Instead, the letter said, the plan would pay for comfort care, including “physician aid in dying,” better known as assisted suicide.

“I told them, I said, ‘Who do you guys think you are?’ You know, to say that you’ll pay for my dying, but you won’t pay to help me possibly live longer?’ ” Wagner said.

Dr. Som Saha, chairman of the commission that sets policy for the Oregon Health Plan, said Wagner is making an “unfortunate interpretation” of the letter and that no one is telling her the health plan will only pay for her to die.

One critic of assisted suicide calls the message disturbing nonetheless. “People deserve relief of their suffering, not giving them an overdose,” said Dr. William Toffler. He said the state has a financial incentive to offer death instead of life: Chemotherapy drugs such as Tarceva cost $4,000 a month while drugs for assisted suicide cost less than $100.

Saha said state health officials do not consider whether it is cheaper for someone in the health plan to die than live. However, he admitted they must consider the state’s limited dollars when dealing with a case such as Wagner’s. “If we invest thousands and thousands of dollars in one person’s days to weeks, we are taking away those dollars from someone,” Saha said.

But the medical director at the cancer center where Wagner gets her care said some people may have incredible responses to treatment. The Oregon Health Plan simply hasn’t kept up with dramatic changes in chemotherapy, said Dr. David Fryefield of the Willamette Valley Cancer Center. Even for those with advanced cancer, new chemotherapy drugs can extend life.

Yet the Oregon Health Plan only offers coverage for chemo that cures cancer - not if it can prolong a patient’s life.

“We are looking at today’s … 2008 treatment, but we’re using 1993 standards,” Fryefield said. “When the Oregon Health Plan was created, it was 15 years ago, and there were not all the chemotherapy drugs that there are today.”

Patients like Wagner can appeal a decision if they are denied coverage. Wagner appealed twice but lost both times. However, her doctors contacted the pharmaceutical company, Genentech, which agreed to give her the medication without charging her. Doctors said that is unusual for a company to give away such an expensive medication.

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Whose Medical Decisions?

By Thomas Sowell

The serious, and sometimes chilling, provisions of the medical care legislation that President Obama has been trying to rush through Congress are important enough for all of us to stop and think, even though his political strategy from the outset has been to prevent us from having time to stop and think about it.

What we also should stop to think about is the mindset behind this legislation, which is very consistent with the mindset behind other policies of this administration, whether the particular issue is bailing out General Motors, telling banks who to lend to or appointing "czars" to tell all sorts of people in many walks of life what they can and cannot do. The idea that government officials can play God from Washington is not a new idea, but it is an idea that is being pushed with new audacity.

What they are trying to do is to create an America very unlike the America that has existed for centuries-- the America that people have been attracted to by the millions from every part of the world, the America that many generations of Americans have fought and died for. This is the America for which Michelle Obama expressed her resentment before it became politically expedient to keep quiet. It is the America that Reverend Jeremiah Wright denounced in his sermons during the 20 years when Barack Obama was a parishioner, before political expediency required Obama to withdraw and distance himself.

The thing most associated with America-- freedom-- is precisely what must be destroyed if this is to be turned into a fundamentally different country to suit Obama's vision of the country and of himself. But do not expect a savvy politician like Barack Obama to express what he is doing in terms of limiting our freedom.

He may not even think of it in those terms. He may think of it in terms of promoting "social justice" or making better decisions than ordinary people are capable of making for themselves, whether about medical care or housing or many other things. Throughout history, egalitarians have been among the most arrogant people.

Obama has surrounded himself with people who also think it is their job to make other people's decisions for them. Not just Dr. Ezekiel Emanuel, his health care advisor who complains of Americans' "over-utilization" of medical care, but also Professor Cass Sunstein, who has written a whole book on how third parties should use government power to "nudge" people into making better decisions in general. Then there are a whole array of Obama administration officials who take it as their job to pick winners and losers in the economy and tell companies how much they can and cannot pay their executives.

Just as magicians know that the secret of some of their tricks is to distract the audience, so politicians know that the secret of many political tricks is to distract the public with scapegoats.

No one is more of a political magician than Barack Obama. At the beginning of 2008, no one expected a shrewd and experienced politician like Hillary Clinton to be beaten for the Democratic nomination for President of the United States by someone completely new to the national political scene. But Obama worked his political magic, with the help of the media, which he still has.

Barack Obama's escapes from his own past words, deeds and associations have been escapes worthy of Houdini. Like other magicians, Obama has chosen his distractions well. The insurance industry is currently his favorite distraction as scapegoats, after he has tried to demonize doctors without much success.

Saints are no more common in the insurance industry than in politics or even among paragons of virtue like economists. So there will always be horror stories, even if these are less numerous or less horrible than what is likely to happen if Obamacare gets passed into law.

Obama even gets away with saying things like having a system to "keep insurance companies honest"-- and many people may not see the painful irony in politicians trying to keep other people honest. Certainly most of the media are unlikely to point out this irony.

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23 August, 2009

The NHS is deeply and irrevocably flawed

Story from a disillusioned Brit excerpted below:

A simple thing. Another blood test, some more investigations into whatever flawed gene or missing protein might be the cause of my daughter's troubled life, with her terrible seizures, her blindness, her inability to walk or talk or eat unaided. Over the past 15 years, there have been many such attempts to identify her condition. One year later, we asked the doctor, a top geneticist at one of the world's most famous hospitals, what had happened to the results.

His office told us a rambling story about financial restrictions and the need to send such tests to a laboratory in Germany. They said there was little he could do, but promised to pursue our case. It was a bare-faced lie. The precious vial of blood had been dumped in storage and forgotten. The following day it was dispatched to a laboratory in Wales and 40 days later the specialists came up trumps. They identified her condition, an obscure genetic mutation called CDKL5.

The breakthrough was rather mind-blowing, giving us some peace of mind and the chance to talk to families of the hundred or so other children worldwide identified with the condition. It was also life-changing, since it means our other child and close relatives are in no danger of passing on the condition. Indeed, had we known sooner we might have even tried for more children.

But the most shocking thing was not the lying. Nor even the incompetence. It was our total lack of surprise at the turn of events, since after 15 years suffering from the failings of the National Health Service, we are prepared for almost any ineptitude.

Of course, everyone loves the NHS now. It is officially sacrosanct. Our doctors are deities, our health care the envy of the world. And anyone who says anything different is an unpatriotic schmuck who should go and join those losers in the United States. (Although American doctors terrified of litigation would have done all the tests possible on my daughter if I had sufficient insurance, and would think twice about lying to patients.)

So forgive a harsh dose of reality. I used to share these delusional views, wrapped in a comforting blanket of national pride over Aneurin Bevan's legacy. But that was before the birth of our daughter sent us hurtling into the hell of our health service. Since then, hours and days and months and years have been spent battling bureaucracy, fighting lethargy and observing inefficiency while all the time guarding against the latest outbreak of incompetence.

Despite my daughter being under palliative care, my wife spends two hours a day struggling against the system, to say nothing of the endless appointments that go with being primary carer of a severely disabled child. Right now, following some dramatic hormonal and physical changes, we are waiting to talk to one of our daughter's doctors: the first call went in three weeks ago, followed by three more phone calls and one email. No reply yet.

Or take the request for a bigger size of nappies [diapers], urgently needed because of our daughter's sudden weight spurt. A simple thing to sort, you might think. Not in the parallel universe of the NHS. It has taken four weeks, three phone calls, two home visits from community nurses to assess our needs and fill in the requisite forms - and still looks like being one more week before there is any hope of delivery.

It might seem comical, but the result is a distressed child and endless extra laundry. The warning signs of what lay ahead came on our first visit to Great Ormond Street, when there was a young couple who had travelled down from the North-East of England in front of us, their tiny sick baby almost lost in its blankets. 'Didn't anyone tell you - your appointment's been cancelled?' the receptionist told them breezily. They looked at each other despairingly.

Such insensitivity is typical. When my daughter was seven, she underwent a major review at a specialised unit in Surrey, spending three days and nights with sensors connected to brainscanning devices glued to her head, under constant video surveillance while my exhausted wife comforted her and stopped her ripping off the electronic pads. A huge strain, but worth it given the hope of a breakthrough. When we went to get the results a few weeks later, there was the usual wait.

After eventually summoning us, the neurologist asked why we were there. Then she opened our daughter's notes and asked what was wrong with her. Then she couldn't find the results. We stormed out, me in fury, my wife in tears.

There are countless other examples. The celebrated neurologist who measured our heads before blithely asserting that our daughter - suffering up to 30 fits a day - would just have a slightly lower IQ than the average person. The GP who gave her an MMR injection against our wishes, despite warnings it might prove fatal. The nurse who, having been told our daughter was blind, asked if she would like to watch a video.

And that is to say nothing of the endless minor irritations: the overcrowded waiting rooms, the blase receptionists, the unanswered emails, the blinkered attitudes to people with disabilities.....

Unfortunately, it is equally clear that billions have been wasted, poured into a centralised monopoly that focuses on the manipulation of a target culture rather than delivery and innovation. It was little surprise to learn that more managers than doctors were hired last year. And all too often these managers seem to reinforce rather than challenge the patronising attitudes that often predominate, while failing to tackle glaring waste....

Clearly there is systemic failure. And it is a question of management, not money...

More here




Australia: Another ambulance bungle -- man dies

(Ambulances are part of the public health bureaucracy in Queensland)

The widow of a Queensland man said his last act was to trust the ambulance service that ultimately bungled the response to his fatal heart attack. Karen Howlett has recalled how her husband Peter, 44, urged her to call an ambulance when he began to feel the effects of a heart attack in his Mackay home. But a series of communication miscues in the Queensland Ambulance Service were highlighted after Mr Howlett died in front of his three young children before an ambulance arrived.

The ambulance – leaving from a station about 15 minutes' drive away – got lost and arrived almost one hour after the initial Triple 0 call. "He was the one who asked me to call an ambulance. He had faith they would come in time," Mrs Howlett said. "But they didn't and a good man lost his life."

Mr Howlett's death in April 2006 remains the subject of a coronial inquest which has heard QAS admissions that it made several errors in responding to the callout. These include the incorrect prioritising of the call which, the inquest heard, was among factors that led to paramedics making a cup of tea before they headed out.

The incident has been one of many researched by The Courier-Mail as part of a special investigation into the QAS since its 2007 overhaul. The series, from Monday, will look at the QAS's dispatch process, spending and workplace culture.

Mr Howlett's emergency occurred at 7.22am on April 21, 2006, in clear weather at Farleigh, an historic community just off the Bruce Hwy northwest of Mackay. The street and address of the family home, built in the 1980s, were clearly marked. Mrs Howlett called Triple 0 three times while her husband's condition worsened. After her second call, she received a call from the ambulance seeking directions and had to go outside with the phone. "I couldn't hear because Peter was screaming in pain," she said.

Mrs Howlett returned to the room to find her husband "turning purple" and then gave him CPR. "He had his children – who were 8, 6, and 2 at the time – watching this. It was very, very traumatic," Mrs Howlett said.

Mrs Howlett doesn't blame the paramedic, who was new to the area and worked frantically on her husband, or his assistant on her first day on the job. But she has lost confidence in QAS management. "I could never rely on an ambulance again. I would put my family in the car and drive," she said. "It's a shame really. I think about that every day."

Mrs Howlett was angry a tape of the call revealed an ambulance dispatcher felt she was a "stroppy little thing".

The inquest has heard that the call was not given the highest emergency code because of a misunderstanding at the QAS communications centre.

After her husband's death, Mrs Howlett expected an apology and explanation from QAS managers. There was nothing but silence until her brother-in-law complained and a general apology was made. "It seemed all hush-hush to me. My feeling was if we hadn't initiated contact, I don't know that we would have heard anything. They did an investigation but I wasn't asked anything," Mrs Howlett said. "My husband died a very painful death without any medical assistance. I would have appreciated some feedback."

QAS medical director Dr Stephen Rashford told the inquest that mistakes were made and that "this was not a good case for us". The ambulance lacked a backup GPS that could have assisted the paramedic, who had only worked in Mackay for two months.

SOURCE




Paging Dr. Reform

A view from the more moderate Left

Reading the transcripts of President Obama's "town hall meetings" this month on heath-care reform is painful. He's preaching the right gospel, but the parishioners are getting restless. The harder he tries to sell his program, the louder and angrier the debate gets -- and the more the general public tunes out the politicians.

It reminds me of the polarizing Iraq debate of several years ago. Forgive the analogy between war and health care, but maybe Obama needs the medical equivalent of a Gen. David Petraeus -- that is, a professional who can break through the political chaff and describe a strategy for reform that can unite the country.

I have a nomination for the medical commander role, and it won't surprise anyone who follows this issue: Dr. Denis Cortese, the chief executive of the Mayo Clinic. He's already doing what the nation needs -- that is, providing high-quality health care at relatively low cost. Every time I listen to Cortese explain what's wrong with the system, I have the same reaction: Let him and other smart health professionals lead us out of the political morass.

Talking to Cortese this week, I heard two themes that cut to the heart of the debate. First, he thinks Obama has made a mistake in moving toward the narrower goal of "health insurance reform" when what the country truly needs is health system reform. Imposing a mandate for universal insurance will only make things worse if we don't change the process so that it becomes more efficient and less costly. The system we have is gradually bankrupting the country; expanding that system without changing the internal dynamics is folly.

Second, Cortese argues that reformers should stop obsessing over whether there's a "public option" in the plan. Yes, we need a yardstick for measuring costs and effectiveness. But we should start by fixing the public options we already have.

Cortese counts six existing public options that should be laboratories for reform: Medicare, with its 45 million patients and a fee-for-service structure that all but guarantees bad medicine; Medicaid, with an additional 34 million beneficiaries; military medicine, through which government doctors deliver state-of-the-art care; the Department of Veterans Affairs, which has improved performance at its hospitals by embracing new technology; the "Tricare" insurance plan for military retirees; and the Federal Employees Health Benefits Program.

Adding a new public option for insurance, as congressional reformers are demanding, would be useful. But it's not necessary now, and it is creating a poisonous debate that's undermining the more important reforms -- which are in the delivery system, not insurance.

If liberals really want to show they are serious, they should begin with our existing single-payer behemoths, Medicare and Medicaid. Cortese argues that the White House should mandate that, within three years, these programs will shift from the current fee-for-service approach to a system that pays for value -- that is, for delivering low-cost, high-quality care. If doctors performed unnecessary tests that ballooned costs, their compensation would be reduced. And doctors would be compensated by regional formulas, to encourage them to work cooperatively in local networks where they could all make more money by practicing better medicine.

What difference would such Medicare reform make? Take a look at estimates prepared by the Dartmouth Institute for Health Policy and Clinical Practice (which developed the national "health atlas" that was the basis for the widely read New Yorker article by Dr. Atul Gawande). At current spending rates, Medicare will run a $660 billion deficit by 2023. But by cutting the annual growth in per-capita spending from the current national average of 3.5 percent to 2.4 percent (the rate in San Francisco, for example), Medicare could save $1.42 trillion and post a big surplus.

This "pay for value" approach would amount to a cultural revolution in American health care. It would take our bloated system and make it cheaper and better. The adjustments wouldn't be easy, and the medical profession would balk unless respected doctors such as Cortese led the way.

Obama has been campaigning furiously in this crazy summer of bogus debates about "death panels," but he's losing traction. Reformers aren't helping by drawing a false line in the sand over a "public option" when we already have one, in Medicare, that provides a laboratory for systemic change. I hope that Obama understands that his health plan is in mortal danger -- and that it's time to call for the doctor.

SOURCE




Reid: ObamaCare "By Any Legislative Means Necessary"

Harry Reid has delivered his ultimatum to Republicans in the Senate. And it is nothing short of a coup of representative government. Either Republicans bow to the demands of Senate leadership and pass a "bipartisan" bill, or he'll invoke a process known as "reconciliation," whereby only 51 votes would be needed to pass the bill.

Reid's problem is that he doesn't have enough Senate Democrats to break a filibuster—which requires 60 votes. And so, he's rolling the dice, gambling that the Senate parliamentarian will go along with his blatant breach of procedure and that his thuggish threats will cause Senate Republicans to capitulate to his demands.

The truth is, however, this may be the only way Barack Obama's takeover of the nation's entire health care system will be passed this year or any year. The so-called public "option"—which is not at all optional—cannot clear the 60 votes needed in the Senate. And a bill in the House without the public "option" cannot pass either because of demands by the so-called "progressive" caucus.

All of which leaves Reid, Pelosi, and Obama with but one option: to change the rules and eliminate the filibuster in a sharp departure from more than 200 years of parliamentary history.

According to Reid spokesman Jim Manley, "The White House and the Senate Democratic leadership still prefer a bipartisan bill. However, patience is not unlimited, and we are determined to get something done this year by any legislative means necessary."

That's right. "By any legislative means necessary." Attila the Hun would be proud.

To make matters worse, Reid's dictatorial move is a definite shift to a "Senate-first" strategy to pass ObamaCare. In this scenario, Senate Democrats would pass the legislation through the "reconciliation" process and send the bill(s) directly to the House for a vote. Then, there wouldn't be a conference bill, which would still need 60 votes in the Senate to get cloture.

Instead, it would just get rubber-stamped against the express wishes of the American people.

And don't be surprised if Reid and his cabal surreptitiously insert the force "option" into the bill. According to the Wall Street Journal, "In recent days, Democratic leaders have concluded they can pack more of their health overhaul plans under this procedure, congressional aides said. They might even be able to include a public insurance plan to compete with private insurers, a key demand of the party's liberal wing, but that remains uncertain."

But then again, Reid is committed to getting this done "by any legislative means necessary." And that certainly includes ignoring the intent and spirit of the reconciliation rule—which is only supposed to deal with budget resolutions.

As a result, the normal rules are likely to be circumvented, and Congress will try any underhanded, backroom maneuver possible to get government-run health care without any opportunity for a filibuster.

The worst part is, there may not be a thing that Senators opposed will be able to do to stop it.

That is, unless the American people make their voices heard and let members of Congress know that it is they who will be rolling the dice with their political careers should they go along with this subversion of the time-honored filibuster.

Concerned Americans need to specifically let Senate Republicans know they must not cave into Harry Reid's ultimatum and sign on to any mealy-mouthed compromise. If they hold the line, it is Reid and his caucus who will pay the price for this coup, and not they.

SOURCE




Health Care Rationing: Its No Myth!

By Victor Morawski

I awoke one morning last week, as I often do, with my clock radio playing The Wall Street Journal Report. A representative of the AARP was being interviewed. When asked whether his organization had concerns about rationing of health care to senior citizens, he assured the reporter that rationing is just a myth being perpetrated by the opponents of health care reform.

This, of course, does not fit other analyses I have read on the issue. Nor, I might add, does it fit the truth. Reading the bill carefully (something one or two members of Congress might consider doing) makes it clear to me that, if a public option is out there, health care rationing is no myth. And senior citizens better beware.

Rationing decisions, like those made within Britain’s National Health Service, are made within a system that both guides and ethically justifies them. So, let’s take a quick look at two such rationing systems. The first is currently in use in Great Britain and was recently defended by Obama Health Care Team member Dr. Peter Singer. The second was proposed by Dr. Ezekiel Emanuel, Obama’s top health care advisors.

What will become unmistakably clear is just how heavily these two systems are weighted against the interests of the elderly.

1. The QALY System

Peter Singer, in his New York Times Magazine article “Why We Must Ration Health Care” (July 19, 2009) has boldly claimed: “The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?”

Now, one might think that the chief good promoted by health care is the saving of lives---a good that we could easily measure in terms of the number of lives saved. If this were so, then presumably saving the life of an 85-year-old would count as much as saving the life of a teenager, both reflecting an instance of a life saved.

But this way of looking at things is “too crude” for both Singer and the British NHS [National Health Service] because it doesn’t reflect our basic intuition that the death of a teenager is a greater tragedy than the death of an 85-year-old. What government should really aim for, Singer and his ilk contend, is not saving lives, but life-years.

If we save the life of a teenager who could normally be expected to live another 70 years then we have saved 70 life-years. On the other hand, if we save the life of an 85-year-old, who could normally be expected to live only another five years, then we have saved only five life-years. “That suggests,” says Singer, “that saving one teenager is equivalent to saving fourteen 85-year-olds.” A perspective, which obviously gives the elderly little chance when it comes to the allocation of health care Singer and Obama advocate.

2. The Complete Lives System

As chilling as Singers’s views are, those of top Obama health care advisor, Ezekial Emanuel, may be even more devastating. In a Lancet article entitled “Principles for allocation of scarce medical interventions” Emanuel proposes what he and his colleagues call “the complete lives system.”

The only problem is: it empowers those in government to decide who lives and who dies by determining who is really living – or, could yet live -- what they determine is a “complete life.” And by “complete,” they mean both the quality of life and the length of years.

Emanuel and his co-authors concede that their system “prioritizes younger people who have not yet lived a complete life and will be unlikely to do so without aid.” And they make no apology for this. While some things might constitute ageism---treating the elderly “differently because of stereotypes or falsehoods”…“treating them differently because they have already had more life years” would not.

So, there you have it. And so, really, does AARP – though they will likely never admit it. Both Barack Obama’s top health care advisor, Ezekiel Emanuel (who also happens to be the brother of Obama’s Chief of Staff) and one of his foremost Health Care Team members, Peter Singer, have come our foursquare for rationing health care. Perhaps the only silver lining for the elderly is that if the bill passes in its present form, you won’t have to worry about it – for long.

SOURCE




Catch me if you can

Last week, Barack Obama treated us to a traveling road show crusading for his heath care overhaul plan. But what he actually said at those staged, orchestrated, town halls packed with his fervent supporters was so unhinged from the reality of the Congressional legislation he is supporting that he must have consciously decided to challenge us all with the dare: "Catch me if you can."

President Obama keeps repeating over and over that his plan does not include any cuts in Medicare. But the legislation he is supporting specifies $500 billion in reduced funding for Medicare, scored by CBO. When arguing that his health overhaul is paid for, he wants credit for these cuts. But when challenged, he wants to deny before the whole country in broad daylight that he is doing it. I can't recall any precedent for such a Presidential disconnect from reality.

In trying to deny these Medicare cuts, President Obama said at one town hall that AARP had endorsed his plan. He said, "AARP would not be endorsing a bill if it was undermining Medicare, okay?" But just the night before, AARP was on national television denying that it had endorsed the Obama health plan. It issued a press release saying the same just after Obama's town hall misstatement.

President Obama also repeats over and over in these town halls that his health plan will reduce health costs, thereby reducing federal spending and deficits. But CBO, which is now in complete control of the Democrat Congressional majorities, says just the opposite. It says the Obama health overhaul plan will increase federal spending by close to a trillion dollars or more, and increase the federal deficit by hundreds of billions. On health costs, CBO Director Doug Elmendorf told Congress,

In the legislation that has been reported we don't see the sort of fundamental changes that would be necessary to reduce the trajectory of federal spending by a significant amount…[O]n the contrary, the legislation significantly expands the federal responsibility for health costs….[The government public option for health insurance] raises the amount of [spending] that is growing at this unsustainable rate.

And here's a dirty little secret. The CBO surely underestimates the costs of the Obama health plan, just as it regularly does for new government programs, health programs in particular. The official government estimates for Medicare when it was adopted in 1965 projected that the program would cost only $12 billion by 1990. But the actual costs of the program by that year were $109.7 billion, nine times larger than the original estimate.

Independent private estimates have ranged far higher than what CBO projects. HSI Network used its proprietary ARCOLA simulation model to estimate that the House bill would cost $3.5 trillion in additional federal spending alone over 10 years. HSI estimates that the Senate bill would cost $4.1 trillion over 10 years. These estimates seem far more realistic than the CBO estimates. In my study of the Obama health plan for the Heartland Institute, I explain in thorough detail how and why the Obama health overhaul will raise rather than lower health costs.

But in the town halls, President Obama just goes from bad to worse. In Colorado on Saturday, President Obama even suggested that his health overhaul scheme would "bend the cost curve," reducing "health care inflation" so much that the enormous long-term deficit of Medicare (unfunded liability: $89 trillion) would be eliminated! He said that without his health overhaul plan, "We'll either have to cut Medicare, in which case seniors then will bear the brunt of it, or we'll have to raise taxes, which nobody likes." But the CBO has never ever come anywhere near to confirming anything like this. This is just abusive…

More here





22 August, 2009

List of public hospitals with high death rates published by British regulator

A list of hospitals that have sparked safety alerts after unusually high numbers of patients died has been published by the NHS regulator. The Care Quality Commission (CQC) revealed details of all trusts where mortality rates were high enough to require a formal investigation in the past two years. Overall, there were 85 alerts that required investigations among trusts in England, but of those only seven were required to produce action plans to improve their care.

These included Mid Staffordshire NHS Foundation Trust, where an official report published in March found that appalling emergency care had led to between 400 and 1,200 patients dying needlessly.

The alerts, based on information from the Dr Foster Unit at Imperial College London and the CQC, are triggered if numbers of deaths among hospital patients admitted for particular conditions or procedures are significantly higher than expected.

The Department of Health said that it welcomed the publication of the data, which will be updated every three months. But Richard Lilford, Professor of Clinical Epidemiology at the University of Birmingham, said that the data revealed little about the quality of care. “We’re saying that these hospitals are bad apples. I don’t think the methodology is capable of doing that,” he told the Health Service Journal (HSJ).

The other trusts that required action plans were investigated in connection with their death rates in a range of patient groups, from newborn babies at University Hospitals of Leicester NHS Trust to adults with broken hips at Basingstoke and North Hampshire NHS Trust and Sheffield Teaching Hospitals Foundation Trust.

Death rates also triggered warnings among heart attack patients at Salisbury NHS Foundation Trust, those who suffered aneurysms at Pennine Acute Hospitals NHS Trust and septicaemia (blood poisoning) at Barking, Havering and Redbridge NHS Trust. Out of 45 alerts followed up with trusts, in 29 cases quality of care was not a concern, the HSJ reported.

SOURCE




British healthcare trusts 'not paying for officially approved drugs'

Despite being legally required to do so

Four in 10 local healthcare trusts are not funding medications which have been approved by the Government’s drugs rationing body, a new survey shows. Only 60 per cent say they routinely pay for drugs for leukaemia and other types of blood cancer that have been passed by the National Institute for Health and Clinical Excellence (Nice). Campaigners claim that patients are being let down by the system. One of the drugs not currently funded by all healthcare trusts, called rituximab, or mabtherma, was passed by Nice for use in the first relapse of a blood cancer called multiple myeloma as long ago as 2006.

Some of the drugs were only paid for after patients apply for “exceptional funding”, a route often used for drugs which have yet to be assessed by Nice, rather than those which have already been approved.

Tony Gavin, director of cancer campaigning at Leukaemia CARE, the charity which carried out the research, said: “We don’t know why this is happening but we are very concerned. “If this delays treatment for patients, that is time that some patients don’t have.”

Blood cancers are the fifth most common kind of the disease in Britain, with around 27,000 patients diagnosed every year. Around 7,200 cases of leukaemia alone are identified annually.

The report requested data from all of England’s 157 Primary Care Trusts, as well as their equivalent health boards in Wales. The charity received answers from 63 per cent of those asked.

Trusts have a legal obligation to pay for drugs which have been approved by Nice, although they can also choose to pay for medication which the rationing body is still in the process of assessing.

The charity has also called on Trusts to collect data on their compliant with Nice recommendations. Hilary Jackson, Cancer Research UK’s policy manager, said: “There seems to be some confusion about the need for local health providers to make NICE-approved drugs available - and a lack of consistency in the way that drugs that are still under review are used. "It is important we understand why NICE approved drugs aren't being made available. “Local health providers need better ways of measuring where and how new treatments are provided by the NHS. They should publish this information to make clear comparisons across the UK and PCTs should share best practice on how they make new drugs available.

“It is important that patients know that they will be able to access drugs that have been shown by NICE to be both clinically and cost effective, regardless of where in the country they live.”

SOURCE




Third of a million pathology samples mishandled by NHS staff

A third of a million samples sent to National Health Service pathology laboratories were wrongly labelled in the past year, figures show, leading to 46 deaths or serious delay in treatment. Almost 366,000 specimens were mislabelled before they arrived at the pathology laboratories, figures obtained under the Freedom of Information Act disclose.

A total of 46 recorded cases over the past financial year where uncovered where “mislabelling was found to have been related either to a patient death or a significant delay in patient treatment”, said the survey of every NHS trust in Britain, undertaken by the Channel 4 programme, More4 News. Out of the 120 Trusts that replied, the programme also found that almost 12,000 samples were incorrectly labelled by pathology lab staff. Figures for the previous years were not disclosed.

Professor John Kay, a consultant for John Radcliffe Hospital, Oxford and a Royal College of Pathologists spokesman said the figures were concerning. “Most of those errors actually occurred because we are using hand written request cards, they then come into the laboratory, we have to copy type them and that's where these errors are coming into the system,” he told the programme.

“A small number of those examples, there will be really serious problems. “A good example of that are blood transfusions. If the specimen that comes into the laboratory is wrong then the blood product that goes out is going to be wrong and some of them will be important things, like the diagnosis of cancer."

A Department of Health spokesman said the NHS tested and reported on 700 million pathology samples every year and took patient safety “very seriously”. "The NHS makes every effort to reduce mislabelling errors and only a very tiny fraction of the total number of pathology tests carried out in English NHS laboratories in a year contributes to a serious adverse impact on patients,” he said. "Many of these labelling errors happen outside the laboratory, with very few the result of error inside labs, where bar codes are almost universally used for patient/sample identification.”

The NHS is currently promoting the use of electronic requests for laboratory tests and similar systems were also being deployed in hospitals, he added.

SOURCE




Canada: Thousands of surgeries may be cut in Metro Vancouver due to government underfunding, leaked paper

Vancouver patients needing neurosurgery, treatment for vascular diseases and other medically necessary procedures can expect to wait longer for care, NDP health critic Adrian Dix said Monday. Dix said a Vancouver Coastal Health Authority document shows it is considering chopping more than 6,000 surgeries in an effort to make up for a dramatic budgetary shortfall that could reach $200 million. “This hasn’t been announced by the health authority … but these cuts are coming,” Dix said, citing figures gleaned from a leaked executive summary of “proposed VCH surgical reductions.”

The health authority confirmed the document is genuine, but said it represents ideas only. “It is a planning document. It has not been approved or implemented,” said spokeswoman Anna Marie D’Angelo.

Dr. Brian Brodie, president of the BC Medical Association, called the proposed surgical cuts “a nightmare.” “Why would you begin your cost-cutting measures on medically necessary surgery? I just can’t think of a worse place,” Brodie said.

According to the leaked document, Vancouver Coastal — which oversees the budget for Vancouver General and St. Paul’s hospitals, among other health-care facilities — is looking to close nearly a quarter of its operating rooms starting in September and to cut 6,250 surgeries, including 24 per cent of cases scheduled from September to March and 10 per cent of all medically necessary elective procedures this fiscal year.

The plan proposes cutbacks to neurosurgery, ophthalmology, vascular surgery, and 11 other specialized areas. As many of 112 full-time jobs — including 13 anesthesiologist positions — would be affected by the reductions, the document says. “Clearly this will impact the capacity of the health-care system to provide care, not just now but in the future,” Dix said.

Further reductions in surgeries are scheduled during the Olympics, when the health authority plans to close approximately a third of its operating rooms.

Two weeks ago, Dix released a Fraser Health Authority draft communications plan listing proposed clinical care cuts, including a 10-per-cent cut in elective surgeries and longer waits for MRI scans. The move comes after the province acknowledged all health authorities together will be forced to cut staff, limit some services and increase fees to find $360 million in savings during the current fiscal year. In all, Fraser Health is looking at a $160-million funding shortfall.

D’Angelo said Vancouver Coastal’s deficit is closer to $90 million — almost a third of which ($23 million) has already been absorbed through reductions in non-clinical administration efficiencies.

Vancouver Coastal performed 67,000 surgeries last year, an increase of 6,500 surgeries over 2007. “What has now happened is that now our wait times are about 25 per cent lower than the provincial average,” D’Angelo said. “We have put a dent in that wait list.”

Brodie acknowledged surgical waiting times have dropped significantly in recent years, particularly for patients needing hip and joint replacements. He said the proposed cuts threaten those advancements. “It sounds like we are going backwards here,” he said.

Total health spending in British Columbia was $15.7 billion this year, up about four per cent over last year’s total of 15.1 billion, according to figures provided by the ministry of health.

Health Minister Kevin Falcon was unavailable for comment Monday on the proposed health-care cuts. A ministry spokesman said Falcon is away on his honeymoon until the end of August.

Elsewhere in British Columbia, the province will look to replace the head of the Interior Health Authority, Murray Ramsden, after he announced he will step down at the end of the year. Ramsden has said his decision to retire is not related to financial problems faced by the authority.

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The Death Book for Veterans

If President Obama wants to better understand why America's discomfort with end-of-life discussions threatens to derail his health-care reform, he might begin with his own Department of Veterans Affairs (VA). He will quickly discover how government bureaucrats are greasing the slippery slope that can start with cost containment but quickly become a systematic denial of care.

Last year, bureaucrats at the VA's National Center for Ethics in Health Care advocated a 52-page end-of-life planning document, "Your Life, Your Choices." It was first published in 1997 and later promoted as the VA's preferred living will throughout its vast network of hospitals and nursing homes. After the Bush White House took a look at how this document was treating complex health and moral issues, the VA suspended its use. Unfortunately, under President Obama, the VA has now resuscitated "Your Life, Your Choices."

Who is the primary author of this workbook? Dr. Robert Pearlman, chief of ethics evaluation for the center, a man who in 1996 advocated for physician-assisted suicide in Vacco v. Quill before the U.S. Supreme Court and is known for his support of health-care rationing.

"Your Life, Your Choices" presents end-of-life choices in a way aimed at steering users toward predetermined conclusions, much like a political "push poll." For example, a worksheet on page 21 lists various scenarios and asks users to then decide whether their own life would be "not worth living."

The circumstances listed include ones common among the elderly and disabled: living in a nursing home, being in a wheelchair and not being able to "shake the blues." There is a section which provocatively asks, "Have you ever heard anyone say, 'If I'm a vegetable, pull the plug'?" There also are guilt-inducing scenarios such as "I can no longer contribute to my family's well being," "I am a severe financial burden on my family" and that the vet's situation "causes severe emotional burden for my family."

When the government can steer vulnerable individuals to conclude for themselves that life is not worth living, who needs a death panel? One can only imagine a soldier surviving the war in Iraq and returning without all of his limbs only to encounter a veteran's health-care system that seems intent on his surrender.

I was not surprised to learn that the VA panel of experts that sought to update "Your Life, Your Choices" between 2007-2008 did not include any representatives of faith groups or disability rights advocates. And as you might guess, only one organization was listed in the new version as a resource on advance directives: the Hemlock Society (now euphemistically known as "Compassion and Choices").

This hurry-up-and-die message is clear and unconscionable. Worse, a July 2009 VA directive instructs its primary care physicians to raise advance care planning with all VA patients and to refer them to "Your Life, Your Choices." Not just those of advanced age and debilitated condition—all patients. America's 24 million veterans deserve better.

Many years ago I created an advance care planning document called "Five Wishes" that is today the most widely used living will in America, with 13 million copies in national circulation. Unlike the VA's document, this one does not contain the standard bias to withdraw or withhold medical care. It meets the legal requirements of at least 43 states, and it runs exactly 12 pages.

After a decade of observing end-of-life discussions, I can attest to the great fear that many patients have, particularly those with few family members and financial resources. I lived and worked in an AIDS home in the mid-1980s and saw first-hand how the dying wanted more than health care—they wanted someone to care.

If President Obama is sincere in stating that he is not trying to cut costs by pressuring the disabled to forgo critical care, one good way to show that commitment is to walk two blocks from the Oval Office and pull the plug on "Your Life, Your Choices." He should make sure in the future that VA decisions are guided by values that treat the lives of our veterans as gifts, not burdens.

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Arrogant Democrats don't want to sell Healthcare



Opponents of the Democrats' all-out push for healthcare legislation have been striking back hard. Some have condemned it as "socialized medicine," others have dissected it line by line to reveal its more egregious provisions, and still others have simply labeled it "deathcare" citing the sections of the bill calling for healthcare rationing and government death counselors. They have given the Democrat Party elites one opportunity after another to fight back with the "facts." But, instead, "Obamacare" apologists have hurled invective, launched carefully orchestrated smear campaigns, and cloistered themselves behind barricades to fend off peaceful protestors.

Speaker Nancy Pelosi (D-CA) and House Majority Leader Steny Hoyer (D-MD) penned a piece together over the weekend in which they called Obamacare opponents "un-American." And they even claimed, contrary to recent polling, that most Americans want the healthcare legislation they are proposing.

When Democrats have run into opposition from those they serve at town hall meetings, they have not shown the slightest inclination to seriously listen to those concerns. Sheila Jackson Lee, infamously talked on her cell phone while taking attendees' questions. Pelosi and Hoyer called concerned constituents "mobs" and "astroturf" (phony grassroots organizations).

And the White House isn't doing much better. A call for all citizens to send in the names of those who espouse "fishy" and "misleading" information about the healthcare legislation – "even in casual conversation" -- to the ominous sounding flag@whitehouse.gov has already sparked public outrage. And it has prompted one Senator to accuse the White House of creating lists of enemies.

Another White House call to its union cronies to "punch back twice as hard" on healthcare, may have played a direct role in the savage beating of an African American opponent of the plan. This beating was so severe that a local emergency room treated him for numerous injuries.

There have been some rather feeble attempts to sell it. Health and Human Services Secretary Kathleen Sebelius wrote two opinion pieces that were heavy on the lofty goals and good intentions of Democrat healthcare plans. But they fell far short on actual facts. In one of the pieces she went so far as to tell people that she and the President were taking care of the details, and that people should not "let the details distract [them] from the huge benefits reform will bring."

So, why aren't Democrat leaders trying harder to sell what is actually the warp and woof of their massive healthcare package? Because they have no intention of selling it. They talk of dialogue and then revile their opponents, without truly discussing the legislation or answering objections.

They have made up their minds on what is good for the country -- and regardless of any concerned constituents and their protests, as Mr. Obama has pointedly said time and again, they plan to enact their agenda. Come hell or high water. In short, every time the party leadership opens its mouth about healthcare, it is a simple extension of Obama's smug observation to Republicans in January: "I won. So live with it."

Well, they did win in 2008. But, as massive protests continue to build nationwide over the largest government power grab in recent U.S. history, there is a resounding question as to whether they will be able to say the same in 2010.

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ObamaCare's Contradictions

The President does both sides now on his health insurance plan

Over the past week, President Obama has held three town-halls to make the case for his health-care plan. While he didn't say much that he hasn't said a thousand times before, his remarks did offer another explanation for the public's skepticism of ObamaCare. Namely, the President contradicts himself every other breath. Consider: He likes to start off explaining our catastrophe of a health system. "What is truly scary—what is truly risky—is if we do nothing," he said in Portsmouth, New Hampshire. We can't "keep the system the way it is right now," he continued, while his critics are "people who want to keep things the way they are."

However, his supporters also want to keep things the way they are. "I keep on saying this but somehow folks aren't listening," Mr. Obama proclaimed in Grand Junction, Colorado. "If you like your health-care plan, you keep your health-care plan. Nobody is going to force you to leave your health-care plan. If you like your doctor, you keep seeing your doctor. I don't want government bureaucrats meddling in your health care."

Mr. Obama couldn't be more opposed to "some government takeover," as he put it in Belgrade, Montana. In New Hampshire, he added that people were wrong to worry "that somehow some government bureaucrat out there will be saying, well, you can't have this test or you can't have this procedure because some bean-counter decides that this is not a good way to use our health-care dollars."

So no bureaucrats, no bean-counters. Mr. Obama merely wants to create "a panel of experts, health experts, doctors, who can provide guidelines to doctors and patients about what procedures work best in what situations, and find ways to reduce, for example, the number of tests that people take" (New Hampshire, again). Oh, and your health-care plan? You can keep it, as long your insurance company or employer can meet all the new regulations Mr. Obama favors. His choice of verbs, in Montana, provides a clue about what that will mean: "will be prohibited," "will no longer be able," "we'll require" . . .

Maybe you're starting to fret about all those bureaucrats and bean-counters again. You shouldn't, according to Mr. Obama. "The only thing I would point is, is that Medicare is a government program that works really well for our seniors," he noted in Colorado. After all, as he said in New Hampshire, "If we're able to get something right like Medicare, then there should be a little more confidence that maybe the government can have a role—not the dominant role, but a role—in making sure the people are treated fairly when it comes to insurance."

The government didn't get Medicare right, though: Just ask the President. The entitlement is "going broke" (Colorado) and "unsustainable" and "running out of money" (New Hampshire). And it's "in deep trouble if we don't do something, because as you said, money doesn't grow on trees" (Montana).

So the health-care status quo needs top-to-bottom reform, except for the parts that "you" happen to like. Government won't interfere with patients and their physicians, considering that the new panel of experts who will make decisions intended to reduce tests and treatments doesn't count as government. But Medicare shows that government involvement isn't so bad, aside from the fact that spending is out of control—and that program needs top-to-bottom reform too.

Voters aren't stupid. The true reason ObamaCare is in trouble isn't because "folks aren't listening," but because they are.

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21 August, 2009

Is this a new low for socialized medicine?

British paedophile given free Viagra on the NHS - despite string of attacks on children

A paedophile with a 30-year history of abusing children is being prescribed Viagra on the NHS - and there is nothing the authorities can do to stop him. Roger Martin, 71, merely has to visit his GP to obtain the libido-enhancing drug, even though experts warn it will enable him to continue preying on children despite his age.

The probation officers who oversee Martin are powerless to interfere with the administration of prescription drugs. He does not have to tell his GP about his criminal past and even if he does, doctors cannot take convictions into account. Martin suffers from numerous illnesses including diabetes, for which Department of Health guidelines say Viagra can be prescribed. He has forced himself on a string of youngsters and his latest assault was on an 11-year-old girl last year.

But when he was sentenced at Peterborough Crown Court yesterday a judge chose not to send him to prison after being persuaded he 'wouldn't be able to cope' with a spell behind bars.

Last night Martin, a widower, claimed he 'wasn't doing anything wrong' by taking Viagra. But child safety campaigners and MPs reacted with horror and demanded the loophole be closed. One critic said it was 'sickening' that taxpayers' money was being spent on Viagra for a convicted child abuser. Claude Knights, director of children's charity Kidscape, said: 'I am shocked that someone has been given a chemical aid to sexual activity when they are misdirecting their urges. It gives them a chance to abuse more children.'

Peterborough MP Stewart Jackson said: 'This is a bizarre and outrageous example of where common sense gets thrown out of the window in preference to so-called human rights and political correctness. 'Someone needs to get a grip here and start thinking about what's in the public interest instead of ticking boxes like a robot.'

Martin, of Dogsthorpe, Peterborough, has a history of sex offences dating back to 1978 when he was convicted for having unlawful sex with a 15-year-old baby-sitter. He pleaded guilty to his latest offence of touching an 11-year-old inappropriately when she visited his sheltered accommodation home in December 2008 to do some cleaning for pocket money. Judge Nicholas Coleman ordered him to attend a three-year sex offenders' treatment programme and banned from having contact with children indefinitely.

Last night he said his Viagra use was 'a personal thing really'. He added: 'I live on my own and I don't have any female company and I don't think I'm doing anything wrong.'

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Want your NHS records to stay private? Good luck

If you don’t want your health records stored online, you may have some trouble finding the 'opt out' section. A British example of the reality behind greasy socialist promises

If you are registered with a GP in any of six primary care trusts — Bolton, Bradford and Airedale, Bury, Dorset, South Birmingham and South West Essex — you will, in the past week, have received a leaflet about new “summary care records”. It comes with a letter explaining what’s in the leaflet, and a form to order another leaflet in one of 12 formats, from the sensible (Braille) via the surprising (Farsi) to the faintly depressing (easy-read picture version).

If, like me, you develop an eye spasm when privacy issues arise, you might want to opt out of having your health records stored online. If you have no continuing medical conditions (besides the eye tic) and are capable of speaking and listening to doctors, you might think you don’t need your records to be computerised. And opting out means that when the laptop of private information is inevitably left in a pub somewhere in Berkshire, you won’t have to grind your teeth in impotent rage.

The leaflet explains that if you want to opt out, you can do so at www.nhscarerecords.nhs.uk — but go to that site, and you will search in vain for any mention of opting out. And when I say search in vain, I mean by clicking on each available link, not using a search box.

There is no search box. Once you’ve clicked on all the links, you will be no wiser. Many of the links have sub-links, which you are welcome to try. They also yield nothing, other than the occasional derisive hoot when they are called “HealthSpace Troubleshooting”.

You will have need to refer to your glossy leaflet, ignore it and try the covering letter again. Eventually you will discover that you must type www.nhscarerecords.nhs.uk/patients/info to gain access to the list of “early adopter PCTs”. Click on your area. Only then can you download the opt-out form. There is no link to a “patients” or “info” page on the site you first went to. The patient page is the internet equivalent of being behind the fake door covered in books that leads to the secret room.

This, you will recall, is exactly why you are incensed about privacy. Because when they tell you that they value your privacy, what they are actually telling you is that they will take advantage of people being too busy to track things down or too polite to bother their GP’s practice manager during a pandemic.

Douglas Adams’s Arthur Dent once sighed that plans to demolish his home were “on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard’”. Do not fear the leopard. The form can be accessed from here.

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Why ‘Obamacare’ Is Failing

The Obama administration has been astoundingly incompetent

By Jonah Goldberg

To listen to the White House and its supporters in and out of the media, you would think that opposition to “Obamacare” is the hobgoblin of a few small minds on the right. Racists, fascists, Neanderthals, the whole Star Wars cantina of boogeymen and cranks stand opposed to much-needed reform.

Left out of this fairly naked effort to demonize many with the actions of a few is the simple fact that Obamacare — however defined — has been tanking in the polls for weeks. President Obama’s handling of health care is unpopular with a majority of Americans and a majority of self-proclaimed independents.

Focusing on the town halls has its merits, but if you actually want Obamacare to pass, casting a majority of Americans as the stooges of racist goons may not be the best way to go.

Imagine if George W. Bush, in his effort to partially privatize Social Security, had insisted that the “time for talking is over.” Picture, if you will, the Bush White House asking Americans to turn in their e-mails in the pursuit of “fishy” dissent. Conjure a scenario under which then-Senate Majority Leader Trent Lott derided critics as “evil-mongers” the way Harry Reid recently described town-hall protesters. Or if then-House Speaker Dennis Hastert and then-Majority Whip Tom DeLay had called critics “un-American” the way Nancy Pelosi and Steny Hoyer did last week, or if White House strategist Karl Rove had been Sir Spam-a-lot instead of David Axelrod.

Now, I’m not asking you, dear reader, to do this so that you might be able to see through the glare of Obama’s halo or the outlines of the media’s staggering double standard when it comes to covering this White House. Rather, it is to grasp that the Obama administration has been astoundingly incompetent.

Lashing out at the town-hall protesters, playing the race card, whining about angry white men, and whispering ominously about right-wing militias is almost always a sign of liberalism’s weakness — a failure of the imagination.

The Left, broadly speaking, has been attacking conservative talk radio and all it allegedly represents for the better part of 20 years now. When Bill Clinton needed a convenient villain, he attacked Rush Limbaugh. When Bush emerged victorious from the Florida recount, liberals concluded that what they really needed was their own version of Limbaugh. In March, at the first sign of resistance from congressional Republicans, Obama complained that the GOP was Limbaugh’s lap dog, and both the White House and much of the press corps went into anti-Limbaugh campaign mode.

It’s funny how these supposed champions of the Enlightenment can’t grasp that people can disagree with them for honest reasons. Instead, we simply must be Limbaugh’s automatons, which is to say racist, fascist thugs.

In addition to the slander, such complaints are monumentally, incandescently lame coming from a party that controls Washington. According to liberals themselves, these evil-mongers are a tiny minority, a bunch of “Astroturf” frauds. So why not ignore them and get on with the work you were elected to do?

Well, because they can’t — or won’t.

One of the reasons the term “Obamacare” has become a journalistic convention is that there is no bill. You can’t talk about Obama’s actual health-care plan because there isn’t one. There are a bunch of competing bills, proposals, and ideas swirling around the halls of Congress like flotsam in a sewer. As even Robert Reich, Clinton’s labor secretary, recently conceded, the failure to put forward a concrete proposal allows opponents to pick from a menu of scary ideas and possibilities, all of which can be labeled Obamacare.

Suspicion of bad motives is only reinforced by Obama’s determination to steamroll to victory. Indeed, Democratic dudgeon that the town-hall protesters don’t want civil debate is hysterical, given that Obama wanted this over before the August recess. No wonder the president who thought the time for talk was over long ago now doesn’t like the talk he’s getting.

Some might say the real story is to be found in the eroding support from independent voters and Blue Dog Democratic congressmen. Or in the panic among seniors that Obama will raid Medicare. Or in his inability to get progressive Democrats to agree to a bipartisan approach. Or maybe the real story is Obama’s manifest inability to sell a program he’s invested his presidency in.

But no. Obama wants the debate to be about angry white men. And, as lame as that is, that’s what’s happening. It won’t make Obamacare a reality, but it will shift the blame from where it rightly belongs.

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Public Health Care Option Still Available

In the debate over health care reform, the White House said a public health insurance option is not off the table after all. The government-run public option would provide insurance to millions of uninsured Americans. The public option is the most controversial aspect of the president's reform plan, but the White House said reports that the president is ready to abandon it are just not true.

Over the weekend, Obama and Health and Human Services Secretary Kathleen Sebelius seemed to signal a willingness to drop the public option. "That is not the essential element," said Sebelius. No public option, no reform bill, many Democratic lawmakers warned and now Sebelius said the media got it wrong. "All I can tell you is that Sunday must have been a very slow news day because here's the bottom line: absolutely nothing has changed," Sebelius said.

What may be changing is consumer confidence. The latest Robert Wood Johnson Foundation survey shows Americans' confidence in health insurance coverage and affordability dropped in July with the largest drop among seniors. The AARP blames it on what it calls scare tactics by opponents of reform.

"People are hearing about rationed care and death panels, things like that. Things that aren't in the bill aren't remotely true, but it certainly gets people concerned," said AARP spokesman Jordan McNerney.

Critics of reform said people are concerned because they don't want a "government take over of health care."

Those critics continue to speak out at town hall meetings like one in Oklahoma.

"People are trying to say, 'Washington you're not paying attention to us,' and it's common when you feel somebody's not listening to you. You get in their face and raise your voice," said analyst Ernest Istook, with the Heritage Foundation.

In an interesting twist, the drug industry and a consumer advocacy group have launched a multimillion dollar ad campaign thanking 15 senators for working across the aisle to try to get a reform bill passed.

Currently, there is much to debate. Speaker Nancy Pelosi said the public option will be a part of the bill the House considers, but on the Senate side analysts said dropping the public option may be the only way to win over conservative Democrats. It could, however, also alienate progressives in the party.

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Unfair government competition

The Postal Service is a scary model for health care



According to President Obama, government health insurance will create competition in the health insurance industry. It simply would provide another alternative to existing plans offered by private companies, the argument goes. Like many Americans, we simply don't believe it. Whenever the government enters into a market, it will try to expand its share and take over the sector.

During a town hall meeting last week at Portsmouth, N.H., Mr. Obama pointed to the U.S. Postal Service as evidence that private companies don't need to worry about competition from the government. "If you think about it, UPS and FedEx are doing just fine, right? No, they are. It's the post office that's always having problems."

If the president considers the Postal Service as an example, we should all be scared. The Postal Service is a classic example of both inefficiency and extreme monopoly power.

The Postal Service has staunchly resisted competition from UPS and FedEx since their infancy. Even though the Postal Service loses money in the overnight delivery business, it resisted infringement on its turf. The Postal Service has often increased its first-class mail rate to be well above cost, then used those profits to subsidize its overnight delivery service. For example, it raised first-class stamps to 33 cents in January 1999 and simultaneously reduced the price of domestic overnight express mail from $15 to $13.70, even though it was already losing money at the $15 rate.

Despite numerous advantages that FedEx and UPS could only dream of having, the Postal Service loses money. In addition to direct subsidies, the Postal Service is exempt from paying state sales, property and income taxes. It uses some of the most expensive real estate in the country rent-free. Perhaps Mr. Obama has not noticed, but nobody else but the Postal Service is allowed to deliver regular first-class mail, and only the Postal Service has access to Americans' mailboxes.

The Postal Service has not managed to kill off UPS and FedEx because these private companies have better on-time delivery and much lower costs. But that is not because the government postal business did not try to squeeze out the competition. When a government agency gets into an industry, it tries to get bigger, even when it is not profitable.

The competition that Mr. Obama envisions between government and private insurance companies won't be fair. Many proposed regulations, such as eliminating caps on what insurance companies will pay out or preventing insurance companies from discriminating against those with pre-existing conditions, will eliminate private insurance. But even if the government only tilts the playing field partially in favor of a government insurance plan, making it artificially cheaper, a lot of Americans will give up their private insurance to save money. Government insurance gradually will take over, and service will deteriorate.

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Dirty secret No. 2 in Obamacare

In my last column I explained that dirty secret No. 1 in Obamacare is that the House bill grants government the authority to come into homes and usurp parental rights over child care development. I have a few more secrets to share over these hot August political nights.

Dirty secret No. 2 in Obamacare is that Obama is not the leader of Obamacare. And neither is Congress. The one who has been spearheading the initiative behind the scenes is one who goes under the misnomer "adviser" to the Obama administration, Dr. Ezekiel Emanuel, a bioethicist and breast oncologist and brother of White House Chief of Staff Rahm Emanuel. And "his bible" for health care reform is his book, "Healthcare Guaranteed."

Dr. Emanuel has served as special adviser to the director of the White House Office of Management and Budget for health policy as far back as February, when he confessed to the Washington bureau chief for the Chicago Sun-Times that he was "working on (the) health care reform effort." The first draft of Obamacare?

If you want to know the future of America's universal health care, then you must understand the health care principles and plans of Dr. Ezekiel Emanuel. I find it far more than coincidence how much Dr. Emanuel's book parallels Obamacare's philosophy, strategy and legislation. First, Dr. Emanuel rejects any attempts at incremental change or reform to our health care system (Page 185). What's needed, he concludes in his book (p. 171), is an immediate and totally comprehensive reconstruction of health care as we know it. That of course describes the vision of Obamacare to a tee.

Second, in the chapter "Opening the door to comprehensive change" starting on p. 171 (which reads more like a political and mass-manipulating strategy than a health care manual), Emanuel drives home "a key political lesson: the need to rush the legislation through." (Seen this methodology being used lately?!)

He then cites historical proof: "Within a few months, President Johnson rammed the four central elements of his Great Society program through," and Medicare and Medicaid were born. Emanuel says that the reason the Clinton administration couldn't pass a health care bill was because it waited too long (after his inauguration – the political honeymoon period) and it "established a large task force that worked in secret. … The delay and the secrecy were deadly" (p. 181). Sounds to me that Dr. Emanuel is as much a political strategist as he is a doctor.

You are bearing witness to these political principles at work at this very moment in Washington and across this nation with Obamacare. President Obama and Dr. Emanuel both know that if too much time elapses their legislation is likely to die (and their preferences with it) because Americans will actually have time to examine it and come up with better alternatives.

Third, as Obama crusades around the country pitching Obamacare, he continues to avoid giving virtually any specific details of the program. That too is a strategy of Dr. Emanuel: "Americans need to avoid the policy weeds. Focusing on details will only distract and create tangles and traps" (p. 183). So "details" of health care reform are "weeds"? That is why we continue to hear only warm-and-fuzzy generalities from Obama like,"If you've got health care, the only thing we're going to do is we're going to reform the insurance companies so that they can't cheat you."

Fourth, Dr. Emanuel describes a comprehensive government health care program that is completely run by a national health board with 12 regional health boards ("modeled on the Federal Reserve system" – p. 83).

Imagine a national health board with the power of the Federal Reserve?! Imagine them doing with medicine and health what the Fed does with interest rates and the financial system. An apolitical board like that sounds appealing at first, until it is immune in ways (like the Federal Reserve) to congressional protocol and oversight. Once these boards are in place, like the Federal Reserve system over our financial system, they will have absolute power over the ebbs and flows of the medical world.

Critics would say, "But that is not the national board as described in Obamacare or H.R. 3200." Not yet anyway. Of course, Obamacare uses much softer language for describing a national board – they call it the "Health Benefits Advisory Committee" (there's that "advisory" word again!), which would be under the executive branch (like the Federal Reserve).

Does anyone doubt that the duties and power of the Health Benefits Advisory Committee will morph and grow over time? And what liberties and controls will they have 10 years from now? I have a hunch they will be very reflective of the power of the Federal Reserve – I'll let you guess why.

Fifth, Dr. Emanuel believes in the "phasing out of Medicare and Medicaid" (Pages 88-89, 94-95). Of course, no proposed legislative wording by the current administration is going to describe the eventual elimination of these programs, at least in these incipient stages – remember, this bill is a sales pitch, too. But what stops the "Health Benefits Advisory Committee" care from "phasing them out" down the road? Could their eventual termination be the reason this administration won't merely reform those programs to accommodate their universal health care desires? But then again, maybe you believe Obama when he "avoids the policy weeds" by saying, "Nobody is talking about trying to change Medicare benefits. What we want to do is to eliminate some of the waste that is being paid for out of the Medicare trust fund."

Sixth, Dr. Emanuel believes in ending employer-based health care (Pages 109-112). President Obama knows that to propose such a restriction on American freedoms and choice would mean certain death to this legislation, let alone likely his popularity as president. However, throughout all Obama's rhetoric about how Americans will have the choice of health care insurance, they will have little choice in the matter, especially when employers are footing the bill. As any businessman knows, why would a company pay the exorbitant costs for employees' private health care insurance when they can benefit big time from a free ticket for government health care coverage? Some have even proposed that provisions in the House's health care legislation, under the titles "Limitation of New Enrollment" and "Limitation on Changes in Terms or Conditions" (p. 16), could essentially make individual private medical insurance illegal.

Seventh, Dr. Emanuel believes a universal health care program could be paid for by phasing out Medicare and Medicaid, adopting a value-added tax of at least 10 percent, etc., and then allowing Americans themselves to "pay extra with after-tax dollars" (p. 100) for additional medical benefits (beyond the norm of the government program). Ironically, Obamacare proposes cutting $500 billion from Medicare and proposing taxes upon the wealthy, as just a couple ways to pay for the $1 trillion it will cost to run the new national health care program over 10 years. But even the Congressional Budget Office says that won't be near enough.

Just last week at a Montana town hall meeting, the president continued to struggle to explain how he would pay for Obamacare without taxing the middle class. Of course, three of his top advisers (Treasury Secretary Timothy Geithner, National Economic Council Director Lawrence Summers and White House senior adviser David Axlrod) have already gone on the record saying they will not rule out the need for a middle-class tax hike to pay for Obamacare.

The truth is, whether the money comes from higher corporate taxes, taxing employer-provided health insurance, eliminating health savings accounts or flexible spending accounts, limiting the deductibility of medical expenses, increasing taxes on selective consumptives, etc., or all the above, trust me, sooner or later, we all will pay.

Eighth, speaking of ethics, enough has been written lately about Dr. Emanuel's end-of-life counsel and consultation, including his advice from The Hastings Center Report (1996) that medical care should be withheld from those "who are irreversibly prevented from being or becoming participating citizens. ... An obvious example is not guaranteeing health services to patients with dementia."

I find it striking that Obama's ethics have similarly allowed him already to pass more laws increasing the terminations of life in the womb than any administration since Roe v. Wade. To add insult to injury, Congress has repeatedly rejected amendments to this universal health care bill that would prevent federal funds to be used for abortions.

Friends, if you don't think Dr. Emanuel's and President Obama's "life ethics" will bear out in the practice of the policies within their future universal health care program, I have a London bridge to sell you in Lake Havasu City, Ariz. Obama was telling the truth about this campaign promise: His presidency would provide "the most sweeping ethics reform in history." I guess more Americans should have been watching which way he was sweeping.

In short, whether in title or not, Dr. Emanuel is Obama's health care czar. Obamacare is a junior version of Emanuel-care, or should I say the beginning stage of Emanuel-care. What's almost eerie is how they both could be juxtaposed to intersect in full bloom sometime in America's future.

One last thing: Someone once said to me, "If two people think so much alike, you can bet that one person is not thinking." Think about it.

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Some more news and views

Dem investigators target health insurers: "House Democrats are probing the nation's largest insurance companies for lavish spending, demanding reams of compensation data and schedules of retreats and conferences. Letters sent to 52 insurance companies by Democratic leaders demand extensive documents for an examination of 'extensive compensation and other business practices in the health insurance industry.' The letters set a deadline of Sept. 14 for the documents. Rep. Henry Waxman (D-Calif.), chairman of the House Energy and Commerce Committee, and Rep. Bart Stupak (D-Mich.), chairman of the Subcommittee on Oversight and Investigations, signed the three-page letter dated Monday. An industry source replied when asked for comment: 'This is nothing more than a taxpayer-funded fishing expedition designed to silence health plans.'"

Obama: Ignorant or lying?: "The proliferation of Obama's gaffes and non sequiturs on health care has exceeded the allowable limit. He has failed repeatedly to explain how the government will provide more (health care) for less (money). He has failed to explain why increased demand for medical services without a concomitant increase in supply won't lead to rationing by government bureaucrats as opposed to the market. And he has failed to explain why a Medicare-like model is desirable when Medicare itself is going broke. The public is left with one of two unsettling conclusions: Either the president doesn't understand the health- insurance reform plans working their way through Congress, or he understands both the plans and the implications and is being untruthful about the impact."

We've long had a public option: "Rebutting concerns that the public option would be a government- subsidized plan, Obama has said repeatedly that it won't be. Rather, it would function as a nonprofit insurer. He said in Colorado, 'a public option can only work if they have to collect premiums just like a private insurer and compete on a level playing field.' If that is true, then there is no need for a public option plan because roughly half of Americans who have private health insurance get it from the same type of entity Obama says he wants to create -- a nonprofit insurer. According to the same Census report that produced the figure of 46 million uninsured Americans, 202 million of us are covered by private insurance. According to the Alliance for Advancing Nonprofit Health Care, an industry group, 'Of the 138 health plans in the United States with at least 100,000 medical enrollees, 84 or 61% are nonprofit.'"

Why do Democrats pretend they’re fighting Big Insurance?: “Democrats are fighting the greedy medical insurance and pharmaceutical companies to provide Americans healthcare, right? Surely anyone who listened to President Obama talk last week in Portsmouth, New Hampshire last Tuesday would think that. But while the Democrats are calling these companies evil for wanting to prevent the government takeover of healthcare, Democrats are working closely with these very same companies to support President Obama’s healthcare plan. In fact, in exchange for favorable treatment in the healthcare plan, these companies are financing a massive ad campaign to support it. … According to FOX News, the dreaded pharmaceutical companies are apparently ready to spend at least $150 million, and possibly as much as $200 million, to push the healthcare changes President Obama wants. Private insurance companies, who launched the famous Harry and Louise ads that were deemed so important in defeating the Clinton takeover of the healthcare industry in the 1990s, have now launched similar ads with the opposite message supporting President Obama.”

Insuring health : "When [American voters] voted for ‘free’ health care, they were proactively declaring, by pulling those voting levers, that it was fine and dandy by them to take the needed funds from their neighbors and ultimately to shoot them dead if they refused. So it’s not really ignorance alone; there is, at root, an ethical question at work, and it centers on the gross immorality of casting a vote. Yes, politicians are malevolent or stupid, most likely the former in my view, but everyone who votes for them is complicit, up to his neck, actively taking part in the most humongous act of armed robbery in the history of man. That is not ‘insurance’ — a perfectly sound idea involving the voluntary sharing of the risk of heavy but unpredictable loss — this is theft, neither more nor less. That is the real, moral disease that has infected the core of this society and no amount of medical care is going to cure it.”

New public option, same as the old public option? : “OK, so what is a health insurance co-op? Many Americans are familiar with neighborhood food co-ops in which members join and then purchase a variety of produce, meats, and other groceries at cost. Some 120 million Americans are served by various co-ops according to the National Cooperative Business Association. Unlike most private companies, cooperatives are owned and controlled by their members, not by outside investors. In addition, co-ops return any surplus revenues they may earn to members. In June, Sen. Kent Conrad’s (D-N.D.) floated a plan for creating consumer-owned nonprofit health insurance cooperatives as an alternative to the Democratic plan. Conrad is part of a senatorial gang of six which includes three Republicans and three Democrats that has been trying to hammer out a bipartisan health care reform package for several months. He sees rural electric cooperatives and agricultural cooperatives as models for his health insurance cooperatives.”





20 August, 2009

NHS ordered to pay £100,000 to family of Alzheimer’s sufferer Judith Roe

Rather unbelievably, Britain's "caring" government bureaucrats claimed that Alzheimer's was not a health problem!

The family of an Alzheimer’s sufferer have won a legal battle to reclaim more than £100,000 in care home fees that the local NHS trust had refused to pay because it claimed that her condition was not health related. Health authorities had ruled that Judith Roe, who died aged 74 last October, did not qualify for NHS funding because her condition was deemed to be a social rather than a health problem. As a result, she was forced to sell the home that she had lived in for 30 years for £170,000 to pay for her £600-a-week nursing home fees.

Her family began a five-year legal battle to reclaim the money and the Health Service Ombudsman has now ordered NHS Worcestershire to repay them more than £100,000.

Yesterday Mrs Roe’s son, Richard, 40, urged other families in a similar situation to fight for the care they are entitled to. He said: “The way the health trust behaved was scandalous. It has been very stressful. All the time we were told we were wrong while believing we were right. ”They told me I should count myself lucky because there are people that are more ill than my mother, which was an outrageous thing to say. "I want anyone else going through a similar experience to know they may be entitled to care. Even if they’re being told they’re not entitled, they should fight for it. With us, they made a mistake. They did not carry out their duties properly.”

Mrs Roe, a retired church warden and school teacher, was cared for in The Firs care home and then Henwick Grange Nursing Home, both in Worcester. Her care should have been funded by NHS Worcestershire Primary Care Trust. Mrs Roe died at Worcestershire Royal Hospital on October 30 last year from a combination of pneumonia and physical and mental deterioration as a result of Alzheimer's.

Mr Roe, a manager for Homebase in Telford, Shropshire, said: ”We became very angry because the primary care trust was very arrogant and unhelpful. They took a long time to respond to letters and requests for information.”

Under English law, elderly people must pay for their own residential care unless their needs are health related, even though it is provided free in Scotland. The Health Service Ombudsman upheld the family’s appeal and awarded them the costs of Mrs Roe's care on June 23, eight months after her death.

Paul Bates, chief executive of NHS Worcestershire, which has replaced NHS Worcestershire Primary Care Trust, said: “Decisions around eligibility for continuing NHS care are extremely complex and difficult, even though we have national guidance to assist us. ”The line between the need for healthcare and social care is a very thin one indeed, but the impact for the individual is the difference between free care and care which is means tested. “We would not wish to see Mrs Roe’s experience repeated and clearly there lessons for us to learn. "Mr Roe pursued his claim that the NHS should have funded his mother’s care and all the formal procedures put in place to allow families to do so were followed.”

SOURCE




Blunders cost the NHS £807m: Targets blamed as payouts rise by a quarter

The amount paid out by the Health Service for serious medical blunders and other accidents has soared by almost a quarter in just one year. Last year, the NHS paid out £807million - up from £661million the year before - after the number of claims against it rose. Figures obtained by the Conservative Party show that the overall number of claims has risen by 11 per cent to almost 8,900 in 2008/09.

The 22 per cent surge in payouts mirrors a huge rise in the number of patients killed by hospital blunders. Official records show that 3,645 patients died as a result of outbreaks of infections, botched operations and other mistakes in 2007/08. That was up 60 per cent from 2,275 two years before.

Critics say quality of care has suffered in the NHS over the past few years as doctors and nurses come under mounting pressure to meet Government waiting time targets. Experts say the true toll is certain to be far higher, because many hospitals do not record all 'patient safety incidents'.

About a fifth of the total paid out - some £143million - went to lawyers, rather than as compensation to victims and the families of those who died. Experts say increasing numbers of cases are being taken to court by 'no win, no fee' soliciaccidentstors, who even tout for business in A&E waiting rooms. To cover their extra risk, these 'ambulance-chasing' lawyers get more in costs if they win than would be paid in legal aid cases.

The annual report of the National Health Service Litigation Authority said that clinical claims - including claims for botched operations and wrong drugs dosages - rose by more than 11 per cent while nonclinical claims - which cover general such as falls - were up by more than 10 per cent. It added: 'We have not been able to identify any single factor that might have precipitated the rise.'

Of the 8,885 total claims made in 2008/09, less than 4 per cent will go to court, the report said. But it added: 'The costs claimed by claimant lawyers continue to be significantly higher than those incurred on our behalf by our panel defence solicitors. This remains a very significant concern for us.'

Last night, Conservative health spokesman Mark Simmonds said: 'We need a robust and fair way for patients who have received negligent treatment in an NHS hospital to get the compensation they deserve. 'Instead, we have an inefficient system which incurs vast legal costs for NHS Trusts. 'Our proposals would have required an initial "fact-finding" phase, which would then allow more cases to be resolved without costly litigation. 'But the Government missed this opportunity and as a result hospitals will now have less money to spend on patient care.'

SOURCE




PUBLIC MEDICINE IN AUSTRALIA

Four current articles below. America can look forward to much the same if Obama has his way:

Federal government plan to cut its healthcare spending hits a rock

If the federal coalition wants to sink Labor's plan to cap Medicare payments for IVF treatment they've got a willing partner, with the Australian Greens declaring they'll vote against the change. The Rudd government wants to cap reimbursement for a range of items under the extended Medicare safety net - including IVF and obstetric services - in order to save $258 million over four years.

Health Minister Nicola Roxon argues Labor is cracking down on excessive fees being charged by specialists, and the changes won't affect patients charged $6,000 or less for IVF treatment.

But the Greens says the extended safety net is itself inflationary and they'll oppose Labor's changes in the Senate. "While the Greens understand the intent of the proposed changes is to reduce the costs to the public purse, we are not convinced that the government's approach will be effective," health spokeswoman Rachel Siewert said in a statement. "(Labor's) legislation is a half-way house - it only addresses part of the problem and will introduce another set of inequities."

Senator Siewert said the extended safety net advantaged those who could afford to pay upfront fees, and encouraged specialists to raise their prices. It was an "inflationary measure", she said. "The government's amendments are simply to use patients to pressure specialists to reduce their fees, which is unfair to the patients, and ultimately likely to prove ineffective in reducing the burden of unnecessary costs on the public purse."

Earlier today, the coalition announced it would join forces with Family First's Steve Fielding and independent senator Nick Xenophon to delay a vote on the changes. It will move an amendment in the Senate to stymie debate until the government tables regulations outlining exactly who'll pay what under the new scheme.

The upper house was expected to debate Labor's legislation this week, but with senators still thrashing out changes to renewable energy targets there's now a possibility it will be deferred until September.

SOURCE




Labor Party's attack on private health insurance set for Senate defeat

THE Federal Government is set to add another potential early election trigger to its arsenal, with the Senate likely to vote down its changes to the private health insurance rebate this week. The Opposition vowed to block the move earlier this year because it breaks a Labor election pledge, and key cross-bench senators Nick Xenophon and Steve Fielding are now indicating they'll also vote against the measure.

On Tuesday, the Senate defeated Labor's draft laws which would have allowed universities to charge students a compulsory $250 services and amenities fee. Last week, the Rudd Government's emissions trading scheme was also voted down in the upper house. If defeated Bills are reintroduced after three months and again voted down the Government can call an early election.

Under Labor's changes to private health insurance, the 30 per cent rebate will be means-tested for individuals earning more than $75,000 a year and couples earning more than $150,000 a year. In a double whammy, the wealthy will also be hit with a higher Medicare levy surcharge if they opt out of private cover.

Health Minister Nicola Roxon says it would be "fiscally irresponsible'' for the Coalition to sink the changes, which are expected to raise $1.9 billion over four years. "I don't think that people think it's appropriate for secretaries and nurses to be funding the private health insurance of millionaires,'' she told ABC Radio on Wednesday. "Why is that a good use of public money.''

But Family First's Steve Fielding says the changes undermine families, because they don't take account of how many children are in the household. "I won't be supporting the Rudd Government's proposal to means-test the 30 per cent private health insurance rebate because it's unfair to families,'' Senator Fielding said in a statement. "Under the Government's proposal, a couple with no children on $149,000 will be eligible for the full rebate, while a family of five with a household income of $150,000 would have their rebate reduced. This makes no sense and undermines the family.'' Senator Fielding said he was happy to negotiate with the Government "but the health minister is yet to get back to me''.

Independent senator Nick Xenophon insists he can't support the move until the findings of a Productivity Commission report are released later this year. "The Government made an explicit election promise not to change the rebate,'' he said today. "That's something that people relied on at the last election. I think it's a question of trust.''

The Australian Greens support means-testing the private health insurance rebate but not the surcharge hike. "The Medicare levy surcharge unfairly penalises people who have chosen not to take out private health insurance and support the public health system,'' health spokeswoman Rachel Siewert said in a statement. "The Government is targeting conscientious objectors.'' Senator Siewert said the Greens would move to split the bills so the Senate could vote on each measure separately.

SOURCE




Another state-of-the-art government hospital

DOCTORS at one of Sydney's oldest hospitals are demanding the State Government urgently rebuild what they claim is ''a slum'', with possum urine on the walls and dangerous cabling snaking across the floors in the operating theatres. More than 40 senior clinicians at Hornsby Ku-ring-gai Hospital have called for a meeting with the Health Minister, John Della Bosca, in a bid to have the hospital renovated before it becomes too unsafe for staff and patients.

Doctors say most of the operating theatres lack emergency arrest buttons, forcing nurses to yell for help; the theatres are too small for modern equipment, which blocks hallways; and wires hang from ceilings and cables run across the floors, putting staff at risk of electrocution. Some ceilings had collapsed from rain damage and possum nests were found near wards.

''It is offensive and medieval,'' the hospital's clinical director of surgery and anaesthetics, Pip Middleton, said yesterday. ''This hospital serves a burgeoning population of young and old with new housing developments everywhere and is on the crossroads of major freeways, yet we have a significant issue with ageing infrastructure.''

Hornsby Ku-ring-gai Hospital admits about 18,000 people a year and has more than 1500 staff, but its physical condition was ''one of the worst in the state'', the chairman of the medical staff council, Richard Harris, said. ''It is really 19th-century stuff. The only thing that keeps this place going is the goodwill and expertise of the staff.''

It was one of the few in NSW without a coronary care unit, despite research 60 years ago that mortality rates from cardiac arrest were halved if patients were treated in a specialist unit rather than a medical ward, Jason Sharp, a cardiologist, said.

The executive clinical director and head of rehabilitation and aged care, Sue Kurrle, said most of the hospital was ''slum-like and primitive with patients living cheek-by-jowl''. ''There is no privacy, there are holes in the floor, possum wee on the walls. Staff have to jostle to look at the one computer on each ward to get blood test and X-ray results. It is simply third-rate.'' The geriatric and rehabilitation wards survived on bequests from former patients, she said. ''We'd be living in a slum like the rest of the hospital if it wasn't for that money.''

A spokeswoman for Mr Della Bosca said staff had been given $1.3 million for maintenance last year and $21 million had gone towards a building to house a new emergency department and maternity ward. The chief executive of the Northern Sydney Central Coast Area Health Service, Matthew Daly, will meet doctors today.

SOURCE




The difference one dedicated doctor can make

There should be such a facility in every capital city. If needed, fire a bureaucrat to pay for it. Strokes are very common and it is a scandal if people are left needlessly disabled by them

BRITISH tourist Jean Pollock would be severely paralysed - if not dead - if she had not had her brain "vacuum cleaned" at Queen Elizabeth Hospital. Instead of a life of disability, she is looking forward to resuming her holiday after Lotto-sized odds allowed her to shrug off a devastating stroke.

Ms Pollock, 53, flew in from Glasgow planning to surprise relatives by turning up unannounced at her sister-in-law's 50th birthday party in Bendigo this weekend. While visiting friends in Lockleys on Wednesday morning she suddenly slumped, her left arm and leg paralysed, her face droopy and her vision affected. A huge blood clot had blocked an artery in the right side of her brain - a stroke.

Serendipity stepped in. Her friends were aware enough to immediately call an ambulance. Being in Lockleys meant she was in the QEH catchment. The ambulance officers were trained to recognise stroke and called ahead to alert the QEH stroke unit. As seconds played out, the stroke team swung into action, knowing time was as tough an enemy as the clot itself.

On arrival at the QEH, Ms Pollock was quickly assessed with tests including CT scans which confirmed a blood clot in her brain, and that she was clinically eligible for the clot-busting drug tPA. The streamlined stroke management team ensured she had the drug within the mandated three-hour time limit from the onset of stroke. But as one of the 40 per cent of patients on whom the drug doesn't have the desired effect, Ms Pollock faced a future of having her left side paralysed from stroke - or even death.

Serendipity, however, meant she had been brought to one of only two hospitals in Australia with the Penumbra Device, the other being Sydney's Royal North Shore Hospital. The QEH has quietly worked to have its stroke unit equipped and trained as an internationally-recognised centre of excellence. Unit head Dr Jim Jannes had seen the Penumbra Device during a conference in Barcelona, and after checking its potential had successfully lobbied to have the $60,000 device installed at the QEH. Since February, two women suffering strokes had been treated by the machine, improving their recovery, although each still faces lengthy rehabilitation.

On Wednesday morning, with the clot-busting drug not working, Ms Pollock was lucky enough to be in the right place at the right time to allow one more treatment option - the Penumbra Device. Interventional radiologists Steve Chryssidis and Ruben Sebben used the machine to carefully guide a catheter up arteries from Ms Pollock's groin all the way to her brain, while she was conscious. When it reached the clot a probe gently broke up the clot and it was sucked down the tube, clearing the blockage. "There was a big clot blocking her artery and killing her brain - we went in and just vacuumed it out," Dr Chryssidis said.

Dr Jannes said the stroke team weighed up the situation and decided the chance to restore a good quality of life to Ms Pollock outweighed the substantial risks of the procedure. "She went from being paralysed to giving me the thumbs up from the operating table when the procedure was over," Dr Jannes said. "There is nothing more successful than a complete recovery. She would have been left paralysed, possibly dead, if we had not been able to offer her other treatment."

Ms Pollock faces several days of tests but is expected to be released from hospital early this week, fully recovered. "Someone was looking after me - I get goosebumps just thinking about the odds of what might have happened if I had been somewhere else," she said."You have an absolute jewel in the QEH, you should be proud of the work they do."

SOURCE




Democrat rift threatens to doom Barack Obama's healthcare reforms



After weeks of fierce protests against his plans to reform the US healthcare system, President Obama faced revolt inside his own party yesterday amid accusations that he was surrendering to its vociferous opponents. The powerful liberal wing on Capitol Hill threatened to withdraw support for Mr Obama’s healthcare legislation if it did not include a government-run insurance programme — something he has appeared willing to abandon in recent days to try to garner Republican support. However, fiscally conservative Democrats appeared increasingly opposed to the “public option”, leaving Mr Obama with the potential for a dangerous split in the Democratic Party that could doom the legislation.

The eruption of such a fight among Democrats underscored the huge challenge Mr Obama faces in getting legislation passed. It is the centrepiece of his domestic agenda and an issue on which he has spent enormous political capital. Yet despite his efforts, voters are increasingly opposed to the idea of reform amid concerns about its huge cost.

For months Mr Obama has insisted that a government-run programme must be included in his effort to reform the health industry because it was the only way to give private insurance companies the competition needed to reduce soaring costs.

The scheme is opposed fiercely by Republicans, who claim it is too costly and will eventually lead to a solely government-run healthcare system. The conservative “Blue Dog” Democratic caucus in the House of Representatives is also unconvinced by the idea, and without its support the legislation could fail to pass the lower chamber.

In an effort to peel away more Republicans and assuage Blue Dog concerns, Mr Obama appeared to suggest at the weekend that a public option was not essential, describing it as only a “sliver” of his reform plans. His Health Secretary, Kathleen Sebelius, also hinted that the White House was open to dropping the idea.

The reaction from liberals was furious, with one Democratic congressman, Anthony Weiner, saying that without the option Mr Obama could lose 100 votes in the lower chamber, a reaction that would kill any Bill. Yesterday 60 House Democrats sent a letter to Ms Sebelius warning that without a government-run option the legislation would fail. “To take the public option off the table would be a grave error; passage in the House of Representatives depends upon inclusion of it,” the letter declared.

A bipartisan group of six senators trying to reach a deal on the troubled legislation has been pushing the idea of healthcare “co-operatives” as an alternative to a government-run programme. The co-ops would be non-profit, consumer-owned providers of healthcare — yet the idea is so ill defined that Republicans remain unimpressed by it, while liberals decry it.

More here




Legal experts and Civil Rights Commission attack Obama health-care plan as unconstitutional

Constitutional law professor Rob Natelson argues that Obama’s health-care plan is unconstitutional in four different ways. The U.S. Commission on Civil Rights says that the racial preferences and quotas contained in ObamaCare are likely unconstitutional. Professor Natelson says that ObamaCare is unconstitutional because:

“1. It is not based on any enumerated power of Congress, not even on a very expansive reading of the power to regulate interstate commerce.

2. It relies on Excessive Delegation of the type held unconstitutional in Schechter Poultry.

3. It violates Substantive Due Process, and interferes with doctor-patient medical decisions to a vastly greater extent than did the laws declared unconstitutional in Roe v. Wade.

4. It violates the Tenth Amendment by commandeering state governments.”

(However, commenters in response to Professor Natel’s post argue that by the time any challenge to ObamaCare reaches the Supreme Court, Obama will have packed the court with liberal justices who are unsympathetic to such arguments).

The U.S. Commission on Civil Rights has criticized the racial preferences in the health-care bill backed by Obama, saying that they are likely unconstitutional under the Supreme Court’s Adarand decision, which subjected race-based affirmative action to “strict scrutiny” and barred federal racial preferences absent evidence that they are needed to remedy intentional past discrimination by the government. (In cases like Rothe Development Corp. v. Department of Defense and the Western States Paving case, the courts have sometimes struck down federal affirmative-action plans sponsored by liberal lawmakers, citing the Supreme Court’s Adarand decision. ObamaCare goes even further in mandating the use of race than past affirmative action plans.)

Fact checkers say Obama is lying about health care. ObamaCare will cost far more than its predicted trillion-dollar price tag.

One of Obama’s own advisers says the Obama Administration’s health-care plan will harm people with insurance while raising their taxes. Obamacare will take away 5 important freedoms, notes a CNN commentary. It will also destroy many affordable health-care plans while breaking Obama’s campaign promises.

SOURCE




COMMENTARY GALORE

Co-ops: A “public option” by another name : “The real issue has never been the ‘public option’ on its own. The issue is whether the government will take over the U.S. health care system, controlling many of our most important, personal, and private decisions. Even without a public option, the bills in Congress would make Americans pay higher taxes and higher premiums, while government bureaucrats determine what insurance benefits they must have and, ultimately, what care they can receive, says Tanner. ObamaCare was a bad idea with an explicit ‘public option.’ It is still a bad idea without one, explains Tanner.”

When will the health-care debate start? : “I’m waiting for the health-care debate to start. The preliminaries have been spirited and loud, but how about a debate? You may think there’s been a debate, but if you’d been listening carefully, you’d realize it’s a fake, like professional wrestling. To be of value a real debate requires fundamental disagreement. But this pseudo-debate is between one side, led by President Obama, that wants more government control than the large amount we already have, and another, the Republicans, that thinks we already have the right amount.”

A four-step healthcare solution : “It’s true that the US health-care system is a mess, but this demonstrates not market but government failure. To cure the problem requires not different or more government regulations and bureaucracies, as self-serving politicians want us to believe, but the elimination of all existing government controls. It’s time to get serious about health-care reform. Tax credits, vouchers, and privatization will go a long way toward decentralizing the system and removing unnecessary burdens from business.”

Obama kills health competition : “President Obama has repeatedly said that one of his ‘reform’ goals is to increase ‘competition and choice’ in the US health-care system — but the policies he’s pursuing would actually reduce competition and give consumers fewer choices. Meanwhile, he’s ignoring reforms that would bring more choices and competition. The nation now has some 1,300 insurance companies, but most consumers actually have far fewer choices. An American Medical Association survey found that in 299 of 313 largest metro areas, one insurer controls at least 30 percent of the market.”

America’s socialized health care: “Health-care systems in most developed nations are in financial trouble. Health benefits are being cut back because of exploding costs. Degenerative illnesses such as diabetes and cancer are at epidemic levels in spite of new drugs and treatments. While doctors, politicians, and insurers blame each other, they rarely mention the real problem. Skyrocketing costs are due to the structure of health care in all these nations. All are mainly socialized, including America’s.”

Criticising the NHS is not treason : “The deification of this creaking, bloated and massively over-rated money pit has always mystified me. But its reputation as an untouchable and glorious institution is set in stone and, for better or worse, it’s here to stay.”

NHS: No Health Statism : “No system is perfect. But the furthest you can get from perfection is a government controlled monopoly, such as education or healthcare. So it’s no wonder to find the people who are culpable for what passes for healthcare provision defending it to the hilt, as if it was flawless, and claiming that those who criticize it are, ‘un-patriotic’ …. A healthcare system where users don’t have to wait, drugs aren’t rationed, care is not substandard and you’re not more likely to leave with disease rather than a cure is all people request. What we get is the opposite: and to deny that fact (as Cameron et al. have) is to deny us a proper discussion about how our system needs overhauling. The remote political class are trampling over our desire to discuss the problems we face on a daily basis, a fact made even more galling because undoubtedly the majority of them will hold private health insurance.”





19 August, 2009

Thin Skins Across the Pond

There's been a bit of a fuss in Britain the last few days. It's keyed to Americans taking a look at the performance of their government-run health care system, the National Health Service, or NHS, and finding it wanting.

It seems that more than a few Britons are taking this personally, as if our horror at seeing, for example, Britons routinely denied potentially-lifesaving cancer drugs because of their cost is a hostile, anti-Britain sentiment.

Quite the contrary: If we did not like you, we wouldn't be so horrified.

This debate is more than of passing interest to me because this week the National Center for Public Policy Research will release its newest book, "Shattered Lives: 100 Stories of Government Health Care."

The chapter on Britain is the longest.

Beginning soon, we'll be running a story a day from the book in this blog. As we do, I expect I'll also be editorializing a good bit more about what our friends in Britain have said in defense of their own health system, and their attacks on our own.

In the meantime, I recommend this excellent post on the Classically Liberal blog, which contains several stories from Britain. [See below]

SOURCE




The NHS, life expectancy and America's health care debate

Excerpt from the post mentioned above

Bureaucrats who work for the British government’s health care system are unhappy that their system of centrally planned care is being used as an example of what Americans should fear with Obamacare. One such individual, from the Faculty of Public Health, Alan Maryon-Davis, claimed “The NHS (National Health Service does a damn fine job.” And his proof: “We spend less on health in terms of GDP than America but if you look at health indices, especially for life expectancy, we have better figures than they do in America.”

What is interesting is how Maryon-Davis was able to include so much misinformation into one sentence. It is almost breathtaking. So let’s unpack his claim one phrase at a time. “We spend less on health in terms of GDP than America...” This is true. But does it mean anything?

Americans spend more on cars, in terms of GDP, than do Brits. Does this mean Brits have better automobile transportation than Americans? Not at all, they have significantly less. The British government puts a lid on health care in some very simple ways: they deny it. So you can’t get the treatments in the UK that you can get in the United States.

Americans can choose to spend on these treatments, British subjects can not. If we cut the amount of health care we give out, we could cut our costs significantly. Take one example that was in the news recently, because this British woman, agreed to be interviewed by opponents to Obama’s take-over of health care.

Katie Brickell asked for a pap smear when she was 19. The NHS told her she could not have it. When she turned 20, she was told, she could ask again. She asked again, one year later. Now they told her they had changed the rules and she could only have a pap smear when she turned 25. So, once again she delayed the test. When she was 23 they told her she had cervical cancer, the very thing the test is designed to detect. She said: I gave an interview and everything I saw was truthful...” She said: “I would say to anybody in my situation now that if they had the money, they should go private.”

Luckily she was working a company that also provided private insurance. So she was immediately put on drugs that, so far, have saved her life, and appear to have put the cancer in remission. She has to take two different drugs and she acknowledges, that under NHS care “I would have had to get a lot of clearance to get that level of care. On private, that just was not an issue. If I needed a scan, it was immediate. On the NHS, it was often a two or three-week wait.”

The NHS was doing what it was designed to do: cut the costs of health care by rationing health care according to edits set by bureaucrats as their best guess as to what, is a good idea, on average. The rules are set to cut costs. In most cases a 19-year-old doesn’t need a pap smear, Katie wasn’t “most cases.” The system can’t individualize needs the way that private care can.

Thelma Nixon was told that her case of wet macular degeneration would mean she would go blind. She need injections into the eyes to prevent this. Injections, or blindness, there was no other option. The NHS told her she didn’t fit their guidelines because the cost was too great. So they decided she needed to go blind, after all NHS provides health care at a lower cost than the US and that’s a good thing.

Thelma remortgaged her home while the Royal National Institute for the Blind went to bat for her. The press caught on to the story and started campaigning for her. Since British health care is politically controlled this was causing bad publicity for the ruling party and the NHS relented—for Thelma. Those who don’t manage to create a media frenzy around themselves are not so fortunate.

But Thelma’s initial treatments were paid for by herself, from the house mortgage. And when that ran out a local businessman gave her the funds for two more treatments. Other readers of her local paper rallied to her case and provided funding. ONLY after this media frenzy was created did the NHS relent. They sent up new guidelines for assessment and will not disqualify people from care according to the new policies.

More here




British woman gives birth on pavement 'after being refused ambulance'

Don't you just love that good ol' NHS?

A young mother gave birth on a pavement outside a hospital after she was told to make her own way there. Mother-of-three Carmen Blake called her midwife to ask for an ambulance when she went into labour unexpectedly with her fourth child. But the 27-year-old claims she was refused an ambulance and told to walk the 100 metres from her house in Leicester to the city's nearby Royal Infirmary.

Her daughter Mariah was delivered on a pavement outside the hospital by a passer-by, just before ambulance crews arrived. Today the Trust that runs the hospital said it would look into any complaint made about the advice and care the 27-year-old received.

Ms Blake said she started going into labour at about 7.15am on Sunday, August 2. She said: "I phoned up the Royal Infirmary, it's just across the road, and they said to go into a hot bath, and then to make my way over there. "I went into the bath and realised she was going to come quickly. I didn't think I'd be able to make it out of the bath, so I phoned the maternity ward back and told them to get an ambulance out. 'They said they were not sending an ambulance and told me I had had nine months to sort out a lift.'

Experienced mother Ms Blake today said she knew she had to get herself out of the bath and try to get to the hospital. 'The friends with me would have had no idea what to do. I knew at that point that she was nearly here so I had to get out of the house,' she said. 'I thought if I got across the road then at least somebody would be able to help me. 'I left the house and got to the end of the close, but there was no-one around to help.'

Eventually Ms Blake and her friends enlisted the help of a physiotherapist who happened to be passing on her way to work. She dialled 999 and helped deliver baby Mariah while waiting for emergency services. She even helped remove the cord from around the tot's neck, Ms Blake said today.

She said: 'I don't really remember much after that. Mariah was born, then the paramedics arrived then after that the midwives arrived. I think I went into shock. 'It's just lucky that the physio was there.'

Ms Blake said despite the happy ending she was upset she was told to make her own way to the hospital as, being an experienced mum, she knew she did not have the time.

Today a spokeswoman for the University Hospitals of Leicester NHS Trust said: 'We are disappointed that Ms Blake was not happy with the advice and care she received and will of course investigate any complaint. 'We are pleased that both Ms Blake and her daughter are well and healthy.' [Mealy-mouthed indifference]

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Flight to private health insurers in Australia

PEOPLE have flocked to private health insurance in an apparent rejection of the Rudd Government's ability to fix the public health system and in a bid to escape a new levy. The Private Health Insurance Administration Council will today report that private health coverage increased by about 43,000 people since the March quarter – or about 211,000 more people compared with the same time last year.

The Courier-Mail can also report that Queensland Health cancelled 273 elective surgeries in the past month – up from 121 the year before. "Queensland hospitals are currently experiencing an increased demand due to seasonal winter symptoms and H1N1 (and) the increased demand has resulted in some elective surgery patients being postponed due to no ward or intensive care unit beds," a spokesman said.

Federal Opposition health spokesman Peter Dutton questioned the ability of Queensland Health to run an effective system at a time when billions have been diverted to the public health sector, much of it to cut elective surgery waiting lists.

Today's release of the new private health statistics – recorded during rising unemployment, the global financial meltdown and a 6 per cent rise on premiums – comes just days before the Rudd Government introduces a Budget measure that will no longer give high-earners a rebate for taking up private health insurance. But the Bill will be knocked back in the Senate by the Coalition and Independent Senator Nick Xenophon.

The Coalition has accused the Government of breaking its promise to retain support for private health insurance. The Government has already implemented a measure this year, requiring more people to take on private health insurance or face a levy. It sparked the Opposition to claim people would drop out, thereby driving up premiums.

Buoyed by the results, Health Minister Nicola Roxon, who attacked the Liberals yesterday on News Ltd's online site, The Punch, said the Coalition should not use low and middle-income earners to prop up rebates for the rich. Under the new Bill, rebates will be removed for singles earning more than $120,000; reduced from 30 to 10 per cent for those earning more than $90,000; and to 20 per cent for those on more than $75,000.

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We Don't Spend Enough on Health Care

It's crazy to adopt a bean-counting mentality amid revolutionary, albeit expensive, advances in medicine.

Americans are being urged to worry about the nation spending 17% of its gross domestic product each year on health care—a higher percentage than any other country. Addressing the American Medical Association in June, Barack Obama said, "Make no mistake: The cost of our health care is a threat to our economy." But the president is mistaken. Japan spends 8% of its GDP on health care—the same as Zimbabwe. South Korea and Haiti both spend 6%. Monaco spends 5%, which is what Afghanistan spends. Do all of these countries have economies that are less "threatened" than that of the U.S.?

No. So there must be other factors that affect the health of a nation's economy.

Mr. Obama has said that "the cost of health care has weighed down our economy." No one thinks the 20% of our GDP that's attributable to manufacturing is weighing down the economy, because it's intuitively clear that one person's expenditure on widgets is another person's income. But the same is true of the health-care industry. The $2.4 trillion Americans spend each year for health care doesn't go up in smoke. It's paid to other Americans.

The basic material needs of human beings are food, clothing and shelter. The desire for food and clothing drove hunter-gatherer economies and, subsequently, agricultural economies, for millennia. The Industrial Revolution was driven by the desire for clothing. Thus Richard Arkwright's water frame, James Hargreaves's spinning jenny, Samuel Crompton's spinning mule, Eli Whitney's cotton gin and Elias Howe's sewing machine.

Though it hasn't been widely realized, the desire for shelter was a major driver of the U.S. economy during the second half of the 20th century and the first several years of the 21st. About one-third of the new jobs created during the latter period were directly or indirectly related to housing, as the stupendous ripple effect of the bursting housing bubble should make painfully obvious.

Once these material needs are substantially met, desire for health care—without which there can be no enjoyment of food, clothing or shelter—becomes a significant, perhaps a principal, driver of the economy.

A little-noticed feature of the current recession is the role of the health-care industry as a resilient driver of the general economy. Health-care now accounts for 10.4% of nonfarm employment. Health-care employment grew by 19,600 jobs in July 2009, on a par with the average monthly gain for the first half of 2009, which was down from an average monthly increase of 30,000 in 2008. Remarkably, these gains occurred in a period during which total employment shrank by 6.7 million.

The U.S. health-care economy should be viewed not as a burden but as an engine of growth. Medical and orthopedic equipment exports increased by 65.1% from 2004 through 2008. Pharmaceutical exports were up 74.6%. The unprecedented advances expected to come out of American stem cell, nanotechnology and human genome research—which other countries' constricted health sectors cannot support—will send these already impressive figures skyward.

A study by Deloitte LLP has found that more than 400,000 non-U.S. residents obtained medical care in the U.S. in 2008, and it forecasts an annual increase of 3%. Some 3.5% of inpatient procedures at U.S. hospitals were performed on international patients, many of them escaping from Canada's supposedly superior health system.

"Inbound medical tourism," Deloitte stated, "is primarily driven by the search for high-quality care without extensive waiting periods. Foreign patients are willing to pay more for care within the United States if these two factors play a large role." The deficiencies of the foreign health-care systems the Obama administration wishes to emulate can be counted on to generate ever-increasing revenues for U.S. providers and employment for Americans.

In a 2007 study, Stanford University economists Robert E. Hall (who will take office next year as president of the American Economic Association) and Charles I. Jones reported that modeling they've conducted has found that mid-21st century U.S. health-care expenditures would optimally amount to 30% of GDP or more. They wrote:

"We examine the allocation of resources that maximizes social welfare in our model. We abstract from the complicated institutions that shape spending in the United States and ask a more basic question: from a social welfare standpoint, how much should the nation spend on health care, and what is the time path of optimal health spending? . . .

"Viewed from every angle, our results support the proposition that both historical and future increases in the health spending share are desirable. . . . [W]e believe it likely that maximizing social welfare in the United States will require the development of institutions that are consistent with spending 30 percent or more of GDP on health by the middle of the century."

The administration's health-care plan is biased toward bean-counting rather than designed to maximize American physical and mental well-being. We need to ask ourselves whether there is truly anything more valuable to us than our loved ones and our own health and longevity.

In the signature radio sketch of Jack Benny, whose performing persona was laughably frugal, actor Eddie Marr snarled at him, "Don't make a move—this is a stickup. Now, come on: Your money or your life." Benny didn't respond. The "robber" said, "Look, bud—I said your money or your life!" Whereupon Benny shot back, "I'm thinking it over!"

Confronted for the first time in history with a constant stream of medical innovations that are marvelously effective but tend to be very expensive, our legislative representatives—in particular, the Blue Dog Democrats—would do well to stop "thinking it over" and to commit themselves to action that will preserve the ability of Americans to choose life over money.

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I want my referee

Currently, consumers enter into a health-care contract with an insurance company. This contract has an asymmetric payoff, in that the insurance company gains when a consumer stays healthy, and the consumer gains if they fall ill. If a consumer falls ill, the insurance company would like to renege on its obligation. Yet it cannot, because the contract is enforced by an unbiased referee. That referee is the United States government.

The fundamental problem with the Democrat's health care proposal is that it will cause the the government to abandon its "referee" role in order to become my "contractual opponent." Democrats suggest that government can play the role of both opponent and referee. Maybe I'm too competitive, but I prefer when my opponent and my referee are not the same person.

Opposition to "health care reform" is not so much philosophical as it is practical. Sarah Palin learned something at the University of Idaho that a lot of folks didn't learn at Harvard: when contractual payoffs are asymmetric, you need a referee to ensure compliance. I want my referee, and the Democrats are trying to take it away from me. Doesn't that justify a little anger?

To clarify, this debate is one of degrees. The government has been involved in providing health care for decades, and from that perspective, perhaps current proposals may not seem so radical. Yet at some point, the government's engagement as a contractual opponent will cause it to abandon the role of referee. My concern is that the current proposals before Congress would push us well past that point.

I'm not much interested in defending the current system we use to provide and finance health care in the United States. However, the "right way" to do it (whatever that may be) is going to incorporate the role of an unbiased referee. Health insurance contracts are designed such that the insurer (regardless of whether it's an insurance company or the federal government) always has an incentive to shirk on their end of the bargain. The referee's job is to make sure they don't.

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18 August, 2009

A pathetic Brit relies on lies and innuendo to defame U.S. healthcare

He says that U.S. healthcare "throws out" sickly babies. The truth is absolutely the reverse. It is because U.S. doctors pull out all stops in an attempt to save premature babies that the U.S. has a higher infant mortality rate. Some of those heroic efforts necessarily fail and that is recorded as an infant death. In other countries it would be counted as stillborn or not recorded at all. And he says that he did not go to the top U.S. surgeon because he thought an "apprentice" might operate on him. Did he not think that he could arrange whether or not that would happen? It could not happen without his permission. And in the end he found that the treatment still cost him a bundle on the NHS. His insurer would most likely have given it to him free in the U.S. The guy is just trying to justify his own bad decisions

One of the killer statistics bandied about in the present dogfight over “Obamacare” is that under the UK’s “socialised” medicine, 57 per cent of men with prostate cancer survive to die of something else. In the US, under “free-world” medicine, that figure is 90 per cent. Which means, presumably, that if Abdul Baset Ali al-Megrahi had been incarcerated in a US jail he’d be eating prison chow for years to come, instead of being released on compassionate grounds. Put another way, the NHS kills.

September will be yet another Prostate Cancer Awareness Month. And, as before, awareness about the second leading cause of death among ageing men will remain abysmal. Those pink ribbons for breast cancer win out every time.

The truth is that the only thing that makes a fellow really “aware” is when he hears the ominous words: “I’m sorry to tell you, the biopsy reveals that you have prostate cancer.” I had that message by phone, at 4.25pm on February 17, 2009.

As Dr Johnson said, death sentences concentrate the mind wonderfully. But, of course, it’s not a death sentence. Go to any of the websites for prostate cancer survivors and the first thing you learn is that only one out of six who have this particular carcinoma die of it, even if it’s left untreated. It’s Russian roulette. With the barrel pointed at your testicles. “Do you feel lucky punk? Well do you?” as the man said.

My situation forced me to engage, in a very practical way, with the current arguments over the NHS and American healthcare. I taught for three months in California last winter. While there I had top-notch health coverage. Under enlightened US law, my employer was obliged to continue that coverage, for minimal co-payment, for 18 months after my leaving their employ. No exclusions. I could, therefore, have state-of-the-art treatment at somewhere such as Cedars Sinai. It would cost me not a cent.

But I’m also covered by the NHS, have been since 1948, and by Bupa: but it covers only half the cost of the surgery. What would you choose with killer cells multiplying like homicidal lice in your groin? I decided on surgery. But which nation’s healing scalpel?

One thing that strikes you, after you’ve done some research, is why is the best treatment for prostate cancer always pioneered in America? Nowadays you can pick from radium seeds (what Rudy Giuliani chose); nerve-sparing da Vinci robotic surgery (what John Kerry chose) or Hifu (high-intensity focused ultrasound). What do they have in common? IiA — Invented in America. What else do they have in common? They are hard to come by on the NHS. Not impossible (except for Hifu, which is not approved by the National Institute for Health and Clinical Excellence), but hard.

Why has America led the way against this horrible scourge of elderly men? Follow the money. Males in the red zone for prostate cancer (roughly 50 to 80-year-olds) are the most lucratively insured sector of the US population. American medicine is not a “service” it’s an “industry”, driven by the bottom line. The spin-off? Research and development goes where the dollars are. Old guys strike lucky.

Now cross the Atlantic. You’re holding the NHS pursestrings, and have the following dilemma:

1. A one-month-old baby with a hole in the heart. Cost to cure, £x;

2. A 30-year-old woman with breast cancer. Cost to cure, £x;

3. A 70-year-old man with prostate cancer. Cost to cure, £x;

but you only have £2x to hand out. Whom do you throw overboard? The iron law of triage in the UK tilts the board against the luckless prostate. America throws the (often unremunerative) babies overboard, which is why (as Michael Moore crows) it has higher infant mortality than Cuba. And old guys strike out.

So, being an elderly man, I should have gone American: particularly as I had resolved on robotic prostatectomy. But I didn’t. Why not? The reason is everywhere on websites, where the consensus is: “Go for the very best surgeon. And be sure to choose one who’s done more than a thousand procedures.”

I could have chosen a leading da Vinci specialist in Los Angeles. But so big is the robotic business in the US that those star surgeons have troops of young surgeons in training with them. Well disposed as I am to teaching hospitals, I did not want to be some starlet’s apprentice work.

If I wanted robotic surgery in the UK the best person, I was told, was Professor Roger Kirby. Kirby is forever raising charity money for prostate cancer treatment but — so expensive and in such short supply is the robotic machinery he uses — that he charges. In point of fact, the charge is modest: less than the cost of every second car that passes you in the fast lane on the motorway.

In a few years time I suspect the NHS will be where the US now is on prostate cancer treatment. At the moment, if you want US standards of treatment in the UK you will probably have to pay, out of your pocket or through medical insurance.

There were some painful incisions on my wallet. But the histopathology revealed that the cancer had been expertly scooped out by Professor Kirby and his pal Leonardo. I felt lucky. And very grateful.

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Scrap swine flu phone checks says father of British tonsillitis sufferer who died after misdiagnosis

Another death from Britain's careless swine flu procedures

The distraught father of a teenage girl who died after her tonsillitis was deemed to be swine flu is calling for over-the-phone diagnosis to be scrapped. Karl Hartey accused the Government of having 'blood on its hands' after his 16-year-old daughter Charlotte died from complications arising from tonsillitis. The case will further increase concerns that illnesses, some of them serious, are increasingly being misdiagnosed as swine flu.

Following revelations that 16-year-olds are being employed at a swine flu call centre, there are also fears that many of those doling out advice and the anti-viral drug Tamilfu are not qualified to do so. Last week the parents of a girl of two told how their daughter died of meningitis after she was misdiagnosed.

In the latest case Charlotte Hartey was told she had swine flu over the phone by a local GP. She was prescribed Tamiflu but her condition deteriorated and she was admitted to Royal Shrewsbury Hospital on July 29 where she died two days later after her lungs collapsed when bacteria overwhelmed her immune system. A post-mortem found Charlotte, from Oswestry, Shropshire, died from natural causes.

Her father Karl attacked Ministers over the introduction of call centres, manned by teenagers to diagnose potential swine flu cases. Mr Hartey, 42, said: 'The Government has blood on its hands. 'This was tonsillitis. Every child in the country is likely to get it. We have to change the Government policy on this. 'We have got to go back to old-fashioned doctoring.'

Mr Hartey has begun a campaign to end the telephone diagnoses of swine flu, using Charlotte's memorial page on Facebook to gather pledges of support which will be presented to Downing Street. Six-hundred visitors to the site have so far promised their support since it went live last Thursday.

Mr Hartey, an investment adviser, said: 'We have to ban call centres giving medical diagnosis. We want this to go as high as it possibly can, to the Prime Minister. 'I want him to accept that Charlotte was misdiagnosed. I want him to look me in the eye and say sorry for our loss. 'It won't bring Charlotte back, but it will stop other children being misdiagnosed. 'Charlotte had such a life ahead. Her future was enormous and has been snatched away.

'Charlotte is not the first person to have died because of misdiagnosis. We are fighting a war against call centre advice. 'I am not putting blame on the doctors because they follow instructions from the Government, which says not to see swine flu victims. 'This is a breach of our human rights. The Government is restricting us from going to the doctor.'

Two-year-old Georgia Keeling died from meningitis after being misdiagnosed over the phone and by a paramedic. Her parents were repeatedly told she didn't need to go to hospital and she was given Tamiflu and paracetamol. Salesman Paul Sewell, 21, and his wife Tasha, 22, from Norwich, claimed medics had diagnosed her before they looked at her.

Mother-of-three Jasvir Gill, 48, of Leicester, also died this month days after being misdiagnosed with swine flu. She began suffering from a sore throat and vomiting and was told to take Tamiflu in a telephone diagnosis. Around 12 hours later she had a heart attack and died from blood poisoning caused by meningitis.

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Australia's Leftist government simply hates private health insurance

The idea that those who work and save get better treatment than those who blow all their money on beer and cigarettes is just anathema to them -- so they are trying to make private health insurance harder to afford

Make no mistake about it. The battle to preserve Australia’s mix of public and private health care will be joined in earnest this week. At stake is a worsening of the shaky health of our public hospitals. At stake also is a direct cost impact for almost half the population who have private health insurance and an indirect, or delayed, impact on those who rely on public hospitals for treatment.

Labor’s attack on private health insurance through this year’s Budget will force substantial numbers of people to drop or downgrade their insurance coverage meaning many, many more people will be seeking treatment at public hospitals. Longer waits in Accident and Emergency Departments, longer waits on lists for surgery lay ahead if this attack succeeds.

Nothing holds the potential to increase the stresses and strains on our hospitals more than the changes to private health insurance rebates contained in the erroneously named Fairer Private Health Insurance Incentives Bills, which are expected to be debated in the Senate this week. Every decision Kevin Rudd has taken since coming to Government will make our public health system worse – making a mockery of his oft-repeated promise that he had a plan to “fix” the nation’s public hospitals.

There is no doubt that the health sector is paying a high price for Labor’s reckless spending over the past nine months which has the nation spinning into massive debt. The Government has targeted many areas of health to claw-back savings, but the targeting of private health insurance rebates carries the added factor of ideology – Labor hates private health insurance - and this is a serious direct attack upon it.

It is also a trashing of numerous promises both Mr Rudd and his now Health Minister Nicola Roxon made before the last election - to both the public and the insurance sector - that Labor would not change these rebates paid to those who take out private health insurance and in so doing relieve the call on public hospitals.

The phasing down of the universal 30 per cent rebate, in three stages, to 20 per cent, 10 per cent and eventually to zero for those earning over $75,000 (singles) and $150,000 (families or couples) will mean 1.7 million Australians will immediately face private health insurance premium increases of between 14 and 43 per cent. One million people are likely to drop or downgrade their insurance cover forcing premium increases for all who maintain insurance.

In seeking to cut the rebate to so-called higher income earners the Rudd Government will hammer low and middle income earners with higher prices. It’s worth noting that a million people – one million Australians, probably many of them elderly – earning less than $26,000 a year make the struggle to pay for private health insurance. Does it want them to also opt out of private insurance and join the queue at our public hospitals? If so what impact could all this have?

The private health sector estimates it could transfer 75,000 treatment episodes from private to public health care. Public hospitals will have to accommodate an extra 190,000 bed days at a cost of $200 million. Four million allied health services would no longer be covered by insurance costing another $200 million. Two million dental care treatments for which private insurance would have paid $100 million would also no longer be covered.

If those estimates even partially come to pass, it creates a huge hole in the $1.9 billion in savings Rudd Labor estimates it will make by changing the rebates. It will also push our public hospitals further toward breaking point.

Reductions in Medicare rebates for cataract surgery and various other treatments, caps on the Extended Medicare Safety Net and the 2008 Budget changes to the Medicare Levy threshold all have implications for adding to pressures on the hospital system – the one that Kevin Rudd said he would “fix” by June this year.

The Coalition will oppose the private health insurance rebate cuts when they come before the Senate this week. The savings needed by this Government to the nation’s bottom-line can be achieved in other ways. The Coalition has proposed an increase in the excise on cigarettes that would more than cover the $1.9 billion in savings projected from the rebate changes. Rudd Labor does not have to further threaten our public hospitals which its State Labor Governments have so dramatically mismanaged for far too many years.

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Coverup after negligent Australian public hospital causes two deaths

A HOSPITAL patient, who was discharged and allowed to drive home despite pleas from his family, died minutes later in a car crash that also killed another driver. Rodney Knowles rang his son and brother from Shoalhaven District Hospital in NSW on October 25 last year after having routine dialysis and sounded "delusional". Both separately begged the nurse on the phone not to let him drive home, but he got behind the wheel and had a head-on crash, killing himself and another driver aged in his 50s.

The Health Care Complaints Commission declined to investigate and the NSW Medical Board dismissed a complaint made after the incident. The hospital's doctor, Shanka Karunarathne, acknowledged to the HCCC that he amended Mr Knowles' medical records after Mr Knowles' death to say he offered to admit him, but Mr Knowles declined. Dr Karunarathne said he was the only medical registrar at the hospital at the time and did not have time to complete his notes. "As I was required elsewhere in the hospital at that time, I later made a retrospective entry to confirm the discussion," he wrote in answer to questions from the Health Care Complaints Commission.

Shoalhaven Hospital said Mr Knowles, 71, was medically assessed as competent the day of his death, despite him reporting feeling unwell and skipping some meals. They gave him juice and food which boosted his blood sugar levels prior to him leaving.

The HCCC said an investigation was not warranted because it was unlikely to lead to disciplinary action against the nurse involved, Julie Owen, or any recommendations to Shoalhaven Hospital. The NSW Medical Board also dismissed the complaint against Dr Karunarathne.

Mr Knowles' son Brendan said: "He had kidney failure, we expected at some point he would go, but to happen so tragically and in the circumstances which it happened when we begged them not to let him drive, I just can't fathom how they can turn around and say they couldn't do anything. "We want some answers. We don't want it to happen again. As well as dad being killed there was another gentleman killed, an innocent party. We want some answers for his family too."

Rodney Knowles had been admitted to the emergency department three days before his death with chest pains and was discharged on October 24. He returned the next day for dialysis. Police believe he blacked out and veered onto the wrong side of the road. The coroner said he died "nearly immediately" from traumatic injuries.

Opposition health spokeswoman Jillian Skinner said the family deserved an explanation. "This family has been through hell and deserve a full explanation from Health Minister John Della Bosca," she said. Mr Della Bosca said while he felt for the family, he would not comment on the case until all inquiries had been completed.

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Protests force Obama to consider dropping health insurance scheme



BUCKLING under the weight of popular fury, the Obama administration seems ready to ditch one of the central planks of its controversial health reforms - the creation of an insurance scheme funded by taxpayers. At a town hall meeting in Colorado at the weekend, President Obama conceded for the first time that his final reform bill might not include an NHS-style system. Fears of a government bureaucracy deciding who gets medical treatment have provoked confrontations between voters and their representatives in Congress across America in the past two weeks. "The public option - whether we have it or we don't have it - is not the entirety of healthcare reform," Mr Obama told a largely sympathetic crowd at Grand Junction, Colorado.

The message was further amplified yesterday by Kathleen Sebelius, his Health Secretary, who told CNN that the public option was "not an essential element". The concession should help to remove a significant obstacle to the bill's passage through Congress. About 80 per cent of Americans are covered by private insurance schemes. The government-funded Medicare program pays private insurers for the treatment of another 46 million.

Promising to create near-universal healthcare, Mr Obama had sought competition to the much criticised insurance companies through the establishment of a public sector rival. Such plans have, however, sparked fears of creeping socialism.

Apart from ideological objections, even many Medicare patients did not fancy their chances with government-appointed panels scrutinising treatment. Those already insured worried that they would be driven to the cheaper, and supposedly leaner, public scheme. It is often the employer, paying a large part of the premiums, who decide the level of coverage.

Stung by the town hall protests and mounting resistance in Congress, Mr Obama has decided to appeal to voters directly for support. In an emotional outing in Colorado, he evoked the memory of his grandmother to lay rumours about government "death panels" to rest. He said: "I just lost my grandmother last year ... So the notion that somehow I ran for public office, or members of Congress are in this so they can go around pulling the plug on grandma? When you start making arguments like that, that's simply dishonest."

He also took a swipe at the insurance lobby, which funds many of the alarmist adverts against the health reforms. Citing a 2007 survey, Mr Obama said in an article written for The New York Times that "insurance companies discriminated against more than 12 million Americans in the previous three years because they had a pre-existing illness or condition". "We will put an end to these practices," he pledged.

He will be able to do that only if the bill is adopted. In the Senate, Mr Obama needs the votes of all 60 Democrats to prevent the Republicans blocking it and one of his closest allies, Edward Kennedy, is unlikely to be able to help. Mr Kennedy, a lifelong advocate of universal healthcare who is suffering from a brain tumour, has not been seen in public for months.

With the public insurance scheme included, Mr Obama would in any case be far short of the 60 votes required, as a key Democratic senator indicated yesterday. "The fact of the matter is there are not the votes in the United States Senate for the public option," Kent Conrad said on Fox News Sunday. "There never have been. So to continue to chase that rabbit, I think, is just a wasted effort."

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American health care expectations are already distorted

The other day, I was in the pharmacy at my local HMO facility picking up a prescription. I know you aren’t supposed to listen to what the people up at the window are saying, but this one guy was virtually shouting and was quite hard to ignore. He was upset with the staff member who was trying to talk him through something that was obviously terribly upsetting. Again, it really wasn’t appropriate to eavesdrop, so please don’t pass this along.

It seems that he was picking up a refill on some meds (my thought was that I hoped they were chill pills of some sort) and he was distressed that a previous prescription of 150 pills was refilled with only 75. Now, it wasn’t the capsule-count that bothered him – he just didn’t want to have to pay the same $10.00 co-pay for the 75 that he did for the 150. Never mind that the co-pay scale is pretty well set and that $10.00 is the bottom-line fee. Nope. He thought he should pay less. Or nothing.

The flustered, yet knowledgeable lady at the window then proceeded to show him how much the medicine would cost if he were to purchase it out of the system. Needless to say it wasn’t 10 bucks, but rather several multiples of it. Yet the guy who was buying medicine at a paid-down price still thought he was paying too much.

It’s a mindset – one that seems to be pervasive. In fact, I suspect he may be one of millions of Americans who seem to think that medicine and medical care should not really cost them personally much of anything. Let the rich people pay for all of us – or the employer, or the government, it’s too expensive for me. Because it costs so much, goes the thinking, I really shouldn’t have to pay. God forbid that any American should have too many out of pocket health care expenses. The logic is: Nobody can afford it; somebody else should pay. Why does that remind me of something Yogi Berra might have once said?

Some time ago, I came to a parting of the ways with an employee. When our human resources person briefed him on COBRA to allow him to continue with health insurance coverage, he balked saying something to the effect: “I’m not paying for that.” Never mind that he had a wife and children and that being uninsured put them all at financial risk, he was unwilling to pay up out of pocket. To him, it was apparently just not something that was a financial priority. At any rate, he had told me and others that he was looking forward to the day when Barack Obama became president and everyone got coverage, whether they worked or not. Of course, under the Obama plan this man would be fined for not having insurance when it was accessible to him.

I got the same kind of response when I put the health care reform issue out to a talk radio audience recently. I asked specifically for callers who had no coverage – wondering how they felt about the whole megilla. Frankly, I was surprised that so many who did not have health insurance actually had access to it, but really didn’t feel it was worth it to pay for it. One caller told me that, at any rate, if he got sick he could just go to the emergency room, indicating that if the bill were too big and he couldn’t pay it would be the hospital’s problem. I suspect that more people think this way than we’d like to admit.

Actually, that kind of thing becomes everyone’s problem. And being lost in this national “teachable moment” are concepts like personal responsibility and living in such a way so as not to be a burden on others.

The reason something as integrity-rich as the idea of paying for what you receive is widely resisted when it comes to health care is because it is, in fact, so very expensive. But maybe if people accepted more personal responsibility and resisted the it-costs-so-much-I-can’t-afford-it-let-them-pay philosophy we might see some common sense enter the discussion.

Here’s an idea, why don’t we reform the system by turning it into one where individuals purchase their own insurance. What if every employer stopped providing health insurance as a benefit and instead translated the actual dollars spent on an employee’s plan into straight income - saying, in effect, “Here’s your health insurance money, you shop and buy your own plan.” This would need to be accompanied of course by market-based reform, eliminating the practice where states deny health plans from other states into their markets, and making such insurance completely portable, not tied to where you work.

The income used for health insurance could be tax exempt. If it wasn’t used to purchase insurance, it could be taxed – creating incentive. And if someone refused to spend the money they had on actually accessible insurance because, say, they wanted to buy a bigger house or car, well, then put a system in place where the government would help the hospital collect a bill over time, in the event of a costly illness. Pay me now or pay me later. Something like this has been described by John McClaughry president of the Ethan Allen Institute in a recent article entitled: What To Do With The Uninsured.

How many Americans would actually pay for health insurance under such circumstances? It’s hard to say. Possibly, we have been so conditioned to having another entity provide and pay for it that we truly see it as something that should be done for us?

It is axiomatic. Failure to act responsibly leads to the intervention of other parties, in the health care case – that would be the government. This intervention always means less autonomy and liberty.

Health insurance as we know it has only been around for about 80 years. With the rise of the New Deal and labor unions in the 1930s and then the economic realities during the crisis of World War II, Americans became increasingly accustomed to having the whole health care thing being part of an employee benefits package. In fact, during the war, when wages were somewhat regulated, the one way an employer could give someone a little more was through the benefits package. Before long it became part of how things were done. You got a job and you got paid in money and stuff like health insurance. Cool.

The problem with it was that it began to put a degree of separation between the consumer and the health care service provider – we moved from a fee for service approach to something much more indirect and impersonal. Someone else was paying the bill. And when the apartment comes with utilities included you don’t look at the thermostat as much. Out of sight, out of mind. It’s no longer a market-driven enterprise.

When I was young boy, my dad had really good insurance because he was a Teamster. It wasn’t really called health insurance, though. It was hospitalization insurance. It was there for the tonsillectomy – not the runny nose. It was there for stitches in the emergency room, not for the yearly physical, or the chicken pox. In fact, when we went to the doctor, mom wrote a check. Doctor visits were not really health insurance issues. Even if people had good insurance, they usually still had to pay out of pocket to go to the family doctor, as with the dentist.

These days, though, with our whole health maintenance and managed care way of thinking, it’s all about minimizing out of pocket expenses. The problem is that this doesn’t eliminate the actual expense – it just takes it from view and increases the costs exponentially behind the scenes. We don’t see the transaction, so it isn’t really there.

Health insurance morphed into a right. Every one should have it and it should only cost those who can afford it. And few can really afford it, so the government should pay. We sure hope they have enough money – oh, what the heck, they’ll just print more. Or tax the rich more. So what if the top 1% of American households fork out more in taxes than the bottom 95% combined.

Our desire never to be out of pocket will one day soon lead to our country being out of pockets.

Putting a so-called public option into the mix is a poorly disguised foot in the door en route to the real goal of a single payer system. And once such a system is in place, it will never go away. Even conservatives in Britain don’t mess with their National Health Service (NHS). It’s part of the national fabric, like Social Security and Medicare are here already. Never mind that cancer patients over there have to wait on treatment so bureaucrats can meet “target” goals or that neurology delays put lives at risk or that some patients will now be paid to go “private” in certain cases.

After all, they have only had 61 years to work the kinks out of a program that is even now facing a funding crisis. Give them time. And surely we’d do better, right? Just look at the Post Office. Or Amtrak.

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17 August, 2009

Death toll from hospital bugs hits new high in British government hospitals

More than 30,000 people have died after contracting the hospital infections MRSA and Clostridium difficile in just five years, official figures will show this week. Most places you go to hospital to get well. In Britain you often go to hospitals to get worse, even to get killed. British government hospitals are very dangerous places for sick people. Isn't that socialist "caring" great? How do 30,000 unnecessary deaths grab you as testimony to the benefits of socialized medicine?

Data from the Office for National Statistics covering 2004 to 2008 is expected to show record numbers of deaths linked to the superbugs in England and Wales. Opposition politicians said the Government had allowed "a horrifying death toll" because of its "slow and sloppy" response to spiralling levels of infection in NHS hospitals.

Official data shows a doubling in the death toll linked to MRSA during the period 2004 to 2007, compared with the previous four years, and a quadrupling in deaths linked to C. diff, when two sets of three-year figures are compared. Between 2004 and 2007 there were more than 20,000 deaths linked to C. diff and more than 6,000 associated with MRSA.

Norman Lamb, the Liberal Democrat health spokesman, said: "These figures describe an absolutely horrifying death toll, and many of these people have lost their lives because of infections which could have been avoided if firm action on infection had been taken a long time ago".

Annual deaths linked to MRSA quadrupled between 1997 and 2007, while those associated with C. diff quadrupled between 2004 and 2007, figures show. The spread of infections into most British hospitals, which occurred under the last Conservative government, had been allowed to "escalate, and become out of control" under Labour, Mr Lamb said, with waiting targets and efficiency prioritised over basic safety and cleanliness.

Katherine Murphy, from the Patients Association, said the statistics showed the gulf between "flowery" Government rhetoric about a war on infection, and poor hygiene which had been allowed to continue unchecked. "The NHS has been told to put other targets ahead of safety, and this is the inevitable outcome," she added.

Infection experts have repeatedly warned that assessments based on the number of death certificates which record the presence of MRSA and C. diff are likely to underestimate the scale of the problem, because doctors are reluctant to admit that basic infections have caused fatalities.

Earlier figures published by the ONS have shown that the worst hospital for C. diff deaths in England or Wales was the Royal United Hospital in Bath, which had 268 deaths from the infection between 2002 and 2006. The George Eliot hospital in Nuneaton, Warwickshire, the Walsgrave Hospital in Coventry and the Royal Infirmary in Leicester all had more than 200 deaths caused by the infection over the same period. The worst-ever outbreak of C. diff in this country occurred between 2004 and 2006 at Maidstone and Tunbridge Wells NHS Trust, where the bug was linked to the deaths of 331 patients.

More than 5,000 people have backed The Sunday Telegraph's Heal Our Hospitals campaign, which is calling for a review of hospital targets to make sure they work to improve quality of care.

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Australia: Negligent doctors and public hospital kill young mother

After all the publicity about swine flu, you would think that the doctors would take that possibility seriously from the outset. If the hospital had given her Tamiflu and admitted her for observation she would almost certainly be alive today. Instead they sent her home with just a household headache medication

A previously healthy 34-year-old mother-of-two who died from swine flu last week was seen by four separate doctors over four days before she was finally admitted to hospital. Her family say her deteriorating health – including difficulty walking – was mostly ignored as she was repeatedly sent home when seeking help for her illness.

Sheridan Wilson died in Brisbane's Prince Charles Hospital on Thursday. She had presented herself at Townsville Hospital's emergency department a week earlier, saying she was in extreme discomfort from flu-like symptoms. Doctors told Mrs Wilson to go home, take some Panadol and get some sleep, her family said. She had no underlying health conditions and was not immediately tested for swine flu. Nor was she given any of the anti-viral drug Tamiflu.

Mrs Wilson's distraught family yesterday pleaded with Queensland Health to stop treating potential swine flu victims like "lumps of meat" and start taking the pandemic seriously. They want Tamiflu offered to everyone with flu symptoms and not just those deemed by the department as being in the "at-risk" group which includes pregnant women, the elderly, the obese, indigenous people and those with other health problems.

Mrs Wilson's mother-in-law Marilyn broke down in tears yesterday as she told The Sunday Mail that Sheridan followed Queensland Health's official advice on swine flu to the letter. She first went to her GP, then later when symptoms worsened, went to the emergency room at Townsville Hospital. She was later transported to Brisbane, where she died. "Sheridan did everything right," Marilyn Wilson said. "She went to a GP first, who sent her home with hardly a second thought.

"Then I took her to the emergency department who put her on a drip for dehydration for two hours before sending her home and telling her to take some Panadol. "She was getting worse so she went to a GP the next morning (Friday), and then another GP on Saturday morning who told her 'wait a few hours and if it gets worse go to the hospital'." After seeing three GPs and a doctor at the hospital's emergency department, Mrs Wilson was finally admitted to Townsville Hospital's ICU last Saturday.

"Sheridan put her life in these people's hands and all the GPs did was take her money and kick her out," she said. "Our family will never be the same again."

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WHO ARE THE UNINSURED AND SHOULD WE PAY TO COVER THEM?

Keith Hennessey has analyzed 20 statements made by President Obama during the town hall meeting on health care at Portsmouth, New Hampshire. You can read Hennessey's analysis at his home page. One of the statements Hennessey examines pertains to what, for Obama and many others, is the starting point in the debate - the number of people who are uninsured. In Portsmouth, Obama had this to say:

I don't have to explain to you that nearly 46 million Americans don't have health insurance coverage today. In the wealthiest nation on Earth, 46 million of our fellow citizens have no coverage. They are just vulnerable. If something happens, they go bankrupt, or they don't get the care they need.

Hennessey breaks this group of nearly 46 million into five categories. The first, consisting of about 6.5 million, actually is insured. According to Hennessey, they are enrolled in Medicaid or S-CHIP but didn't tell the census taker. This is called the "Medicaid undercount."

The second group, about 4.5 million, consists of people who are eligible for Medicaid or S-CHIP but have not enrolled. If they need care, the hospital or clinic generally enrolls them. In other words, they do not (as Obama claims) go bankrupt or without treatment. In any case, it would be ridiculous to overhaul our healthcare system to provide insurance to people who are already eligible for government assistance but have failed to avail themselves of it.

The third group, about 9.5 million, is comprised of non-citizens. Hennessey notes that people will disagree about what portion of this group should receive government subsidized health insurance. In my view, none should.

And keep in mind that being uninsured is not the same as having to pay (or pay much) for treatment. I've heard illegal immigrants say that they find ways to receive free or inexpensive treatment for themselves and their children. In general, I've read (though I can't find the source) that the uninsured receive about half the amount of money per capita to pay for medical treatment that the insured receive.

The fourth group, another 10 million, earns an income more than three times the poverty line. As such, they can afford to buy medical insurance. Taxpayers should not be required to buy it for them.

This leaves about 15.5 million (one-third of Obama's 46 million) who actually are uninsured, cannot become insured simply by enrolling in a free program, are U.S. citizens, and cannot easily afford to purchase insurance. About 5 million members of this cohort are childless adults.

It is understandable that many Americans would like to see the government do something for this group, or at least those members who are not young, childless, healthy adults with decent starter salaries who simply think it makes economic sense to assume the small risk that they will incur large medical expenses. But it is also understandable that many Americans favor targeting this group through incremental measures to assist them in purchasing insurance, rather than through a radical overhaul of our healthcare system at a massive cost.

Obama knows he needs a big number of "uninsured" to even get in the vicinity of selling what he has in mind to a skeptical public. But the big number he has selected would not get him in the vicinity if the public better understood who it consists of.

JOHN adds: Many young, single people make a perfectly rational decision not to buy health insurance. Accidents are the biggest threat to their health; car accidents are covered by automobile insurance and work-related accidents are covered by workmen's comp. The chance of a young person contracting a catastrophic disease (leukemia, say) is remote, and people aren't stupid: they know that if they contract such a disease they will be treated whether they can pay or not. And young, single people have not acquired a substantial net worth that they could lose to medical bills. This is why, when Pizza Hut made cheap health insurance available to its part-time employees a few years ago, hardly any of them chose to take advantage of it.

One of the purposes of most health care "reform" proposals, stated or unstated, is to force these young people into the system--to force them, that is, to contribute money to pay the medical bills of others, beyond what they already pay in Medicare taxes. Whatever you think of either the justice or the wisdom of such a policy, it is not worth turning our health care system upside down in order to achieve.

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What to Do About Pre-existing Conditions

Most Americans worry about health coverage if they lose their job and get sick. There is a market solution. Even if you don't like the massive health-care package being considered in Congress, you have to admit that health insurance and health care in this country are not working well. There are two basic problems:

First, if you get sick and then lose your job or get divorced, you lose your health insurance. With a pre-existing condition, new insurance will be ruinously expensive, if you can get it at all. This, the central defect of American health insurance, explains why most Americans are happy with their current coverage yet also support reform.

Second, health care costs too much. Yes, we get better treatment, but the cost-cutting revolution that has swept through manufacturing, retail, telecommunications and airlines has not touched health care. The problems are real, but the proposed remedy—even more government intervention—is counterproductive. A market-based, deregulation-focused reform is possible, and it will work.

Health care and insurance are service-oriented, retail businesses. There is only one way to reduce costs in such a business: intense competition for every customer. The idea that the federal government can reduce costs by negotiating harder or telling businesses what to do is a triumph of hope over centuries of experience.

Take the claim that centralized record-keeping can cut costs. In his July 22 press conference, President Barack Obama noted that a new doctor today might run a test again rather than ask for records of a previous result. That seems silly. But maybe it isn't. Maybe the test is cheap, the condition changes, the test can fail, and the cost of setting up an integrated record system between these two doctors isn't worth two tests a year.

The cost-cutting revolutions in other industries didn't settle questions like these with acts of Congress, expert commissions, armies of regulators, or via a "public option"—while leaving in place a system in which consumers have little choice, aren't spending their own money, and suppliers are protected from lower-cost competitors. That approach has never spurred efficiency, and for good reasons. Cost-cutting is painful. Even in Mr. Obama's trivial example, lab technicians and secretaries will lose their jobs to computer programs, and they will complain. Patients might have to get tests at inconvenient times and locations. They will do this when their money is at stake—what people will put up with from airlines for a few dollars is truly amazing—but they will never accept it from the government.

But what about pre-existing conditions?

A truly effective insurance policy would combine coverage for this year's expenses with the right to buy insurance in the future at a set price. Today, employer-based group coverage provides the former but, crucially, not the latter. A "guaranteed renewable" individual insurance contract is the simplest way to deliver both. Once you sign up, you can keep insurance for life, and your premiums do not rise if you get sicker. Term life insurance, for example, is fully guaranteed renewable. Individual health insurance is mostly so. And insurers are getting more creative. UnitedHealth now lets you buy the right to future insurance—insurance against developing a pre-existing condition.

These market solutions can be refined. Insurance policies could separate current insurance and the right to buy future insurance. Then, if you are temporarily covered by an employer, you could keep the pre-existing-condition protection.

Some insurers avoid their guaranteed-renewable obligations by assigning people to pools and raising rates as healthy people leave the pools. Health insurers, like life insurers, could write contracts that treat all of their customers equally.

The right to future insurance could be transferrable to another company, for example, if you move. You could have the right that your company will pay a lump sum, so that a new insurer will take you, with no change in your premiums. Better, this sum could be occasionally placed in a custodial account. If you got sick but had something like a health-savings account to pay high premiums, you could always get new insurance. Insurers would then compete for sick people too. Innovations like these would catch on quickly in a vibrant, deregulated individual insurance market.

How do we know insurers will honor such contracts? What about the stories of insurers who drop customers when they get sick? A competitive market is the best consumer protection. A car insurer that doesn't pay claims quickly loses customers and goes out of business. And courts do still enforce contracts.

How do we get to a competitive market? The tax deduction for employer-provided group insurance, which has nearly destroyed the individual insurance market, is a central culprit. If we don't have the will to remove it, the deduction could be structured to enhance competition and the right to future insurance. We could restrict the tax deduction to individual, portable, long-term insurance and to the high-deductible plans that people choose with their own money.

More importantly, health care and insurance are overly protected and regulated businesses. We need to allow the same innovation, entry, and competition that has slashed costs elsewhere in our economy. For example, we need to remove regulations such as the ban on cross-state insurance. Think about it. What else aren't we allowed to purchase in another state?

The bills being considered in Congress address the pre-existing condition problem by forcing insurers to take everybody at the same price. It won't work. Insurers will still avoid sick people and treat them poorly once they come. Regulators will then detail exactly how every disease must be treated. Healthy people will pay too much, so we will need a stern mandate to keep them insured. And this step further reduces competition. Private, competitive insurance markets are a superior way to solve the pre-existing-conditions problem, and the only hope to lower costs.

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Obama's Senior Moment

Why the elderly are right to worry when the government rations medical care.

Elderly Americans are turning out in droves to fight ObamaCare, and President Obama is arguing back that they have nothing to worry about. Allow us to referee. While claims about euthanasia and "death panels" are over the top, senior fears have exposed a fundamental truth about what Mr. Obama is proposing: Namely, once health care is nationalized, or mostly nationalized, rationing care is inevitable, and those who have lived the longest will find their care the most restricted.

Far from being a scare tactic, this is a logical conclusion based on experience and common-sense. Once health care is a "free good" that government pays for, demand will soar and government costs will soar too. When the public finally reaches its taxing limit, something will have to give on the care and spending side. In a word, care will be rationed by politics.

Mr. Obama's reply is that private insurance companies already ration, by deciding which treatments are covered and which aren't. However, there's an ocean of difference between coverage decisions made under millions of voluntary private contracts and rationing via government. An Atlantic Ocean, in fact. Virtually every European government with "universal" health care restricts access in one way or another to control costs, and it isn't pretty.

The British system is most restrictive, using a black-box actuarial formula known as "quality-adjusted life years," or QALYs, that determines who can receive what care. If a treatment isn't deemed to be cost-effective for specific populations, particularly the elderly, the National Health Service simply doesn't pay for it. Even France— which has a mix of public and private medicine— has fixed reimbursement rates since the 1970s and strictly controls the use of specialists and the introduction of new medical technologies such as CT scans and MRIs.

Yes, the U.S. "rations" by ability to pay (though in the end no one is denied actual care). This is true of every good or service in a free economy and a world of finite resources but infinite wants. Yet no one would say we "ration" houses or gasoline because those goods are allocated by prices. The problem is that governments ration through brute force— either explicitly restricting the use of medicine or lowering payments below market rates. Both methods lead to waiting lines, lower quality, or less innovation— and usually all three.

A lot of talk has centered on what Sarah Palin inelegantly called "death panels." Of course rationing to save the federal fisc will be subtler than a bureaucratic decision to "pull the plug on grandma," as Mr. Obama put it. But Mrs. Palin has also exposed a basic truth. A substantial portion of Medicare spending is incurred in the last six months of life.

From the point of view of politicians with a limited budget, is it worth spending a lot on, say, a patient with late-stage cancer where the odds of remission are long? Or should they spend to improve quality, not length, of life? Or pay for a hip or knee replacement for seniors, when palliative care might cost less? And who decides?

In Britain, the NHS decides, and under its QALYs metric it generally won't pay more than $22,000 for treatments to extend a life six months. "Money for the NHS isn't limitless," as one NHS official recently put it in response to American criticism, "so we need to make sure the money we have goes on things which offer more than the care we'll have to forgo to pay for them."

Before he got defensive, Mr. Obama was open about this political calculation. He often invokes the experience of his own grandmother, musing whether it was wise for her to receive a hip replacement after a terminal cancer diagnosis. In an April interview with the New York Times, he wondered whether this represented a "sustainable model" for society. He seems to believe these medical issues are all justifiably political questions that government or some panel of philosopher kings can and should decide. No wonder so many seniors rebel at such judgments that they know they could do little to influence, much less change.

Mr. Obama has also said many times that the growth of Medicare spending must be restrained, and his budget director Peter Orszag has made it nearly his life's cause. We agree, but then why does Mr. Obama want to add to our fiscal burdens a new Medicare-like program for everyone under 65 too? Medicare already rations care, refusing, for example, to pay for virtual colonoscopies and has payment policies or directives to curtail the use of certain cancer drugs, diagnostic tools, asthma medications and many others. Seniors routinely buy supplemental insurance (Medigap) to patch Medicare's holes —and Medicare is still growing by 11% this year.

The political and fiscal pressure to further ration Medicare would increase exponentially if government is paying for most everyone's care. The better way to slow the growth of Medicare is to give seniors more control over their own health care and the incentives to spend wisely, by offering competitive insurance plans. But this would mean less control for government, not more.

It's striking that even the AARP—which is run by liberals who favor national health care— has been backing away from support for Mr. Obama's version. The AARP leadership's Democratic sympathies will probably prevail in the end, perhaps after some price-control sweeteners are added for prescription drugs. But AARP is out of touch with its own members, who have figured out that their own health and lives are at stake in this debate over ObamaCare. They know that when medical discretion clashes with limited government budgets, medicine loses.

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16 August, 2009

British cancer patients denied life-saving 'near-label' drugs

Thousands of cancer patients are being denied drugs that could extend their lives because of restrictions on supplying medications outside their licensed use, campaigners say. Almost 3,200 patients have been forced to plead for funding from the NHS for so-called “near-label” treatments – medicines licensed for use in some cancers, but not in other, similar forms of the disease. In the past three years, 1,053 applications for funding were rejected by local primary care trusts (PCTs), meaning that patients had either to go without or pay up to £20,000 for treatment.

The figures, uncovered through Freedom of Information requests to every PCT in England, are published today by the Rarer Cancers Forum. The charity says that the problem arises because the National Institute for Health and Clinical Excellence (Nice), which assesses drugs for NHS use, cannot recommend a treatment outside its licensed use.

After a review of access to cancer treatments last year, Nice promised to speed up its processes and consider the greater value attached to some drugs designed to treat terminal conditions. However, where drugs could be used outside their licensed fields, doctors have to apply to local PCTs for funding to use a drug on a case-by-case basis, generating a postcode lottery of access to the treatments.

Stella Pendleton, executive director of the Rarer Cancers Forum, said: “The NHS is forcing desperate patients into the cruel situation where the chances of their being given the treatment they need depend on where they live. “No patient should be denied a treatment recommended by a doctor simply because the cancer it treats is too rare for the medicine to be licensed. We need these obstacles removed. “Drugs companies, politicians and the NHS have a responsibility to patients to fix this system.”

The Department of Health said: “Doctors can use their clinical judgment to prescribe any treatment that will benefit their patient, even if it is outside its licensed indication. “Such decisions need to be made in discussion with the patient concerned and funding may need to be agreed with the local PCT. “Where NICE guidance is not available, it is only right that local PCTs should continue to make these difficult funding decisions according to the needs of their local population."

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The Health-Care Grail

A public policy debate takes on religious overtones

“I believe that by the end of my first term in office that we will have a universal health-care system instituted in this country. That is a commitment that I’ve made, and it is a commitment I want to be held accountable for.”

The words belong to Barack Obama, and he spoke them in April 2007—the last time he visited Portsmouth, N.H., for a town-hall meeting on health care. The Associated Press reported the crowd that day “was almost single-mindedly focused on a single-payer system.” Candidate Obama asked if they would agree to much higher taxes for such a system. And he emphasized that he would remain open to changes even after he released his plan.

Today, a very different Mr. Obama returns to Portsmouth for another town hall on health care. Gone is the demand that supporters acknowledge the implications of their plans (e.g., higher taxes). Gone too is the openness to good ideas from others. In their place is a my-way-or-the-highway president who impugns the character and motives of dissenters.

In his Saturday radio address, the president characterized opponents as “defenders of the status quo” trafficking in “misleading information” and “outlandish rumors.” His communications officer for health care, Linda Douglass, tells CNN that those who show video clips of Mr. Obama speaking are spreading “disinformation.” And far from scaling back the attacks, the same Obama aide who asked people to forward “fishy” emails critical of the president’s proposals yesterday unveiled a new White House Web site accusing critics of scaring Americans “with half-truths and outright lies.”

Now, at one level the intimation that anyone who questions the president must be a liar probably reflects frustration with the legislative outlook for health-care reform. Nevertheless, it is highly unpresidential. And it suggests that the president and his allies see disagreement over health care as less a political dispute than the trampling of sacred doctrine.

That doctrine begins with the notion that health care is a human right, and that government is the only honest player. Accordingly, any health-care plan must be both universal and guaranteed (read: paid for) by the government. And as long as we’re guaranteeing fundamental rights, let’s throw in abortion—no matter how much it complicates getting the bill through.

Different people have different objections to these proposals, almost all practical. Many loathe the status quo and advance reforms that would make health care more market-friendly and coverage more affordable—especially for the working poor. The questions they ask are likewise grounded in common sense: “What will it cost?” “How will we pay for it?” and “Is the public option a Trojan Horse for a single-payer system, just as Massachusetts Rep. Barney Frank suggests?”

Cost is probably the biggest objection. When Mr. Obama first proposed his overhaul, he justified it on the grounds that it would bring costs down. Now the Congressional Budget Office says costs are likely to go up. So what does the president do? He calls the CBO director onto the Oval Office carpet—a virtually unprecedented White House intrusion into a nonpartisan congressional institution.

“President Obama says that both sides agree we need to lower costs, promote choice and provide coverage for every American,” says Grace-Marie Turner, president of the Galen Institute, a free-market health-care think tank. “But he never confronts the simple fact that the measures he’s supporting achieve none of those goals. Instead of debating, the White House attacks anyone who raises a question.”

Of course, when fundamental human rights are at stake, it seems churlish to worry about little things such as the price tag. Or higher taxes. When it comes to the Holy Grail of universality, liberal intentions are far more important than actual outcomes.

“Think of public education,” says James Capretta, a health-care expert at the Washington-based Ethics and Public Policy Center. “They want to do for health care what they’ve done for education—establish a government-run, universal system. Once in place, they will defend such a system whether or not it delivers the results it promised.”

In his inaugural address, Mr. Obama dinged his predecessor when he asserted that his administration would “restore science to its rightful place.” The implication was unmistakable: In place of rigid religious orthodoxies, Team Obama would be clear, cool and pragmatic.

It turns out that the president has his own orthodoxies. These may owe more to his liberalism than to his faith. But they help explain the tenor of the attacks on those who dare question them—and the growing prospects for a major defeat in Congress on the president’s signature issue.

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The Blue Dog "Forlorn Hope Brigade"

By Robert Romano

Nancy Pelosi does not care if the passage of ObamaCare costs her seats in the House come 2010. She has already done a head count. And she knows exactly how many Blue Dogs and other vulnerable Democrats in that chamber she can spare in 2010 to fully enact her and Barack Obama's radical agenda to quickly implement a government takeover the health care system.

Call them the Blue Dog "Forlorn Hope Brigade." The real Forlorn Hope Brigade was nicknamed after the French army pawns that would always be the first to charge into battle, with little to no hope of survival. They were in essence cannon fodder. But they were told to think of the glory. To know that their sacrifices were for a good cause. And that's the position Pelosi and Obama have put the Blue Dogs into. They are now the sacrificial lambs by which to enact an agenda that is almost alien to the American people. They gave the radicals in the Democrat Party the numbers they needed to achieve a majority in 2006.

And if 30 or so of them must now be sacrificed to achieve that end, then that's just what Pelosi is going to do. They're expendable. Only they have a choice. Which was undoubtedly why 40 Blue Dogs in June signed a letter stating they would not support a plan that was not "deficit-neutral." Barack Obama said that, too, only one hopes that the "Forlorn Hope" actually means it.

Testifying in July the director of the Congressional Budget Office (CBO), Douglas Elmendorf, told the nation that the plan now proposed would not include "the fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount." "On the contrary," he said, "the legislation significantly expands the federal responsibility for health-care." Mr. Elmendorf said the cost curve was being raised instead of cut. Previously, Barack Obama and Democrat leaders had promised to cut the growth in spending of health care programs with their proposal.

In July, Americans for Limited Government President Bill Wilson explained the dynamics involved, "The Blue Dog Democrats realize that there is blood in the water. They are hearing from constituents angry over the $1.8 trillion deficit, the $13 trillion in committed bailouts, the failed, wasteful $787 billion 'stimulus', and the costly cap-and-tax. So, the Dogs know that their political necks are on the line." Wilson added, "The American people do not want government-run socialized medicine. Right now, the Blue Dogs have enough signatories to kill the legislation or, at the very least, slow it down. And if they value their political survival, that's exactly what they will do."

They did slow it down, but now they know that will not save them in the end.

Recently, meeting with El Dorado Tea Party leader John Wilson, Congressman Mike Ross (AR-CD4), a Blue Dog leader, on Wednesday told his constituent that he did not think the final version of the bill would include the contentious public "option"—the mandatory government-run health care currently contained in the bill. Which is funny. Because he already voted for the so-called public "option," in a compromise deal with lawmakers on the House Energy and Commerce Committee. Is he now saying he will not vote for the bill when it comes up again on the floor?

John Wilson does not know, because Ross did not say. "I certainly hope he's right, but what I still want to know is, will he support or oppose having a government-funded 'public option?'" Good question.

The fact is, Ross' silence on the matter is telling. He is, after all, the captain of the Blue Dog "Forlorn Hope Brigade." And now he is simply hoping that he is not going to be sacrificed when in his heart he knows the fateful decision has already been made.

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Auto & Health Insurance: A Just Government Would Mandate Neither

By Victor Morawski. Morawski is a professor of philosophy at Coppin State University

Let me first alert regular readers that I will do two things below uncharacteristic of most center-right writers: agree with Robert Reich and disagree with Rush Limbaugh.

In a pre-election Wall Street Journal article comparing the proposed health care plans of Hillary Clinton and Barack Obama, former Clinton Labor Secretary Robert Reich correctly assessed the controversial nature of government mandates. He observed, "Democrats are leading with their chins…to many Americans…it conjures up a big government bullying people into doing what they'd rather not do." Mr. Reich is, of course, correct, proving anew the old adage, "Even a blind squirrel finds an occasional acorn.

An argument now being used by "Obamacare" proponents to justify their onerous mandates rests on seeing health insurance as analogous to auto insurance. They ask, if government can mandate auto insurance, then why shouldn't it also mandate health insurance? In a response uncharacteristically out-of-sync with his normal defense of individual liberty, Rush Limbaugh challenged the liberals on this point by denying that the analogy holds. Which, of course, is true. He then surprisingly defended government mandated auto insurance while rejecting the same mandates for health insurance. And there, he went askew.

Government is justified in mandating auto insurance, he reasoned, because it does so not primarily to protect you, the insured, but the other driver. You buy health insurance, on the other hand, he averred, to protect yourself. And, as this is the case, government should stay out of your decision whether to do so.

This response plays right into the hands of the nanny staters arguing for mandated health insurance. To claim that the good of others in society morally justifies government mandating auto insurance leaves one little response to the liberal argument that it also for the good of others in society that health insurance be mandated for all.

In short, the left proclaims, you should have a binding legal – rather than elective moral – obligation to "love thy neighbor." And that is quite simply an operational definition of "poppycock."

The philosopher Immanuel Kant argued rather persuasively that it is morally wrong for a society to use one person as a mere means to the achievement of an end rewarding a second person, especially if such use meant overriding the free choices of the person used. In the current Obamacare scenario, this would mean that imposing government mandates to purchase health insurance on uninsured members of society because it promotes the common good by lowering everyone's health insurance premiums uses these uninsured persons as a mere means to society's ends. And, as Kant contends, this would be immoral on government's part because it effectively de-humanizes the uninsured by not respecting their freedom of choice.

Some hold that what justifies government in mandating health insurance it that it is only mandating for all what is a basic civic responsibility. But why is it your civic responsibility to lower my health insurance premiums, any more than to lower my car payment, mortgage payment or auto insurance premiums? What makes the case of health insurance unique in this regard?

The Obamatons owe the American people an answer. And they need to provide it before they destroy the finest health care system on the face of the earth in order to provide forced coverage to the less than 15 percent of the population that remains without insurance either because they so chose, or – more likely – because they are welfare slackers who simply prefer not to work or pay premiums.

Even if society does occasionally get stuck with an uninsured person's bill (predominantly those of the welfare slackers), this is slim reason for universally mandated coverage---especially if harm can be done to citizens by penalties for non-compliance. We are also causing harm to the person who has other priorities but is forced to lay them aside to pay for mandated health insurance, or be dragooned into doing so by government mandates.

So, yes, Rush, there is an analogy between health insurance and auto insurance – and, as Kant observed, government has as little right or reason to mandate the former as the latter.

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Alternatives to ObamaCare

By John Mackey, co-founder and CEO of Whole Foods Market Inc.

With a projected $1.8 trillion deficit for 2009, several trillions more in deficits projected over the next decade, and with both Medicare and Social Security entitlement spending about to ratchet up several notches over the next 15 years as Baby Boomers become eligible for both, we are rapidly running out of other people’s money. These deficits are simply not sustainable. They are either going to result in unprecedented new taxes and inflation, or they will bankrupt us.

While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:

* Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees’ Personal Wellness Accounts to spend as they choose on their own health and wellness.

Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan’s costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.

* Equalize the tax laws so that that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

* Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

* Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

* Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

* Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor’s visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

* Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

* Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren’t covered by Medicare, Medicaid or the State Children’s Health Insurance Program.

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That’s because there isn’t any. This “right” has never existed in America

Even in countries like Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments.

Although Canada has a population smaller than California, 830,000 Canadians are currently waiting to be admitted to a hospital or to get treatment, according to a report last month in Investor’s Business Daily. In England, the waiting list is 1.8 million....

Health-care reform is very important. Whatever reforms are enacted it is essential that they be financially responsible, and that we have the freedom to choose doctors and the health-care services that best suit our own unique set of lifestyle choices. We are all responsible for our own lives and our own health. We should take that responsibility very seriously and use our freedom to make wise lifestyle choices that will protect our health. Doing so will enrich our lives and will help create a vibrant and sustainable American society.

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Obama's ignorance of the practice of Medicine

Why is the president convinced so many doctors and patients are making irrational decisions?

By SCOTT GOTTLIEB

On the defensive because of an increasingly skeptical public, President Barack Obama has recently spoken extemporaneously about his health plan. In doing so, he has revealed his lack of understanding about aspects of medical practice and the reasons for rising health-care costs.

One theme the president has focused on is doctors' motives. During a prime-time press conference on July 22, the president referred to a doctor who muses that she makes "a lot more money if I take this kid's tonsils out" —even if the child might not need surgery. Responding to a woman whose spry 100-year-old mother was given a needed pacemaker despite her age, the president said a few weeks earlier (at an ABC News town-hall event at the White House) that doctors should let patients know that sometimes "you're better off not having the surgery, but taking the painkiller."

Mr. Obama's clinical scenarios represent an excessive —if not erroneous— take on how doctors are influenced by financial incentives. This jaundiced view on medical decision-making may explain why programs the White House is proposing to lower health-care costs rely on the direct regulation of medical decisions. If Mr. Obama is serious about lowering costs, he'll need to reform the economic structures in medicine —especially programs like Medicare.

Medicare data shows that for the most part, major surgeries aren't the source of waste in health care. These kinds of procedures are typically guided by clear clinical criteria and are closely scrutinized by doctors and patients alike. Rather it is in routine procedures and treatments that economic incentives factor heavily into doctors' decisions.

The use of branded over cheaper generic drugs until recently fell into this category. Doctors would regularly prescribe the more expensive option. Today this is far less prevalent, since patients with private plans realized that they were being saddled with higher co-pays when they opted for the brand-name drugs over generic alternatives.

Other areas where doctors have been accused of excessive utilization include radiology scans and home medical equipment. In the absence of financial incentives to restrain excess use, relatively safe diagnostic procedures can often be justified —even if their benefits are slim.

Instead of addressing the distorted financial incentives that influence these kinds of routine tests and treatments, Mr. Obama's policies seek to directly regulate doctors and their decisions.

The Obama administration has proposed establishing an "Independent Medicare Advisory Committee" to set binding rules on Medicare reimbursement policies. Mr. Obama has also called for the creation of a new federal entity that would conduct "comparative" research on the cost-effectiveness of various treatments in order to establish federal "guidelines." The House health reform bill calls for "health information tools" that would enable Medicare to deny payment for a particular treatment right in the doctor's office.

Regulating medical decisions should not be the responsibility of a remote Washington bureaucracy. The only way to instill more reflection at the point of medical decision making is to give doctors and patients reasons to consider the cost of various options. For doctors whom Medicare pays per intervention, the problem isn't the fee-for-service model, but the way that the government program sets the fees. Fees are set according to a fixed price schedule with no tie to the physician's quality, experience level, or the outcome of the service. A more rational system would pay doctors for entire "episodes of care," rather than individual procedures. Private health systems like the Geisinger Clinic and some Blue Cross plans have adopted this model and pay doctors for taking care of an entire illness.

Medicare doesn't have the ability to track episodes of care. It has struggled to adopt even modest payment reforms such as restricted panels of providers, value-based insurance, and account-based coverage, where consumers control their own spending —all techniques used by private insurers to improve efficiency.

Medicare's size demands that it keep payment systems simple. Thus it relies on fixed prices for checklists of services tied to discrete billing codes. These uniform payment rules reward low and high quality care the same. What's troubling is that the heart of the president's plan —a government-run "public" insurance program— is modeled directly on Medicare.

Medicare compounds its shortcomings by insulating patients from costs. This causes a total lack of financial restraint at the point of care. Cost-sharing in Medicare has actually declined over time as a percent of patients' total health bill.

My colleague at the American Enterprise Institute, Tom Miller, estimates that U.S. patients have the lowest out-of-pocket costs as a percent of total national health spending of any developed country except France, Luxembourg, the Czech Republic and Ireland. They're even lower than the single-payer health system in Canada. Mr. Miller calculates that out-of-pocket spending on physician and clinical services in the U.S. was about 60% of total real per capita spending on health care in 1960. By 2002 it had fallen to 10%.

Unsurprisingly, Medicare data show that over the past two decades Medicare's costs for care have sharply outpaced spending in private plans, where co-pays and cost sharing are standard. While these estimates are confounded by factors such as the age of Medicare's population, Medicare certainly hasn't been austere.

Mr. Obama says as much as one-third of medical spending is wasted on services that provide little or no benefit. But closer scrutiny of these kinds of marginal medical decisions can't be imposed by government regulation. Cost consideration must be internalized at the point of care by patients and doctors with a stake in the price, as well as the outcome.

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15 August, 2009

The Coming Referenda on Obamacare

The contests for statehouses in New Jersey and Virginia are the best referenda the country could ask for on Obamacare, and Congress would be wise to wait to see how these two states vote in November before it takes any final vote on the president's plans to radically rewrite the rules of American medicine. Recent polls show that Republican Bob McDonnell in Virginia leads his opponent Creigh Deeds by double digits. An anti-Democrat trend is also shaping up in New Jersey where GOP nominee Chris Christie is also far ahead of incumbent Jon Corzine.

Both New Jersey and Virginia went for President Obama ten months ago and thus should be providing their liberal nominees with a cushion, not a collapse. What has happened? The answer is obvious: the president's policies are deeply unpopular outside of the Beltway and the hard left precincts of the Democratic Party, and the idea of giving even more power to the party that controls all the levers in D.C. is out of the question. The stimulus is understood not to have worked. The cap-and-tax-and-tax-and-tax House bill threatens every business in the land. The vast deficits dwarf those that triggered anger against Republicans. And now Obamacare looms over every American with health insurance they like, including seniors who understand that the president's program targets Medicare and thus their access to doctors and treatments.

Polling on the health care scheme being pushed on the country show its support plummeting and opposition soaring. Even a huge infusion of cash from Big Pharma on behalf of the "government option/public plan" will not decisively impact the debate. The ice has hardened, in fact, and the doctors America depends upon are overwhelmingly against the scheme which means that most patients who talk to their physicians will hear the same negative message. All of AARP's spin can't change this, and the doctors won't sit quietly by as their profession is nationalized no matter what the AMA advises. A San Diego neurologist e-mailed me yesterday saying that he was refusing to meet with any pharmaceutical rep until Big Pharma withdrew from the field. I expect that sort of hostility will deepen, and those sorts of actions will spread. Unlike most debates inside the Beltway, this one has immediate and huge real-world implications for tens of thousands of professionals and millions of seniors, not to mention everyone with health insurance through their employer. Spin doesn't work when people are paying close attention. The president's "guarantees" aren't believed.

Pursuing such a deeply unpopular and obviously ideologically-driven extremist solution like a "government option/public plan" is a recipe for electoral disaster for Congressional Democrats and even races far emoved from the federal level. Allowing Nancy Pelosi to slander the huge majorities against Obamacare is not good politics, but telling people to sit down and shut up as the president did in Virginia last week --"Get out of the way!"-- is even worse. Arrogance never works in politics.

The president is still well-liked, even by many conservatives, but his agenda has disquieted the center and everyone on the right. Even many Democrats and not just the Blue Dogs are worried that the huge lurch to the left if the fist six months of the new administration has sowed the seeds of a counter-reaction next November.

Whether that counter-reaction is building into a huge political shift back to the right will be clearly visible after November's votes, and if Democrats see two statehouses swept away, they will know that the center of American politics has rejected the grab-bag of initiatives and massive deficits as well as the president's excuse that he inherited all the problems besieging the country. The Bush-bashing is already a tired tune, and even those who have talked themselves into believing the housing bubble was W's fault know that the public doesn't much care for excuses.

Self-preservation is telling the Blue Dogs that the president's insistence on the radical parts of his program is a legislative suicide note, and they are reluctant to sign. Even some Senate Democrats must sense a huge and unnecessary risk in the president's plan. If Corzine and Deeds can rally and win against the backdrop of the debate in D.C., these fears will be allayed and a vote taken on health care with much less risk a year out. A president concerned with his party would wait to see how the agenda is affecting his colleagues.

But because the president's pollsters must be seeing the same thing as everyone else, don't expect him to accept a delay until the referenda are in. The hard sell is all he has left, and if the Congressional Democrats lack the spines to resist it for two months, they will have no one but themselves to blame a year hence.

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Why Americans fear the accountant’s knife

Protesters against Obama’s reforms are defending their excellent medical service. It’s all about cost-cutting, not liberty

A pregnant American arrives at her doctor’s office. It’s time for her ultrasound check. The doctor wheels over the machine from the corner of the room: of course he has his own.

A child has a fall from a slide. There’s blood in his urine. The parents race him to the emergency room. Two hours later, the boy’s having a CAT scan. (An American is twice as likely to use a CT machine in any given year as a Canadian, four times as likely as a Briton, and seven times as likely as a Dane.) A car driven by an illegal immigrant smashes into a tree. The driver and his family are horribly injured. They are raced to the nearest emergency room and treated, no questions asked, no bill presented.

That’s American healthcare at its best. America at its worst, of course, you know. Or do you? Europeans see the American health system as a brutal Darwinian struggle. The poor are abandoned, the sick must produce credit cards at hospital emergency rooms and government disavows responsibility for the health of the population.

But those are largely imaginary or exaggerated ailments. The hardest problems for Americans are not so much medical as financial. Insurance premiums have doubled in the past decade and Medicare and Medicaid, the government health programmes, are growing at a rate that cannot possibly continue. Tens of millions of people lack insurance. Yet they do not go uncared for. Rather they use the most expensive care, emergency care, and hospitals add the cost on to the bills of paying patients.

Almost all the problems of the US health system trace back to a pair of unexpected ironies: profit-driven private insurance corporations find it much harder to say “no” than governments do, and American governments are more unsustainably generous than their European and Canadian counterparts.

That sounds incredible, I know. But consider: government looms huge in the US health system. An absolute majority of all health dollars spent in America are spent by one form of government or another. Everybody knows that the US has a private health system while neighbouring Canada’s is public. Yet US federal and state governments spend as much public money on healthcare per American as Canadian federal and provincial governments spend per Canadian.

For all practical purposes, healthcare is just as much a right in the US as it is in Europe. Since 1986, federal law has required all hospitals that receive federal money (ie, just about all of them) to provide emergency care to any patient who presents himself or herself. Many states back this federal law with even stronger laws of their own.

Government generosity drives private health costs higher and higher. Health insurance is regulated by state governments. Each government decides what local insurers must cover and how they may cover it. Fifteen of the 50 states require insurers to cover fertility treatments. Twenty-four states require coverage of eating disorders. Thirty-five states require coverage of reconstructive surgery after a mastectomy. New York state requires insurers to charge the same rate for all customers, regardless of health conditions, while 11 other states tightly restrict the ability to charge more for more sick patients.

Despite the rhetoric, Republican administrations expand government coverage just as much as their Democratic counterparts do. George W. Bush’s Administration, for example, created one huge new healthcare programme (prescription drug coverage for the elderly) and greatly expanded another (the State Children’s Health Insurance Programme, which now covers under-18s whose parents earn up to 250 per cent of the poverty level).

Again despite the rhetoric, Democratic administrations fret as much about healthcare costs, perhaps even more, than Republicans. Because of the Clinton Administration’s fierce promotion of health maintenance organisations — the much-hated but super- economical insurance plans — healthcare costs grew more slowly in the 1990s than in the decades before and after. Barack Obama has publicly mused about the need to spend less on the elderly in their final years. Here he is speaking to The New York Times in April, a comment that puts some credibility in those fears of “death panels”:

The President: “The chronically ill and those toward the end of their lives are accounting for potentially 80 per cent of the total healthcare bill out here.”

Interviewer: “So how do you — how do we — deal with it?”

The President: “Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance.”

The raucous protesters at the town hall are not defending the liberty of the individual; they are defending the status quo, a status quo that for many means lavish government healthcare for the elderly. They (rightly) fear that government is much more concerned to hold costs down than to improve care.

Objective studies find little difference in outcomes between America’s costly care and the much cheaper care in more statist systems. Canadians live longer, the Dutch have better infant mortality statistics, etc. Healthcare systems do not make much difference to health outcomes. Americans are more likely to be obese than Europeans. (One health dollar in ten is attributable to the obesity-caused type 2 diabetes.) Americans shoot each other, and give birth prematurely, more often. Healthcare can do only so much to compensate for these choices (and a severely underweight baby is more likely to survive in the US than just about anywhere on Earth).

What the US system offers to those who enjoy good coverage is much harder to measure: convenience, security, responsiveness to patients and personal attention from doctors who compete to attract customers. Fear of the loss of American medicine at its best is what is riling the town halls. Americans like what they have. They worry that it cannot continue. And they correctly surmise that a President with other spending priorities seeks to take it away.

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British women say that they were "tricked" into telling the truth

Two British women who have become the unwitting stars of a campaign to derail Barack Obama’s healthcare reforms yesterday said that their views on the NHS had been misrepresented. Katie Brickell and Kate Spall said that they strongly supported state-funded healthcare, but their descriptions of poor treatment at the hands of the NHS form the centrepiece of an advertising campaign against the proposed reforms in America. Both appear in adverts for Conservatives for Patients’ Rights (CPR), a lobby group that opposes Mr Obama’s plans for universal medical insurance, which have caused a transatlantic rift over the merits of the NHS.

Government ministers and the Prime Minister have weighed in to the row to defend the healthcare service as Republicans claimed that adopting an NHS-style system would lead to “death panels” that would preside over who received lifesaving treatment.

Ms Spall, whose mother died of kidney cancer while waiting for treatment, and Ms Brickell, who had cervical cancer diagnosed after being refused a smear test because she was too young, appear in the adverts telling how they were failed by the NHS.

But they informed The Times that they were told they were being interviewed for a documentary examining healthcare reform. Neither was aware that the footage was to be used for right-wing advertisements. Ms Spall said: “It has been a bit of a nightmare. It was a real test of my naivety. I am a very trusting person and for me it has been a big lesson. I feel I was duped.”

CPR was set up by Richard Scott, a multimillionaire who founded the Columbia Hospital Corporation. Ms Spall was approached by a woman, who identified herself as Betsy Kulman, who said that she was making a documentary for the company. In an e-mail Ms Kulman wrote: “Columbia Healthcare in the US is underwriting a web documentary spanning the US, the UK, and Canada on the debate on healthcare reform. This segment will explore the difficult issues around the intersection between private and nationalised medicine. “Who has been failed by socialised medicine and why? What can be done to change things for the better?”

Ms Spall, who runs the Pamela Northcott Fund, to fight for patients denied treatment, said that she stood by what she said but was horrified by how her words had been used. “What I said is what I believe, and I stand by it, but the context it has been used in is something I was not aware would happen,” she said. “The irony is that I campaign for exactly the people that socialised healthcare supports. I would not align myself with this group at all.”

Ms Brickell, whose cancer is in remission, said that she had had a similar experience. “I was told that they were a company in the United States who were doing a documentary on whether healthcare in the US should be nationalised,” she said. “The NHS let me down and I just wanted to make the point that people should not rely solely on it. But what I said has been skewed out of proportion. I am slightly worried that people might think I am taking a negative position on the NHS.

“My point was not that the NHS shouldn’t exist or that it was a bad thing. I think that our health service is not perfect but to get better it needs more public money, not less. I didn’t realise it was having such a political impact. I did sign a piece of paper saying they could do what they wanted, so it’s my own fault.”

Karol Sikora, a British cancer specialist who also appears in the adverts, has said that he fell victim to the same technique. Dr Sikora, an outspoken critic of the NHS, told The Guardian: “They came and saw me in my office about a month ago and I gather I am appearing in some advert. They didn’t tell me that would happen.”

Stephen Hawking, the Cambridge scientist, has also been drawn into the row after the American newspaper Investor’s Business Daily used an editorial to claim that he “wouldn’t have a chance in the UK” because the NHS would have deemed him “worthless”, given his physical disabilities. Mr Hawking, who has motor neuron disease, rejected criticism of the NHS yesterday as he collected America’s highest civilian honour, the Presidential Medal of Freedom. “I would not be here today if not for the NHS,” he said.

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Health Care Compromise A Poison Pill For Small Business

Much ado has been made of the tenuous “compromise” between President Barack Obama and “Blue Dog” Democrats in Washington on the issue of government-run health care. Sadly, the reality is that the latest version of “Obamacare” is still a poison pill for America’s small businesses and the millions of workers they employ.

Most small businesses spend between 60 and 80 cents of every dollar they earn on payroll, which is precisely where Obama’s plan would hit them. Not content with simply bleeding “the rich” to pay for the massive up-front costs of his $1.5 trillion socialized medicine proposal, Obama also wants to impose a massive new tax increase on American small businesses – one that will directly impede their ability to create jobs and stimulate economic activity.

In other words, Obama wants to choke off America’s number one job-creating engine in the depths of a recession that has already cost millions of jobs – all so he can create a government health care monopoly that will not only increase costs but also reduce the quality of care. That’s a recipe for disaster, not real reform, and yet Obama continues to use rhetoric to mask his true intent. For example, in proclaiming a “National Small Business Week” three months ago, Obama touted small businesses as “the lifeblood of cities and towns across the country.” “(Small businesses) help enhance the lives of our citizens by improving our quality of life and creating personal wealth,” Obama said. “Small businesses will lead the way to prosperity, particularly in today’s challenging economic environment.”

Obama further claimed that he supported “economic policies that encourage enterprise” and “tax policies that promote investment in small businesses.”

Unfortunately, Obama’s rhetoric of support for small businesses has been accompanied by policies that threaten to put them “out” of business. For example, while state and local government bureaucracies have been bailed out to the tune of hundreds of billions of dollars, small businesses remain overtaxed and frozen out of credit markets. So much for “stimulating Main Street.”

With his socialized medicine proposal, however, Obama is attempting to erect the most sizable roadblock yet in the path to small business prosperity in America. In addition to imposing a new surtax on the “wealthiest Americans” – including the sixty percent who report income from small businesses or partnerships – Obama’s plan would also force a new tax hike directly on the backs of small businesses with annual payrolls of $500,000 or more.

According to data released by the U.S. Small Business Administration, the small businesses that would be affected by the latest “Obamacare compromise” employ 70% of all small business employees in America – or 42.3 million workers.

Even worse, the new small business tax rises dramatically – and quickly – the more a company expands its payroll. In fact, small businesses with payrolls of $750,000 or higher would have to pay 8% of that total cost to the government. This would create a direct disincentive to economic growth and job creation. After all, why would a small business add employees (i.e. additional payroll expenses) if it meant incurring a higher tax rate?

At the same time small businesses are absorbing this new tax, they would be sending a steady stream of new “customers” to the government-run plan, which would force nearly 84 million Americans out of their current health coverage, according to a new study by the Lewin Group.

Simply put, Obama’s plan would force small businesses to pay for in a way that would directly impede their ability to create jobs and stimulate economic activity. In addition to going against everything this nation was founded on, that’s something America’s small businesses simply cannot afford.

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The Health Care Chaos

by Emmett Tyrrell

Allow me a word of encouragement to our president. Mr. Obama, you are doing just fine. You wanted to set a new tone in Washington, and you have. You wanted an open debate on health care, and you have it. Admittedly, the tone is astoundingly rancorous, and not incidentally, your approval ratings continue to decline. Then, too, support for your health care reform is dropping, especially among independents. Yet I believe you can take heart. You have roused the interest of the American people in you, the Democratic Party, the Congress and health care. That is good news, at least for us conservatives. Again, you are doing fine. Ever-larger numbers of Americans are alarmed by you, your party, the Congress and your health care monstrosity. Mr. President, you are doing fine. Keep it up. Let me know if there is anything I can do to help.

Truth be known, what else were we to expect from the new administration? In the Senate, our president was the most left-wing member by a lot. That is a fact, clearly visible to those who followed his voting record. He was also the least experienced major-party presidential candidate in more than a century. As for his experience before he entered upon his brief political career, he never was in the private sector, where he might have gained knowledge about profit margins, the difficulty of maintaining a work force, or the burden of even a slight tax increase. His sole experience has been a fleeting period teaching law and the anomalous experience of being a community organizer, that is to say, a rabble-rouser who organizes needy people to pester governments and corporations for cash or services.

This campaign for health care reform has been an ongoing chaos. From all I have been able to tell, the Obama White House is a chaos, too. The other day, I heard of a highly placed White House staffer, with glittering credentials, who sits in a cubicle answering 300-400 urgent e-mails a day. That only reinforces the reports that this White House is nearing a state of "burnout." The word circulating about the Democrats is that they are "desperate" over the state of the Obama health care plan. They have reason to be, and my guess is that things will get much worse. Democrats, what were you thinking of when you nominated the most left-wing and inexperienced candidate in the 2008 Democratic field?

Out on the campaign trail, where the Prophet Obama is thumping for health care reform, he should be very much at ease. Campaigning is the one aspect of politics he does well. But here, too, we see desperation. The other day, he accused his critics of engaging in "scare tactics." He objects to their claim that the bill is exorbitant, though that claim is reinforced by the nonpartisan Congressional Budget Office, which puts the price tag at more than $1 trillion. He says he will shave off $500 billion from that sum by cutting waste, fraud and abuse, though the CBO estimates the savings at only 1 percent of the trillion-dollar cost increase. He says his reforms will not fall heavily on the elderly or the disabled, though his own health care advisers have written that reforms (SET ITAL) should (END ITAL) fall heavily on these groups. We can quote them. Call it scare tactics if you will.

Dr. Ezekiel Emanuel -- who is the health-policy adviser at the White House Office of Management and Budget and a member of the Federal Coordinating Council for Comparative Effectiveness Research, as well as White House chief of staff Rahm Emanuel's brother -- propounds discrimination against the elderly and other less-than-robust patients. In the medical journal The Lancet, he wrote in January: "Unlike allocation by sex or race, allocation by age is not invidious (an irrelevancy) discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years." As for the less-than-robust, in The Hastings Center Report, he has written that medical care should be withheld from those "who are irreversibly prevented from being or becoming participating citizens. ... An obvious example is not guaranteeing health services to patients with dementia." Thus, the state should decide when and whether you get treatment. Does that not have a grisly ring to it?

Dr. Emanuel veers from the grisly to the delightfully frivolous in his pontifications on cost cuts. Savor this one, from the Journal of the American Medical Association in May 2007: "Too much money spent on health care reduced the ability to obtain other essentials of human life as well as some goods and services not essential to life but still of great value, such as education, vacations, and the arts." Yes, he said "vacations and the arts." So once we have Obamacare and you are sitting around waiting for a hip replacement or a CT scan, remember that tax revenues are being better spent on vacations or perhaps the performance art of that lady who smothers chocolate on her naked body. On second thought, she may be sitting nearby also awaiting a hip replacement. Remember, chocolate stains.

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Some other recent articles:

Senate committee eliminates “end of life” provision in Obamacare: "A plan to provide hospice counseling and other end-of-life advice to patients and their families is being dropped by US Senate health care negotiators after critics charged that it would lead to the formation of federal ‘death panels,’ a key GOP senator said yesterday. … The original sponsor of the provision and a variety of specialists all debunked the allegation and said end-of-life counseling can help families deal with difficult choices. Nonetheless, Senator Chuck Grassley, the Senate Finance Committee’s top Republican and one of six committee members trying to hash out a bipartisan bill, said yesterday that the provision could be misinterpreted and that it will not be contained in the committee’s proposed legislation.”

Ringo’s law and the healthcare system of doom: “Some years ago, noted philosopher Ringo Starr described an important and now-famous discovery: “By now it should be clear to anyone: This government ‘help’ has made things dramatically worse in healthcare, just as government reliably makes things worse in all spheres of life that government involves itself in. For many reasons, coercive government is the worst way to do anything. Like gravity, Ringo’s Law is a built-in rule of the universe, omnipresent and unavoidable. There is no country on Earth where the Law is not conspicuously on display: ‘Everything government touches turns to crap.’”

Medical mosh pits : "Clashes keep breaking out at the ‘town hall’ meetings devoted to discussing health care reform. Usually the excitement amounts to some angry questions and heckling, but sometimes there’s more. Six people were arrested at a demonstration outside a meeting in St. Louis. Violence erupted at a town hall in Tampa after opponents of ObamaCare were locked out of the building. A North Carolina congressman cancelled a meeting after receiving a death threat; the pro-market group FreedomWorks, which was involved in some of the protests, fielded a death threat of its own. Supporters of the president’s health care reforms, who used to tout the support he’d received from the pharmaceutical and insurance industries, are now accusing the very same companies of riling up ‘mob violence’ to stop the plan.”

Eyes on the real prize: “If you asked House Democrats what they most wanted to leave as their legacy in public office, it’s a good bet that a healthy number would offer a variation of ‘a government-managed health-care plan that is available to every American citizen.’ Some would classify it as ’single payer,’ others would want the ‘public option,’ but they all add up to a massive new entitlement, in which Americans depend upon the federal government for their health care. Conservatives have dreaded it; looking around the globe, they know that once created, these programs are just about politically impossible to repeal. Many congressional Democrats, told that passage of the sweeping health-care legislation will cost them their seats, may find the choice a harder decision than many observers think. Yes, no one should doubt a politician’s instinct for self-preservation. But it’s quite possible that long-serving Democrats might want to enact a sweeping social change instead of taking the safe route.”

Trust the government : “How much is one additional year of your life worth? Or one more year of life for your father or your wife? For your child? In Great Britain, the government has settled on a number: $45,000. That’s how much a government commission with the Orwellian acronym NICE has decided British government-run health care will pay for one additional year of life for a British subject. Think it could never happen here? Then you need to pay closer attention to what Washington is planning for your health care.”

If Uncle Sam becomes your doctor: “Americans are doing their homework on healthcare reform. And, unlike some members of Congress, they’re reading the legislation, even though it’s more than 1,000 pages long. They see that the numbers don’t add up. They note the contradictory claims by the Obama administration and Democrat-controlled Congress. And they recognize the unintended consequences of the government controlling one-sixth of the US economy. According to several recent polls, on key issues of access, quality of care, and cost, Americans don’t support this government power grab.”

Health care protests on target: “Now we know the enemy in the health-care debate, the really, truly despicable people, the worms who ought to be stuffed back in the dirt they crawled out of. It’s ordinary citizens who have had the temerity to show up at meetings of their representatives in Congress, asking in so many words — ‘What in the name of heaven are you planning to do with our lives?’ Happy enough to be cheerleaders when Cindy Sheehan and her ragtag followers were out and about calling George W. Bush a mass murderer, Democrats, the left generally, some pretend journalists and a number of big-name commentators are aghast at a lack of respect for the Washington malefactors, fearful that someone will think everyday Americans actually know what they’re talking about and worried about how hard it will be to set the record straight if their critiques are widely circulated.”

Busting the Bay State: “Health care’s silly season is upon us. If we can be sure of anything, it is that President Barack Obama and his congressional allies will do whatever they can to hide the cost of their health plan. Lucky for them, former Massachusetts Gov. Mitt Romney, a Republican, has shown the way.”

Obamacare meltdown: “The revelation last week that a majority of Americans may actually disagree with the President was something for which his team was clearly not prepared. Their attempt to marginalize citizens across the country who dared to speak out against a government-takeover of health care is shameful, arrogant, and desperately sad. With the American people growing increasingly unhappy with the President’s health care plan, Democrats in Congress are working feverishly to cast those who are concerned as radical props to the special interests. … The notion that Americans may not want the federal government making health care decisions on their behalf appears to be truly beyond the comprehension of Democrats in Congress and the White House. So they have responded by slandering honest folks looking to have their voices heard.”

Yes, they really are mad as hell: “Who, exactly, were these people who had converged in the middle of Lebanon to protest ObamaCare? Walking through the crowd, finding them waving signs as they chatted with each other, they were happy to talk. These were in fact the flesh-and-blood of John O’Hara’s Pennsylvania world. There was the registered nurse who was so incensed about the President’s plans she went on the Internet to find Senator Specter’s list of town meetings — and drove two hours from her home in Chambersburg only to find the meeting already filled. She chose to stay, her own sign held high with a scrawled message on free speech, her feet firmly planted on the street corner. There was the local small businessman, the woman who had lost a beloved sister to cancer — teary but deeply gratified that her sister had health care choices every step along the way. Her friend, a child of immigrants who arrived in 1924 — ‘legally’ she added with a smile — shyly gave a name but preferred to think of herself as just ‘an American patriot.’”

This Libertarian and health care: “In this I differ from a lot of other Libertarians. I am a Braudelian: super-concentrations of capital beyond a certain point become anti-free-market and threaten human freedom in almost as many ways as the State can. But that does not exonerate the State here either: there are literally thousands of Physicians’ Assistants, Nurse Practitioners, and even LPNs or midwives who would be more than willing to make careers in the small towns across America providing low-cost basic care to good people. Yet the licensing laws that the health professionals’ lobby have so carefully cultivated over the years prevent that.”

Health reform must endure for the long term: “Health reform has dominated the news lately, but many Americans are wondering what reform will actually entail for them. According to a recent survey conducted by my firm, most believe that healthcare reform will provide coverage for long-term services and supports. These are medical services for people who can’t care for themselves for extended periods of time due to illness or disability. And they’re of critical importance, as 60 percent of Americans over the age of 65 will require long-term care during their lives. But it’s hardly a foregone conclusion that the final health reform package will ensure that Americans have access to affordable long-term services.”





14 August, 2009

£1.2bn bill for the bureaucrat army within Britain's NHS

The NHS has become a 'bureaucratic black hole' under Labour. Spending on NHS bureaucracy has almost doubled in four years, research shows. Nearly £1.2billion went on administrators and clerical staff in Primary Care Trusts in 2007/8, a rise of 81 per cent since 2003/4. The total is nearly twice as much as the £700million the Health Service spent on anti-cancer drugs last year, with some patients being denied life-prolonging medication. A further £139million was spent on management consultants - almost three times as much as the £ 53million spent five years ago.

The increase comes despite the number of PCTs halving from 303 to 152 - which was supposed to release £250million to front line services. PCTs are spending £115million a year on agency administrative and clerical staff, more than twice as much as in 2003-04. At the same time acute hospital trusts - which provide the healthcare patients receive in hospital - have cut their spending on bureaucrats by 8 per cent.

Andrew Lansley, health spokesman for the Conservatives, who obtained the figures under the Freedom of Information Act, said: 'Every penny spent on unnecessary management and paperwork is a penny less to provide better care for patients. 'These figures show just how far Labour have broken the promise they made in 1997 to spend NHS funds on patients not bureaucracy. 'The Conservatives are the only party that has set out a clear plan to root out this waste and bureaucracy and get money to the front line.'

Michael Summers, of the Patients Association, said 'Surely if these management consultants were doing the job they're paid for the bill would be going down because there's less need for them.' But health minister Ann Keen said administrative and clerical staff formed only 8 per cent of the NHS workforce of more than 1.3million. [What about all the time that doctors and nurses spend on paperwork? EVERY NHS employee is a bureaucrat, with the possible exception of the cleaners -- but there are not many of them]

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I deeply resent the Americans sneering at our British health service - but perhaps that's because the truth hurts

President Barack Obama's political enemies are rounding on his controversial proposals to extend government involvement in health care. One way in which they are doing so is to hold up our own cherished NHS for ridicule. His Right-wing critics accuse the NHS of putting an 'Orwellian' financial cap on the value of life by allowing elderly people to die without treatment.

The case of a dental patient in Liverpool who supposedly had to superglue a loose crown has been mentioned as an example of the appallingly low standard of dentistry in Britain. At the wilder reaches of seemingly lunatic allegations is the suggestion that anyone over the age of 59 in Britain is ineligible for treatment for heart disease. One leading Republican has also declared that the 77-year-old Senator Edward Kennedy, who is suffering from a brain tumour, would have been allowed to die in this country on account of his relatively advanced age.

In fact, President Obama's plans fall well short of the sort of state-run health service we have in this country. He wants to ensure that the 40 or 50 million Americans - many of them black or Latino - who do not have health insurance are able to receive the same standard of care as the majority who do. Nevertheless, his proposals are characterised as 'socialist medicine', and the NHS is invoked as the living example of this abomination.

We may be sure, I think, that most of those who are cheerily dredging up British scare- stories do not really believe them. We are merely providing the ballast in a domestic American argument that is getting dirty. Let's not take offence at this wildly overstated depiction of Britain as a sort of feral, failed state with Third World standards of health care.

The question that interests me is whether there is a grain of truth hiding amid these insults. I'd say there was. I'd say that under the present system which President Obama is hoping to improve, most middle-class Americans are liable to receive better health treatment than their British counterparts. If I were a middle-income American living in Seattle or Chicago, I could almost certainly rely on superior care than if I lived in Birmingham or Newcastle.

This would probably not apply if I were poor, though there is a safety net for the sick and uninsured in the United States that is more effective than British critics commonly suppose. I accept, too, that American healthcare can be wasteful and unnecessarily extravagant. It suits vested interests to perpetuate this lavish system, which partly explains the attacks on President Obama.

Once, in America and suffering from bad earache, I visited a local doctor. In this country I would probably have been greeted with a weary smile, and, if lucky, offered an aspirin. In the United States I was cosseted by a pretty nurse, and subjected to several exhaustive tests by an accommodating doctor, one of which involved me sitting in a sound-proof booth to have my hearing tested. At the end of it all I was presented with a bill for several hundred dollars - and the verdict that I had nothing to worry about.

But whatever the failings and excesses of the American system, the statistics suggest that it delivers better outcomes than the NHS when dealing with serious illnesses. I say 'suggest' because we should always be wary of comparing figures compiled in different ways in different countries. In treating almost every cancer, America apparently does better than Britain, sometimes appreciably so. According to a study in Lancet Oncology last year, 91.9 per cent of American men with prostate cancer were still alive after five years, compared with only 51.1per cent in Britain. The same publication suggests that 90.1 per cent of women in the U.S. diagnosed with breast cancer between 2000 and 2002 survived for at least five years, as against 77.8 per cent in Britain.

So it goes on. Overall the outcome for cancer patients is better in America than in this country. So, too, it is for victims of heart attacks, though the difference is less marked.

If you are suspicious of comparative statistics, consult any American who has encountered the NHS. Often they cannot believe what has happened to them - the squalor, and looming threat of MRSA; the long waiting lists, and especially the official target that patients in 'accident and emergency' should be expected to wait for no more than four - four! - hours; the sense exuded by some medical staff that they are doing you a favour by taking down your personal details.

Most Americans, let's face it, are used to much higher standards of healthcare than we enjoy, even after the doubling of the NHS budget under New Labour. Of course, the U.S. is a somewhat richer country, but I doubt its superior health service can be mainly attributed to this advantage. Americans should beware of any proposals that might threaten their standards, though President Obama is right to want to extend them to the poor.

As for us, it is time we accepted that the NHS is not the envy of the world, if it ever was. Even though it may not deserve many of the brickbats being thrown at it by Right-wing American critics, the practice of rationing expensive cancer drugs and treatments is undoubtedly more widespread in Britain than it is in America.

The principle of equal healthcare for everyone regardless of income is a precious one. The fact is, though, that there are other, better ways to achieve this than through an increasingly inefficient, centrally planned leviathan set up over 60 years ago. In our hearts many, perhaps most, of us know this. We all have horror stories to tell about the NHS, though we are likely to have good things to say about it, and its sometimes selfless medical staff, as well.

An increasing number of us take out private health insurance, and many others would like to do so if they could only afford to, which hardly indicates unbounded confidence in the NHS.

And yet, despite its shortcomings, we are reluctant to think about changing it, and any politician who suggested doing so might as well slit his own throat. For all his admiration of the NHS as a result of the treatment it offered his severely disabled son, David Cameron is quite clever enough to recognise its deficiencies, but he will only dare talk about putting ever more money into it as it is. I doubt he will be any braver, or more imaginative, in government.

In view of the failure of President Bill Clinton's healthcare proposals more than 15 years ago, and the opposition he is now facing, the omens may not be good for Mr Obama. If he really could preserve all that is good about the present U.S. system, while making it available to everyone regardless of income, I would wish him all the luck in the world.

The President is discovering that people are apt to want to defend and preserve what they have. The same is true of we British and our lumbering health service. The difference, though, is that what the Americans have is, for the most part, better than the NHS.

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Britain's NHS ‘is putting the patient last’

In Britain the health secretary matters far more than the patient, argues a new report

While British health ministers have been quick to applaud the advantages of a “national” health system to fight the swine flu outbreak, the very centralised nature of the service cuts two ways, according to a new report. Civitas, the think tank, blames the monolithic nature of the National Health Service for “putting the patient last”. It argues that the “customer” of the NHS business model introduced by Tony Blair and continued by Gordon Brown is the health secretary rather than the patient.

The report sees much in favour of attempting to introduce private provision within the state system and competition between NHS trusts to attract patients. But it says that all this has been stymied by incessant interference from the Department of Health. Health service managers say that a staggering total of 69 public bodies – excluding the Department of Health and 10 regional strategic authorities – currently regulate, inspect or demand information from NHS organisations. Questions posed by bodies such as the Care Quality Commission and the Environment Agency are frequently duplicated or irrelevant, imposing a huge unnecessary burden.

James Gubb, director of the health unit at Civitas, which has no political affiliation, said the nature of Britain’s centrally funded system inevitably meant that ministers were constantly intervening and setting targets because they saw themselves as the taxpayers’ guardian. This undermined the market mechanism. He contrasted Britain's “unique” approach with that in continental Europe, which is based on competition between insurers and between hospitals and clinics. “The continental system seems to deliver better results than the NHS and has done so for a number of years,” he said.

Recent government reforms in the Netherlands to introduce more competition between insurers showed the way ahead. “Some 20 per cent of patients switched insurers in the first year. Some insurers are burgeoning because they are so popular while others seem to have gone bust.”

The Civitas report, Putting Patients Last, concludes that the NHS has put into practice the 10 Commandments of Business Failure as drawn up by Donald Keough, past president and former CEO of Coca-Cola. Among these commandments are “assume infallibility” – the report says politicians talk of the NHS as “the envy of the world”. However its outcomes are worse than other universal health care systems and the NHS ranks low in international surveys.

Another commandment is “isolate yourself” – healthcare is conducted in separate "silos", particularly regarding communication between GPs and hospitals.

A further commandment, “be inflexible”, is met by hamstringing units with state control: staff pay is set centrally, capital expenditure is constrained, IT is a top-down programme and availability of drugs, such as expensive cancer treatments, is centrally determined.

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Below is a report of a GOOD experience by the standards of what many British mothers experience

She was lucky nature did most of the work. If there had been complications ....

"Rationing" is a word justifiably wreathed with alarm in the United States. With the looming prospect of Obamacare, horror stories are pouring in from Britain and Canada about nationalized medicine: The callous administrators, the long waiting lists for routine treatments, the scandalously high death rates for ailments that are, within our borders, swiftly cured.

But rationing isn't always as extreme as it sounds, as I discovered 12 years ago when I lived in London. I had just climbed out of a black cab and entered the hospital where I was about to have our second child. I was experiencing the fierce urgency of now, and if you've ever had a baby you will know exactly how urgent and fierce "now" can be.

Very quickly, I was ushered into a grim little room with a gurney. The great thing about hospitals under nationalized systems like Britain's National Health Service is that you don't go through an absurd amount of paperwork before gaining entrance.

The lousy thing is that no one working at the hospital even remotely shares your sense of urgency, or feels the need to pretend he does. This is an unappreciated aspect of the rationing that invariably results from single-payer systems: Those who are fragrantly termed "caregivers" needn't lavish sympathy on patients who can't go anywhere else. In my grim little room, I seemed to have been forgotten by the authorities. When a nurse finally arrived, her attitude was decidedly brisk. "You look ready to go," she observed. "Right, do you have your paper supplies?"

"My what?"

The nurse was annoyed. She explained that I was supposed to have brought a supply of towels and cotton wadding. Did I not know this? I did not, I apologized, eager to appease a powerful individual who might bring me to a bed. I explained that I was used to American hospitals, which, so far as I could recall, provided paper products to their customers. I hoped it would not be too much trouble that I had failed to provide the materials needed by the National Health Service.

Privately I was shocked, though I did not say so. Having traveled in the impoverished Third World, I was used to bringing syringes and other medical supplies with me in case they weren't available. But here, in Britain?

The nurse, only faintly exasperated, led me to another, much nicer small room. I told her I didn't want an epidural, which she said was just as well since there was very little chance of getting one. Paper products were clearly not the only comforts in short supply. What followed was medically uneventful. The infant arrived, and was weighed and measured. Now, obviously, it was time for us to be wheeled to a maternity ward to recuperate for a couple of days.

But hospital personnel kept popping in to say that they were having trouble "getting a bed" for us. The room we occupied was needed by the next customer, yet there was no spot in the maternity ward for us to take. So it was that six hours after arriving at the hospital, I was in a taxi again heading home. This time I held a newborn in my arms.

I had just tasted the health care rationing that Britons live with as a matter of course. It wasn't a ghastly experience, but it also wasn't something that Americans, accustomed as we are to comfort and plenty, would regard as acceptable.

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Fury over Obama healthcare plans

Barack Obama faces the biggest crisis of his presidency as seething opposition, stoked by alarmist rumours and fear of rationed healthcare, threatens to sweep away the cornerstone of his political agenda. America’s biggest group representing older people accused him yesterday of falsely claiming their support, and Democratic congressmen who were trying to sell the health Bill to constituents were drowned out by protesters.

Veteran observers said that they had not seen gatherings as big as those flocking to the town hall-style meetings in August, usually the quietest month of the year, for a generation. At a meeting on Tuesday night Claire McCaskill, a Democratic Senator, asked her constituents in Missouri: “You don’t trust me?” “No,” came back the reply in unison.

So many are packing the halls that the numbers of voters called to speak have had to be limited. The cameras have captured middle-aged mothers and the elderly scuffling with security guards. “If they don’t let us vent our frustrations out, they will have a revolution,” a woman warned at Ms McCaskill’s meeting in Hillsboro.

At a meeting in Lebanon, Pennsylvania, hosted by Arlen Specter, the Democratic senator who defected from the Republicans in April this year, more than 1,000 people turned up at a hall that could hold only 250. Mr Specter was greeted outside with posters denouncing “Obamacare” and comparing Mr Obama to President Ahmadinejad of Iran. Inside the protest was more mild-mannered, with a 59-year-old man explaining the frustrations of his generation. These are the people who have paid into the government-funded Medicare sytem all their lives and fear facing NHS-style waiting lists.

Standing face-to-face with Mr Specter, Craig Anthony Miller shouted: “You are trampling on our Constitution.” As security guards rushed towards Mr Miller, the Senator intervened. “Wait a minute,” he said. “The man has a right to leave.” Mr Miller stood his ground, however, shaking with fury. “One day, God is going to stand before you, and he’s going to judge you,” he said as he left to thunderous applause.

Worse has happened in the past two weeks as Democratic legislators have tried to sell Mr Obama’s $1 trillion (£607 billion) health Bill to their constituencies. They have seen their effigies hanged, they have been made to flee from the meeting hall and one legislator received death threats.

They have been branded variously as Communists and Nazis. Their offices have been daubed with swastikas — an act that the White House denounced as a “sign that things have gotten out of hand” — and Mr Obama acquired a Hitler moustache on one of his portraits. When legislators take the voters’ message to Congress it is unlikely to grant the Bill the swift endorsement that Mr Obama hoped for.

Judging by the polls and opinions at town-hall gatherings, most Americans do not approve of the reforms. Pensioners with Medicare, the biggest demographic group among voters in mid-term elections — believe they have nothing to benefit from the promised improvements, but everything to lose when, as Mr Obama suggests — Medicare is “rationalised”. In other words, its kitty will lose $159 million.

Members fear that they will be at the mercy of their doctors and that it will be like the NHS, as depicted by advertisements put up by political lobbies and insurers.

Some have more alarming concerns. Sarah Palin, the Republican candidate for vice-president in the election, claimed that the new regime would have power over life and death, and be able to discard disabled people. “The America I know and love is not one in which my parents or my baby with Down’s syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society’, whether they are worthy of healthcare. Such a system is downright evil,” she wrote last week.

A right-wing newspaper said that the physicist Stephen Hawking would not receive treatment in Britain because of his disability. Conservative groups have alleged that taxpayers would have to pay for abortions. Such claims are spread by chain e-mails, blogs and right-wing talk show hosts. The White House is trying to fight them with a website that links to social networking sites, but the opposition will not cede.

Mr Obama has taken it upon himself to spread the word personally. Referring to “death panels that will basically pull the plug on grandma because we’ve decided it’s too expensive to let her live any more”, Mr Obama told a crowd in New Hampshire on Tuesday that “I am not in favour of that”. He denied that patients would have to queue for care and not be allowed to choose their doctor.

The assurances have failed to cool tempers so far, with allies warning that the malaise runs deeper than the health reform. Mr Specter said: “It’s more than healthcare. I think there is a mood in America of anger with so many people unemployed, with so much bickering in Washington . . . with the fear of losing their health care. It all boils over.

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The Truth About Health Insurance

Only nine states have the costly rules that Obama wants to impose nationwide

The White House is priming the defibrillator paddles to revive ObamaCare, and its new strategy is to talk about "health-insurance reform," rather than "health-care reform." The point is to make its proposals seem less radical than they are, while portraying private insurers as villains for supposedly denying coverage to the sick.

Sounds like a good time to explain a few facts about the modern insurance market. Start with the reality that nine out of 10 people under 65 are covered by their employers, most of which cover all employees and charge everyone the same rate. President Obama's horror stories are about the individual insurance market, where some 15 million people buy coverage outside of the workplace.

Mr. Obama does have a point about insurance security. If you develop an expensive condition such as cancer or heart disease, and then get fired or divorced or your employer goes out of business—then individual insurance is going to be very expensive if it's available. But what the President and Democrats won't tell you is that these problems are the result mainly of government intervention.

Because the tax code subsidizes private insurance only when it is sponsored by an employer, the individual market is relatively small and its turnover rate is very high. Most policyholders are enrolled for fewer than 24 months as they move between jobs, making it difficult for insurers to maintain large risk pools to spread costs.

Mr. Obama wants to wave away this reality with new regulations that prohibit "discrimination against the sick"—specifically, by forcing insurers to cover anyone at any time and at nearly uniform rates. But if insurers are forced to sell coverage to everyone at any time, many people will buy insurance only when they need medical care. This raises the cost of insurance for everyone else, in particular those who are responsible enough to buy insurance before they need it; they end up paying even higher premiums. And the more expensive the insurance, the less likely people will buy it before they need it.

That's one reason that only five states—Maine, Massachusetts, New Jersey, New York and Vermont—have Mr. Obama's proposal for "guaranteed issue" on the books today. New Hampshire and Kentucky repealed such laws after finding that they soon had an even smaller individual insurance market as companies fled the state.

Another proposed reform known as "community rating" imposes uniform premiums regardless of health condition. This also blows up the individual insurance market, by making it far more expensive for young, healthy or low-risk consumers to join pools—if they join at all. And if the healthy don't join risk pools, then premiums go up for everyone and insurers have little choice but to reduce their risk by refusing to cover those who have a high chance of getting sick, such as people with a history of cancer. This is why 35 states today impose no limits whatsoever on how much insurers can vary premiums and six states allow wide variation among consumers.

New York, New Jersey and Massachusetts have both community rating and guaranteed issue. And, no surprise, they have the three most expensive individual insurance markets among all 50 states, with premiums roughly two to three times higher than the rest of the country. In 2007, the average annual premium in New Jersey was $5,326 for singles and in New York $12,254 for a family, versus the national average of $2,613 and $5,799, respectively. ObamaCare would impose New York-type rates nationwide.

There are better ways to go. Tax credits to individuals to buy insurance would make it more affordable and thus strengthen the individual market. Other tax rule changes could also make it easier for people to join and form their own risk pools beyond their employers, such as through business federations, labor unions or, say, the Kiwanis Club. They would no longer be hostage to one job for insurance.

University of Chicago economist John Cochrane also argues that in a more rational individual insurance market, people could insure not merely against medical expenses but also against changes in health status. This kind of insurance would cover the risk of premiums rising as you get older and your health condition changes.

In turn, that would free insurers to compete for the business of all patients, including those with pre-existing conditions, because then they could charge enough to cover the costs—instead of passing them to others. As for those with rare conditions ("orphan diseases") that require a lifetime of special care and are thus uninsurable, this is where government subsidies could be both appropriate and affordable.

ObamaCare would impose on all 50 states rules that have already proven to be failures in numerous states. Because these mandates would raise the cost of insurance, ObamaCare would then turn around and subsidize individuals to buy the insurance that the politicians made more expensive. Only in government could such irrationality be sold as "reform."

SOURCE




AARP wields its power in health care debate

If there is anyone or anything President Obama cannot afford to offend in his battle to overhaul the nation's health care system, it is the powerful seniors lobby, AARP.

Perhaps that is why the White House was so quick to backpedal Wednesday after Mr. Obama mistakenly claimed that the organization, with its tens of millions of politically active members, had already signed on to his plan. Mr. Obama drew a forceful rejoinder from the group, the nation's largest organization for retirees, when he said during a town-hall meeting Tuesday in New Hampshire that it was endorsing his health care reform proposal. White House press secretary Robert Gibbs acknowledged the error Wednesday but said Mr. Obama was not trying to mislead anyone.

That the AARP so forcefully knocked down the claim of support shows the group is wary of being used as a political football. Leaders on both sides of the debate are well aware that seniors have the power to help push through a health care bill or block it entirely. "We knew [the health care debate] would get to this position, that it would be very difficult, with partisan politics and ... misinformation," AARP spokesman Jim Dau said.

AARP has supported the concept of overhauling the system and has endorsed an $80 billion White House deal with pharmaceutical drug manufacturers that will save seniors money under Medicare Part D, but it has not expressed support for any of the specific pieces of legislation making their way through Congress.

"AARP's decision to put daylight between them and the president, coupled with the activity of seniors at these town-hall meetings, indicates that the supporters of health care reform haven't sold it well enough yet," said David Di Martino, a Democratic media consultant at Blue Line Strategic Communications. "Because of their depth of knowledge and participation rate in political debates, [seniors] usually have the loudest voice, figuratively, and in this case it seems literally as well."

Senior citizens, the largest consumers of health care and recipients of the Medicare government health care program, are increasingly questioning the health care reform plans on Capitol Hill. Polling shows that in general, seniors, who are also more likely to be Republican, aren't likely to support the reform plan. A CNN/Opinion Research Corp. poll released last week found that the majority of voters older than 50 oppose a health care overhaul, while voters younger than 50 support it.

More here




Some older postings

I am having trouble keeping up with the huge amount being written on the subject at the moment -- JR

Why not try ownership? : "America does not face a health-care crisis. America faces a manageable challenge: how to help a relatively small share of the population purchase health insurance. Obamacare is too big a solution chasing too small a problem - like hunting quail with a howitzer. Rather than endorse such big-government overkill, pro-freedom members of Congress should promote a simple concept: Let every American own and control an individual health-insurance policy that can be transported among jobs, self-employment, graduate school, and life's other twists and turns."

Designing the health care economy: "It's crazy for a group of mere mortals to try to design 15 percent of the U.S. economy. It's even crazier to do it by August. Yet that is what some members of Congress presume to do. They intend, as the New York Times puts it, `to reinvent the nation's health care system.' Let that sink in. A handful of people who probably never even ran a small business actually think they can reinvent the health care system."

Healthcare blinders: "For decades, outdated ideologies have hamstrung national politics. Now it's happening again: Healthcare reform threatens to derail over the burning question of whether we need another public program. This is a massive diversion. If structured correctly, a new public program could help transform the healthcare marketplace. But if it's Medicare-for-all, with fee-for-service reimbursement, it could intensify the rate of healthcare inflation and make universal coverage unsustainable. The crucial issue is not public or private. It is the incentives and performance standards built into the system. If we don't change those, we're sunk. Put simply, we must change the way we pay for care. The financial incentives in our system are backwards."

Channeling Woody Allen on health care: "For nearly two decades - and probably longer - Republicans lagged Democrats when it came to voter trust on health care. But for a variety of reasons, that deficit is easing. `People seem ready to hear our message,' Congressman Dave Camp, the senior Republican on the House Ways and Means Committee, told me this week. `They are paying closer attention because of the president's emphasis on the issue, but we've stepped up our efforts as well.' He's right. Voters normally ignore the GOP on health care because Democrats talk about the issue and Republicans don't. Yet as Mr. Camp notes, that's changing: in part because the GOP is now engaging on this issue. And it's starting to have an impact."

How much is a year of your life worth?: "All advocates of socialized medicine, including the President and his congressional accomplices, believe that government-imposed rationing is necessary to control health care costs. Having little faith in the judgment of individual patients and even less in the workings of the market, they are convinced that only the state is capable of efficiently allocating our medical resources. Very few of these people, however, have the courage of their convictions. With a few notable exceptions, they vehemently deny that they are for rationing. Indeed, as a matter of general strategy, they have done their best to exclude the `R' word from the reform debate. President Obama has gone so far as to explicitly to admonish his political allies `to avoid terms like `rationing" while promoting the Democrat health care agenda. But, make no mistake about it, rationing will be an integral component of Obamacare."

Losing control of health decisions: "Who should have the ability to make medical decisions when it comes to your care - your family doctor or a bureaucrat responsible for nothing more than looking out for the government's financial bottom line? Three states recently weighed in on that question, filing a federal suit to have final medical decision-making authority transferred from doctors to state bureaucrats. In March, Georgia, Florida and Alabama joined in an appeal of a 2008 U.S. District Court ruling that a patient's physician was better positioned - and better qualified - to make decisions about that patient's medical treatment than state bureaucrats."





13 August, 2009

Slap on the wrist for negligent Australian cancer doctor

So you cannot trust even a specialist and the regulators who are supposed to protect you do nothing to stop it. Could he not at least have been fined a substantial sum or barred from anything but general practice work? His interest in patient care was obviously nil. Regulators so often let negligent and incompetent people run riot that you wonder what they are for. Even when complaints are received, it always seems to take them years to act. DO NOT rely on them to protect you from incompetents. Make your own enquiries when and where you can. And Google your own illnesses so you get an idea of what SHOULD be happening

A UROLOGIST repeatedly failed to order a biopsy for a patient who presented with symptoms of prostate cancer over four years, by which time the tumour had become aggressive and spread, an inquiry has found. William Lynch, a consultant at the Sydney Prostate Cancer Centre and Urology Sydney, has been reprimanded by the NSW Medical Board for displaying ''a serious lack of care in the management of [the] patient''.

The treatment of all Dr Lynch's patients will now be subject to an audit that will look at his history taking, recall system for follow-up of patient test results, diagnostic process and decision-making.

Last month the Professional Standards Committee found that Dr Lynch failed to monitor the patient's escalating prostate specific antigen (PSA) levels, which can indicate the presence of prostate cancer. He also failed to arrange a biopsy, which would have diagnosed the cancer and indicated how likely it was to metastasise, despite suspicious results of rectal examinations and the patient's symptoms and strong family history of the disease. When the cancer was finally diagnosed 3½ years later it was graded nine out of 10.

Dr Lynch is a director of the Australasian Urological Foundation and has published extensively on the use of minimally invasive treatments for prostate cancer such as cryotherapy, in which intense cold is used to kill cancerous cells. He consults at Sutherland and St George Hospitals as well as St George Private, President Private and the Mater Private hospitals.

A number of expert reports to the Health Care Complaints Commission said his conduct was significantly below the standard expected of a specialist of his seniority.

Dr Lynch told the committee that some of the patient's clinical notes had gone missing when Dr Lynch moved offices, but from memory, the patient had been reluctant to undergo a biopsy - an argument the patient's wife strongly rejected and the committee did not accept. He did not know why alarm bells did not ring when the patient's PSA reached a high level of 15.8 and could not explain why he failed to write detailed letters back to the patient's GP.

The committee also found that Dr Lynch had not provided any evidence of the changes he claimed to have made since the case, such as an electronic medical record system and ''triple checks'' to ensure abnormal results were followed up.

SOURCE




Australian Leftist health reform ideas as crazy as Obama's

More limits on what care you can get will be coming

Barack Obama wants $US1000 billion over a decade to fund health reform. It is an unfathomable amount of money and if the drug companies and other vested interests in US medicine's vast corporate edifice fail to sink his proposal, then the seeming impossibility of financing may sink it anyway. If Kevin Rudd accepts the proposals of his own health reform gurus, he may have to ask us for what amounts to almost the same sum, per capita.

Last month the National Health and Hospitals Reform Commission estimated its proposals - with a dental health scheme, better community care for long-term conditions including mental illness, and new performance standards for emergency care and surgery - would cost at least $2.8 billion to $5.7 billion a year. Over a decade, that makes $32 billion to $64 billion. Multiply the upper end by 15 (roughly the factor by which the US population is larger), convert the currency and you reach $US800 billion.

It's no coincidence. Despite different financing regimes, both countries need to spend now to realign towards more rational health care, which keeps people well instead of just saving them when they are sick. We have identical pressures: an ageing population and the rising real cost of treating more people better for longer. Each year the use of intensive care beds (which cost $1.5 million a year to run) by those over 70 increases 14 per cent, the Australian and New Zealand Intensive Care Society says. Changing technology means more now survive previously unthinkable treatment.

While specialists want debate about limiting medical heroics for the very old and very sick, they do not want to start it. As the head of intensive care at a large Sydney hospital recently commented privately, it is ''tiger territory''. It's not hard to see why. Take Erbitux, a drug for advanced bowel cancer. It costs $US80,000 for an average extra 1.2 months of life, say doctors from the US National Institutes of Health. Calculations published last week in the Journal of the National Cancer Institute put the annual cost of extending the life of every American cancer patient by one year at the same price pro rata at $US440 billion. If you use the same formula for Australia, it's about $35 billion.

Australia does health care comparatively efficiently and well. We spend half, per capita and as a proportion of gross domestic product, what the US does - where outrageous private doctors' fees are rife and the quality of care is uneven and often woeful. We spend about 10 per cent more than Britain, but for that we get a life expectancy two years longer. It's a good start, although insufficient to hold back the twin tides of demographics and technology. Minor tweaks are not going to help in a world where a single costly breakthrough drug can bring the system to its knees.

But in the reform commission's nearly 300-page report lurks a grenade. Under the anodyne name Medicare Select is the seed of a plan that could end the generally unlimited access to medicine Australians enjoy. The Government would determine a ''mandatory set of health services made explicit in a universal service obligation'', or minimum treatment standards all Australians could expect from their health insurance, of which the Commonwealth would become just one, no-frills, provider. All services, including doctors, public hospitals and ambulances, would be covered. Private opt-in funds could supplement that legislated minimum with extras such as fancier hospitals and orthodontics, as they do now.

The key word is ''explicit''. How explicit? Australians have grown used to implicit access to medicine, a warm and fuzzy sense that in our darkest hour the system will rescue us. State public hospitals have few explicit caps on what care is offered to whom and for how long, and managers have leeway to fund unusual therapies in special circumstances. Medicare and the Pharmaceutical Benefits Scheme have more precise rules. But doctors work around them, stretching the truth to, for instance, justify dementia medication if they believe standard tests miss the subtleties of the person's condition.

Another clue to the commission's agenda is in its description of how Medicare Select might be funded: ''To aid the community's understanding of the cost of the universal entitlement to health care, it could be financed through a publicly identified share of consolidated revenue or from a dedicated levy.''

Australia spent $94 billion on health care in 2007 - a rise of 4.8 per cent (double the inflation rate) on the previous year - but fragmented among state and federal accounts and out-of-pocket payments. A single government budget item - goes the thinking - running to $70 billion and spiralling upwards, would focus the community mind. The current round of health reform talk is just the beginning. Next, we need to discuss how much medicine we are prepared to pay for, and when we stop.

SOURCE




Botched NHS surgery in Scotland

It is a macabre and not particularly amusing joke shared by doctors that the absolutely worst time to have a baby, undergo surgery or be involved in a road traffic accident is around now. Early August and February are traditionally when new medical rotations for junior doctors begin and hospital corridors are filled with panicky people in white coats and surgical scrubs who look as if they should be advertising Clearasil, not assisting with aortic valve replacements.

I know of two consultants who on their very first day as junior doctors in different Accident & Emergency wards were faced with multiple victims of serious road accidents, people whose lives depended on the first doctor they met being confident, knowledgeable and very fast. Instead of ER they got “er . . .”.

The only thing worse than being a new junior doctor expected to perform potentially life-saving interventions beyond your capabilities and experience is being the patient. Yet, that sense of being out of your depth is an accepted rite of passage for young medics, something to be joked about over a pint in the pub.

The news that 5,500 operations were botched or bungled in Scottish hospitals over the past five years will come as no surprise, then, to the medical profession. In 3,000 cases, organs were accidentally punctured or damaged but there were also incidents of the wrong operation being performed, surgical instruments being left inside patients’ bodies and sterilisation of instruments not being carried out beforehand.

The response of the government and the medical authorities to the news is revealing. Dr Charles Swainson, medical director at NHS Lothian, the health authority with the highest number of “incidents” said that because of the way the data are recorded, the statistics are unreliable. A spokeswoman for the Scottish government described the figures as regrettable but insisted they must be seen in the context of the vast majority of procedures being carried out safely.

Both responses are axiomatic of what is wrong with the NHS today. It is unlikely to be of much comfort to the former Scotland football captain Colin Hendry that in the vast majority of cases of liposuction there are no complications. All that matters to him is that his wife Denise died last month at the age of 42 following 20 operations to try and rectify plastic surgery that went horrifically wrong.

You don’t tend to hear car manufacturers or airlines stating that a faulty car or a crashed plane should be seen in the context of all the thousands of planes which take off and land safely or all the cars which don’t develop potentially lethal faults. If there is an incident with a plane — however minor — air accident investigators are all over it, usually producing an initial report within 48 hours. If a new car develops an unexplained fault, every car in that range is recalled and checked. Passengers and drivers will simply take their business elsewhere if an airline or a manufacturer behaves irresponsibly or doesn’t make safety its priority. The NHS can afford a scandalous degree of complacency because, despite successive government mantras of “patient’s choice” most patients have about as much choice as Hobson.

There is a consensus among the medical profession that because all medical procedures carry a degree of risk, a certain level of risk is acceptable. But is an average of three botched operations a day in Scotland really tolerable? Were our airlines to maim three passengers a day, there would be outrage. Last year the National Audit Office said that there may be up to 34,000 deaths annually in Britain as a result of what it coyly calls “patient safety incidents”. The NHS’s attitude to safety is frankly appalling and would not be accepted in any other industry. Forgetting to sterilise equipment or leaving foreign matter inside a patient after an operation is never an acceptable risk. It is carelessness bordering on malpractice.

Then there is Swainson’s argument that the statistics are irrelevant because of the way they are collated. The 5,500 botched operations cover everything from removing the wrong kidney to a tiny nick with a scalpel. It is certainly true that, for the statistics to be meaningful, we need to know how many of the botched operations were fatal, life-threatening or serious enough to affect quality of life. They also need to be broken down on a surgeon-by-surgeon basis to see if patterns emerge.

As a result of devolution, Scotland, England, Ireland and Wales have been following significantly different health policies. We are involved in a huge medical experiment in which we are all guinea pigs by default. The one upside would be the ability to analyse which of the four models has proved the most successful. However, the idiosyncratic way in which the different countries collate statistics has meant that in many key areas, comparisons are simply impossible. It is outrageous that there isn’t a universal system for collating health statistics that would allow direct comparisons not only throughout the UK but across Europe.

While the NHS insists on treating patients as statistics and statistics as propaganda tools, the safety and efficiency of the health service will never improve.

SOURCE




On Canadian Health Care

My wife is Canadian. So are my kids. The kids are American, too -- they have US Birth Abroad papers, and yes, they have birth certificates. They have passports from both countries. I met my wife while shooting in Vancouver. She didn't want to leave just because we were getting married, so I lived there for 3 years. Those three years changed my views about a lot of things. Health care is one.

I went into it with an open mind. After all, I'm not Canadian, so I wasn't paying for it. I paid if I needed to go to the doctor. The prices were really low, because they were government-subsidized. One pretty big emergency room visit for a kidney stone cost me CDN $500. Not bad, in comparison. Of course, Canadians picked up the rest of my tab. Boy, did they ever.

One of the reasons I never became a Landed Immigrant (Canadian equivalent of a Green Card) was because I didn't want Revenue Canada near my paycheck. My business was in the US, and the IRS is plenty, thank you. Back then, which was almost 10 years ago, I think it was CDN $35,000 or so that was the beginning of the 50% bracket. (I do not know if that number is accurate. It could be higher. But it's really, REALLY low, compared to our highest threshold.) Now, add Provincial (state) income tax to that. Note that you cannot deduct any mortgage interest, or much of anything, from either. Then add a national GST (Goods and Services Tax) to everything you buy. On top of that, add PST (Provincial Sales Tax) to everything you buy. AND add special provincial and local taxes to purchases of special things, which aren't, typically, all that special, and actually cover a lot of the things you buy. One special thing, for instance, is gasoline. I just got off the phone with my brother-in-law, who can't remember, exactly, but he thinks gas is about $1.09 right now in Vancouver. That's for a liter of gasoline. A LITER. Which would make it over $4.00 a gallon. And that's not too bad, these days, he says. If you smoke (I don't), the tobacco taxes will kill you before cancer will.

So, what do all those taxes buy you, in the form of health care? Well, let's talk about that kidney stone I had. If you've ever had one, you know immediately why I went to the emergency room. As it turns out, growing up in Florida, and as a member of my particular family, means I'm predisposed to more. Looking forward to that. Anyway, this one was my first one, and it hurt worse than anything had ever hurt. I didn't see a doctor at the ER, but the nurse (or PA - I don't know for sure) was able to give me some Darvocet, and a prescription for more. I also got an appointment with a urologist for the following week, which was a fast-track exception, because I was a foreigner. A week later, still a bit dazed from a growing Darvocet habit, I got to see the guy, who was really nice, and was hoping to move to the US to practice, so he could make a decent living. He told me I'd probably pass the stone, and would simply need to take the Darvocet until I did. If, however, I didn't pass it in about a week, they'd have to think about breaking it up with ultrasound. I'd heard about this from my dad. Apparently, it's pretty quick, and totally painless -- the machine breaks up the stone into small bits with sound waves, and you pass the bits easily. Most US hospitals, and a lot of clinics, have a machine to do this. The only hitch? In all of BC, there's one machine. This is a place about 125% bigger than Texas. Vancouver is the third largest city in Canada. And there's one machine. It travels the province like a roving minstrel. It wasn't due back in Vancouver for 6 more weeks. I passed the stone two days later. Thank God.

The brother-in-law I spoke to tonight is an interesting story. Seems his tonsils reached the point, about 3 years ago, when they simply could not do their job anymore. In fact, they began to cause serious infections. So serious that, more than once, he had to be rushed to the hospital, and kept for several days. He required IV for fluids, and for drug delivery, while in the hospital -- and was listed as critical on both occasions. The doctor informed him he required a tonsillectomy as soon as possible. Until he got his tonsillectomy, there would be, he was assured, more hospital visits. The first available date for him -- a guy in his 20s -- was two years away. For 9 months, in order to stave off infection, he did an outpatient plan where he went to the hospital 3 times a day, every day, to receive treatment via IV. (Once every 8 hours.) A week on the plan, a week off. Doesn't seem like a cheap, or pleasant, experience to me, but what do I know? Luckily, his tonsillectomy got fast-tracked, and he was able to get it after only 9 months of this regimen. Nine freakin' months. Makes the expense of ice cream and cowboy pajamas, and the week of quiet, back when I was five and had my tonsils out, seem -- I dunno -- quaint.

I have a lot of stories like this. More than I can write here, and way more than you'll read. And I only lived there three years. Stories about my wife, her mom, more brother-in-law stories, some pretty scary ones about my kids, and a particularly sad one about my wife's grandmother. Most aren't life and death -- the grandmother one is -- but all of them illustrate a health care system that's inefficient, and reduces choice -- because it's run as a government bureaucracy. I tell the funnier ones because there are plenty of truly scary ones already out there. I didn't want to be accused by the YouTube lady at the White House of spreading disinformation. Hey, this is comedy. Of sorts. I do want to tell one more story, though. Because it illustrates how socialized health care -- socialism in general -- reaches beyond the doctor's office:

One night when my son was six months old, he had a raging fever that went beyond normal baby fever. My boy is, well, feverish, so it wasn't a completely unusual thing -- but this one was unusually high, and climbing. Unfortunately, we were out of Infant Tylenol, which had shown past success in bringing his fever down. So I went to the store to get some. Now, we lived in a suburb, about an hour from downtown Vancouver. It was about 9:30 p.m., so the only nearby store that was open where I could buy Infant Tylenol was the big Safeway, which had a good pharmacy. When I got to the cold medicines isle, I found that the Tylenol, including Infant Tylenol, was locked up behind a plexiglass door on the shelf. I was no stranger to locked OTC medicines -- I've lived in New York and Miami, and I know that people steal stuff. Especially drugs. So I asked the clerk if she could unlock it so I could buy some Infant Tylenol. She looked at me like I was from Mars.

"Oh, no, Hon -- the pharmacist has gone home. She leaves at 9:00. She has to be here for us to sell it."

Well, that's a stupid rule, I thought. And I said so. But, it's not a rule, she assured me. It's the law in BC. That's right -- the law. Never mind that even if the pharmacist had been in the store, she wouldn't have a clue what I was buying -- or even that I exist -- because when she's there, it's unlocked, and it's four aisles away from where she works. You can buy it at a regular register. That is, as long as the pharmacist is in the building. Why? Because somebody might have a question. This is Infant Tylenol, for cryin' out loud! What is there to ask?

We ended up calling an ambulance when my son's fever reached 103F (still can't do Celsius) and continued to climb. We had an emergency room visit, where, you got it -- Infant Tylenol -- brought the fever down, and he was ok in an hour. Well, thank goodness we took the economically efficient way out of that one. The Tylenol at the Safeway might have cost us $25 or $30 (remember all those taxes...). But the ambulence and the ER were FREE. Well, ok, the Canadians paid for it somehow.....

Incensed, I went back to Safeway the next day to see what, exactly, I can't buy when there's no pharmacist on site. Cold medicines, of course, can be dangerous, so what else is too dangerous for people without proper guidance? Turns out most anything with any kind of medicine in it. Tegrin Medicated Shampoo, is, apparently, dangerous. So is Oxy-10 facial scrub. And the list goes on, and on, and on. It's funny, in a very sad kind of way. Socialized medicine leads to socialized over-the-counter medicine, which leads to socialized zit medicine. It, itself -- socialism, I mean -- is a disease.

I know this post is long. But the stories are worth repeating. Because the issue is big, and it's complex, and it has unintended, and intended consequences. Our elected representatives don't want to read the bill, because they don't want to know, or hear about those consequences. Or because they do know, and they believe those consequences are perfectly acceptable, in the name of increased control of our choices, and our lives. I won't pretend that the US health care system is perfect. It's not. But it's a hell of a lot better than what exists in Canada. And anyone who tells you different is either lying, or just plain wrong.

SOURCE




Rasmussen: 32% Favor Single-Payer Health Care, 57% Oppose

Thirty-two percent (32%) of voters nationwide favor a single-payer health care system where the federal government provides coverage for everyone. A Rasmussen Reports national telephone survey finds that 57% are opposed to a single-payer plan.

Fifty-two percent (52%) believe such a system would lead to a lower quality of care while 13% believe care would improve. Twenty-seven percent (27%) think that the quality of care would remain about the same.

Forty-five percent (45%) also say a single-payer system would lead to higher health care costs while 24% think lower costs would result. Nineteen percent (19%) think prices would remain about the same.

There's wide political disagreement over the single-payer issue. Sixty-two percent (62%) of Democrats favor a single-payer system, but 87% of Republicans are opposed to one. As for those not affiliated with either major party, 22% favor a single-payer approach while 63% are opposed.

Investors oppose a single-payer system by a three-to-one margin. However, a narrow plurality of non-investors favor such a plan.

Data released earlier today shows that 51% of voters fear the federal government more than private insurance companies when it comes to health care decisions. Forty-one percent (41%) have the opposite fear.

More here





12 August, 2009

In a Tight Spot, Pelosi Calls Health Care Critics un-American

? She would certainly know all about being un-American. That good old Leftist projection again



House Speaker Nancy Pelosi turned the health care debate up a notch Monday, penning a column along with her top deputy that questioned the patriotism of those disrupting town hall meetings to air their complaints. Pelosi and House Majority Leader Steny Hoyer claimed such behavior is "simply un-American."

It's hardly the first time Pelosi, who earlier this year accused the CIA of lying to Congress and repeatedly has called Republicans unpatriotic, has employed some serious name-calling to characterize her opponents' views.

The jab Monday drew swift scorn from Republicans and critics who say the health care demonstrations are as American as apple pie. "I, like most Americans, would find that kind of characterization of citizens exercising their First Amendment rights to be offensive," Rep. Mike Pence, R-Ind., told FOX News. "There's nothing more American than letting your elected representatives know how you feel about important issues facing the nation." House Republican Leader John Boehner, R-Ohio, released a statement calling the charge "outrageous and reprehensible."

Pelosi and Hoyer made the accusation as part of a lengthy column in USA Today stressing the need for action on health care reform. The piece was published as lawmakers return to their districts for summer recess, a period that could imperil the legislation if health care critics cause moderate Democrats to lose their stomachs for sweeping reform. Critics have confronted lawmakers about the bills, sometimes shouting at them, at a number of town halls in the past week alone.

On Monday, Democratic Sen. Claire McCaskill tried a new tack in rebutting the protesters while also minimizing their complaints. She got several hands when she asked audience members at a town hall meeting to raise their hands if they're so scared about the federal government running health care that they "can't think straight."

For Pelosi and Hoyer, they charged that an "ugly campaign" is afoot to misrepresent the legislation, "disrupt" the public meetings and prevent members of Congress from "conducting a civil dialogue" on the topic. "Let the facts be heard," they wrote. "These disruptions are occurring because opponents are afraid not just of differing views -- but of the facts themselves. Drowning out opposing views is simply un-American. Drowning out the facts is how we failed at this task for decades."

The "un-American" dig was a sign the debate is heating up. In a tight spot, Pelosi is known for employing tough rhetoric and accusations to muscle her way out. Back in September 2008, Pelosi used similar language to complain about Republicans who weren't showing up to talks on a Wall Street bailout package. "I thought it was very unpatriotic of them not to show up, not to show up, in some ways, boycott the meetings earlier in the week," she said. She also reportedly called the GOP budget in 2006 "unpatriotic" because it drove up the national debt.

This past May, she accused the CIA of lying to Congress, as she was facing questions about how much she knew early on about the Bush administration's interrogation policies. Then last week, with the health care debate growing more heated, she invoked Nazi Germany, accusing protesters of "carrying swastikas and symbols like that" to meetings. A spokesman for Pelosi later said the speaker was referencing a photo taken at a town hall meeting hosted by Rep. Ed Markey, D-Mass., which showed a protester holding a sign of a swastika crossed out over President Obama's name and a question mark.

Yet the language Pelosi is using for health care critics is nothing like the language she used to describe anti-war protesters criticized by war supporters as unpatriotic. Pelosi, who led efforts to withdraw from Iraq before troops had finished the job, tolerated anti-war hecklers on several occasions. "It's always exciting," she said of protesters who interrupted a meeting in January 2006, according to an account in the San Francisco Chronicle. "This is democracy in action. I'm energized by it, frankly." At an event in June 2007, she told anti-war protesters "just go for it, I respect your enthusiasm," according to another account.

The claims of "un-American" behavior by critics is not something made by President Obama, who on Monday withheld criticism of his health care detractors. "We are having a vigorous debate in the United States and I think that's a healthy thing," he said, speaking at a North American summit in Mexico.

Sen. John Cornyn, R-Texas, said there's not really any "substantive difference" between the anti-war protests of MoveOn and Code P