The blogspot version of this blog is HERE. The Blogroll. My Home Page. Email John Ray here. Other mirror sites: Greenie Watch, Political Correctness Watch, Dissecting Leftism, Australian Politics, Education Watch, Gun Watch, Recipes, Immigration Watch, Tongue Tied and Food & Health Skeptic. The archive for this site is accessible here or here. For a list of backups viewable in China, see here. (Click "Refresh" on your browser if background colour is missing)
************************************************************************************



30 June, 2009

Welcome to Canada!

By Mark Steyn

Somewhere in America Alone, I cite an example of the logical reductio of socialized health care: "the ten-month wait for the maternity ward". I've been adding to the file ever since. Here's the latest entry, from Hamilton, Ontario: "Hamilton's neonatal intensive care unit (NICU) was full when Ava Isabella Stinson was born 14 weeks premature at St. Joseph's Hospital Thursday at 12:24 p.m. A province-wide search for an open NICU bed came up empty, leaving no choice but to send the two-pound, four-ounce preemie to Buffalo that evening."

Well, it would be unreasonable to expect Hamilton, a city of half-a-million people just down the road from Canada's largest city (Greater Toronto Area, five-and-a-half million) in the most densely populated part of Canada's most populous province (Ontario, 13 million people) to be able to offer the same level of neonatal care as Buffalo, a post-industrial ruin in steep population decline for half-a-century.

But wait! The fun and games are only just beginning. When a decrepit and incompetent Canadian health bureaucracy meets a boneheaded and inhuman American border "security" bureaucracy, you'll be getting a birth experience you'll treasure forever: "Her parents, Natalie Paquette and Richard Stinson, couldn't follow their baby because as of June 1, a passport is required to cross the border into the United States. They're having to approve medical procedures over the phone and are terrified something will happen to their baby before they get there".

Once Buffalo enjoys the benefits of Hamilton-level health care, I wonder where Ontario will be shipping the preemies to. Costa Rica?

SOURCE




British doctors want right to pray for patients without fear of reprisal

Doctors are calling for the legal right to be allowed to pray alongside their patients. The British Medical Association is to debate whether the threat of disciplinary action should be lifted from NHS staff who try to meet patients' spiritual or religious needs. There has been concern among doctors and nurses that even offering to talk about such matters could be grounds for suspension.

Guidance issued by the Department of Health in a document called Religion Or Belief: A Practice Guide For The NHS has fuelled anxieties. It says such requests could be seen as harassment or intimidation and could lead to staff being disciplined.

Cancer specialist Dr Bernadette Birtwhistle, of the Christian Medical Fellowship, said the debate on Wednesday at the BMA's annual meeting in Liverpool would clarify how doctors and other staff could provide spiritual care for patients. She said: 'It's getting to where many of us feel we cannot talk to patients about their spiritual or religious needs or ask them about praying. 'Christianity is being seen as something that is unhelpful. 'Freedom of speech is being curtailed too much, and I don't think it is always in the benefit of patients.'

The move follows the case last year of nurse Caroline Petrie, from Westonsuper-Mare last year, who was suspended after a patient complained that she had offered to pray for her. North Somerset NHS Trust agreed she could return to work and pray for patients as long as she asked them first if they had any spiritual needs.

The Department of Health guidance states that members of some religions are expected to convert other people. It adds: 'To avoid misunderstandings and complaints, it should be made clear to everyone from the first day of training or employment that such behaviour could be construed as harassment under the disciplinary and grievance procedures.'

Dr Hamish Meldrum, chairman of the BMA Council, said the importance of the issue for a minority of people 'could not be underestimated'. He said no healthcare professional should be able to impose their beliefs but it was 'perfectly acceptable' for patients with a terminal illness to be asked if they wanted to see a chaplain. Dr Vivienne Nathanson, director of professional activities at the BMA, said: 'It's hugely important that it's allowed, but it's not an opportunity to impose your views on patients.'

The BMA will debate the matter, making it clear that offering to pray for a patient should not be grounds for suspension. The Department of Health said the document was a guide to encourage awareness for staff and patients.

SOURCE




States consider opting out of federal healthcare

Lawmakers in six states are considering legislation to "protect" citizens from a federal health care plan by creating statewide initiatives to vote on whether to opt out of the national program -- even before Congress has created the program

Congress has yet to come up with a clear prescription for the nation's health care system. But some state legislators are already urging voters not to take the medicine. Under Arizona's Health Care Freedom Act, which was passed by the state legislature this week, a voting initiative will be placed on the 2010 ballot that, if passed, will allow the state to opt out of any federal health care plan. Five other states -- Indiana, Minnesota, New Mexico, North Dakota and Wyoming -- are considering similar initiatives for their 2010 ballots.

"Our health care freedoms are very much at risk by health care reforms proposed in Washington, D.C.," said Arizona state Rep. Nancy Barto, the Republican legislator who sponsored the measure. "We needed to act as a state to protect our citizens and ensure that they will always be able to buy their own health care and not be forced into a plan they don't want."

But an opponent of the bill, state Rep. Phil Lopes, says the measure has less to do with individual freedom and more to do with the protecting the status quo. "The proponents of this are saying the system we have now works and we don't want any kind of reform," the Democratic legislator said. "This flies in the face of what the public tells us they want."

Not so, says Christine Herrera, director of the Health and Human Services Task Force for the American Legislative Exchange Council (ALEC). The group's 1,800 state legislator members have endorsed a resolution opposing a Medicare-modeled federal health plan and a national health insurance exchange, two concepts that are gaining ground in Washington. "Our state legislatures are looking at what's going on in Washington as trampling state's rights," Herrera says.

Some state legislators say they worry that a government-mandated program will effectively eliminate their traditional role in regulating health insurers -- an important power base. Others raise constitutional concerns. "The real goal of national health insurance exchange isn't competition -- it's a federal power grab that flies in the face of the Tenth Amendment," says Wisconsin state Rep. Leah Vukmir, a Republican.

The Tenth Amendment ensures that "the powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." It's the same constitutional roadblock Franklin D. Roosevelt ran into during the Great Depression when he tried to ram through the first round of recovery programs under the New Deal. In a series of rulings, the U.S. Supreme Court found the National Recovery Act, the Agricultural Adjustment Act and several other recovery programs unconstitutional.

But constitutional scholars say it's unlikely history will repeat itself with health care reform efforts. "It's hard to imagine Congress passing anything that would be plausibly challengeable under the Tenth Amendment, but it's certainly theoretically possible," said Paul Bender, professor of constitutional law at Arizona State University. He said Congress has broad powers to regulate interstate commerce, which would include something as big as health care.

But Bender also said he sees a striking similarity between the current makeup of the Supreme Court and the "Nine Old Men" who stymied FDR's sweeping reform efforts in the 1930s. "Both sets of jurists seem to share a belief that the balance of power has shifted too far in favor of Congress at the expense of the states," Bender said.

Some state lawmakers who oppose President Obama's efforts to implement a national health care plan say the inevitable result will be socialized medicine. "The public plan and national health insurance exchange will squeeze out private insurance and put us on the road to single-payer health care," warns Georgia state Sen. Judson Hill, a Republican. "Having the public plan now will mean socialized medicine later," he said.

Hill and other state legislators expressed concerns that millions of people will drop their private coverage if there is political pressure to keep a public plan's premiums low and benefits high. And if private insurers leave the market, they say, consumers will essentially be left with no choice of plans and no control over how their health care dollars are spent.

"Pure speculation," says Lopes. "In 1964 this was the same argument insurance companies made with President Lyndon Johnson when he proposed Medicare. Medicare did not do away with private insurance companies. They did very well."

"Protecting the rights of individuals to be in control of their health and health care must be a fundamental component of health care reform," says Dr. Erick Novack, chairman of Arizonans for Health Care Freedom, which promoted the state's ballot measure. "We are confident that the people of Arizona will vote to ensure their own rights."

With a constitutional challenge to health care reform problematic at best, that vote may turn out to be largely symbolic. But for now, that doesn't seem to be stopping other states from following Arizona's lead.

SOURCE





29 June, 2009

A Duty to Die?

Coming to you sooner than you may think. Don't get old in Obama's America. Withdrawing at least some care from the elderly is going to be very tempting once costs balloon they way they will

About twenty-five years ago, then-Colorado Governor Richard D. Lamm stirred up a bee's nest of controversy with his assertion that elderly, terminally ill patients have “got a duty to die and get out of the way.” While the Governor has since waffled on whether he actually meant the words he actually said, plenty of others have not on this issue. A good example of this, and perhaps a good gauge of where the debate in this country is headed as we come closer to the reality of a one-payer system for health care is the claim by British Baroness Warnock that dementia patients “should consider ending their lives because they are a burden on the NHS [National Health Service] and their families.”

How does one get to the point of saying that some members of society have an actual duty to die? What moral reasoning lies in back of such a stance? While it is possible to produce a full-blown Marxist-Socialist argument in support of such a position—for example that these people cannot actively support and indeed may actually hinder Marxist Revolutionary progress, hence they have a duty to get out of the way—in Western Society, arguments underpinning a “duty to die” have usually arisen instead from the moral theory of Utilitarianism. Not itself a Socialist Ethic, it more often than not comes down with the same moral prescriptions as Socialism because like it, Utilitarianism emphasizes the supposed general good of society over the interests of the individual.

Invented in the nineteenth century by philosopher Jeremy Bentham as a means to provide moral support for reforms to the British legal system, Utilitarianism has become one of the dominant systems of secular ethics. Its deceptive simplicity has lured many into its camp for, under this view, we as human beings have only one all-encompassing moral duty: to act so as to promote the greatest good (as far as the consequences of our actions are concerned) for the greatest number of people (be it those immediately affected by what we do or society as a whole).

Its founder Bentham originally understood as ‘good’ that which increases the overall balance of happiness in society or at least lessens unhappiness. Optimistically, Bentham initially thought that we could work out our moral duty with near mathematical precision by comparing the consequences of two possible courses of action in terms of their production of overall societal happiness. Unrealistically, he thought we could talk about it in measurable units. This turned out to be a non-starter because we cannot know whether we have two or ten of something until we know what counts as having one of that thing. And how can we say with any precision what is to count as one unit of happiness?

Enter the Cost-Benefit Analysis. While we may not be able to specify with any precision what counts as a unit of happiness, we do know what counts as one dollar. Because of the impracticality of talking about moral right and wrong in terms of the promotion of human happiness, a number of modern utilitarians have tied together their theory with the business practice of developing a cost-benefit analysis. Here the morally right course of action then becomes what on balance produces the greatest benefits for the costs involved. This marriage of an essentially value-neutral accounting practice with utilitarian moral theory produces a deadly combination. For now, in the realm of health care spending, it is not just financially prudent—a matter of good business sense—to make decisions in terms of what produces the most benefits for the costs involved, it is our moral duty to do so!

The costs of treating elderly patients whose prognosis is poor and who have much less to give back to society than those much younger, even if their course of treatment is successful, result in insufficient benefits to justify them for the utilitarian. In a health care system governed by the free market, individuals may nonetheless choose to incur these costs of treatment because they are spending their own money either directly or for insurance premiums to their private insurer. But in a single-payer system, the costs of health care for individuals are the costs of it to society. If in it officials deciding on the allocation of care see it as their moral obligation to do so in a way that produces the most benefits for society for the costs involved, then elderly patients whose treatment will likely produce far fewer benefits will invariably lose out and be denied care. But moralists like Baroness Warnock argue that they should accept this consequence as their moral duty to society as it reduces society’s costs and the emotional burden on their families. It is, she argues, their moral duty to die!

At this point, some readers may want to ask, “But isn’t human life itself an unqualified good, to be preserved no matter what the costs? Does not this patient have an inalienable right to life that alone would justify his or her treatment?” What would a utilitarian say of an appeal to this right? For utilitarians, rights are derivative on duties, any rights we have are derived from duties others have toward us and these duties are determined by what produces the greatest good for the greatest number of persons. If it does so to provide members of society with universal health care, as some utilitarians would claim, then society has a duty to do so. As a result, individuals have a right to expect this provision from society. Utilitarianism can thus support this supposed positive right to universal health care. Conversely, however, we have no rights that are not derived from our sole obligation to promote society’s greater good and, what is more important, can have no rights that would conflict with this obligation. So, if providing care to an elderly, terminally ill patient conflicts with this obligation then that patient has no right to expect such care. Thus, utilitarianism is destructive of rights like the right to life —as will be government-administered universal health care.

SOURCE




Beware New York Times Polls, “46 Million Uninsured” and Other ObamaCare Hoaxes

If Barack Obama’s health care overhaul is such a good idea, why must its proponents resort to deception when advocating it?



When something can stand on its own merits, there is obviously no need to prevaricate. And the fact that efforts to socialize America’s health care sector cannot stand on their own logical merits betrays the dangerous nature of Obama’s scheme. The latest example came this past week, when ObamaCare proponents trumpeted a New York Times/CBS News opinion poll purportedly showing that large majorities of Americans support government-run health care.

The June 12-16, 2009 poll indicated broad, substantive support for Obama’s plan, as 72% of its respondents favored a government health care provider to compete with private insurers. Suspiciously, the poll also reported that by a 57% to 39% margin, respondents are “willing to pay higher taxes for insurance for all.”

Revealing its predictable ideological bias, CBS News’ website could hardly contain its enthusiasm: “A clear majority of Americans – 72 percent – support a government-sponsored healthcare plan to compete with private insurers, a new CBS News/New York Times poll finds. Most also think the government would do a better job than private industry at keeping down costs, and believe that the government should guarantee healthcare for all Americans. The new poll shows the idea of a government-sponsored plan, or ‘public option’ to be fairly non-controversial.”

It turns out, however, that the poll was stacked with a disproportionate number of Obama supporters. Of the poll’s 895 respondents, some 48 percent stated that they voted for Obama this past November, whereas only 25 percent reported they voted for Senator John McCain. That disproportionate two-to-one margin contrasts with the actual November 2008 election results, in which Obama’s margin was 53% to 46%. If the CBS News/New York Times poll had been representative, Obama would have defeated McCain by a 66% to 34% margin last November. As polling expert Kellyanne Conway noted, “was the vote 66 to 34? You tell me.”

Of course, this is merely the most recent instance of distortion in the current healthcare debate. Perhaps the most pernicious deception advanced by those who allege a health care “crisis” and advocate a socialized system is that 46 million Americans are uninsured. But a closer examination reveals the dubiousness of that claim.

First and foremost, approximately 21 percent of that number, or 10 million, are not American citizens. Is it the responsibility of American taxpayers to subsidize health insurance for ten million non-citizens? Of course not.

Second, it’s estimated that as many as 14 million of the 46 million are already eligible for existing government insurance programs, such as Medicaid and S-CHIP, but for whatever reason have failed to -- or have chosen not to -- enroll.

Third, approximately 19 million of the uninsured are people between the age of 18 and 34, according to the National Center for Policy Analysis. As they note in their study, “most of them are healthy, and know that they can pay incidental expenses out-of-pocket. Using hard-earned dollars to pay for healthcare they don’t expect to need is a low priority for them.” Consequently, they have little incentive to insure themselves, and instead refrain from buying coverage unless and until they suddenly need emergency care.

Fourth, 9 million of the oft-cited 46 million live in households with incomes above $75,000 per year, and another 9 million in households earning above $50,000. While nobody would contend that these income levels qualify as “wealthy,” both levels far exceed the federal poverty level.

Together, these realities expose the deceptive nature of the “46 million” statistic routinely cited by advocates of government-run health care. Moreover, scientific polling regularly shows that between 70% and 80% of Americans are actually satisfied with their level of healthcare. In fact, a recent USA Today/ABC News/Kaiser Family Foundation survey reveals that 89% of respondents were pleased with their plan.

Accordingly, improvements to the nation’s health care system must focus on free-market principles and empowering individuals and families, not stifling government takeovers. Through medical tort reform, for example, we can limit the litigation costs and frivolous “jackpot justice” awards that drive up medical costs. We can also allow citizens to purchase insurance policies across state lines, which would drive down insurance costs and provide individuals and families the freedom to choose health care coverage that best suits their needs from a national marketplace.

In any case, beware the fraudulent numbers cited by those who advocate a wholesale government takeover of the American health care system. The fact that they must resort to deception is the surest sign that they’re prescribing the wrong medicine.

SOURCE





28 June, 2009

Health care reform: Questions for the president

Health care reform is on life support," says Rep. Jim Cooper of Tennessee. And he's a Democrat. President Obama has spent months building momentum for health care reform. But when the Congressional Budget Office put the price tag near $2 trillion, it stopped reform dead in its tracks.

What Senate Finance Committee chairman Max Baucus, D-Mont., once called "nearly inevitable" now seems much less so — and that's before supporters have confronted the really tough questions. Before this debate is over, Obama should answer a few questions about his plans for reform, including:

Mr. President, in your inaugural address and elsewhere, you said you are not interested in ideology, only what works. Economists Helen Levy of the University of Michigan and David Meltzer of the University of Chicago, where you used to teach, have researched what works. They conclude there is "no evidence" that universal health insurance coverage is the best way to improve public health. Before enacting universal coverage, shouldn't you spend at least some of the $1 billion you dedicated to comparative-effectiveness research to determine whether universal coverage is comparatively effective? Absent such evidence, isn't pursuing universal coverage by definition an ideological crusade?

A draft congressional report said that comparative-effectiveness research would "yield significant payoffs" because some treatments "will no longer be prescribed." Who will decide which treatments will get the axe? Since government pays for half of all treatments, is it plausible to suggest that government will not insert itself into medical decisions? Or is it reasonable for patients to fear that government will deny them care?

You recently said the United States spends "almost 50 percent more per person than the next most costly nation. And yet ... the quality of our care is often lower, and we aren't any healthier." Achieving universal coverage could require us to spend an additional $2 trillion over the next 10 years. If America already spends too much on health care, why are you asking Americans to spend even more?

You have said, "Making health care affordable for all Americans will cost somewhere on the order of $1 trillion." Precise dollar figures aside, isn't that a contradiction in terms?

Last year, you told a competitiveness summit that rising health care costs are "a major anchor on the ability of American business to compete." In May, you wrote, "Getting spiraling health care costs under control is essential to ... making our businesses more competitive." The head of your Council of Economic Advisors says such claims are "schlocky." Who is right: you or your top economist?

You recently told an audience, "No matter how we reform health care, we will keep this promise to the American people. ... If you like your health care plan, you'll be able to keep your health care plan, period. No one will take it away, no matter what." The Associated Press subsequently reported, "White House officials suggest the president's rhetoric shouldn't be taken literally." You then clarified, "What I'm saying is the government is not going to make you change plans under health reform." Would your reforms encourage employers to drop their health plans?

You found $600 billion worth of inefficiencies that you want to cut from Medicare and Medicaid. If government health programs generate that much waste, why do you want to create another?

You and your advisors argue that Medicare creates misaligned financial incentives that discourage preventive care, comparative-effectiveness research, electronic medical records, and efforts to reduce medical errors. Medicare's payment system is the product of the political process. What gives you faith that the political process can devise less-perverse financial incentives this time?

You claim a new government program would create "a better range of choices, make the health care market more competitive, and keep insurance companies honest." Since when is having the government enter a market the remedy for insufficient competition? Should the government have launched its own software company to compete with Microsoft? Are there better ways to create more choices and more competition?

When government entered the markets for workers compensation insurance, crop and flood insurance, and disaster insurance, it often completely crowded out private options. Do you expect a new government health insurance program would do the same?

You have said there are "legitimate concerns" that the government might give its new health plan an unfair advantage through taxpayer subsidies or by "printing money." How do you propose to prevent this Congress and future Congresses from creating any unfair advantages?

President Obama needs to address questions these directly. The health of millions depends on his answers.

SOURCE




Whistleblower helpline for NHS doctors as concerns for patient safety grow

Hospital doctors wanting to raise fears about patient safety are to be given an anonymous “whistleblower” helpline because of growing evidence of staff reluctance to speak out for fear of recriminations. The dedicated phoneline has been set up as part of new guidelines issued by the British Medical Association, and seen by The Times, designed to help to formalise the process of “whistleblowing” in the NHS.

Doctors will be presented with two motions at the BMA annual conference next week calling for action to address staff concerns about reporting malpractice. One motion, proposed by the BMA’s agenda committee, warns that the NHS risks another patient safety scandal like that of Mid-Staffordshire where 400 deaths were linked to poor care, such is the scale of the problem. It calls for trusts and regulators to pool all complaints from clinicians to identify worrying trends. A second motion, proposed by junior doctors, calls on the General Medical Council to recognise formally that the harassment of whistleblowers is a serious breach of medical regulations. It also requests guidance on whistle-blowing.

Tom Dolphin, a junior doctor specialising in anaesthesia based in East London, said he had felt compelled to act after hearing of the experiences of colleagues who had to work without some patient-monitoring equipment. “One colleague needed equipment that wasn’t there, and was told there wasn’t any. There can be a culture of ‘that’s the way it's always been and no one’s come to harm yet anyway’. Others tried to raise concerns, got nowhere and had pretty much given up.”

The BMA guidelines, released today, follow research suggesting hospital doctors are frequently frustrated in their attempts to raise concerns about standards of care, despite recommendations by the Department of Health for the development of whistleblowing policies six years ago. A survey of 565 doctors working in hospitals in England and Wales found that three quarters had had concerns about issues relating to patient safety, malpractice or bullying in the NHS, the majority linked to standards of patient care.

Many said that their experiences of reporting issues had been negative — either because they were ignored or because their complaint was shared more widely than they were comfortable with. One in six doctors who reported concerns said that their trusts had indicated that their employment could be negatively affected.

The BMA advises hospital doctors to err on the side of raising any concerns about malpractice or systemic failures, and to do it as soon as they can, rather than allowing the situation to reach a point where patient safety is threatened. It points out that employees who are victimised after raising their concerns can go to an employment tribunal, and that employers can be heavily fined. “If told not to raise or pursue any concern, even by a person in authority such as a manager, you should not agree to remain silent,” it states, adding that “raising concerns is not just a matter of personal conscience — in some circumstances it is a professional obligation”.

Last month Jonathan Fielden, the chairman of the BMA consultants committee, called for sweeping changes to reporting problems in the NHS. He said that “a culture of inactivity and despair is preventing issues from coming to light, and putting patient care at risk”.

Margaret Haywood, a nurse, is appealing to the High Court against a decision by the Nursing and Midwifery Council to strike her off the register for secretly filming at a Brighton hospital. Footage showed examples of neglect, including an elderly patient sitting in clothes he had soiled the night before.

Earlier this month the National Patient Safety Agency (NPSA) called for greater reporting of safety issues in hospitals in a report on paediatric healthcare. It said that 10,000 alerts over medication given to children were being issued annually in the NHS, including errors in the calculation of drug doses and health workers forgetting to give patients their medicine. The NPSA report concludes that over the period of a year 33 children and 39 newborn babies died with “indicators of avoidable factors”.

SOURCE





27 June, 2009

Dr. Obama’s Swamp Root Snake Oil

Amazing negligence and incompetence at the VA again

Tough break for Barack Obama. Just when he is merrily rolling along peddling his socialized stealthcare as it were the most potent elixir since Violet Blossom’s Swamp Root snake oil, along comes NY Times with a decidedly sordid tale about government medicine gone awry. And since ABC (Always Barack Channel) wasn’t about to interrupt its infomercial to reveal the full facts of the matter, let’s take a quick look behind the Barakathon.

Those who can’t wait to turn their lives and limbs over to Big Government’s pseudo-sawbones need first to pay a visit to the government-run Veterans Administration hospital in Philadelphia, PA. But, first, a word of warning: if you’re a guy, leave the family jewels at home. Because, if you think the Liberty Bell is irreparably damaged … well, you ain’t seen nothin’ yet.

One of the most popular (if I can use that word) procedures for treating prostate cancer is the implantation of dozens of radioactive seeds to attack and destroy the cancerous cells. True, it’s drastic. But, it sure beats a long-drawn, painful death. Unless, of course, they plant the radioactive cells in the wrong organ. Which is exactly what Dr. Gary D. Kao did at the VA Medical Center in Philadelphia, citadel of socialized medicine. Obama should be proud. In fact, he should have covered it in his ABC infomercial – perhaps while waving his arms and shouting, “But, wait, there’s more!”

You see, Dr. Kao implanted the 40 radioactive seeds not in the patient’s ailing prostate, but in his perfectly healthy bladder. So much for Tenet One of the Hippocratic Oath – “First, do no harm.”

But, wait, there’s more! Of course, the ever vigilant federal bureaucrats in charge of VA stealthcare (coming soon to a hospital near you) knew that this probably wasn’t a good idea. So they investigated—and promptly allowed the doctor to doctor his report to match the number of seeds in the prostate.

This, naturally, did little for the patient. So, like any conscientious government employee, Dr. Kao decided to cover his tracks by doing over what he hadn’t done right—whereupon he planted the seeds in the patient’s rectum. Which, apparently for the good doctor was “close enough for government work”—since this time, he didn’t even bother filing a report.

But, wait, there’s even more! With the eager acquiescence of his government overlords, Dr. Kao was on a roll. Two years later, Dr. Kao rewrote another surgical plan after once again putting half the seeds in the wrong organ. And, once again, the socialized stealthcare regulators did not object. Perhaps the reason they did not object is that they had long since become past masters at doing well what bureaucrats do best—absolutely nothing. As the NY Times story reveals:

“Had the government responded more aggressively, it might have uncovered a rogue cancer unit at the hospital, one that operated with virtually no outside scrutiny and botched 92 of 116 cancer treatments over a span of more than six years -- and then kept quiet about it, according to interviews with investigators, government officials and public records. “The team continued implants for a year even though the equipment that measured whether patients received the proper radiation dose was broken. The radiation safety committee at the Veterans Affairs hospital knew of this problem but took no action, records show.”

I have a distinct feeling that any guy reading this piece is by now already squirming around in his chair, praying diligently that the Avodart, Cipro, Doryx, or Floxin works well if his prostate ever needs it. Because, clearly, Obama’s socialized stealthcare won’t. And for the women: let’s just say that if you have even the remotest idea of remaining sexually active with your hubby in your Golden Years, pray equally hard that Dr. Obama gets his license lifted.

Here’s the bottom line: socialized medicine doesn’t work. Whenever and wherever it rears its malignant head, it is poorly conceived, pathetically organized, and callously administered. If the VA is the microcosm (or the MVA, Amtrak, or the U.S. Congress, for that matter), imagine the horror of the macrocosm.

It was said that Violet Blossom was the Queen of Pitch Doctors.” Barack Obama may be the “King of Pitch Presidents.” But if the American people end up catching what he’s pitching, the result may be the most deadly medical crisis since the flu epidemic of 1918. And all the ABC snake oil in the world isn’t going to cure that devastating blight.

SOURCE




New models for real health care reform

Paying for health care has been a problem since ancient times. In the Middle Ages, guilds collected funds to provide care for infirm members. In 1789, imitating the British, the U.S. Congress funded the Marine Hospital Service by taxing American seamen 20 cents a month.

As U.S. governments grew, they continued passing laws to regulate the kind of health coverage people could purchase. By 1960, most people with coverage got it through their employer. Plans provided by hospital monopolies controlled the coverage market. The true cost of health care was hidden from covered individuals. Vast spending increases were the result. The introduction of Medicare and Medicaid in 1965 made the situation worse. Finkelstein found that Medicare increased real hospital expenditure by 23 percent between 1965 and 1970. Extrapolating from the Medicare estimates suggests that the spread of health coverage may “explain at least 40 percent of the rise in real per capita health spending” between 1950 and 1990.[1]

Only in the last two decades have economists reconsidered the effect that government regulations have had on the form health coverage takes, its cost, and how it encourages people to use health care. Government coverage programs obscure the real cost of health care and increase health spending by shifting the out-of-pocket cost of health care spending from the savings of individuals to the paychecks of working Americans.

Unlike government coverage or coverage purchased through employers, private coverage purchased directly by individuals encourages people to choose between health coverage and all other goods. It controls health spending by pricing individual risk, encourages substantial variation in plan design to accommodate differences in individual risk tolerance, and provides incentives for cost minimization.

All private health coverage arrangements must solve two problems. The first is to collect enough money to deliver enough health care to satisfy people who can stop paying if dissatisfied. The second is to control moral hazard, the tendency to use more care when other people are paying for it.

Early History of Health Insurance

By 1910, an estimated one third of all adult males in the United States belonged to fraternal societies. Like modern HMOs, some societies provided prepaid health plans that controlled the supply of medicine to member patients by refusing to provide care considered beyond the organizations’ means. They hired “lodge doctors” who worked for the plan and were less likely to side with patients in recommending more care than the plan wanted to deliver. The societies used a variety of tools to control moral hazard. These tools included home-visiting committees, waiting periods for benefits, and curfews on members receiving benefits. People not covered by the fraternal societies could choose from plans operated by trade and industrial unions, various governments, commercial insurers, and company-sponsored mutual benefit societies.

The Birth of the Blues

The Depression produced a dramatic change in health coverage. One year after the stock market crash of 1929 “average hospital receipts per person fell from $236.12 to $59.26, and average hospital deficits rose from 15.2 to 20.6 percent of disbursements.”[2] To boost revenues, hospitals created community-wide hospital benefit plans. The American Hospital Association created Blue Cross to promote hospital benefit plans that conformed to guidelines that reduced interhospital price competition.

The hospital benefit plans offered guaranteed services in exchange for an annual premium. The Blue Cross monopolies were extraordinarily successful, particularly after the hospitals persuaded state officials to exempt them from insurance company capital requirements and taxes. By 1950, Blue Cross sold almost half of all hospital insurance. As economist John Goodman notes, Blue Cross and Blue Shield (the equivalent organization for physician services) so dominated the market that “they made it difficult for a commercial insurance company to adopt reimbursement procedures that differed fundamentally from those of Blue Cross and Blue Shield. If a commercial company attempted radical deviation, the medical community could threaten a boycott.”[3] At the beginning of the 1990s, Goodman estimated that “net revenues (premiums minus benefit payments) on group policies [were] usually less than 5 percent of total premiums, [therefore] a 2 to 3 percent premium tax is equal to about 50 to 60 percent of net revenues.”[4]

Medicare and Medicaid expanded the Blue Cross coverage model to government coverage programs. It paid minimal attention to controlling moral hazard. It encouraged patients to use any hospital they saw fit. It reimbursed hospitals on a cost-plus basis. It emphasized one price for everyone in a given community, and it had little cost sharing and no waiting requirements. A structure that made sense when hospitals could do relatively little for patients ended up creating unprecedented increases in medical expenditures as medical technology improved.

The fraction of the U.S. population with health coverage stabilized in the 1980s. Since then, the percentage of Americans with health coverage has fluctuated in a narrow range between 84 and 87 percent. The favorable tax treatment bestowed on employer-based coverage after World War II encouraged most people to purchase coverage through their employers. In 2007, roughly 59 percent of Americans had employer-based coverage. Government plans, state-subsidized high-risk insurance pools for the uninsurable, Medicaid, Medicare, SCHIP, the Veterans Administration, and other forms of military health care, covered 28 percent of Americans. Just 9 nine percent of Americans with health care coverage purchased their own coverage directly from insurers.[5]

After nearly 50 years in which employer-based coverage modeled after Blue Cross dominated, researchers in health policy often implicitly assumed that Blue Cross, Medicare, and Medicaid defined the form that health coverage should take. As costs exploded, researchers focused on cost control, ways to charge the same premium for all regardless of health risk, and ways to control costs in a system that bypassed patients with direct payment to providers. The tight controls on health care demand used by the guild systems and the fraternal societies were variously reborn in the managed care, evidence-based medicine, pay-for-performance, and “comparative-effectiveness” movements. Like the fraternal societies, some state governments forced insurers to issue policies to everyone at the same price, and focused on controlling the practitioners that people in state plans could see, denying certain kinds of care altogether, and rationing care by waiting.

The Market for Individual Insurance

Recent research has shown that such tight controls can do harm by reducing overall coverage and making medical care difficult to access. Economists have also realized that health policy has paid so little attention to direct-purchase health coverage that policy makers know very little about it. As late as 2002, Pauly and Nichols published an article entitled “The Nongroup Health Insurance Market: Short on Facts, Long on Opinions and Policy Disputes.”[6] They wrote that “there is considerable disagreement among policymakers and policy analysts about how the nongroup insurance market works now” and that “factual disagreements about this market are true impediments to policy consensus.” In 2006, Marquis et al. noted that while a variety of proposals have been offered to overcome perceived weaknesses in the direct-purchase market, “until now, this market has been the subject of relatively little study. As a result, there is much disagreement about the importance of the advantages cited for this market, the extent of the barriers to participation, and the likely effects of policy proposals.”[7]

Direct-purchase coverage is owned by an individual. Premiums are based on the costs that an insurer expects a particular individual will generate in the future. People with low health risk, where risk is shorthand for expected future expenditure, pay less in premiums. Because premiums in the direct-purchase market are paid with after-tax dollars, individuals know exactly what their coverage costs. Because paying for health care with insurance coverage is more expensive than paying cash, people who buy direct-purchase coverage are more likely to insure against large costs, relying on out-of-pocket cash to cover routine expenses.

Because employer-related coverage is tax advantaged, employer plans generally follow the more expensive route of insuring even low-cost routine care. Employees “pay” the bulk of their employer-provided group health premium in the form of lower wages. Their artificially low out-of-pocket costs insulate them from the true cost of health care. This increases the demand for health care. According to Manning et al., data from the RAND Health Insurance Experiment show that the higher out-of-pocket payment characteristic of direct-purchase plans “reduces expenditures 31 percent relative to zero out-of-pocket price.”[8]

In 2008, the Kaiser Foundation Survey of Employer Coverage estimated that the average cost of employer-based group coverage was $4,704 for a single person and $12,680 for a family. On average, the out-of-pocket “premiums” that employers charged employees equaled about 16 percent of the total premium for single coverage, roughly $60 a month, and 27 percent of the total premium for family coverage, roughly $280 a month.[9] According to the AHIP 2006-2007 individual market survey, average annual premiums for roughly 2.3 million direct-purchase individual policies sold to single adults, were $1,359 for people aged 18-24 and $5,090 for people aged 60-64.[10]

Direct-purchase markets pool risk extensively, charging high risk people far lower premiums than their health status might indicate. Most direct-purchase policies are renewable without additional underwriting. This means that as long as he pays the premium, an insured person can keep his policy no matter how sick he gets. Contrary to popular claims, state laws generally prohibit raising a sick individual’s premiums unless an insurer also raises the premiums of everyone else in his rating class.

Pauly and Herring report that direct-purchase insureds who had medical expenses about 4 times that of other people enjoyed premiums that were only 1.6 times as high. People who buy a policy and become ill have a strong incentive to continue paying. This may explain why age and sex were generally better predictors of direct-purchase premiums than chronic conditions.[11] Marquis et al. concur, reporting that the individual direct-purchase market is “an important source of long-term coverage for many who purchase it” and that “there is substantial pooling” that “increases over time because people who become sick can continue coverage without new underwriting.”[12]

Adverse Selection Due to Community Rating

In states that are so wedded to the Blue Cross model that they have community rating laws requiring that premiums be the same for everyone in a given geographic region, premiums are higher for everyone. In a study of 26.8-million commercially insured people, Willey et al. found that just 0.8 percent of the population was severely ill. That group had average annual expenses of $29,273. Those with less-serious chronic disease spent $8,225 a year. Half of the population had expenses below $989 a year.[13]

Charging everyone the same price does lower the premium for high-risk people. This increases the probability that they will buy coverage. However, as more high-risk people enroll, premiums must increase for everyone in order to cover the plan’s higher costs. Some low-risk people respond by refusing to pay the artificially high prices for coverage caused by the one-price-for-all requirement. Insurance economists call this phenomenon “adverse selection.” Although economists usually use the term “adverse selection” to refer to the result of the individuals having more information than the insurance company, this is adverse selection due to regulation.

There are more low-risk people harmed by one-price requirements than high-risk people who benefit from them. Pauly and Herring find that regulations on insurance premiums raise the average premium considerably, by 12 to 15 percent, and that the number of people who drop coverage exceeds the number of higher-risk people who sign up. In all, “the overall proportion of eligible people in the individual market with insurance [falls] by 6.0-7.4 percent.” They note that policies that reduce administrative costs and create high-risk pools are likely to cover more people than government control of premiums. Avoiding price controls on premiums also “avoid[s] regulation-induced incentives to insurers to avoid money-losing high risks.” In short, allowing competitive markets to set the price for coverage will end up covering more people.

The Benefits of Variety

Results like this underline the fact that health insurance has value only because it allows those who buy it to pay for expensive medical care without forcing them to liquidate their assets or suffer big drops in current consumption. Some people are willing to pay a lot to have an insurance company bear the risk of large medical payments. Others are willing to pay very little. Cutler, Finkelstein, and McGarry find that individuals who have a higher risk tolerance, as revealed by engaging in risky behaviors such as smoking, drinking, and employment with high mortality rates, are less likely to purchase all kinds of insurance, including life insurance, private health insurance, annuities, long-term care insurance, and Medigap coverage.[14] This suggests the variety of plans offered in the individual direct-purchase market, a variety not present in employer-based coverage or government plans, adds to individual welfare. Health coverage is not necessarily the most important thing in life, and as circumstances, finances, and risk tolerance change, people are better off if they can change their coverage to match their circumstances.

Assertions that people without coverage have no access to health care ignore the fact that people can and do access care by paying cash. Though the self-employed are less likely to have health coverage than comparable wage earners, Perry and Rosen show that they use health services at roughly the same rates as insured wage earners.[15] Glied’s findings on the spending patterns of the uninsured suggest that, in addition to cash payment, even low-income “uninsured people have some de facto insurance coverage available to them through the uncompensated care system and Medicaid conditional coverage.”[16] Overall, national estimates suggest that the uninsured pay for about half of their care and that government and private spending for uncompensated care equals roughly 3 percent of total personal health spending, about $150 for an average annual premium of $5,000. As the budgetary disasters in Massachusetts, Kentucky, and Tennessee have shown, government programs seeking to eliminate uncompensated care by requiring insurance for all typically cost more than the uncompensated care they seek to eliminate.[17]

Recent work also makes it clear that people adjust their coverage as their estimate of their individual risk changes, something that mandated coverage, controlled enrollment seasons, and government standardized policies discourage. Bundorf et al. find that higher-risk people are more likely to have coverage, even at incomes of less than 200 percent of the poverty level. Regardless of income, the probability that someone will have coverage rises 17 percent when his health risk changes from low to high.[18] This increase in coverage is remarkable in view of the fact that low-income people are especially sensitive to premium cost. In Massachusetts, a $10 increase in monthly MassHealth premiums increased the odds of leaving the MassHealth program by five percent.[19] Small increases in already low subsidized premiums have been associated with significant enrollment declines in government programs in Oregon, Vermont, Wisconsin, and Rhode Island. Gruber and Simon conclude that price-sensitive people substitute government insurance for private insurance in large numbers. For every 100 newly enrolled children in state children’s health insurance programs, they estimate, 60 had previously been privately insured.[20]

The substitution may also go the other way. George Borjas found that the 1996 law limiting Medicaid eligibility for immigrants increased the likelihood that affected households worked and, therefore, increased the probability of eligibility for employer-sponsored health insurance. Their health insurance coverage rates at least remained the same after their Medicaid eligibility was curtailed.[21] Without government coverage programs, he wrote, “the targeted immigrants themselves would have taken actions to reduce the probability that they would be left without health insurance coverage.”

Although some people genuinely cannot pay even the small premiums charged by government programs, Bundorf and Pauly show that income based “affordability” calculations are not good predictors of whether or not a person chooses to sign up for coverage. For example, while 36 percent of people in families with incomes less than 200 percent of the federal poverty level are uninsured, 44 percent have private coverage. By some measures, coverage in 2000 was affordable for over 50 percent of the uninsured.[22]

Conclusion

Eighty years after governments began seeking to determine the shape of U.S. health coverage, economists who study direct-purchase insurance have created a body of literature suggesting that market-oriented health care reform has far more promise than the decades-old plans that seek to impose the Blue Cross model on the entire population. In view of Medicare’s insolvency, reform plans calling for further expansions of the Blue Cross single-price guaranteed-issue model, both via Medicare/Medicaid expansions and so-called “public” policies designed by government and sold through government run connectors, are unlikely to succeed in providing more medical care for more people at current expenditure levels.

Direct-purchase of health coverage, along with guaranteed renewability, flexible premiums, and high-risk pools, is a promising approach to reducing health care costs, increasing the value received for health care expenditures, and making more healthcare available for all. Given that roughly the same percentage of people has had health coverage for the last 20 years despite numerous expansions of government coverage programs and a massive increase in illegal immigration, the direct-purchase results also suggest that expecting everyone to have coverage is not a sensible policy goal.

Another danger, one too infrequently considered in the drive to lavish government funds and attention on extending the 70-year-old Blue Cross model to basically healthy people, is that insuring everyone is an unattainable goal. No one can make an adult alcoholic or drug abuser sign up for anything. If government gets out of the way, basically healthy people should be able to make their own health financing arrangements. Furthermore, the focus on universal coverage diverts attention from the radical reforms necessary to save Medicare and Medicaid, two government programs based on the Blue Cross model that are dysfunctional, insolvent, and already failing the frail and vulnerable people who depend on them.

SOURCE





26 June, 2009

The real crisis is Obamacare

President Obama has never met a crisis he didn't love; particularly the ones that involve spending trillions of dollars. What fun it is to propose programs that involve borrowing or taxing Americans to death.

On June 9, the Associated Press reported, "President Barack Obama on Tuesday proposed budget rules that would allow Congress to borrow tens of billions of dollars and put the nation deeper in debt to jump-start the administration's emerging health care overhaul."

Since the stealth heathcare "reform" that Bill and Hillary Clinton tried to foist on Americans during the 1993-94 Congress, this "crisis" has been off the radar screen of Americans who have the audacity to think they should decide whether and how much health insurance they want, and to expect healthcare that is not rationed on the basis of how old they are and other factors determined by some faceless government bureaucrat.

Liberals obsess over healthcare options because, of course, they want "fairness" no matter how much it will cost Americans in general and the economy in particular.

To that end, various "progressive" (liberal) groups have gotten together and have launched an $82 million campaign to support President Obama's healthcare program. The umbrella for this massive public brainwashing is called Health Care for America Now. Why is it that everything Obama wants has to be done "now"? Oh yes, I forgot. It's a "crisis." Health Care for America is directed by Richard Kirsch and has been joined by the AFL-CIO, MoveOn.org, and Democracy for America, a group founded by former Democrat National Committee Chairman, Howard "the scream" Dean. The group is essentially a re-branded version of liberal lunatic groups.

An excellent analysis of Obamacare has been published by the Cato Institute in a May 21 Policy Analysis (No. 638) titled, appropriately, "Seven Bad Ideas for Health Care Reform." Authored by Michael Tanner, it points out some very ugly truths.

* At the time of rising unemployment, the government would raise the cost of hiring workers by requiring employers to provide health insurance to their workers or pay a fee (tax) to subsidize government coverage.

* Every American would be required to buy an insurance policy that meets certain government requirements.

* A government-run plan similar to Medicare would be set up in competition with private insurance.

* The government would undertake comparative-effectiveness research and cost-effectiveness research and use the results to impose practice guidelines on providers, initially in Medicare and Medicaid, but ultimately extending the rationing to private insurance plans.

* Private insurance would face a host of new regulations.

* Subsidies would be available to help middle-income people purchase insurance while expanding Medicare and Medicaid.

* Finally, the government would subsidize and manage the development of a national system of electronic medical records.

According to a June 8 Bloomberg News report, "President Barack Obama wants Congress to consider taxing the wealthy instead of workers to pay for a health-care overhaul." This is yet one more lie by the Obama administration in the run-up to impose the most vile form of government control over everyone's lives imaginable.

The American Medical Association, the nation's largest physician organization, has let it be known that it will oppose creation of a government-sponsored insurance plan.

The promise of the Declaration of Independence that everyone has a right to life, liberty and the pursuit of happiness will be rendered meaningless by Obamacare if your life depends on government policies regarding healthcare.

A June 1 Business Week commentary pointed out that "there are only three ways to pay for universal coverage: Raise taxes, cut payments to medical providers, or ration care." All three are the worst possible options imaginable.

"The Congressional Budget Office estimates that covering the uninsured could add anywhere from $1 trillion to $2 trillion to the federal budget over ten years," said the BW commentary. "On top of that, government economists expect Medicare to run out of money in 2017 if current spending trends continue."

Here's a handy tip regarding estimates by government economists. Multiply them by a factor of ten! As this healthcare horror awaits its run through Congress, think of it as a massive Medicare, the government program for seniors that cost 3.2 percent of the country's Gross Domestic Product in 2008 and which will become insolvent this year! Medicare faces $34 trillion in unfunded liabilities; the cost of services for which seniors are eligible in the future. According to the Medicare Trustees, the program will require a 134 percent increase in the payroll tax paid by every working American in order to remain solvent!

And this insane Democrat-controlled Congress wants to expand on Medicare while requiring everyone to purchase healthcare insurance, even if they don't want to. Then it will compete against existing private insurance companies without having to have the funds in place as they must to meet their obligations.

This isn't healthcare reform. It is the destruction of the best healthcare system in the world. It is the destruction of the nation's economy. It, along with the tax on energy use, must be stopped. We are being attacked by one "crisis" after another when the only one that matters is the restoration of the full faith and credit of the U.S. dollar. If the "health" of the U.S. dollar is not restored, nothing else will matter very much.

SOURCE




Rhetoric vs. reality in the health care debate

Half-truths about "rationing"

Last week, the Democratic leadership in the House of Representatives unveiled their discussion draft of a sweeping bill to reform America's health care system. The bill would create health insurance exchanges and a government insurance scheme, require insurers to sell insurance no matter a purchaser's health status, set minimum benefit standards, subsidize insurance purchases to families up to 400 percent of the federal poverty level ($43,000 for an individual or $88,000 for a family of four), mandate that all Americans carry health insurance, and impose price controls on what doctors and hospitals may charge. The Democratic leadership hasn't the faintest idea what its reform proposals will cost.

The draft bill also would establish a public-private Health Benefits Advisory Committee to recommend covered benefits and an essential benefits package. This is the only section of the bill that mentions the word "rationing." It declares that "the Committee shall take into account innovation in health care and ensure that essential benefits coverage does not lead to rationing of health care." Of course, it would be helpful to know what the bill means by "rationing."

Earlier in the week, New York Times economic columnist David Leonhardt set out to explain what rationing is. First, let's acknowledge that Leonhardt does identify many dysfunctional aspects of our current health care system, including how we reimburse primary care physicians and specialists.

But in the article, Leonhardt claims that "health care rationing rhetoric overlooks reality." Leonhardt asserts that health care is already being "rationed." Since this is so, those who warn against proposed government health care rationing, according to Leonhardt, are either confused or liars. Such people, Leonhardt explains, are deploying "a clever set of buzzwords that tries to hide the fact that societies must make choices." The phrase "societies must make choices" is the first hint of how confused Leonhardt is about the concept of rationing. Rationing is all about who gets to make those choices.

Leonhardt goes on to cite what he thinks are three supposedly telling examples of rationing. "We ration spots in good public high schools. We ration lakefront homes. We ration the best cuts of steak and wild-caught salmon," he writes. Which one of those examples doesn't fit? Figuring this out is another key to Leonhardt's misunderstanding of the debate over health care rationing.

Next up he cites the dictum of one of capitalism's great defenders, economist Milton Friedman: "There is no such thing as a free lunch." True. But Leonhardt follows up this insight by writing: "The choice isn't between rationing and not rationing. It's between rationing well and rationing badly." Does Leonhardt think that lakefront homes are rationed badly? Steaks? Or for that matter clothing, restaurant meals, shoes, cars, computers, or airline tickets?

Moving beyond lakefront homes and steaks, Leonhardt eventually gives readers three examples of current health care "rationing." The first example is that employers are forced to decide between paying higher wages or providing higher health care benefits to their employees. He notes that the tradeoff between wages and benefits is often "invisible" to employees and thus it appears to them that their compensation is not increasing much.

Of course, the way to avoid this kind of "rationing" would be to just pay the employees all their money and let them buy their own health insurance. Thus health insurance would become "rationed" just the same way that we ration cars and cellular telephones. Allowing consumer choices in health insurance and health care will also help drive down prices and increase the range of health insurance products in just the same way consumer choice operates in other areas of our economy.

The current provision of medical care to the uninsured is Leonhardt's second example of rationing. This example is closer to the mark since health care for the uninsured is already mandated and/or paid for (Medicaid and SCHIP) by federal and state governments. He notes the poor quality of care that such people receive without musing for a moment that such poor government-funded care might be a harbinger for what "universal" health care would become.

Leonhardt's third alleged example of current health care rationing is the "failure to provide certain types of care, even to people with health insurance." The fact that certain health insurance policies chosen by individuals and/or their employers don't cover certain treatments is no more "rationing" than it is when people choose not to eat a USDA prime steak or pay tuition for a private college education.

On the other hand, Leonhardt is right to say that our dysfunctional health care system misses opportunities to offer good treatments to people in need. The current system misses those opportunities, in part, because there is so little competition and thus very little incentive for health care providers to supply information to consumers. Consumers can competently choose between complicated computer technologies and evaluate automobile performance because competitors are motivated to supply consumers with relevant information. The same kind of competitive dynamic could work with the provision of health care and health insurance.

So if Leonhardt gets it so wrong, what is rationing? Leonhardt is correct when he writes, "In truth, rationing is an inescapable part of economic life. It is the process of allocating scarce resources." The crucial question that Leonhardt misses is that "rationing" depends on who is allocating the scarce resources. It's not rationing if an individual decides to spend his money on a 16-ounce steak—but it is rationing if he can only purchase a USDA prime rib eye when he has a coupon issued from a government agency. In other words, true rationing occurs when individuals are forbidden from spending their money on products or services they want to buy.

Imperfect as private health insurance markets are, if a customer doesn't like the decisions made by Blue Cross Blue Shield, Kaiser Permanente, or Golden Rule insurance bureaucrats, he can look elsewhere for his health insurance coverage. But if the government health care scheme becomes a monopoly, when the bureaucrats at the new Health Benefits Advisory Committee decide that a treatment should be withheld, that treatment will be withheld. That's rationing.

"Americans should get the first chance to limit their own health spending," Rep. Jim Cooper (D-Tenn.) observed recently. "Once they learn the true cost of what they are buying, share a larger portion of the cost, and can judge the benefits—if any—of treatment options, then they will choose more wisely than the government." He's right. Congress should think about "rationing" health insurance and health care the old-fashioned way—through the market.

SOURCE





25 June, 2009

ObamaCare will save money? Don’t believe a word of it

President Obama is selling government health insurance to the American people as the way to save money. That government health insurance will merely provide competition to keep private insurance companies from gouging their customers.

Indeed, Obama even claimed on Monday, in a speech before the American Medical Association, that a government insurance system is essential to holding down medical costs: “if we fail to act, federal spending on Medicaid and Medicare will grow over the coming decades . . . . and impose a vicious choice of either unprecedented tax hikes, overwhelming deficits, or drastic cuts in our federal and state budgets.”

There are a couple of problems with Obama’s argument. Government is just not known for its cost effectiveness or quality. And the way for government enterprises to survive is with massive taxpayer subsidies and charging customers prices below the firm’s actual costs, driving more efficient private firms out of business. These subsidies mean that when government enterprises “win” they do so by driving more efficient private firms out of business.

Milton Friedman was well-known for pointing to a very good rule of thumb in evaluating government enterprises: “on the average anything government does costs twice as much as if it were being done by private enterprise.” Whether it is education or the post office, the reason is very simple: When people have their own money at stake they are much more careful in how it is spent.

Despite lower costs, private schools still do a better job. Americans send their kids to private schools despite having to pay taxes for public schools, too. How bad must public schools be if parents are willing to pay private school tuitions even though price for public schools is “zero.” Academic evidence consistently shows that children in private schools learn faster than those in public ones.

A second problem with government-run firms is that they typically engage in what is called “predatory pricing.” Obviously public schools don’t charge anything for students attending them, limiting competition from private schools. Also take the post office. The U.S. Postal Service would often increase its first-class mail rate, where it had a monopoly, to raise money to subsidize its overnight delivery service where it faced stiff competition. For example, it raised first-class mail to thirty-three cents in January 1999 and simultaneously reduced the price of domestic overnight express mail from $15.00 to $13.70, even though it was already losing money at the $15.00 rate. The price, which was lowered in response to increasingly successful competition in overnight delivery from FedEx and UPS Overnight, remained below $15.00 for the next seven years. Clearly the Postal Service was not able to drive its competitors out of business with this maneuver, in part because its on-time delivery record and quality was poorer.

The Postal Service lost money on its overnight deliveries despite advantages that FedEx and UPS could only dream of. The Postal Service is exempt from paying state sales, property and income taxes. And it uses some of the most expensive real estate in the country — rent-free. The competition that Obama advocates between government and private insurance companies isn’t going to be any fairer.

The reality of the situation has begun to enter into the health care discussion. Larry Summers, Obama’s chief economic adviser, claimed in April that the government insurance would be so efficient that $700 billion would be saved each year just from stopping unnecessary surgeries –- that is almost 30 percent of all heath care costs he claimed were wasted just on unnecessary surgery. He argued that the efficiencies would be so large that government insurance program actually wouldn’t cost any money. Yet, on Monday night, even the Democratically controlled Congressional Budget Office acknowledged that the cost of the health care proposals would cost at least $1.6 trillion over 10 years, and it warned that the total could go much higher depending upon what features were added to the program. Even at that cost the program would only cover one-third of the uninsured.

The government has consistently underestimated the costs of government health care programs in the past. The biggest problem with current CBO estimates is that they assume that only “15 million individuals” will give up private insurance to get what the government offers. Others have put the number at almost 120 million — massively increasingly the cost of the program.

There is also the question of whether there will be any gain in physical health for those who are currently uninsured. Being uninsured is not the same thing as not getting health care. The uninsured received health care worth $116 billion in 2008. In addition, 2.3 percent of Americans are both uninsured and very dissatisfied with the quality of the health care that they receive.

Already the Congressional Budget Office is predicting a federal budget deficit of over $9.3 trillion. Just that new debt alone means an extra $103,000 for each of the 90 million tax filers who actually pay taxes. Depending on government to magically find ways to create efficiency will only ensure huge additional expenditures and debt. It can also jeopardize a health care system where 89 percent of Americans are happy with the health care that they receive.

SOURCE




No right to health care

What virtually no one has addressed in the debates on health care is that there is no such thing as a fundamental “right to health care.” Even more to the point, health care provided by the coerced expenditure of the time and money of others is even more destructive of rights and freedom.

While medical insurance and health care are certainly desirable values, “forced charity” is a contradiction in terms. Few people would condone a private citizen (or group of citizens) walking into a neighbor’s home, placing a gun to that person’s head, and demanding money. Even if the intruders claimed they needed the money for themselves or for someone else in need, any decent individual would still condemn such robbery. The (“good”) ends do not justify the (bad) means.

Somehow, though, voting for such an immoral set of actions and outcomes is supposed to make such policies okay. But hiding behind an anonymous vote and relying on the government and its armed agents to impose one’s wishes on unwilling others is neither honorable nor moral. Legalized theft is no less theft simply because one group of people is more politically powerful than another. Might does not make right.

Only voluntary actions have moral value. In the end, no one has a right to anyone else’s life, money, or property without that person’s consent. The Thirteenth Amendment to the Constitution abolished involuntary servitude. Congress, the President, and the majority of the American public have brought it back.

SOURCE




Medicare for all: Wrong answer, right question

If America HAS to have a "public" insurer for all, the VA would be a better model than Medicare -- though instrument sterilization practices would need to be much improved

Jacob Hacker's enthusiasm for a 'real' public plan option is laudable. It also dramatically overstates the strengths of Medicare. I'm not entirely convinced that we need a public plan option, and am even less sure that Medicare should be the basis for a public plan option. That said, there are at least three solid arguments for a public plan option;

1.) at least one public health provider actually does a terrific job of holding down costs while delivering outstanding care (hint it's not Medicare);

2.) most markets are already dominated by one or two large private insurers, making it extremely difficult for another private insurer to effectively compete. a government plan may (emphasize MAY) offer more competition which might (emphasize MIGHT) lead to lower costs/better outcomes, and

3.) private insurers have done a lousy job of holding down costs, delivering better outcomes, and servicing their insureds. It is hard to see how a governmental plan could be any worse, and easy to envision much better results.

In my mind those arguments tip the scales in favor of a public plan option, and give the lie to opponents' arguments against said option. But Hacker overstates the case for Medicare, and in so doing weakens the case for a public plan option. Specifically, he argues that Medicare has lower administrative costs and does a better job holding down medical trend. I disagree.

As has been well-documented, government plans have unfair advantages over private plans: they don’t need to maintain reserves, earn profits to attract capital, or pay premium taxes. These result in big dollar 'savings' over private plans. It is also important to note that Medicare's cost structure is dramatically different in other ways. Here are a couple examples:

1.) Medicare has no underwriting or sales expenses or marketing costs. No commissions, either. This saves a lot of admin dollars. This differential would disappear in a health connector-type system, with the playing field leveled by dramatically reducing commercial healthplans' marketing costs and elimination of their underwriting expense.

2.) Medicare has one-time enrollment and dis-enrollment, and greatly simplified eligibility processes. This cuts their costs, but would not continue under a connector model.

As significant as the admin expense argument is, it is Hacker's contention that "Medicare has increasingly out-performed private plans in restraining the rate of increase of health spending while maintaining broad access" that is the real problem with his argument for a public plan option. The unfunded liability for future Medicare costs clearly and convincingly demonstrates that Medicare is not earning enough revenue to pay for future expense. In commercial insurance terms, they are dramatically under-reserved. Why? Premiums are not keeping pace with medical inflation, and Medicare is not controlling the primary driver of medical costs - utilization of services.

Here are a couple examples. Medicare's imaging expenses doubled between 2000 and 2007. Utilization of physician in-office services went up more than 10% in 2006. Back surgery rates for Medicare patients in Fort Myers Florida are five times higher than they are in Miami. And physician fees are scheduled to be cut 20.5% next January because total physician expenses under Medicare are way over budget. Not to mention the cost-shifting that currently has private insurers making up lost revenue from Medicare underpayments.

I could go on, but the point is clear - Medicare's supposed administrative and medical cost advantages are not real. That does NOT mean a public plan option isn't viable. In fact, there is a government plan that is kicking the collective private health plan industry's rear end. It's the Veteran's Administration, and rather than Medicare, I'd base a national plan on a dramatic expansion of the VA. Here are a few factoids...

- compared to commercial managed care plans, the VA provided diabetics with better quality care on seven out of eight metrics (NCQA report).

- In 2005, VA hospitals were the highest-rated health system, outperforming other systems including the Mayo Clinic and Johns Hopkins.

- the VA achieves higher scores than private hospitals for patient satisfaction, staffing levels, surgical volume and other significant quality measures

- for six years running, VA hospitals scored higher than private facilities on the University of Michigan's American Customer Satisfaction Index.

And costs haven't increased nearly as fast as they have in the private sector. In the ten years ending in 2005, the number of veterans receiving treatment from the VA more than doubled, from 2.5 million to 5.3 million, but the agency needed 10,000 fewer employees to deliver that care - as a result the cost per patient stayed flat. (costs for care in the private sector jumped 60% over the same period).

The VA did this by closing down unneeded facilities, developing an industry-leading electronic health record system, opening clinics, and dramatically increasing the quality of care, especially for patients with chronic conditions. Oh, and patients can access their own health records - securely - anytime on the web.

Medicare's not the answer. A public plan option based on an expanded VA would force private plans to get better - a lot better - or lose share quickly to this very efficient, and very effective, health system.

SOURCE





24 June, 2009

Is Government Health Care Constitutional?

The right to privacy conflicts with rationing and regulation

Is a government-dominated health-care system unconstitutional? A strong case can be made for that proposition, based on the same "right to privacy" that underlies such landmark Supreme Court decisions as Roe v. Wade.

The details of this year's health-care reform bill are still being hammered out. But the end result is sure to be byzantine in complexity. Washington will have immense say over how, when and through whom Americans are treated. Moreover, despite the administration's public pronouncements about painless cuts in wasteful spending, only the most credulous believe that some form of government-directed health-care rationing can be avoided as a means of controlling costs.

The Supreme Court created the right to privacy in the 1960s and used it to strike down a series of state and federal regulations of personal (mostly sexual) conduct. This line of cases began with Griswold v. Connecticut in 1965 (involving marital birth control), and includes the 1973 Roe v. Wade decision legalizing abortion.

The court's underlying rationale was not abortion-specific. Rather, the justices posited a constitutionally mandated zone of personal privacy that must remain free of government regulation, except in the most exceptional circumstances. As the court explained in Planned Parenthood v. Casey (1992), "these matters, involving the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy, are central to the liberty protected by the Fourteenth Amendment. At the heart of liberty is the right to define one's own concept of existence, of meaning, of the universe, and the mystery of human life."

It is, of course, difficult to imagine choices more "central to personal dignity and autonomy" than measures to be taken for the prevention and treatment of disease -- measures that may be essential to preserve or extend life itself. Indeed, when the overwhelming moral issues that surround the abortion question are stripped away, what is left is a medical procedure determined to be "necessary" by an expectant mother and her physician.

If the government cannot proscribe -- or even "unduly burden," to use another of the Supreme Court's analytical frameworks -- access to abortion, how can it proscribe access to other medical procedures, including transplants, corrective or restorative surgeries, chemotherapy treatments, or a myriad of other health services that individuals may need or desire?

This type of "burden" analysis will be especially problematic for a national health system because, in the health area, proper care often depends upon an individual's unique physical and even genetic history and characteristics. One size clearly does not fit all, but that is the very essence of governmental regulation -- to impose a regularity (if not uniformity) in the application of governmental power and the dispersal of its largess. Taking key decisions away from patient and physician, or otherwise limiting their available choices, will render any new system constitutionally vulnerable.

It is true, of course, that forms of rationing already exist in our current system. No one who has experienced the marked reluctance to treat aggressively lethal illnesses in the elderly can doubt that. However, what may be permissible for private actors -- including doctors and insurance companies -- is not necessarily lawful when done by the government.

Obviously, the government does not have to pay for any and all services individual citizens may desire. And simply refusing to approve a procedure or treatment under applicable reimbursement rules, as under the government-run Medicare and Medicaid, does not make the system unconstitutional. But if over time, as many critics fear, a "public option" health insurance plan turns into what amounts to a single-payer system, the constitutional issues regarding treatment and reimbursement decisions will be manifold.

The same will be true of a quasi-private system where the government claims a large role in defining acceptable health-insurance coverage and treatments. There will be all sorts of "undue burdens" on the rights of patients to receive the care they may want. Then the litigation will begin.

Anyone who imagines that Congress can simply avoid the constitutional issues -- and lawsuits -- by withdrawing federal court jurisdiction over the new health system must think again. A brief review of the Supreme Court's recent war-on-terror decisions, brought by or on behalf of detained enemy combatants, will disabuse that notion. This area of governmental authority was once nearly immune from judicial intervention. Over the past five years, however, the Supreme Court (supposedly the nonpolitical branch) has unapologetically transformed itself into a full-fledged, policy-making partner with the president and Congress.

In the process, the justices blew past specific congressional efforts to limit their jurisdiction and involvement like a hot rod in the desert. Questions of basic constitutionality (however the court may define them) cannot now be shielded from judicial review.

It is, of course, impossible to predict how and when the courts will ultimately rule on the new health system. Much depends on the details and the extent to which reasonable and practical private alternatives to the national plan remain. In crafting the law, however, its White House and congressional sponsors must keep privacy -- that near absolute right to personal autonomy they have so often praised and promoted -- squarely before them. The only thing that is certain today is that the courts, and not Congress, will have the last word.

SOURCE




NHS still going around in circles over dentistry

NHS dentists should be paid according to the number of patients on their list and penalised for shoddy operations that require repeat visits, an independent review has recommended. The proposals, which have been accepted in principle by the Government, include changes to improve access to NHS dentists and to end the “drill-and-fill” culture of operations. The review said that dentistry had become too preoccupied with treatment rather than prevention over the past 60 years.

The recommendations include rewarding dentists for registering new patients and building up relationships with existing ones, similar to those between GPs and their patients. Jimmy Steele, the lead author from Newcastle University, said that dentists’ responsibilities must be as much about ensuring that people understand oral health and diet as carrying out fillings.

A series of pilot trials will start in the autumn. Income will be determined on patient list size, quality of care and the number of courses of treatment.

The plans for patient registration have marked the return of a policy scrapped by Labour in its much-criticised dental reforms of 2006 — and which the Government said at the time would end the “drill-and-fill” culture. Figures show that around a million fewer people now have access to an NHS dentist in England than before the contract came into force three years ago. Andy Burnham, the Health Secretary, said yesterday that he recognised that dentistry was “an area of unfinished business”. He accepted that the contract had been problematic and that some decisions could have been taken differently.

Professor Steele said that dentists would have as much as 50 per cent of their income linked to the number of patients on their books. “It’s an incentive to take more patients on,” he said.

The review also recommends that dentists have greater accountability. This could mean being penalised for faulty work and having to carry out repairs at no extra charge to the NHS. At present, dentists can charge local health trusts for a procedure and then charge again even if they are the reason why a patient has had to return for further treatment. Under the new plans, the points dentists receive for carrying out an operation would not be awarded a second time if restorative work had to be carried out within three years.

Professor Steele said: “It’s a basic principle of quality and warranty. If I think the filling that I’m about to put in, or the crown I’m about to prepare for, is not going to last three years, then I shouldn’t be picking up that handpiece.”

Other plans include a new system of patient charges, replacing the current three-band system with one of between five and 12 bands. This was in response to the view of some patients that they did not always receive value for money.

Professor Steele said that patients should be called in for check-ups based on their individual need between every three and 24 months. “The six-month recall has no basis in science,” he said. “It’s just got a long history.”

The review also calls for more focus on preventative healthcare, with the aim of teaching people how to better look after their teeth. Mr Burnham said this could include looking at people’s diet. He has long been in favour of adding fluoride to the water in deprived areas.

The 2006 contract, which was supposed to allow dentists to spend more time with their patients, was criticised by dentists, while they were accused of playing the system. Yesterday’s report included examples of dentists recalling patients too often, or choosing more profitable treatments for patients when a less lucrative alternative was available.

Professor Steele added: “In the last 60 years, dental services have all been about quantity. We need to make a jump — and it’s a difficult jump — to move on to quality, to accept that less is usually actually better.”

Norman Lamb, the Liberal Democrat health spokesman, said the “near-destruction of NHS dentistry will be one of Labour’s most shameful legacies”. He added: “The Government has repeatedly botched efforts to reform dentistry services in this country. The NHS must learn from past mistakes and ensure that future reforms are rigorously piloted. It is also vital that the concerns of dentists and patients are listened to.”

Andrew Lansley, the Conservatives’ health spokesman, said that the review confirmed the comprehensive failure of the 2006 reforms. “It is bad news for the Government that their own independent reviewer has highlighted a string of problems with NHS dentistry and recommended moving to a patient registration systemas Conservatives have proposed.”

John Milne, of the British Dental Association, said: “What is important now is that the Government pilots properly the changes it makes and engages fully with the profession and patient groups as we move forward.”

SOURCE




FDA’s bad medicine

They are actually aiming to keep information about medical research away from doctors! Hard to believe but that's the sort of destruction you can expect when you put Leftists in charge. All decisions must be made by government bureaucrats -- even medical decisions, apparently

President Barack Obama promised to shake up the Food and Drug Administration, so it's no surprise that his new FDA leadership team has made bold moves. Deputy Commissioner Joshua Sharfstein, who led the agency until Commissioner Margaret Hamburg was approved by the Senate on May 18, announced his presence with authority. In his first two months, Sharfstein's FDA has threatened to regulate Cheerios as a drug because its label says it can help lower your cholesterol and proposed action against drug companies because Google Internet searches for their products don't show enough safety information.

Sharfstein was chosen to lead the FDA's drug enforcement efforts in part due to his connections as a former staff member for Rep. Henry Waxman (D-Cal.), chairman of the congressional committee that oversees the FDA, and one of the pharmaceutical industry's biggest critics. Since he's already shown a desire to clamp down on even minor infractions, drug makers and the medical community are holding their breath over what Sharfstein may do next. One likely move is a crack down on so-called "off label" prescribing of drugs, which has been one of Waxman's high priorities for years.

When the FDA approves new drugs or medical devices, they are approved to treat specific conditions in particular populations, which are identified on the products' labels. But once they are on the market, doctors are free to prescribe drugs and devices for any safe and effective use, including ones not indicated on the label.

Getting FDA approval to add another use to a drug's label is time consuming and very expensive, even after rigorous clinical testing shows the new use to be safe and effective. But physicians read medical journals. And if they find, for example, that a certain liver cancer drug is effective in treating kidney cancer, or that an antidepressant approved for adults also works for teenagers, these other uses tend to be adopted.

This practice of off-label prescribing is widespread, and is common in every field of medicine. By some estimates, as many as 60 percent of all prescriptions written are for off-label uses. The American Medical Association has repeatedly studied the practice and concluded that "physicians have the training and experience to determine what is the best or preferred method of treatment for their patients."

Accordingly, the AMA says off-label prescribing should often be considered "reasonable and necessary medical care, irrespective of labeling." Indeed, physicians may even be subject to malpractice liability if they do not use drugs and devices for off-label indications when doing so constitutes the medically recognized standard of care.

Still, certain members of Congress and bureaucrats in the FDA think doctors should prescribe nothing without the express consent of the federal government. The FDA, for example, proposed regulating off-label drug use in 1972, but gave this up after vigorous objection from the medical community. Beginning in the 1990s, however, FDA began restricting the ability of pharmaceutical manufacturers to give physicians peer-reviewed journal articles and other information about off-label uses of their drugs. FDA treats any drug information distributed by manufacturers, no matter what its form, as part of the product label. So as far as the agency is concerned, mailing out reprints of peer-reviewed journal articles describing an off-label use makes the drug or device "mis-branded."

Physicians try to keep abreast of new research findings, but they can't read every issue of the hundreds of medical journals published in this country. So drug makers have long distributed journal reprints in an effort to promote their products. Regulators regard the practice as grubby commercial marketing, but the distribution of scientific studies allows physicians to be better informed about new developments and enables them to make better treatment recommendations for their patients.

The practice also happens to be protected by the First Amendment. In a series of challenges to FDA's reprint restrictions, federal courts have held that the policies "restricted considerably more speech than necessary" to ensure the information was truthful and not misleading. FDA may monitor the practice to ensure the information is not biased, but forbidding the practice altogether is unconstitutional. By 2007, recognizing that the FDA could not ban the dissemination of all information about off-label drug uses, the agency published a guidance document in the waning days of the Bush Administration that explained what procedures drug firms had to follow in order to be within the boundaries of the law.

Rep. Waxman, however, chafed at even this modest step. He claimed the guidance would promote "potentially dangerous uses" of drugs and would "short-circuit the FDA review and approval process." Not only did Waxman criticize allegedly "abusive marketing practices" by the drug industry, he even attacked the integrity of medical journals themselves and the peer-review process, and he insisted that FDA bureaucrats be placed in the position of judging the quality of the scientific literature.

It's no wonder industry observers and the medical community suspect that Waxman's acolyte Joshua Sharfstein will soon turn his sights toward restricting this important and beneficial mechanism that inexpensively facilitates the dissemination of valuable information to physicians and their patients.

Opponents of off-label prescribing seem unable to balance the regulatory objective of protecting patients from unsafe drugs against the prerogative of physicians to use their best professional judgment to treat individual patients. They downplay the costs of FDA approval, exaggerate the credulity of physicians and their willingness to unquestioningly trust information distributed by drug manufacturers, and ignore the significant benefits off-label prescribing offers for patient care.

Physicians are reluctant to see FDA further restrict information about off-label uses. They know that the practice has large benefits and few costs. Its use should be extended, not curtailed by stricter regulation. Unfortunately, the FDA has a long, troubling history of succumbing to political pressure even when it harms the interests of doctors and their patients.

SOURCE





23 June, 2009

Government-sponsored health care can be used to restrain liberty

"Live Free or Die" is the title of author and columnist Mark Steyn's speech at Hillsdale College, reproduced in Imprimis (April 2009), a Hillsdale publication that's free for the asking. Canadian born, now living in New Hampshire, Steyn has had firsthand experience with socialist tyranny in his home country that is rapidly becoming a part of America. Commenting on one of his run-ins with Canada's human rights commissions, Steyn points how it might seem bizarre to find the progressive left making common cause with radical Islam. One half of that alliance is pro-gay, pro-feminist secularists and the other half is homophobic, misogynist theocrats. Steyn argues what they have in common overrides their differences, namely, "Both the secular Big Government progressives and the political Islam recoil from the concept of the citizen, of the free individual entrusted to operate within his own societal space, assume his responsibilities, and exploit his potential."

I doubt whether there are many Americans who think Congress has either the right or competency to choose where they live, what clothes they wear or what cars they drive. Yet many Americans stand ready to allow Congress to decide what doctors they go to and what treatments they receive. We forget that once we have government-sponsored health care, it can be used to justify almost any restraint on liberty. That's the justification behind helmet and seatbelt laws. Britain is well along the road toward totally controlling health care. Steyn says, "Under Britain's National Health Service, for example, smokers in Manchester have been denied treatment for heart disease, and the obese in Suffolk are refused hip and knee replacements. Patricia Hewitt, the British Health Secretary, says that it's appropriate to decline treatment on the basis of 'lifestyle choices.'" Steyn adds, "Smokers and the obese may look at their gay neighbor having unprotected sex with multiple partners, and wonder why his 'lifestyle choices' get a pass while theirs don't. But that's the point: Tyranny is always whimsical."

In most of the developed world, the government has gradually taken over many of the responsibilities of adulthood from health care, child care, care of the elderly and other responsibilities formerly seen as individual or family. Nobel laureate economist Paul Krugman suggests that American conservatives preaching "family values" is hypocrisy while Europeans live it. On the continent, Krugman says, "Government regulations actually allow people to make a desirable tradeoff — to modestly lower income in return for more time with friends and family." Steyn insightfully observes, "As befits a distinguished economist, Professor Krugman failed to notice that for a continent of 'family friendly' policies, Europe is remarkably short of families. While America's fertility rate is more or less at replacement level — 2.1 — 17 European nations are at what demographers call 'lowest-low' fertility — 1.3 or less — a rate from which no society in human history has ever recovered. Germans, Spaniards, Italians and Greeks have upside-down family trees: four grandparents have two children and one grandchild." Steyn asks, "How can an economist analyze 'family friendly' policies without noticing that the upshot of these policies is that nobody has any families?" My answer to Steyn's questions is: the kind of economist that looks at the seen and ignores the unseen.

Mark Steyn provides us with a historical tidbit. "Live Free or Die," which graces New Hampshire's license plate, are the words of John Stark, New Hampshire's Revolutionary War hero. He uttered those words decades after the War when he was 81 years old, the complete sentence being: "Live free or die: Death is not the worst of evils." Steyn says these words should not be interpreted "as a battle cry: We'll win this thing or die trying, die an honorable death. But in fact it's something far less dramatic: It's a bald statement of the reality of our lives in the prosperous West. You can live as free men, but, if you choose not to, your society will die."

SOURCE




"For all our sakes, stop calling it insurance. It isn’t, and thinking of it as insurance has got us into a heap of trouble"

With the political left agitating about the need for a massive overhaul of the manner in which our health care is handled. The preferred approach on the left has always been a national single payer plan. Their promotion of this idea dates back to the days of LBJ and the Great Society. Ted Kennedy has been after nationalization of all health care matters now for almost half a century, and it seems that he won’t die until he sees it achieved. The last major iteration in the cycle, often referred to as Hilary-care was derailed when a significant portion of the medical professions objected to their forced into government service with criminal penalties for anyone treating a patient privately. This time around the government health system machine has opted for stealth. Instead of an instant takeover they are proposing a plan that will, at minimum take a few years to crowd private health care systems out of the market. Stealth seems more likely to succeed because the intended targets appear unable to appreciate the peril, and have become oblivious to the long-term effects of a government takeover, to themselves and their patients.

Meanwhile, everyone addressing the issue appears to have no idea what is wrong with the system as it is presently managed. It is the perception of insurance that is at the heart of the issue. Insurance, properly understood does not mesh with health in the vast majority of situations because insurance is linked inextricably with risk, while health care is in many ways more a matter of regular maintenance.

Ask any insurance professional what a policy covers and they will tell you risk of loss, and that loss is catastrophic and unexpected. Take for example, if another driver who isn’t paying attention hits your car. (Reminder, don’t drive and read IntellectualConservative at the same time.) It is unexpected, catastrophic, and causes a loss. Insurance will pay for collision damage, but it will not pay for regular oil changes, replacement tires or belts and hoses when they wear out. It certainly wouldn’t pay for the new motor mounts I needed last year after about 250,000 miles.

By the same logic, insurance should pay for when you fall and break your leg, or suffer a heart attack, or come down with some other severe illness. It should not pay for anything reasonably necessary as regular maintenance on the human body such as vaccinations, annual checkups, and confirmation that you have come down with a cold or the flu. Unfortunately, this is exactly what the average person believes health “insurance” is for. They want it to pay for the equivalent of oil changes and new tires, and this is one of the major reasons why health payment plans are frequently so expensive. It is the equivalent of having a zero deductable on your car or homeowners insurance.

A government, universal, plan covering all health needs will not be cheaper than what the today’s health coverage companies provide. It will certainly be more expensive, which is precisely why such a plan leads in unavoidable rationing. First, in order to cut costs the amount paid to professionals such as doctors, nurses, technicians and so on for the work they do will have to be reduced. However, this will be insufficient, as the amount of work in an “everything covered” plan, which the folks on Capitol Hill envision will lead to increased demand. If you think the people going to emergency rooms for a case of the sniffles are a problem, think how many other minor ailments will become a case for the doctor when there is no cost to the patient. Demand will skyrocket, while the supply of professionals will fall due to the low level of compensation. Or, if the level of compensation is kept high, then the cost to the public will be past the stratosphere before we know it. There is no way on earth that the tax paying public can afford it. The result is either a bankrupt system, or a system, which rations care, and/or provides a low level of quality and service. Probably both.

One other aspect of the current American system that makes it so expensive is accounted for by the high quality of service available. Every hospital wants to have the latest and most effective treatments ready at their location. They don’t want to take second place to anyone. The difficulty with this is that new technology; particularly extremely new technology is expensive. Consider what it costs today for a flat panel television compared to ten years ago. This, combined with the pace of technological development, creates a massive need for continuing capital investment and drives up the cost of doing business in the medical field. Anyone who wants to cut costs can do so by reducing the rate at which innovative technology and new medications are introduced, but this will also reduce the level of quality overall, and likely prevent effective cures from being used.

Finally, there is the problem of the cost of new medications. This has become progressively higher over time as the difficulty of finding effective medications, working on the molecular level increases. Add in the regulatory costs, premarket testing, and it is no wonder that new medications are so expensive. Someone has to pay these costs and the one who gets stuck is the patient, or the person who pays the bills.

Is there an answer? Yes, but it is not one that a lot of people will like. First, they have to give up the idea of “free health care.” They must take responsibility for their own needs, and be willing to pay for them, at least up to a point. Second, health plans should be freed from government regulations that specify what they can and cannot provide. Plan subscribers should be able to pick from a variety of different compensation options, which can fit their individual needs and budgets. Those who are chronic illness victims are the only ones who should be eligible for government assistance in this, which should be in the amount of a subsidy that they get to use any way they wish.

Finally, to deal with the problem posed by people who get tax free medical coverage through their employers, give people who don’t have that benefit a tax credit (that’s credit, not deduction) for the amount they have to pay for health coverage, and for all our sakes, stop calling it insurance. It isn’t, and thinking of it as insurance has got us into a heap of trouble.

SOURCE




Wyden's Third Way

The Oregon senator questions the wisdom of a government health insurance plan

'People don't want the government in the driver's seat . . . They don't want the decisions (about their treatment) made in Capitol hearing rooms with a bunch of legislators in dark suits." So says Oregon Sen. Ron Wyden of the Healthy Americans Act, his plan for compromise in the polarized politics of healthcare reform.

Mr. Wyden, slouched amiably on his office sofa with his long legs on the coffee table, looks awfully relaxed for a man in the middle of the battle over health-care reform. On the day before our meeting, the political calculus shifted: The Congressional Budget Office predicted that the bill from the Senate Finance Committee would increase the federal budget deficit by $1.6 trillion over the next 10 years. Worse for Democrats, the astronomical price tag would still leave millions of people uninsured.

The news changed the views of some who had begun to see a bigger government role in medicine as inevitable. It also shifted attention to less-radical approaches, like the one Mr. Wyden is co-sponsoring with Utah Republican Bob Bennett.

"The country has bailout fatigue," Mr. Wyden explains. "The Congressional Budget Office said our proposal was budget neutral in the short term and that it would essentially start bending the cost curve downward in the third year."

The plans favored by Massachusetts Sen. Ted Kennedy or President Barack Obama rely on a "public option" in which government insurance would supposedly "compete" with private insurers, a move many see as leading to a single-payer system. By contrast, the Wyden-Bennett Healthy Americans Act relies on the private insurance market while imposing a series of regulations to squeeze savings from the private sector. It also requires individuals to buy coverage for themselves, the controversial "individual mandate."

The idea, Mr. Wyden says, is to harness the Democratic desire to get everyone covered to the Republican interest in markets and consumer choice. "Everything I've been up to with this coalition is designed to make reconciliation irrelevant," he explains, referring to a political maneuver whereby Democrats might try to force through health reform on a bare majority of 51 votes rather than the filibuster-proof 60 votes normally required.

"People can't be tricked into fixing health care." If you want to bring the country together, he continues, you have to aim for 70 votes and the kind of bipartisan strength that the Healthy Americans Act has with 14 senators sponsoring the bill. "If you . . . just pound it through on a partisan vote, you don't have that kind of consensus. You have people practically as soon as the ink is dry looking to have it repealed."

Mr. Wyden knows he is walking a wobbly tightrope between the factions. At Oregon town-hall meetings six years ago, he remembers, "you'd have a bunch of people get up and talk about single payer, and a lot of applause." He claps to demonstrate. Then someone else would say, "We don't want that, we had a cousin who lived in Canada, they had to come to the U.S. to get treated because they couldn't get good care. And then both of these groups would look sullenly at each other."

When he first approached Bob Bennett in early 2007 about a compromise plan based on the kind of coverage members of Congress get, he got a similarly unenthused response. Mr. Wyden puts on a deep, croaky Bob Bennett voice and repeats words that Mr. Bennett would later use to characterize his reaction: "I told Ron Wyden I'd look at his proposal." Smiling, Mr. Wyden says, "As Senator Bennett describes it, that's the closest thing you get in the United States Senate to a 'no.'"

Mr. Bennett ultimately came around to the idea, but a lot of Republicans remained dubious. "People kind of looked at him like it was all a kind of big socialist plot. And he basically said, get over it, they've got a point."

"Both parties have come a long way," says Mr. Wyden. "The most conservative Republicans accept the idea that they didn't accept in '93, that you've got to cover everybody to organize the market," he says. "If you don't . . . there's too much cost-shifting, not enough prevention." And some Democrats are seeing the wisdom of a market system where people will benefit if they make wise selections about their care.

Mr. Wyden takes a long view: "Ever since the 1940s, we essentially disconnected individuals from being involved in health care. It's all about third parties, and they pay all the bills and individuals don't have the opportunities for the choices. In fact, millions of people who are lucky enough to have employer coverage don't get any choice."

Which brings us back to dealing with the price tag of reform. Mr. Wyden is in the hot seat because his plan would convert the current tax exclusion for health benefits into a tax deduction for individuals to make insurance more portable. But taxing health benefits was pilloried on the campaign trail by Barack Obama, and the opponents have kept after it. "I think the way to go," Mr. Wyden says, "is with a generous deduction that sends a market-oriented message." He says that means that, if you shop carefully for your health care, you're going to get your taxes cut.

The typical family of four spends about $13,000 a year for their health care for the year, he says. In the Healthy Americans plan, they set the deduction at $19,000. "If you get a deduction of between $17,000 and $19,000 for a middle-class family of four . . . [that] now spends $13,000 on health care, we've got a chance to give millions of people . . . more money in their wallet because they got a chance to shop in a new system driven by informed choice and financial incentives to make those choices."

The tax aspects of the Wyden plan have nonetheless earned him the wrath of some Democrats as well as labor unions that carry fully loaded benefits plans and benefit from the current tax exemption. Some unions have even taken out ads against him in his home state of Oregon. As a powerful Democratic interest group, their objections have caused other would-be health-care reformers to capitulate. Montana Democrat and Finance Committee Chairman Max Baucus has said his own health reform plan will create a union carve-out.

Is Mr. Wyden surprised by the opposition his proposal has generated from the left? "Let's take it one at a time," he tells me. "First, there's a pretty good cross section of Democrats on this bill. Arlen Specter of course is now a Democrat." Other supporters include Debbie Stabenow, Mary Landrieu, Bill Nelson.

And Labor? Unions have every right to bargain for the best possible package, he says. "But nobody, be it a CEO or a labor [union] member ought to be getting what amounts to gold-plated coverage with the tax subsidies paid for by somebody who is a modestly compensated woman at a small business who doesn't have a health plan."

Breaking with the Democratic orthodoxy has earned him a few cold stares in other areas as well, including the plan's treatment of Medicaid and malpractice reform. The Healthy Americans Act transitions poor people out of Medicaid and will give them choices of private plans like members of Congress, he says. "We've taken a lot of flak for it . . . but Medicaid is a caste system. It is unfair to poor people and it is unfair to taxpayers." The system, he says, makes it hard for physicians to take care of the most vulnerable in society.

In a speech to the American Medical Association this week, Mr. Obama also opened the door to the possibility of malpractice reform, something Messrs. Wyden and Bennett support to help keep costs down. Democrats always blame the insurance companies, says Mr. Wyden, and Republicans always blame the trial lawyers. Insurance companies "are going to compete on the basis of price, benefit and quality," he insists. But a new system also requires "tough malpractice reforms."

The problem of spiraling costs is on display in Massachusetts, where a universal coverage plan started under former Gov. Mitt Romney, a Republican, is proving more of a cautionary tale than the inspiration Democrats would like to call it. "I've gone and met with the Massachusetts folks," Mr. Wyden says, and "cost containment is the Achilles heel."

Using government health programs to try to find savings in the short term is problematic, he says, as it leads to inevitable concerns about rationing of care. "If you try to go the government route, the danger is you will find savings that are not realized with massive new commitments, and that's a prescription for trouble."

Mr. Obama has endorsed a public option, though the commitment has lately come under renewed doubt from Democrats. Former Majority Leader Tom Daschle, who was once Mr. Obama's nominee to lead the Department of Health and Human Services, this week endorsed a compromise plan. Partnering with fellow former majority leaders Bob Dole and Howard Baker, Mr. Daschle's idea would seek a compromise on the public option, letting states establish programs with help from the federal government. North Dakota Sen. Kent Conrad has likewise questioned whether Democrats could muster enough votes for a public option.

Mr. Wyden has been meeting with the president on the issue, so is Mr. Obama committed to the public option, I wonder? Mr. Wyden won't tell, but directs me instead to review Mr. Obama's book, "The Audacity of Hope." In it, he says, "he talked about a system like what we're talking about in the Healthy Americans Act."

A single-payer solution is just not the Oregon senator's cup of tea. "I've never even understood how you would get there from here," he says. "A lot of the people who are for a public option want a single-payer system, and they haven't minced any words about it. Bless their hearts, extra points for honesty. But that's not where I am."

Mr. Wyden isn't necessarily opposed to a public option, he says, provided the caveats that it "can hold costs down and deal with the misguided incentives." So would he vote for the public option if it came to that?

"I'll look at it," he smiles. "I think I have an obligation as a legislator." Just like Bob Bennett used to say.

SOURCE





22 June, 2009

Pew survey on healthcare reform

LESS support for reform than in '93!

The survey finds that as Congress opens a major debate over reforming the nation’s health care system, public opinion about the issue has changed somewhat since President Clinton launched his unsuccessful effort to pass an overhaul of health care in 1993.

There continues to be widespread support for changing the health care system so that all Americans have insurance that covers all medically necessary care: 75% favor this currently, while 21% are opposed. However, the percentage favoring this proposal is down from 83% in April 1993. Similarly, while a large majority (61%) believes it is very important to limit annual increases in health care costs, fewer say that now than did so 16 years ago (69%).

When asked which is more important – to control annual cost increases or guarantee all Americans access to needed care – a majority (56%) says that it is more important to provide access to necessary medical care for all Americans while 36% say it is more important to control health care costs. In 1993, the public also opted for guaranteed access to care for all, but by a greater margin (74% to 20%).

Perhaps the most important change since 1993 is in the public’s assessment of how much change the current health care system needs. In April 1993, a majority (55%) said the system needed to be completely rebuilt, 26% said it needed fundamental changes, while 15% said it needed only minor changes. Today, fewer than half (41%) say the system needs to be completely rebuilt, while 30% say it requires fundamental change and 24% say the system works pretty well and needs only minor changes.

SOURCE




ObamaCare Sticker Shock

A $1.6 trillion deficit boost, and the uninsured will still be with us.

This was supposed to be a red-letter week for national health care, as Democrats started the process of hustling a quarter-baked bill through Congress to reorganize one-sixth of the economy on a partisan vote. Instead it was a fiasco.

Most of the devastation was wreaked by the Congressional Budget Office, which on Tuesday reported that draft legislation from the Senate Finance Committee would increase the federal deficit by more than $1.6 trillion over the next decade while only partly denting the population of the uninsured. The details haven't been made public, but the short version seems to be that President Obama's health boondoggle prescribes vast new spending without a coherent plan to pay for it even while failing to meet its own standards for social equity.

Finance Chairman Max Baucus postponed the health timeline, probably until after Congress's July 4 vacation. His team will try to scale down the middle-class insurance subsidies and make other cuts to hold the sticker shock under $1 trillion. (Oh, is that all?) Mr. Baucus also claims he's committed to a bipartisan consensus, yet most Republicans have been closed out of the negotiations, and industry lobbyists have been pre-emptively warned that even meeting with the GOP will invite retribution.

Useful to emphasize amid the mayhem is that CBO's number-crunching is almost always off -- predicting too much spending for market-based policies and far too little for new public programs, especially on health care. The CBO score for a new entitlement is only the teaser rate, given that the costs will inevitably balloon as the years pass and more people mob "free" or subsidized insurance.

Mitt Romney pitched his 2006 health reform -- which Democrats view as a model for universal coverage -- as modest and affordable, yet already its public option is annihilating the Massachusetts fisc. The original cost estimate for last year was $472 million; final spending came in at $628 million. Spending this year is at least $75 million over initial budget, while projections for next year range as high as $880 million -- and even those are probably too low.

Capitol Hill's entitlement Democrats are determined too press ahead, despite this cost detour. Still, this week's lesson is that ObamaCare might not be inevitable once Americans figure out the astonishing price tag.

SOURCE




Australia: That great government healthcare again. Broken neck? Take a Panadol

A MAN who broke his neck in a freak accident was sent home and told to take Panadol after hospital staff failed to diagnose his life-threatening injury. Paul Curtis, 31, endured two days of increasing pain and fear after a doctor in the emergency department at Sydney's Ryde Hospital sent him away without ordering an X-ray. He went back to the hospital where another doctor ordered tests. He said Mr Curtis was lucky to be alive or not in a wheelchair.

The Carlingford man went to Ryde Hospital late on Friday May 29 after he and a friend cracked their heads during a church youth group activity. "I drove home but I didn't feel right and my housemate, a nurse, thought I wasn't looking very good," he said. "I told the hospital staff I had had a serious head collision and the nurse noticed a mark on the back of my neck.

"After 2 hours I saw the doctor and told him my neck was sore. He told me I couldn't have an X-ray because the X-ray unit was shut and told me I would be fine. "He told me to go home and take some Panadol."

By Monday his condition had worsened and he returned to the hospital where another doctor ordered an X-ray and a CT scan. With the break detected, he was put in a brace and sent by ambulance to Royal North Shore Hospital, where he later had surgery and a plate inserted in his spine. "I was crapping myself when they told me my neck was broken - I had been walking around like that for two days," Mr Curtis said. "There was a chip out of my spine and the doctor said it was lucky it hadn't severed my spinal cord."

A Ryde Hospital spokeswoman said Mr Curtis had not complained of a loss of consciousness and told emergency staff he had taken Panadol for the pain. She said hospital records from the Friday night did not show any discussion about an X-ray but said radiologists could be called back to the hospital after 11pm if required. Hospital records showed he returned to Ryde at 9.08am on the Monday, and was in an ambulance en route to Royal North Shore at 9.21am.

Opposition health spokeswoman Jillian Skinner said: "It was nothing more than luck that saved this man from sustaining further damage as a result of not being treated properly - quite frankly the fact he was sent home with the injuries he had is enough to send shivers down the spine. "The Rees Labor Government has failed to provide Ryde Hospital with the resources it needs to deal with cases like this. "Ryde Hospital clearly doesn't have enough funding or staff skill mix to deal with cases like this, and that responsibility falls squarely on the shoulders of Health Minister John Della Bosca and his incompetent area health services."

Ryde MP Victor Dominello, a Liberal, defended hospital staff, saying it was not their fault they did not have sufficient resources to treat patients properly.

SOURCE





21 June, 2009

White House Stands by Obama's Claim That Single-Payer Health Care Works In Other Countries--It's Just Not Sure Which Countries Obama Meant

Two days after President Barack Obama told the American Medical Association that in some countries a single-payer health care system “works pretty well,” the White House reaffirmed that people in those countries liked their health care, but also said it did not know to which countries the president was referring. “I don’t know exactly the countries. I think if you talk to the people in the countries that have that system, they think their health care is pretty good,” White House Press Secretary Robert Gibbs told CNSNews.com Wednesday during the daily press briefing.

Asked again if he knew specifically which countries, Gibbs replied: “I assume Canada, Britain, maybe France. I don’t know the exact countries, but again, I don’t think the president is going way out on a limb that some people in other countries have a health care system that they like. Just as some Americans like the health care system that they have.”

President Obama spoke Monday in Chicago to the American Medical Association, the doctors’ lobby that is skeptical about his “public option” health care reform proposal.

“Let me also say that—let me also address an illegitimate concern that’s being put forward by those who are claiming a public option is somehow a Trojan Horse for a single-payer system,” Obama said on Monday.

“I’ll be honest, there are countries where a single-payer system works pretty well. But I believe – and I’ve taken some flak from members of my own party for this belief – that it’s important for our efforts to build on our traditions here in the United States. So when you hear the naysayers claim that I’m trying to bring about government-run health care, know this: They’re not telling the truth.”

The criticism of single-payer health care – primarily as practiced in Canada and Europe – has been that operations and procedures are long-delayed or denied and health care is rationed to control costs. For example, in Canada, the average wait for a 65-year-old man to get a hip replacement is six months, according to the Freedom Works Foundation.

The average wait time in a Canadian emergency room is 16 hours and 18 minutes. Also, “the average cancer test and radiation treatment cycles vary between 6 to 8 weeks,” the foundation reported.

John Goodman, director of the National Center for Policy Analysis and author of the book, “Lives at Risk: Single-Payer National Health Insurance Around the World,” has reported that in Britain, “at any one time, there are about a million people waiting to get into hospitals. According to the Fraser Institute, almost 900,000 Canadian patients are on the waiting list at any point in time. And, according to the New Zealand government, 90,000 people are on the waiting lists there.”

“Those people constitute only about 1 to 2 percent of the population in those countries, but keep in mind that only about 15 percent of the population actually enters a hospital each year,” says Goodman. “Many of the people waiting are waiting in pain. Many are risking their lives by waiting. And there is no market mechanism in these countries to get care to people who need it first.”

Earlier this year, the Obama administration signed an economic recovery act into law that established a comparative effectiveness council to determine the most cost-effective medical procedures. This economic stimulus bill also included the establishment of a centrally linked electronic infrastructure that would include the medical information of every American by 2014.

Obama and most Democrats in Congress are pushing for a “public option,” or government-run health insurance program that would compete with private health care companies.

Many analysts agree that the private, market-driven companies would be unable to compete with a government-run insurance program, which would have nearly unlimited resources.

SOURCE




Don't get old and sick in Obama's America

By R. Emmett Tyrrell, Jr.

If you have any sense that you may be getting sick in the years ahead, I suggest you get sick immediately. If you will be in need of surgery or any other medical procedure, do it now! If not immediately, be certain that you hand yourself over to the healthcare professionals before October 15 of this year. That is the date on which President Barack Obama hopes to sign his healthcare bill once it has gone through the congressional baloney grinder.

At the heart of President Obama's plan is his stated goal to cut medical costs. That might sound good to you, but it means cutting services, nurses, technicians, medical tests, and most prominently the use of expensive technology. The President's top medical advisers are quite frank about this. Dr. Ezekiel Emanuel, brother of Rahm Emanuel and a health policy adviser in the Office of Management and Budget, has chided Americans for the expense of their "being enamored with technology." Dr. David Blumenthal, another key Obama adviser, charges medical innovations as being responsible for fully two-thirds of the annual increase in healthcare spending. Their solution is to limit expensive innovations. A 2008 Congressional Budget Office report agrees with their cost analysis but concludes happily that such innovations "permit the treatment of previously untreatable conditions." As I shall show, there are more humane ways to cut healthcare costs.

Also at the heart of President Obama's plan is the restriction of services for older people, people 65 and older who by virtue of modern medicine may actually be ten and fifteen years younger in terms of good health than they would have been a generation ago. Alas, they still have higher health risks and costs than younger people. Thus they are going to bear the brunt of the Obama Administration's cost cuts, for 27-30% of Medicaid spending is spent for caring for people at the end of their lives. With the government taking over more of the nation's healthcare costs under the Obama regime, it has already been decided that government monies are more economically spent on younger people than on older people. If a 65-year-old needs a hip replacement, the government will better spend that money on a younger person whose hip will last longer. Or perhaps the government will decide the money is better spent on preventive medicine for younger people.

In the federal stimulus legislation that the president signed February 17, we find funding for a Federal Council on Comparative Effectiveness Research. "Comparative effectiveness research" is a term used by economists in healthcare for making health comparisons based often on age and for limiting care based on a patient's age. In Great Britain comparative effectiveness research is actually used to deny patients treatment for age-related diseases such as heart disease and macular degeneration. When the federal stimulus bill was going through Congress there were warnings regarding the consequences of comparative effectiveness research. Rep. Charles Boustany Jr., a heart surgeon, warned that it would lead to "denying seniors and the disabled lifesaving care."

Yet the policy remained in the bill along with requirements for doctors' offices and hospitals to maintain data banks on patients while creating a national network to monitor patients' care. The good side of that is that a central data base can send out the latest information on treatments, though doctors who keep up with their medical journals already know about these treatments. The dark side is that it will allow the federal government to control how our doctors treat us. The bill speaks of "appropriate" and "cost-effective" care and provides penalties against doctors beginning in 2014. Now there is an Orwellian twist to the Obama promise of "hope" and "change."

As Betsy McCaughey has written in a groundbreaking analysis of the Obama healthcare proposals, draconian cost-control measures are not the answer to healthcare reform and they are based on erroneous data. Healthcare's spending increases over the past five years have been about half what they were in the recent period before that. Average family spending on food, energy, and healthcare have remained the same for decades. Moreover, contrary to myth, there are not 47 million uninsured Americans but actually about 22 million. Rather than pass a healthcare reform that will mercilessly limit healthcare to older citizens (and to chronically ill citizens) while still increasing federal expenditures by at least a trillion dollars, she suggests a modest reform, to wit, debit cards for the uninsured and the needy.

Appearing in a recent installment of Spectator.org, McCaughey wrote, "Providing sliding scale assistance, based on household income, to families to purchase…coverage would cost $20 to $25 billion a year." That is one reform that will deal with our present problems. There are others, which I shall take up in later columns. What we do not need is Orwell's Big Brother overseeing the rationing of healthcare to senior citizens, particularly senior citizens with years of life ahead of them.

SOURCE




The Nation's Medicine, when will they ever learn?

A dialogue

So tell me again why you aren't a doctor. Because my father - an Edinburgh-trained general physician and surgeon - urged his son against it. He foresaw the day, now rushing at us, when the federal government would be setting rates, approving procedures, and broadly regulating the medical profession.

President Obama and congressional Democrats want to extend medical insurance coverage to everyone, drive down health-care costs, and raise the quality of care. They're talking about a "public option" plan to show the way by competing with private-sector insurance plans. What's the matter with that?

All three cannot be done. And the "public option" - the government plan - inevitably will become the only option, hence the only plan. But the president isn't saying that. In his remarks to the American Medical Association, he told the nation's doctors, "The public option is not your enemy; it is your friend."

Sort of like, I'm from the government, and I'm here to help you. Thoreau had it right when he wrote, "If I knew for a certainty that a man were coming to my door with the conscious purpose of doing me good, I would run for my life."

At the AMA, the president talked about people like you, who dismiss his proposals as "socialized medicine" or nationalized care. The hour for reform and change is at hand. Instead of being part of the problem, why don't you become part of the solution - and join the debate? OK. For openers, try on these quotes:

1) Liberal economics columnist Robert Samuelson: "It's hard to know whether President Obama's health care 'reform' is naive, hypocritical, or simply dishonest. Probably all three. The president keeps saying it's imperative to control runaway health spending. He's right. The trouble is that what's being promoted as health care 'reform' almost certainly won't suppress spending and, quite probably, will do the opposite."

2) The conservative Heritage Foundation's Robert Moffit, on the president's AMA speech: "He reiterated the key elements of his health policy agenda: a new government-run health plan to compete with private health plans in a government-run national health insurance exchange. It would include a government mandate on employers to offer government-approved coverage, as well as a government mandate on individuals to buy government-approved insurance."

3) Professor Scott Harrington of the University of Pennsylvania's Wharton School: "In reality, equal competition between a public plan and private plans would be impossible. The public plan would inexorably crowd out private plans, leading to a single-payer system. ... Health-care providers and other Americans should recognize this reality and be prepared for the consequences."

YOU obviously agree with those observations. Why? For a number of reasons. Government estimates of the costs of things - in this case, $1.5 trillion over the next decade alone - always are notoriously wrong on the low side. Not always. Yes, always. Way low.

Next, there's medicine and there's inferior government-run medicine - just as there's the car business and (soon) the government-run car business, education and public (i.e. government-run) education. Where - anywhere - is government-run medicine better in terms of quality and efficiency of delivery than the private medicine available throughout the United States? If there were even a single example, it would be page-one news every day.

So? So Obama and his rubber-stamp congressional lefties are hell-bent to Europeanize the nation's health care with state-run (yes, socialized) medicine. To borrow from two old songs, Give 'em the ol' razzle-dazzle and Promise 'em anything, but give 'em socialized medicine. Waits will grow longer, costs will go up, and quality of care will go down. It doesn't make any sense.

WHAT would make sense? Politically, we probably have reached a time when the government has to mandate health care coverage for everyone. It could do that simply by requiring every taxpayer to attach to his federal tax return a certificate of coverage for him and his dependents. (Non-taxpayers would get medical care through a pool funded in any of various ways.) Then private insurance carriers would compete to sell state-sanctioned plans at the lowest costs for a multitude of coverage ranges.

That sounds a lot like the Federal Employees Health Benefits Plan under which congresspersons and presidents buy their medical coverage. Bingo. Very much like that - and there was a time when Obama was suggesting it, but apparently not anymore. If such an arrangement is good for lofty congresspersons and presidents, is it too good for the everyday rest of us? Wow. A plan already in place - and used by the president himself. Why isn't he using it as a model for the country?

Because he is a statist at heart - and he has the popular support and the votes in Congress to socialize medicine on the European model. And despite his tendency to complexify things and conceal them in an inky rhetorical cloud, that's clearly what he wants to do - and that's what we're likely to get, and don't bring up the new taxes that will be imposed in its name.

Complexify, Europeanize, socialize? Indeed. With the consequent rationing that defines care restrictions and price controls - and the tearing up of the private doctor-patient contract that is the essence of American medicine. That's the freight train rushing at us.

Your father actually foresaw this? He did - and in many ways the train already has arrived, which helps explain the smoldering fury of many of the nation's physicians. The new regime seems set on replacing private medicine with government medicine. In the slang acronym, we face a HICA moment. HICA? For Here It Comes Again.

SOURCE





20 June, 2009

Media Kowtows to Supreme Leader



Obama: "There Are Countries Where a Single-Payer System Works Pretty Well"

President Obama told the American Medical Association on Monday that he thinks single-payer health care systems -- socialized medicine -- work "pretty well" in other countries, but that he does not want to create such a system here because he wants to "build on our traditions." In fact, the predictable endgame of the health care plan Obama is trying to rush through Congress this summer is socialized medicine.

We now know Obama does not oppose socialized medicine in principle or on practical grounds. So on what grounds does he oppose it? Just one: rhetorical. If Obama candidly said he is trying to put America on the path to government-run health care, it would excite exactly the sort of massive national grassroots opposition needed to kill his plan. So what Obama is doing is paving a one-way street to a socialized medicine while expressly denying he is doing so -- and while accusing those who point out what he is doing of being untruthful.

Some in the liberal press are helping Obama perpetrate this big lie. The coverage of his AMA speech provides a stunning example specifically related to Obama's declaration that single-payer health care systems have worked "pretty well."

The full context of Obama's remark is available from the official transcript posted on the White House Website. One paragraph of this transcript reads:

"Let me also say that -- let me also address a illegitimate concern that's being put forward by those who are claiming a public option is somehow a Trojan horse for a single-payer system. I'll be honest, there are countries where a single-payer system works pretty well. But I believe -- and I've taken some flak from members of my own party for this belief -- that it's important for our efforts to build on our traditions here in the United States. So when you hear the naysayers claim that I'm trying to bring about government-run health care, know this: They're not telling the truth."

On Tuesday afternoon, I ran a search of the Nexis "major newspapers" database to see if any major American newspaper had quoted Obama's remark that "there are countries where a single-payer system works pretty well." I searched the terms "Obama," "single-payer" and "pretty well." There was not a single hit.

Then I discovered, also using Nexis, that The Washington Post, The New York Times and the Los Angeles Times had all artfully quoted words Obama said both immediately before and after he said single payer systems work "pretty well" -- without actually quoting his statement about single-payer systems working "pretty well."

The Washington Post reported it this way: "In his speech, Obama said, 'Let me also address an illegitimate concern that's being put forward by those who are claiming that a public option is somehow a Trojan horse for a single-payer system. … When you hear the naysayers claim that I'm trying to bring about government-run health care, know this: They're not telling the truth."

The Post artfully replaced Obama's statement that "I'll be honest, there are countries where a single-payer system works pretty well" with three dots.

The New York Times reported it this way: "'The public option is not your enemy,' Mr. Obama said. 'It is your friend, I believe.' Saying it would 'keep insurance companies honest,' the president dismissed as 'illegitimate' the claims of critics that a public insurance option amounts to 'Trojan horse for a single-payer system' run by the government."

Artfully using broken phrases, the Times was able to report Obama's attack on his critics while avoiding his statement that single-payer systems work "pretty well."

It was the Los Angeles Times, however, that struck upon the cleverest tactic. It reported what Obama said this way: "'Let me also address an illegitimate concern that's being put forward by those who are claiming that a public option is somehow a Trojan horse for a single-payer system,' Obama said. 'But I believe, and I've taken some flak from members of my own party for this belief, that it's important for our reform efforts to build on our traditions here in the United States."

Just as Obama was about to say he believes single-payer systems work "pretty well," the Times broke off the quote and inserted the words "Obama said." It then resumed the quote with the words "but I believe," which come after Obama said he believes single-payer systems work "pretty well."

The Washington Post, The New York Times and the Los Angeles Times are not part of an adversarial press asking tough questions of a president trying to radically reorganize the health care system. They are his accomplices.

In his AMA speech, Obama again said he supports creating a "public option" government-run health insurance company and mandating that every American buy health insurance. The only thing he isn't calling for now is mandating that everyone buy their mandatory insurance from the government company. Once the "public option" is in place, slight changes in regulations and taxes can make it the only option. When that happens, don't expect to see it reported plainly in a major paper.

SOURCE

The media obviously knew that they had to shield Obama from the obvious challenge: "Name one".




Welsh IVF blunder clinic lost another couple's embryos

The HFEA should have closed this clinic down after earlier reports of negligence but they were instead obsessed with pursuing Dr. Taranissi over paperwork issues

The fertility clinic that transferred a woman’s last embryo into another patient has apologised for losing the embryos of another couple. The latest couple, who do not want to be identified, said that they were devastated by the loss of their embryos at the IVF Wales clinic in Cardiff in 2004, which happened when the tube and needle transferring them to the woman’s womb became disconnected. The clinic said in a statement that an apology had been made to the couple and that the incident happened because of an equipment error.

The man, from the South Wales valleys, told BBC Radio Wales that the doctor dealing with them had at first been looking at the wrong notes. “It became apparent the doctor was referring to a different couple’s notes, from Swansea, I believe. When we raised that issue, that we weren’t actually from Swansea, they realised. If they can’t get something as relatively straightforward as record-keeping right it doesn’t bode well,” he said.

His partner said that when they went back to the clinic for the embryo transfer, “unfortunately during this time they lost our embryos. I can’t put it into words, I really can’t. I just cried. We were devastated. We viewed our embryos seconds before it happened. You look at these embryos and think they’re your babies.”

The couple decided to talk about their experience after hearing about the couple from Bridgend, South Wales, whose last remaining embryo was implanted in the wrong woman by mistake. The woman who had had the wrong embryo implanted had a termination when she found out about the error.

The Cardiff and Vale NHS Trust has paid the couple, identified only as Deborah and Paul, whose embryo was wrongly transplanted an unidentified sum after admitting liability for gross failures in care. The couple had been hoping to try for a second baby with their last remaining embryo in 2007 when they were told that it had been implanted in another woman. The mistake occurred when more than one patient’s embryos were temporarily stored in an incubator. A trainee embryologist failed to carry out “fail-safe” witnessing procedures.

The trust said that systems had since been improved, in line with recommendations made in a report by the Human Fertilisation and Embryology Authority investigators in relation to the case. In the latest incident the couple were not charged and they accepted the offer of a further free cycle of treatment.

Janet Evans, the clinical director of IVF Wales, said: “This was an unfortunate but extremely rare failure in a standard piece of equipment used for embryo transfer around the world. We have since changed the equipment that we use. The incident was investigated by IVF Wales staff and a personal apology was made. “The incident was reported to the Human Fertilisation and Embryology Authority (HFEA) as part of the incident alert register so other centres could benefit from the information.

“IVF Wales is regularly inspected, as are all units in the UK, by the HFEA. The unit maintains its licence with no conditions, which demonstrates HFEA satisfaction with our quality of care.”

SOURCE




Amazing: Tough new Australian laws to make homebirths illegal

Only a few generations ago, all of us came into the world at home. How can something so natural be made illegal?

HOMEBIRTHS will become illegal under tough new laws that prevent women using midwives to have children outside hospitals. The move is set to drive homebirths underground, with expectant mothers and their babies at risk. There are fears women determined to have a homebirth will "go it alone" like birthing advocate Janet Fraser, whose baby died during a natural water birth in April, The Daily Telegraph reports.

Under the draft Health Practitioner Regulation National Law, released last week, a midwife cannot be registered unless she has insurance. But with insurance companies and the Government so far refusing to include homebirths in the indemnity scheme, midwives will face being de-registered if they attend a homebirth.

Women's groups accuse the Rudd Government of stripping women of rights by forcing them into hospitals. Australian College of Midwives boss Dr Barbara Vernon said the Government's intention was obvious. "I had been optimistic until now when you can see it in black and white," she said. "Even though only less than half a per cent of women have homebirths, they should have the same rights as a woman who chooses to have a caesarean. Homebirths won't stop."

About 150 midwives do homebirths in Australia. Called independent or private midwives, most do not work in a hospital and are uninsured. But from July 2010, they will no longer be able to call themselves midwives even though they are trained. Only those insured and registered can use the term midwife, otherwise they face a $30,000 fine.

There are about 700 homebirths a year but some say this may be as high as 2100 as they are under-reported. For TV presenter and marriage celebrant Elizabeth Trevan, giving birth to her 18-month old twins Nash and Harvey at home was an "overwhelming experience." "It breaks my heart to hear that the Government will do this," she said. "This is about choice. "The Government should be driving this and helping midwives who want to (do) homebirths. They will never be able to afford insurance."

Home Births Australia secretary Justine Caines said the new law took away the rights of women. "It technically makes homebirthing illegal," she said. The Royal Australasian College of Obstetricians and Gynaecologists is against homebirths. [Well, they would be, wouldn't they? It is competition for them]

SOURCE





19 June, 2009

Health Reform and Competitiveness

Democrats have spent years arguing that corporate tax rates don't matter to U.S. competitiveness. But all of a sudden one of their favorite arguments for government-run health care has become . . . U.S. corporate competitiveness. Political conversions on this scale could use a little scrutiny.

"Businesses now recognize that if we don't get a handle on this stuff then they are going to continue to be operating at a competitive disadvantage with other countries," President Obama recently remarked. "And so they anxiously seek serious reform."

Sure enough, many business leaders who should know better have picked up the White House theme. "You won't fundamentally solve the problems in business until you solve the problem of spiraling health-care costs, which is driving everybody crazy," said Google CEO Eric Schmidt the other day.

Messrs. Obama and Schmidt need to brush up on their economics. Employers may write the checks to the insurance companies, but workers still pay for the coverage they get from those employers. The total cost of an employee is what matters to businesses, and fringe benefits are as much a part of compensation as cash wages. When health costs rise, firms don't become less competitive, as if insurance were lopped out of profits. Instead, nonhealth compensation drops. Or wages rise more slowly than they otherwise would.

A recent study from none other than the White House Council of Economic Advisers notes exactly this point: If medical spending continues to accelerate, it expects take-home pay to stagnate. According to the New York Times, White House economic aide Larry Summers pressured CEA chairman Christine Romer to make the competitiveness argument, "adding that it was among the political advisers' favorite 'talking points.'" Ms. Romer pointedly retorted, "I'm not going to put schlocky arguments in there." How the schlock gets into Mr. Obama's speeches is a different question.

It's certainly true that the U.S. employer-based insurance system can dampen entrepreneurial spirits. There's the "job lock" phenomenon, in which employees fear leaving a less productive job because they're afraid to lose their health benefits. Another problem is that insurance costs more for small groups than the large risk pools that big corporations assemble, meaning that it's harder to form new businesses that can offer policies. But all this is really an argument for developing the individual health insurance market, where policies would follow workers, not jobs.

As for the competitiveness line, it's nonsense for most companies. The exceptions are heavily unionized businesses like auto makers that have locked themselves in to gold-plated coverage, especially for retirees. They have a harder time adjusting health costs and wages. Other companies might get a bit more running room in the short run if government assumed all health costs a la the single-payer systems of Western Europe. But over time the market would clear -- compensation being determined by the demand for and supply of labor -- and wages would rise. Or they might not rise at all if health-care costs are merely replaced by the tax increases necessary to finance Mr. Obama's new multi-trillion-dollar entitlement.

This is where the real competitiveness argument is precisely the opposite of the one pitched by Messrs. Obama and Schmidt. Consider the European welfare states, where costly entitlements and regulations make it extremely expensive to hire new workers. The nearby table lays out the tax wedge, the share of labor costs that never reaches employees but instead goes straight to government. In Germany, France and Italy, the tax wedge hovers around 50%, in part to pay for state-provided health care.

By contrast, the U.S. tax wedge was around 30% in 2008, according to the OECD. In other words, the costs of providing insurance would merely be converted into a larger wedge, which would itself eat into compensation. This is why Europe has tended to have higher unemployment and slower economic growth over the past 30 years.

If Democrats really want to increase U.S. competitiveness, they could look at the corporate income tax, which is the second highest in the industrialized world and a major impediment to U.S. job creation when global capital is so fluid. Or drop their proposals to raise personal income-tax rates, which affect thousands of small- and medium-size businesses that have fled the corporate tax regime as limited liability companies or Subchapter S corporations. Or cut capital gains rates, which deter risk taking and investment. Or rethink their plans to rig the rules in favor of organized labor by doing away with secret ballots in union elections.

On all these issues and more, Democrats want to increase, not reduce, the burdens on U.S. business. Their health-care line is, per Ms. Romer, "schlocky" political spin.

SOURCE




VA inspections show continued hospital flaws

Proper training lacking at many centers. Amazing inattention to asepsis

Fewer than half of Veterans Affairs centers given a surprise inspection last month had proper training and guidelines in place for common endoscopic procedures such as colonoscopies - even after the agency learned that mistakes may have exposed thousands of veterans to HIV and other diseases. The findings, from the VA's inspector general and obtained by Associated Press, suggest that errors in colonoscopies and other minimally invasive procedures performed at VA facilities may be more widespread than initially thought.

The report was slated to be released Tuesday at a hearing before a House Veterans Affairs subcommittee, in which VA officials are scheduled to take questions. Rep. Harry E. Mitchell, Arizona Democrat, chairman of the hearing, on Monday called the situation a "damaging blow to the trust veterans place in the VA." Mr. Mitchell said he wants to learn what changes have been put in place to prevent similar mistakes.

Howard McIntyre, commander at one of two Disabled American Veterans chapters in Augusta, Ga., called the findings "disturbing" and said "there shouldn't have been any low level of training at all. "As soon as it was caught, the training should have been stepped up instantly," the 67-year-old Navy veteran said. Medical care for veterans, he said, "shouldn't be any less than perfect, because these are lives we're talking about."

Agency spokeswoman Katie Roberts said the VA is strictly enforcing a requirement that each facility verify that it's implementing correct standard operating procedures. "We are outraged at these results, of course, and are taking aggressive action to fix this problem quickly and effectively," Miss Roberts said.

The random inspections were conducted May 13-14 at 42 VA medical centers across the country. They found that 43 percent of the centers have standard operating procedures in place and have properly trained their staffs for using endoscopic equipment.

The investigation comes months after the discovery of a mistake at Murfreesboro, Tenn., led to a nationwide safety campaign at the VA's 153 medical centers calling attention to potential infection risks from improperly operating and sterilizing the equipment. Along with Murfreesboro, the agency has said mistakes were identified at a Miami center and at an ear, nose and throat clinic in Augusta. In February, the agency started warning about 10,000 former patients at those facilities, some who had colonoscopies as far back as 2003, to get blood tests for HIV and hepatitis.

As of Friday, the VA reported that six veterans taking the follow-up blood checks tested positive for HIV, 34 tested positive for hepatitis C and 13 tested positive for hepatitis B. There is no way to prove whether the infections came from VA procedures, and some experts say most or all of the infections probably already existed. The VA said the chance of infection was remote.

Sen. Richard M. Burr of North Carolina, the ranking Republican on the Senate Veterans Affairs Committee, said, "Too many questions surrounding the VA's handling of this issue remain unanswered."

The VA has acknowledged that the mistakes were caused by human error. A question has been whether the mistakes might have been repeated at other facilities using similar equipment. In Murfreesboro, officials think use of an incorrect valve may have allowed body fluid residue to transfer from patient to patient, possibly for more than five years after the equipment was installed in 2003.

In Miami, a tube that was supposed to be cleaned after each colonoscopy was instead cleaned at the end of each day, affecting patients between May 2004 and March 2009. And in Augusta, the ENT scopes used for looking into the nose and throat weren't properly cleaned, affecting patients between January 2008 and November 2008.

Since VA reported those mistakes, a key question has been whether they might have been repeated at other facilities using similar equipment.

SOURCE




NHS medication mistakes hitting kids on large scale

Ten thousand safety alerts over medication given to children are being issued annually in the NHS, including serious errors in the calculation of drug doses and health workers forgetting to give patients their medicine, research shows. The first report into health service safety incidents concerning children shows that 61,000 alerts were recorded between October 2007 and September 2008 in the care of patients under 18, with 18,200 involving babies aged under 1 month.

A quarter of the cases were the result of misuse of medication, including examples where patients received ten times too much of a drug owing to a dosing miscalculation. There were more than 2,800 alerts involving wrong or unclear dose or strength and children under the age of 4 were particularly affected.

The report, by the National Patient Safety Agency (NPSA), concludes that over the period there were 33 deaths of children and 39 deaths of newborn babies that had “indicators of avoidable factors”. The findings echo concerns raised in recent years over the lack of treatments tailored for children, and how nurses are often left to carry out complex calculations to ensure that the right amount of a drug tested for adults is given to a child.

The report is the first to calculate the impact of safety alerts on children. It uses information sent in from health trusts to the NPSA’s Reporting and Learning System (RLS) and analysis of key research papers. Of the 900,000 alerts issued annually, 7 per cent were found to involve people under 18. Researchers found that children up to the age of 4 had the second-highest percentage of medication incidents of all age groups, after the over-75s. Most of the incidents reported to the NPSA resulted in no harm or low harm to the baby or child.

Jenny Mooney, head of child health at the NPSA, said that one concern was the very small number of alerts from the primary care sector — only 4 per cent of the 61,000 total — suggesting that the figure was a substantial underestimate.

Dr Mooney said that the review showed that errors could occur when calculating and preparing drug doses for children. “It comes down to the availability in terms of drugs. You would always try to get them in liquid form, but sometimes you may not be able to. You end up having to crush up tablets . . . and it is fraught with potential problems.”

Other examples included confusion over milligrams and micrograms. Among babies, errors relating to treatment or procedure was the most common incident type (3,294 alerts), followed by medication incidents (2,881). Among children, medication incidents were the most commonly reported incident type (7,029), followed by treatment or procedure (5,416) and accidents involving the patient (4,576).

Dr Mooney added that she hoped that reporting of alerts would continue to improve, because a high number of reports did not necessarily indicate that a trust was performing poorly, but that its surveillance was thorough. “It is about changing the culture of reporting,” she said.

The report, called Review of Patient Safety for Children and Young People, said that more than half of accidents involving children related to slips, trips and falls. The report noted that 2,000 children a week are admitted to hospital with accident-related injuries and added: “It can therefore be anticipated that children will also be at risk of accidents while in hospital, and appropriate safeguards should be in place to protect children from accidental injury while receiving healthcare.”

The NPSA is urging NHS organisations to examine a range of best-practice guidance to help to cut the number of incidents, and better training for staff and a review of local procedures for managing medicines.

Kevin Cleary, the NPSA’s medical director, said that the agency had highlighted a range of recommendations for best practice to help to improve care and reduce safety problems: “The majority of patient-safety incidents involving children were reported to have resulted in no harm or low harm. However, we are hoping this constructive feedback will support all trusts and clinicians in delivering even safer clinical care to all NHS patients in the future.”

Case Study: Gentamicin

Gentamicin, an antibiotic used to treat bacterial infections in the very young, was the subject of 400 safety alerts between April 2007 and March 2008. It is administered intravenously for the treatment of neonatal sepsis, but has a narrow therapeutic range: slightly too little or too much can affect its toxicity and efficacy. An analysis of Reporting and Learning System data for neonatal medication incidents involving gentamicin identified 400 incidents. Two thirds of these were related to problems with administration of the drug, 23 per to prescribing and 6 per cent to insufficient monitoring. Gentamicin is the subject of a joint project between the National Patient Safety Agency and the Royal College of Paediatrics and Child Health relating to safe administration.

Best practice in neonatal care, being piloted, includes “no interruption” policies during prescribing, preparing, checking and administering; use of a 24-hour clock when prescribing; and administration of the dose to be given within one hour either side of the prescribed time.

SOURCE





18 June, 2009

Disagree with Obama and you become a target

The media are Obama's stormtroopers

We haven’t lived in President Obama’s America for long, but already we are witnessing a strange new phenomenon: Previously apolitical figures and organizations find themselves demonized, and then forgotten, with the speed, fury, and transience of a summer thunderstorm.

For most of his tenure at CNBC, Jim Cramer was a fairly apolitical creature. First and foremost a stock-market guru, Cramer stated that he eventually split from his partnered show with NRO’s Larry Kudlow “because politics is not my inclination . . . I just really don’t care for [the topic].” But Obama’s early moves spooked the market, and Cramer — who strongly and vocally supported Obama in last year’s campaign — called out Obama and Treasury Secretary Tim Geithner, lamenting the “invisible Treasury secretary” and “the most, greatest wealth destruction I’ve seen by a president.”

Suddenly, Jim Cramer became a much bigger figure. Suddenly, he became a regular butt of jokes on The Daily Show, and host Jon Stewart ripped into Cramer during their “interview.” Suddenly, the New York Times felt compelled to spotlight Cramer’s bad stock predictions and declare, “his personal brand has taken a beating in the last month.” Media Matters felt the need to establish a new site, “Financial Media Matters.”

In recent months, the market has improved some, and Cramer has been less vocal in his criticism of Obama — and, strangely enough, he’s no longer considered so worthy of mockery by the usual suspects. The host retains his same manic, relentless, over-the-top style; but for some reason, when he stopped criticizing the president, major media voices lost interest in ridiculing him.

The latest entity to be subjected to this Two-Minute Hate is the American Medical Association (AMA).

Americans generally like their doctors. Sixty-seven percent rate their physicians’ ethics and standards high or very high; the only professionals with a more favorable rating are nurses, grade-school teachers, pharmacists, and military officers. Most Americans don’t really think much about the AMA, and it seems likely that if the organization objected to a health-care reform proposal, patients would at least want to hear them out.

Last Wednesday, the AMA offered its most detailed response to President Obama’s health reform plans. The association disagreed with Obama that “creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans. . . . The corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.”

Later in the day, the AMA clarified its position: “The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of the public plan that are currently under discussion in Congress.”

But it was too late; the group’s apostasy was already a matter of public record. Suddenly, Media Matters felt the need to refute the notion that the AMA’s position might be that of America’s doctors, insisting that the group “speaks for less than one-third of doctors.” Coverage of the AMA’s announcement often implied that doctors don’t join because they disagree with the association’s stances, when in fact the trend in the profession has been for doctors to join organizations based on their medical specialty.

At the Daily Kos site, contributors argue that “the AMA is just as much a relic of a by-gone era as the little black bag.” One declared that the time has come “to ask our own doctors to stand firm against the AMA or revoke their membership with AMA due to their opposition to a strong, robust Medicare-like public option.” Another post carried the none-too-subtle headline “All Together Now: ‘Screw You, AMA!’”

By way of comparison, there was only one Kos diary that mentioned the AMA in March, and none in April; but since the recent health-care announcement, there have been 18. A switch has been flipped; the organization is now worth paying attention to and criticizing.

“When President Obama addresses the AMA today, he will be speaking to a group that is acting more like a typical Washington special interest than one that is concerned about the health and well-being of all Americans,” said David Donnelly, national campaigns director of Public Campaign Action Fund.

No less than the New York Times editorial page has warned that perhaps you shouldn’t trust your doctor: “There is disturbing evidence that many do a lot more than is medically useful — and often reap financial benefits from over-treating their patients. No doubt a vast majority of doctors strive to do the best for their patients. But many are influenced by fee-for-service financial incentives and some are unabashed profiteers. . . . When President Obama speaks at the annual meeting of the American Medical Association on Monday he will need all of his persuasive powers to bring doctors into the campaign for health care reform. Doctors have been complicit in driving up health care costs. They need to become part of the solution.”

Had the AMA backed the public option, or remained neutral, would that editorial have been written?

When the AMA endorsed gun control and climate change, few Democrats or liberals felt that a group of doctors was meddling outside its area of expertise — even though few of the AMA’s members are criminologists or environmental scientists. Now, when the group warns that a legislative proposal threatens to greatly worsen the current system for providing care — and thus affect the AMA’s central mission — it is suddenly unrepresentative of the nation’s doctors, a “relic,” a “typical Washington special interest,” and “in fact complicit in driving up health care costs.”

If the AMA isn’t supposed to weigh in on an issue such as this, why does it exist? If it won’t look out for the interests of its membership, who will?

A political strategist who influenced Barack Obama once taught, “Pick the target, freeze it, personalize it, and polarize it.” Opposition from doctors could be fatal to the Obama plan; indeed, it represents the single-most dangerous threat to his vision of health-care reform. A politician voting “no” could always justify his decision by saying he trusted America’s doctors more than the administration. (Obama addressed this in his June 15 speech to the AMA in Chicago: “Americans — me included — just do what you recommend. That is why I will listen to you and work with you to pursue reform that works for you.”) So the AMA finds itself getting the Cramer treatment — rapidly elevated out of relative obscurity and turned into the public enemy du jour.

Polite as it seemed, Obama’s speech represented an ultimatum. He said he wanted to work with the organization — but recent history suggests that if the AMA doesn’t play ball, some of the president’s allies will continue dragging it through the mud.

SOURCE




Medical freedom or medical Fascism?

On Thursday I marched with lovers of liberty against the greatest threat to American patients in the history of our country: the rise of Medical Fascism. Some may wonder - what happened to socialized medicine, isn't that the great threat? While it is true that there are attempts to socialize medical care, the fact is that the power players in Washington are ready to set the rules and then hand the keys of health care spending over to large health insurance companies. This is the definition of fascism: the state decides what corporations will do and the corporations do their bidding while making a profit. As it turns out the very corporations making the profit also control the government. That is why I marched with members of the 912 project in Tampa today to spread the message that the government and large corporations should not control your health care dollar: you should.

Some may wonder how medical fascism could possibly come to pass with a democratic president. It is simple, Obama and Congress want to "solve" the problem of unaffordable health care. They want "Universal Coverage." They want to do it this year while they still have a political capital and the votes in Congress -- all to get re-elected later. They know that creating a "single payer" system will be politically impossible. That is why protesters from "Health Care Now" are also trying to get a "Medicare for All" plan on the table: Congress knows it can't deliver on such a promise. So the answer will be to look conciliatory and turn to the insurance industry for the "rescue". They will be willing partners. The Government will find some way to include them -- either through mandated health insurance purchase or heavily subsidized health insurance vouchers. The problem is that even if the large corporations are paying for health care they will still ration care since there is no amount of money that will satisfy the needs of the many interests. However they will take over through a new sort of socialized medicine "American style" or medical fascism.

The United Health Group recently indicated that they could save $500 billion in health care spending simply "by sending patients to less expensive, more efficient doctors, reducing hospital visits by the elderly and cutting unnecessary care." I am a physician victim of tactics mislabeled "efficiency" by United Health Care -- and so are my patients. I perform surgery of the neck for pinched nerves to treat arm pain. United Health Care believes that such patients should receive no more than about $17,000 worth of care. They noted that of seven patients I operated on, they received about $22,000 worth of medical care. They thus rated me as "inefficient" and actively worked to steer patients away from my practice by offering lower co-pays to patients and lower premiums to employers if they used the "efficient" doctors. They put me lower on available physician lists and forced my and my office staff to spend hours to have a non-neurosurgeon approve an MRI or even surgery! No matter that seven patients is far too low a number to calculate such an average or that 90% of the dollars went to hospitals where I have no control of the cost of services there. Such practices will become common place and will worsen when medical fascism becomes the norm. Your doctor will be forced to comply or forced to go out of business -- the patients lose, the doctors lose, the government and insurance companies win.

There are immense pressures to tell doctors how to practice medicine -- all to save the government and large insurance companies money. They would increase their profits by ensuring a patient doesn't receive advanced chemotherapy for breast cancer -- as is now done in England. They would intimidate doctors into ordering fewer MRI's that may be needed for early diagnosis or to not offer hip or knee replacements to older patients. The path to get there is different, but we will have the same sort of system as in England. These sorts of rationing protocols will be established by the "Federal Coordinating Council on Comparative Effectiveness" that was secretly created in the "Stimulus" bill earlier this year. This council is modeled after the rationing committee "NICE" setup in England.

One of the President's key advisors on health care is Zeke Emanuel, brother of his Chief of Staff Rahm Emanuel. Dr. Emanuel is a bioethicist who writes in his blue print for health care reform "Health Care Guaranteed" that the most advanced radiation treatment for prostate cancer costs $42,000 compared to the about $11,000 of more basic radiation. In public talks he dismisses the value of the highly targeted radiation stating that its "only" benefit is decreased side effects from about 13% to 5%. But that is entirely the point of doing the more advanced and more costly radiation: to minimize side effects so higher doses of more curative radiation can be delivered. It appears he is okay with more than twice as many people having rectal bleeding and painful prostate and rectal inflammation after radiation -- as long as it saves money for someone else. Zeke Emanuel also advocates creating a national sales tax (A Value Added Tax) that is the same means of financing health care in socialized systems in Europe. Only, in America, the health insurance corporation will get the money and you will be denied care as they get a large profit. Even if the government keeps the money to spend on health care, they will simply ration the care since there will never be enough money to pay for everyone. As long as Americans don't pay for their routine, annual health care out of pocket, they will constantly see every test and treatment as "free" and order more. That is where medical inflation comes from and is the source of the real crisis. The question for Americans is: do you trust government or insurance company to make the decision on what treatment to receive for you or would you rather make the decision yourself based on the advice of your doctor.

American deserve better than what is currently envisioned in Congress. They don't deserve Nancy Pelosi, Harry Reid, Max Baucus and others to meet in locked rooms and deliver a secret health care reform bill that will be voted on after three days of token debate. Americans deserve lower cost insurance and to be in charge of their own health care spending. Americans deserve the right to buy a less expensive insurance plan from another state or to pay actual cost if they are young and healthy, not increased cost to cover older and sicker patients. They deserve an individual tax break to buy health insurance, not just from their employer where they will get locked into a job. Americans should have greater access to "Super" health savings accounts where an employer can put tax free money in their account and they can use it to find a doctor they want. They can find a doctor that will spend time with them and help them understand their choices and what test or treatments they really do and don't need. After they use their health savings account, they should be covered by low premium, high deductible catastrophic health insurance. This would be a protection against the rare expensive medical conditions one may experience during their lives. If Americans want an expensive health insurance plan that pays for every visit they can buy that too. If they want an HMO that caps how much will be spent on care -- that is another free choice for them. In other words, Americans deserve medical freedom, not medical fascism.

To get medical freedom you will need to fight for it. Join up with your local tea party group for marches across the nation on Medical freedom planned by July 4th. Let Congress know you want medical freedom, not medical fascism.

SOURCE





17 June, 2009

Obama health care plan cuts funds to hospitals

Treat more people with less money? Sure!

The White House said Saturday that President Barack Obama intended to pay for his health care overhaul partly by cutting more than $200 billion in expected reimbursements to hospitals and other medical facilities over the next decade – a proposal that is likely to provoke a backlash from cash-strapped medical institutions.

The high-stakes struggle over medical care is heating up as Obama declares the status quo unacceptable. Obama has insisted that his plan will not add to the federal deficit, and he had already set aside in his budget what he calls a $635 billion "down payment" toward the overall 10-year cost of the overhaul, which is expected to top $1 trillion. But Republicans and some Democratic legislators have been pressing him to provide details on how he would cover the rest. On Saturday, he used his weekly Internet and radio address to do so.

Obama said he had identified "an additional $313 billion in savings that will rein in unnecessary spending and increase efficiency and the quality of care," bringing the total to nearly $950 billion. "These savings will come from common-sense changes," Obama said in his address. "For example, if more Americans are insured, we can cut payments that help hospitals treat patients without health insurance." He added: "If the drugmakers pay their fair share, we can cut government spending on prescription drugs. And if doctors have incentives to provide the best care instead of more care, we can help Americans avoid the unnecessary hospital stays, treatments and tests that drive up costs."

Saturday's announcement came during an intense push by the White House to sell Obama's health care plan, his highest legislative priority. Broadly speaking, Obama wants to extend coverage to the nation's 45 million uninsured, preserve consumer choice and cut rising health care costs. He has argued that fixing the nation's health care system is crucial to the economic health of the U.S.

But as Congress contemplates the details of the legislation, the question of how to pay for the plan is among the thorniest it will face. Already, one of Obama's early proposals – limiting tax deductions for high-income people – has run into major roadblocks on Capitol Hill.

The administration expects to achieve the lowered hospital payments in two major ways. First, said Obama's budget director, Peter Orszag, payments to hospitals will be reduced to try to encourage them to work more productively and efficiently. These "productivity adjustments" would account for $110 billion in savings.

Secondly, the administration expects to lower payments to hospitals that treat large numbers of low-income patients. Medicare and Medicaid make special extra payments to these hospitals, but Orszag said those payments would become less necessary over time, as more of the nation's 45 million uninsured acquire coverage through the new program.

But hospital administrators, already nervous about lowered reimbursements, are likely to oppose such cuts. Less than 24 hours before Obama's radio address, the president of the American Hospital Association, Richard Umbdenstock, issued a call to action to his members across the country, warning that Congress might cut provider payments. Umbdenstock asked hospitals to "push back" against the proposed cuts. "Payment cuts are not reform," he said, denouncing "blunt cuts that cripple hospitals' ability to do better for their patients."

Dr. Patricia Gabow, chief executive of the Denver Health and Hospital Authority, which operates a 477-bed public hospital, said it would be "pretty risky" for Congress to cut payments to safety-net hospitals before knowing whether new legislation actually reduced the amount of uncompensated care they must provide. "What about homeless people, the chronically mentally ill, substance abusers and people with low literacy?" Gabow asked.

Congress ultimately will shape the new laws. Sen. Max Baucus, D-Mont., chairman of the Finance Committee, intends to introduce his plan this week. Aides said it would include a proposal to tax some employer-provided health benefits, a notion that Obama sharply criticized during his campaign for the White House. Workers might, for example, have to pay income tax on the value of family coverage exceeding $15,000 a year. Labor unions, many employers and many House Democrats oppose such a tax.

SOURCE




A British Liberal politician goes to an NHS hospital

Even though he got VIP treatment he could still see lots of problems

Last weekend, when the heart was being ripped out of Gordon Brown’s Government by angry voters, I was having bits of my insides cut out by surgeons. Fortunately, my bits were less essential - merely an appendix. And the voters seemed angrier than the appendix.

The unplanned, emergency hospital visit to St Thomas’s, London, did, however, do me a valuable service - providing first-hand experience of what the NHS now calls ‘the patient journey’ (though much of it was actually second-hand, via my family, as I spent a fair proportion of my time unconscious).

Overall, I came away very impressed and reassured. I was released in good shape 36 hours after surgery under general anaesthetic. I had benefited from recent advances in diagnostics - the acute appendicitis was picked up on a CT scan - and keyhole surgery techniques. The consultants and hospital doctors were highly professional. Nursing care was meticulous and friendly. Staff repeatedly cleaned their hands with MRSA disinfectant. I even enjoyed good hospital food. [They must have sent out for it]

This positive experience reflects, I think, a bigger change. A decade ago, as a newly elected MP, I was deluged by complaints about NHS hospitals. Long waiting times. Slapdash treatment. Bolshie nurses.

Dirty wards. Local and national surveys showed that health care was top of voters’ concerns. Health remains an issue, of course, especially around such big, intractable problems as mental illness and geriatric care. But with a few dramatic, recent exceptions, such as Stafford General Hospital, the sense of crisis which centred on the country’s hospitals has lifted.

One reason is that vast amounts of taxpayers’ money have been spent, and it shows. The worry is that the taps will now be turned off again as we head for a new era of cuts. Last week there were warnings of severe financial curbs as Government tries to rebalance the budget after the terrible damage inflicted on public finances by the collapse of the banking system and recession.

My short experience told me that there is now excellent quality care in the NHS provided by some first-class people. I also sensed that the services are potentially fragile if put under financial stress.

My own adventure began when I collapsed in a heap several times after dinner at a friend’s house. The initial theory was food poisoning - a House of Commons crayfish sandwich eaten earlier in the day was chief suspect.

When the ambulance team arrived, within seconds of the predicted time, they were worried about the fainting and wanted me checked out at the nearest hospital. I hadn’t appreciated ambulance staff have advanced paramedic skills. When you are feeling half dead it is reassuring to know that the first contact with the NHS is with people who really know what they are doing.

There followed the almost obligatory long wait on a trolley in a cubicle in A&E. I am told this violates one of the numerous targets hospitals have to meet. But it wasn’t a problem. There were higher priorities: desperately ill old people and victims of assaults guarded by the police. I was safe and comfortable and the medical staff were calm, efficient and kind.

I was fortunate to have my wife with me who spotted details that the system somehow overlooked - such as dirty toilet floors and missing loo rolls. As morning broke I discovered that my lab tests showed a worrying abnormality and I must stay.

It also transpired that someone had recognised the grey-faced, middle-aged man in the cubicle. A smart lady appeared with a clipboard - Management - and I was taken to a beautiful room with a view. I was getting five-star treatment and felt too weak to insist on equality. My wife later overheard a conversation: ‘I can’t believe it! We’ve actually got an MP here on the NHS.’ It is quite possible that my favourable experience owes something to this observation. But I think the outstandingly good practice I encountered ran much deeper. As did the inefficiencies.

While I was waiting for surgery the next day, long after the appointed hour, my son and daughter were waiting for me, chatting to the surgeons and anaesthetists.

They waited and waited. There was a problem. No porter. No manager to sort it out. I discovered that such waits occur constantly. There aren’t enough porters. But we are in a recession and there are alarming levels of unemployment in Inner London which provides the hospital with its staff. So why is there a porter shortage?

I also discovered that a new multi-million-pound building next door had been poorly designed so that doors are too narrow for porters to take trolleys through.

The underlying problem seems to be a preoccupation with the glamorous ‘frontline’ roles rather than the equally essential backroom systems. Or perhaps funds are rationed in ways which starve these less visible activities. Armies win battles, however, not just because of brave soldiers but because someone is organising supplies of ammunition, lorries, food and drink. Good businesses also understand logistics.

Public services are often woefully deficient in this area. The problem is called management. In the NHS, management seems to mean highly-paid officials sitting in big offices, attending meetings, burnishing their mission statements and issuing edicts to operational staff based on Government targets.

In St Thomas’s I gathered management was insisting on commandeering a doctors’ rest area for new offices - alienating the very people who make the NHS so remarkable.

The problem, as I saw it, is a lack of the NHS equivalent of hands-on supermarket floor managers, factory fore- men and Army sergeant majors: the cogs who make the machine work.

When I was ready to leave, my worries were confirmed. I was told there was a three-hour wait for straightforward drugs from the pharmacy. I was happy enough reading a book but my bed and room, and nursing staff, were likely to be immobilised for a morning. Someone made a fuss and this cut the wait to three minutes. But when my wife visited the pharmacy there were harassed staff too busy to answer the phone, attend the front desk or supervise distribution. Management was nowhere.

In numerous, passionate debates about the future of the NHS I have never heard mention of porter shortages, pharmacy management, hospital transport or trolley logistics. But unless the inefficiencies are sorted the cuts will reverse the NHS improvements of the past decade.

We have been here before. The financial screw tightens. Hospitals are told to make economies. There are cuts in ‘beds’ (in other words medical staff). Key vacancies aren’t filled. Non-emergency cases are pushed back (and their condition deteriorates). Then someone decides that the hospital isn’t ‘viable’.

Protests, barricades, petitions. In the battle for resources, valued local community hospitals and less glamorous bits of the NHS are trampled underfoot. But it needn’t be like that. Sensible steps have to be taken now to ensure the high-quality people who work in the NHS are properly used.

SOURCE




Australia: Victorian government hospital gives woman fatal overdose

Mogadon is well known as a powerful sleeping pill. Why would anybody be given three of them? This sounds deliberate, not accidental. It's not even indicated for depression

A family say they could only watch their mother slowly die after staff at Casey Hospital allegedly gave her an accidental overdose of a sleeping pill. The coroner is investigating the March 30 death of Elsinor Mitchell, 74, who was allegedly given three Mogadon tablets on March 27 when she was not supposed to receive any medication. Ms Mitchell's family say that within 15 minutes of the medication she fell into a coma while being transferred in an ambulance, and they could only watch as her organs shut down over the next three days because doctors were powerless to reverse the damage.

Victoria police have prepared a brief for the coroner, who is reviewing medical records and referring the information to the clinical liaison service for a medical opinion. Southern Health, which runs Casey Hospital, yesterday declined to comment on the incident, saying it was standard procedure not to discuss matters before the coroner. Other medical sources have told the Herald Sun it would typically require a greater dose of Mogadon to overdose.

Ms Mitchell's brother, Alf Hulland, his sister's power of attorney while in hospital, said Ms Mitchell was diagnosed as suffering depression by Casey Hospital doctors and given medication just before being placed in an ambulance to travel to a Heatherton clinic. He claims the hospital's doctors later admitted they realised the mistake only while Ms Mitchell was in transit, but she had already slipped into a coma before they could alert paramedics to the problem.

The Narre Warren mother of five adult children was later rushed to Monash Medical Centre but could not be saved. "A doctor took her youngest son into a room and told us somebody had made a terrible error at Casey Hospital," Mr Hulland said. "She said there would be a big inquiry and it would not be covered up, but apart from that there was nothing more she could do and her organs would shut down so she had 24 to 48 hours at the most to live.

"It is the most distressing thing I have ever had to endure in my entire life - to sit there and watch her die. I think it is absolutely disgraceful. "They had told me that within a fortnight she would be home and back to her normal self again. There was no reason for her to die. "A doctor came over from Casey Hospital the next day and apologised. It is the first time I have seen a doctor cry." Mr Hulland said he could barely recognise his sister in her final hours because her transformation was so severe. "She was a bubbly, happy-go-lucky person who always helped anybody," he said. "She absolutely had a heart of gold."

SOURCE





16 June, 2009

Murder by Bureaucracy

Wise guy liberal talk show hosts and writers of impassioned letters to the editor have been lecturing me with the argument that Obama and his Democrats are not remotely planning any sort of government health-care rationing in their socialized medicine plan, which is going to save so much money that they are now scrounging around for the biggest tax increase in U.S. history to pay for it. But Obama has now made fools out of all of them with the release last week of his White House report, "The Economic Case for Health Care Reform" (.pdf), produced by his Council of Economic Advisors (CEA).

Read the document, and you will see that it envisions a complete government takeover of America's health care in great detail. Wise, all-knowing, government bureaucrats in Washington will identify exactly what health care in each locality in the entire country is waste, and eliminate it. They will determine whether the treatments and health care your doctor has prescribed for you are right, and the best of the alternatives, and they will control his practice through their payment policies and regulations, forcing him to follow what they in their all-knowing wisdom think is best. Worst of all, they will decide whether the health care your doctor thinks you need is "cost-effective," meaning they will decide whether the cost of your health care is worth it, to them.

Listen to Obama, and you will hear him say almost every day that his health reforms are going to save America and its economy by reducing health costs. The CEA report explains exactly how and why he is going to do that. They don't use the word, of course, but nevertheless it is all overwhelming, government, health-care rationing, meaning you and your doctor lose control and choice over your health care, and centralized, government bureaucrats in Washington decide what health care you get and when. Think about it, and you will realize that in the government-run system Obama envisions, there is no other way to achieve the cost reductions he is talking about than through extensive government health-care rationing, meaning denying you the health care you want.

Indeed, the CEA report says 30% of American health care is waste, which government bureaucracy is now going to eliminate. That is a lot of health care to deny you. Doctors and hospitals who don't think this downsizing is going to affect them, and their freedom to control and run their own practices, are whistling past the graveyard. Wake up, and you will realize that in Obama's Brave New World, you are going to be the targets, just like the bank executives are today.

The Government Doesn't, Can't, and Won't Know

The economists who wrote the CEA report on health-care reform start by assuming first that the government is omniscient. They don't say that, but that assumption jumps out of every line. For example, the report says the government is going to sharply reduce health costs by

"Looking systematically at what works and what doesn't in order to provide more high value care and less care that is of low value. For many types of medical conditions, a patient may have a choice of several methods or treatments, each having different benefits or risks. Systematic examinations of the merits of different treatments and dissemination of the results of these examinations to patients and providers is one mechanism for promoting high value health care".

You will notice in reading Obamaspeak on health policy a distinct lack of nouns. Just who is going to look systematically at what works and what doesn't? And just who is going to conduct those "systematic examinations of the merits of different treatments?" And will whoever that is really know what works and what doesn't for 300 million patients across America, and "the merits of different treatments"? The answer to the first two questions is a centralized government health-care bureaucracy in Washington. Intelligent readers might think the answer to the last question is "No," or maybe "Hell, no!" But the answer is really, "Of course not, wake up and smell the coffee before it is too late."

The CEA report says at the beginning that "up to 30 percent of health-care costs (or about 5 percent of GDP) could be saved without compromising health outcomes." Achieving that result to slash the federal deficit, increase GDP ultimately by 8%, and reduce unemployment is going to require a lot more than "dissemination of the results [of the above] examinations to patients and providers [as] one mechanism for promoting high value health care."

No, a more promising mechanism for enforcing what the government decides works and what doesn't is found in another policy for controlling costs in the CEA report:

"Reorienting the financial incentives of providers toward value rather than volume. Payment systems….should reward providers who deliver care that adheres to evidence based guidelines and should not pay for preventable medical errors".

This is supposed to solve a problem identified earlier in the report:

"Provider Incentives. Most provider payment systems are fee-for-service, which creates financial incentives for doctors and hospitals to focus on the volume of services that they deliver rather than the quality, cost, or efficiency of care delivery. In general, payment systems do not reward higher quality and value. In some cases, they reward poor quality of care by paying for the costs associated with additional medical care necessary to fix errors that could have been prevented."

In other words, the government will enforce its decisions as to what works to provide high quality care and what doesn't through the payment system for doctors and hospitals. Those who follow the government's decisions get paid well, and those that don't don't. They will be lucky to get paid at all.

The CEA here also displays more faith in the omniscience of government, which is supposed to develop the prices for all health-care services that will perfectly reward high quality care that works rather than low quality care that doesn't, providing the perfect incentives that will perfectly wring out 30% of total health costs as unnecessary waste. The only problem is that a remote, centralized, government bureaucracy in Washington doesn't, can't, and won't know, out of all the health-care services in the economy, what works and what doesn't, what are the right prices for each that will provide exactly the right incentives to eliminate precisely only the 30% of health-care spending that is waste, and what exactly is waste, rather than the health-care services you want. And this is before politics gets involved, and the bureaucrats answer the phone calls from Congressmen who want an explanation as to the pitiful payments the government is providing to such and such doctors and hospitals in their districts.

Nevertheless, despite the government's severe lack of knowledge as to what it is doing, those doctors and hospitals that do not follow the government's decisions as to what is quality care will get formally labeled as "lower quality," losing out to the good doobies who win high quality provider labels by slavishly following the health-care diktats of the remote government bureaucrats who don't even know their patients. This is found in another CEA cost control measure:

Expanding performance measurement and provider feedbacks. Performance measurements include collecting and summarizing information about clinical quality, consumer satisfaction, and resource use of provider practices….One potential way to increase efficiency is to facilitate the development of a set of performance measures that all providers would adopt and report….Additionally, new efforts could be made to generate risk-adjusted provider performance profiles to encourage quality improvement and to inform consumer decision-making around quality." [Emphasis added.]

The omniscient, central, government, health-care bureaucracy, of course, will know exactly how to measure the performance of every doctor and every hospital in the country for every health-care service. And there won't be any politics in this either.

America's New Waiting Lines

But the CEA has still more bright cost control ideas:

"Rewarding high-value technology creation that reduces morbidity, mortality, and total spending over the lifetime. In most fields, technological progress is generally cost-reducing as individuals discover more effective ways of accomplishing things that were already being done. In medicine, however, technological progress in recent decades has been almost exclusively cost-increasing, without generating a commensurate increase in value. Undoubtedly, provider incentives, which largely reward finding an expensive way of treating a previously untreated condition rather than finding a less costly alternative to an existing treatment, contribute to this trend."

This is meant to address a problem earlier identified in the paper:

"Providers also have strong financial incentives to compete on the basis of technology adoption rather than price, leading to an excess supply of high technology equipment and services (for example, MRI machines and minimally invasive vascular diagnostic and procedure suites) and accelerated replacement of hospital beds in local markets. In turn, this can lead to higher rates of utilization and costs".

But is the government going to know exactly which technological innovation will reduce morbidity, mortality, and overall spending, and which will simply involve "an excess supply of high technology equipment and services"? Is the government going to know exactly how much to reward technological innovators to provide the incentives to gain exactly the right technological innovation, but none of the wrong, excess technology? Or is the government going to use this power to delay implementation of new technological innovations, discourage investment in new technology development, leave patients floundering with long waiting times for the latest high tech diagnostics and treatment, and thereby reduce costs, as in all those foreign countries the CEA admires in its report? What do you think?

Obama OMB Director Peter Orszag was more clear and direct in explaining the policy recently, saying, "Future increases in spending could be moderated if costly new medical services were adopted more selectively in the future than they have been in the past, and if the diffusion of existing costly services was slowed." Told ya'.

Can you see yet how the Obama socialized medicine plan will involve the government taking over and running health care in great detail? Can you see how under that plan, remote government bureaucrats in Washington will be deciding what health care you get and when, rather than you and your doctor? Can you see how the Obama socialized medicine plan involves pervasive and detailed central economic planning, which all experience teaches us will not work? Can you see now how these Obama cost controls involve government rationing of your health care, just like in every other country that has adopted socialized medicine?

CEA's Blind Spots

While Obama's CEA explains exactly how the Obama health reforms will impose severe government health-care rationing to reduce costs, it is totally blind as to how those reforms will increase costs, and bankrupt the nation. Obama's socialized medicine plan will increase health costs by increasing demand, not primarily through increased demand from the currently uninsured, but because of the incentives for all patients under the new system. With the government paying the bill, the incentive is to consume health care until the net benefit from it is equal to zero, rather than equal to costs as in an efficient market.

Even worse are the incentives for health-care providers, which greatly reinforce the rationing. Obama's socialized medicine plan will increase health costs by reducing supply. The government already has a long history of failing to pay adequately for health services under Medicaid, and increasingly for Medicare. With a complete government takeover of health care, these payment policies will soon cover the entire health-care system. That and the loss of freedom of choice and control over their own practices and services due to vastly increased government control will cause doctors and other health professionals to leave the industry, and talented young people to choose other professions.

Still more damaging is that investors will flee health care, taking with them the capital that is needed for new, expanded, updated, modernized, and maintained hospitals and clinics. Gone will be the capital for buying new, modern, advanced, high technology, as the government cannot be expected to pay adequately for such technology, and even wants to discourage it. And who will pay for the research and development of new medical advances and technology, for the new miracle drugs, for the new biotech and genetic breakthroughs that our modern science makes possible? With the government as the new monopoly buyer of all health care, investors will turn to other industries.

Then there is the huge, added cost burden for the government of taking on a new, massive health-care entitlement for everyone, even when we cannot hope to pay for all the current entitlement promises. That will involve huge increases in taxes, deficits and government borrowing, which will introduce enormous new inefficiencies.

All of this means a deep decline in America's standard of living. Today we enjoy the freest, most advanced health care in the world. All that freedom and rapid innovation does involve some waste and inefficiency. That can be addressed by market reforms to improve incentives. But some waste and inefficiency is well worth the health-care freedom and quality we have today, and will enjoy all the more with advancing science over time. Moreover, government is not the place to turn for reducing waste and inefficiency. Obama's government takeover of health care will make everything worse, and ultimately trash our entire health-care sector.

Source




‘Thousands of Britons dying as doctors miss signs of kidney failure’

Thousands of patients are dying unnecessarily because hospital doctors are missing the signs of kidney failure, a national inquiry reports today. Half of people who die from acute kidney injury (AKI) do not receive a good standard of care because of lapses in “basic bedside medicine”, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) says.

AKI, also known as acute renal failure, is estimated to affect up to 5 per cent of all hospital patients, but there are “systematic failings” in identifying and treating patients with the condition. Estimates suggest that at least 2,000 patients die every year from AKI, brought on by dehydration and the side-effects of medication.

The NCEPOD report on 564 patients who died in hospital found that in 43 per cent of cases, there was an unacceptable delay in diagnosing their condition, while in 13 per cent of cases, fatal complications were missed. Complications were also “avoidable” in 17 per cent of cases and “managed badly” in 22 per cent of cases.

The report found failings in basic bedside medicine — the way doctors cared for patients, rather than in the way hospitals organised the care. This included doctors failing to carry out basic tests to check for kidney failure — the study found 33 per cent of patients had had inadequate investigations.

The inquiry focused on the case notes of patients who died from AKI in 215 hospitals between January and March 2007. The hospitals were in England, Wales, the Channel Islands and the Isle of Man.

James Stewart, a joint author of the report and NCEPOD’s clinical co-ordinator, said that the findings indicated a lack of awareness among doctors of the risks of renal failure, a poor understanding of how the condition progressed and inadequate knowledge of how to manage it. “AKI is a common and essentially treatable condition, but a lack of basic bedside medicine is leading to the deaths of at least 2,000 patients a year in this country. The very essentials of medical care were being omitted and, unless attention is paid to the basics, patients will continue to die unnecessarily.”

AKI is distinct from chronic kidney disease, which requires regular treatment with dialysis. It can be identified through a blood test, but the inquiry found that the condition was often recognised late when complications were already evident. “In the past, specialist clinical care has rightly focused on chronic kidney disease, but this has left acute kidney injury to be managed by non-specialists,” Dr Stewart added. “Leaving complex and potentially reversible problems to junior staff is always unacceptable.

The NCEPOD report, Adding Insult to Injury, recommends that all patients admitted to hospital as an emergency should have a blood test to check electrolyte levels, which indicates how well the kidneys are functioning.

Dr Stewart said that the condition was more likely to affect elderly patients but could also result from a lack of fluids, or as a side-effect of common drugs including aspirin, blood pressure medication and antibiotics. He pointed to the failure of undergraduate and graduate medical training as a key factor in the inadequate care of AKI patients: “Education is paramount, but medical student training does not provide junior doctors with the ability to recognise acute illness.”

The inquiry recommended that medical training should promote greater awareness of the condition. All patients in hospital should also be reviewed by a senior consultant within 12 hours of admission, it added. Ann Keen, the Health Minister, said: “We are grateful to NCEPOD for bringing this to our attention. “Predictable and avoidable acute kidney injury should never occur.”

SOURCE





15 June, 2009

This should be the last straw for Britain's IVF regulator

They have wasted huge amounts of time and money in a fruitless legal assault on Dr. Taranissi's highly successful private IVF clinic while ignoring real sloppiness at a government IVF clinic

A MOTHER desperate to have a second child has told how she lost her last IVF embryo when the NHS implanted it into the wrong patient. When the other woman found out that the embryo was not hers, she aborted it.

Details of the blunder raise fresh questions about the way IVF clinics are regulated. The Sunday Times has previously revealed that women undergoing fertility treatment have had their eggs fertilised with the wrong sperm.

Deborah, the woman who lost her chance of another baby, is so traumatised by the error that she is reluctant to risk further IVF to have a longed-for sibling for her son, Jamie, 6. Because Deborah is 40 her prospects of having another child with her boyfriend, Paul, 38, are slim and diminishing. Deborah, who does not want to disclose her surname, said: “I will never forget the moment the hospital broke the news to us. Initially, the hospital told me there had been an accident in the lab and that the embryo had been damaged. I thought that someone had, perhaps, dropped the embryo dish. “I remember thinking: ‘That’s our last hope gone – we will never have another child.’ I left the hospital feeling totally shell-shocked. “When we went back to the hospital two days later and we were told the truth about my embryo being given to someone else I was so angry.”

Deborah, a healthcare worker, and Paul, who have been together for 17 years, went on the NHS waiting list for fertility treatment in 1996. After two failed attempts, Jamie was born on the third cycle in 2003. Three of the couple’s remaining embryos were frozen and they tried for another child with the only embryo to survive the freezing process at the IVF Wales fertility clinic, University Hospital of Wales, in Cardiff in December 2007.

The causes of the blunder remained secret until the couple instructed lawyers to obtain reports into the incident. Documents acquired by their solicitor, Guy Forster of Irwin Mitchell, showed that, the previous year, there had been “near misses” because of problems in monitoring the ownership of embryos. These were reported to the Human Fertilisation and Embryology Authority (HFEA), but Forster says it let patients down by failing to ensure that the problems at the clinic were sorted out.

Forster said: “We are concerned that the HFEA missed opportunities to take action in relation to IVF Wales before this incident occurred. “A report by HFEA investigators shows that the error occurred primarily due to failures by laboratory staff and theatre staff to carry out basic procedures.”

SOURCE




NHS waiting time targets hamper superbug fight, claim BMA

Waiting time targets in the NHS are hampering efforts to reduce “superbug” infections such as MRSA, doctors’ leaders have claimed. Patients are being placed on dirty beds to help hospitals meet the requirement to start treatment within four hours of admission.

Today the British Medical Association (BMA) called on the Government to allow more flexibility in the target to ensure there is enough time to clean equipment. Despite declining rates of MRSA and Clostridium difficile, healthcare-associated infections remain a “significant” problem for the NHS, with Britain having some of the highest rates in Europe, the BMA said in a report on tackling the issue.

The pressure to admit patients quickly and a shortage of isolation facilities at peak times are “critical challenges to maintaining high quality patient care”, the report states. Moving staff and patients around the hospital, in an effort to meet targets, also contributed to the spread of germs. The BMA said that patients with non-urgent conditions would understand if they had to wait an extra hour to be admitted to hospital while a ward was properly cleaned to minimise the risk of infection.

There needed to be a focus on long-term action and a will to drive down all infections, not just MRSA and C. difficile, it added. Medical processes could be improved, and meticulous hand-washing and proper prescribing of antibiotics should be encouraged, as overuse of the drugs is known to build up the resistance of microbes, the report concludes.

Jonathan Fielden, chairman of the BMA’s consultants committee, said: “Hygiene, hand-washing and antibiotic policies have extremely important roles to play, but if we want to reduce the spread of infections we must put safety in front of political targets. “With many hospitals already working at full capacity, they will only get more pressurised as winter arrives, but you need time to clean. “If you ask a patient whether they want care now or safe care in an hour, they wouldn’t mind waiting for the safe care. Existing targets need to take the need for good infection control into account.”

The BMA’s report said that staff or hospitals should face sanctions if they failed to implement simple strategies such as washing hands with soap and water or using alcohol gels. A £50 million deep clean of all hospitals in England was ordered by ministers in 2007, concluding in March last year. But Vivienne Nathanson, the BMA’s head of science and ethics, said that the policy needed to be part of a package of long-term measures to maintain regular, thorough cleaning of hospitals. “Deep cleaning is a good thing provided you go in and do all the other organisational things and keep your cleaning at a high level,” she said. This includes proper cleaning of things such as bedside lockers and rails, the buttons on machines and switches.

Dr Nathanson added that areas of a hospital that posed the greatest risk of harbouring germs were not always included in cleaning contracts. Roughly half of all hospital cleaning has been outsourced to private companies.

Ann Keen, the Health Minister, responded that the latest figures showed that MRSA infections had fallen by 65 per cent and C. difficile infections were down by 35 per cent. “It is difficult to understand the BMA’s suggestion that our broad integrated strategy to reduce healthcare associated infection has been anything other than a success. “However, we accept that one preventable infection is one too many and we continue to battle against infections on every front.”

Norman Lamb, the Liberal Democrat health spokesman, said: “This report provides further evidence that the Government's obsession with targets is putting patient safety at risk. “Ministers need to stop micromanaging the NHS and trust doctors and nurses to decide the best way to care for their patients.”

SOURCE




Reform must empower the consumers

As Congress moves forward with proposals for reforming the U.S. health care system, it is possible to draw some important lessons from the experience of other countries.

First, universal health insurance does not mean universal access to health care. In practice, many countries promise universal coverage but ration care or have extremely long waiting lists for treatment.

For example, at any given time, 750,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the NHS to cancel as many as 50,000 operations each year. In Canada, more than 800,000 patients are on waiting lists for medical procedures. The Canadian Supreme Court has found that many of these individuals suffer chronic pain and that some die awaiting treatment.

Those countries that have single-payer systems or systems heavily weighted toward government control are the most likely to face waiting lists, rationing, restrictions on the choice of physician and other barriers to care. Those countries with national health care systems that work better, such as France, the Netherlands and Switzerland, eschew centralized government control and incorporate market mechanisms such as competition, cost-consciousness, market prices and consumer choice.

Second, rising health care spending is not an uniquely American phenomenon. While other countries spend considerably less than the U.S. on health care both as a percentage of the gross domestic product and per capita, it is often because they begin with a lower base of expenditures. But their costs are still rising, leading to budget deficits, tax increases and/or benefit cuts. As the Wall Street Journal notes, "Europeans ... face steeper medical bills in the future in their cash-strapped governments." In short, there is no free lunch.

Yet many in Congress naively think that if we simply expand coverage, cost control will take care of itself. If, as expected, health care reform costs $1 trillion to $1.5 trillion over the next 10 years, Americans should brace for massive tax increases — and not just for the wealthy. In fact, many of the tax increases being considered to pay for health reform — taxing employer-provided health benefits; soda and beer taxes; restricting or eliminating flexible spending accounts and health savings accounts; eliminating the deductibility of health expenses above 7.5 percent of adjusted gross income, etc. — fall heavily on the middle class.

Moreover, current estimates probably understate the actual cost of health reform. The Urban Institute, for example, suggests the actual cost will be closer to $2 trillion, noting: "If all uninsured people were fully covered [in 2008], their medical spending would increase by $122.6 billion." If we assume that the cost of covering the uninsured will grow at the same rate the federal government assumes for all health spending growth (6.2 percent), then from 2010 through 2019 the cost of covering the uninsured would be $1.8 trillion.

Furthermore, cost estimates for government programs have been wildly optimistic over the years, especially for health care. For example, when Medicare was instituted in 1965, it was estimated that the cost of Medicare Part A would be $9 billion by 1990. In actuality, it was $67 billion. Similarly, in 1987, Medicaid's special hospitals subsidy was projected to cost $100 million annually just five years later; it actually cost $11 billion, more than 100 times as much. And in 1988, when Medicare's home care benefit was established, the projected cost for 1993 was $4 billion, but the actual cost was $10 billion. If the current estimates are off by similar orders of magnitude, we would be enacting a new entitlement that could bury future generations under mountains of debt and taxes.

Finally, the broad and growing trend in countries with national health care systems is to move away from centralized government control and to introduce more market-oriented features. As Richard Saltman and Josep Figueras of the World Health Organization explain, "The presumption of public primacy is being reassessed." The growth of the government share of health care spending in European countries, which had increased steadily from the end of World War II until the mid-1980s, has stopped, and in many countries, the private share has begun to increase, in some cases substantially.

Other countries are loosening government controls and injecting market mechanisms, particularly cost-sharing by patients, market pricing of goods and services, and increased competition among insurers and providers. Pat Cox, former president of the European Parliament, said in a report to the European Commission, "[W]e should start to explore the power of the market as a way of achieving much better value for money."

There is even evidence of a growing shift from public to private provision of health care. If many of the proposals in Congress would push us toward more of a European-style system, the trend in Europe is toward a system that looks more like the U.S.

If there is a lesson that U.S. policymakers can take from national health care systems around the world, it is not to follow the road to government-run national health care, but to increase consumer incentives and control. The U.S. can increase coverage and access to care, improve quality and control costs without importing the problems of national health care.

SOURCE





14 June, 2009

NHS Hospital "sorry" as young mother dies after meningitis is undiagnosed for 15 hours

The rapid progression of meningococcal disease is well-known but it can normally be cured by antibiotics if diagnosed immediately on presentation to a doctor. Treatment should be commenced immediately if there is any doubt

A health trust has apologised after a young mother died when doctors took 15 hours to spot that she had contracted the meningitis that eventually killed her. Shazia Ahmed, 26, died in hospital five days after contracting the bug after out-of-hours doctors twice failed to respond to emergency calls. Health bosses yesterday admitted that she may have lived if they had treated her more quickly.

Miss Ahmed, who lived in Oxford and was engaged to marry her partner Aaron Willett next year, had a six-year-old son called Kaishaan. She began to feel ill on February 20 and phoned an out-of-hours service to explain her symptoms of a tingling sensation in her legs at 7pm and was told she probably had a virus and that a doctor would not visit her.

By 2am she felt worse and was told to collect an anti-sickness tablet from the NHS out-of-hours centre but, again, no doctor was available. Her condition worsened, she began to vomit and suffer diarrhoea and she developed a purple rash so Miss Ahmed's mother Lorraine Lewis, 50, took her to the John Radcliffe Hospital in Oxford.

Mrs Lewis said: "When we got there I overheard a doctor outside the cubicle asking a consultant if he thought it could be meningitis? He just said 'no, it won't be that'. "Then from 5.30am to 9.40am, they just left her and we mopped up her vomit and diarrhoea. "They realised her condition was really bad and took her through to intensive care. "Those hours definitely made a difference."

Miss Ahmed was put into a coma in the intensive care unit before suffering a brain haemorrhage four days later.

A spokesman for the Oxfordshire Primary Care Trust yesterday said: "We are deeply sorry for the distress which Shazia's family are experiencing following her tragic death. "It is possible that an earlier diagnosis may have had a different outcome but it is impossible to say what this might have been in Shazia's case."

SOURCE




How Safeway Is Cutting Health Insurance Costs

Market-based solutions can reduce the national health-care bill by 40%

Effective health-care reform must meet two objectives: 1) It must secure coverage for all Americans, and 2) it must dramatically lower the cost of health care. Health-care spending has outpaced the rise in all other consumer spending by nearly a factor of three since 1980, increasing to 18% of GDP in 2009 from 9% of GDP. This disturbing trend will not change regardless of who pays these costs -- government or the private sector -- unless we can find a way to improve the health of our citizens. Failure to do so will make American companies less competitive in the global marketplace, increase taxes, and undermine our economy.

At Safeway we believe that well-designed health-care reform, utilizing market-based solutions, can ultimately reduce our nation's health-care bill by 40%. The key to achieving these savings is health-care plans that reward healthy behavior. As a self-insured employer, Safeway designed just such a plan in 2005 and has made continuous improvements each year. The results have been remarkable. During this four-year period, we have kept our per capita health-care costs flat (that includes both the employee and the employer portion), while most American companies' costs have increased 38% over the same four years.

Safeway's plan capitalizes on two key insights gained in 2005. The first is that 70% of all health-care costs are the direct result of behavior. The second insight, which is well understood by the providers of health care, is that 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity). Furthermore, 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.

As much as we would like to take credit for being a health-care innovator, Safeway has done nothing more than borrow from the well-tested automobile insurance model. For decades, driving behavior has been correlated with accident risk and has therefore translated into premium differences among drivers. Stated somewhat differently, the auto-insurance industry has long recognized the role of personal responsibility. As a result, bad behaviors (like speeding, tickets for failure to follow the rules of the road, and frequency of accidents) are considered when establishing insurance premiums. Bad driver premiums are not subsidized by the good driver premiums.

As with most employers, Safeway's employees pay a portion of their own health care through premiums, co-pays and deductibles. The big difference between Safeway and most employers is that we have pronounced differences in premiums that reflect each covered member's behaviors. Our plan utilizes a provision in the 1996 Health Insurance Portability and Accountability Act that permits employers to differentiate premiums based on behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.

Safeway's Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above and receive premium discounts off a "base level" premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families. Should they fail any or all tests, they can be tested again in 12 months. If they pass or have made appropriate progress on something like obesity, the company provides a refund equal to the premium differences established at the beginning of the plan year.

At Safeway, we are building a culture of health and fitness. The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant. When surveyed, 78% of our employees rated our plan good, very good or excellent. In addition, 76% asked for more financial incentives to reward healthy behaviors. We have heard from dozens of employees who lost weight, lowered their blood-pressure and cholesterol levels, and are enjoying better health because of this program. Many discovered for the first time that they have high blood pressure, and others have been told by their doctor that they have added years to their life.

Today, we are constrained by current laws from increasing these incentives. We reward plan members $312 per year for not using tobacco, yet the annual cost of insuring a tobacco user is $1,400. Reform legislation needs to raise the federal legal limits so that incentives can better match the true incremental benefit of not engaging in these unhealthy behaviors. If these limits are appropriately increased, I am confident Safeway's per capita health-care costs will decline for at least another five years as our work force becomes healthier.

The Healthy Measures program currently applies only to our nonunion work force. While we have numerous health and wellness provisions in our union contracts, we are working with union leaders like Joe Hansen of the United Food and Commercial Workers to incorporate healthy measures provisions in our union work force as well.

While comprehensive health-care reform needs to address a number of other key issues, we believe that personal responsibility and financial incentives are the path to a healthier America. By our calculation, if the nation had adopted our approach in 2005, the nation's direct health-care bill would be $550 billion less than it is today. This is almost four times the $150 billion that most experts estimate to be the cost of covering today's 47 million uninsured. The implication is that we can achieve health-care reform with universal coverage and declining per capita health-care costs.

There is a very real possibility that we will see positive transformational health-care reform in the near future. I am encouraged by the effort I see on Capitol Hill, particularly the bipartisan effort in the Senate. While some tough issues remain, if we continue to work in a bipartisan manner I believe we will resolve these issues successfully and find agreement on meaningful reform.

SOURCE




Australian public health bureaucrats botching swine flu response

It really is an epidemic in Victoria but the bureaucratic response there borders on the insane. It is a situation where prompt responses are crucial, but promptness is simply beyond bureaucrats

ANGRY GPs have slammed a "conspicuous lack of leadership" in Australia's response to the swine flu crisis, with some patients waiting eight days for test results or receiving anti-viral drugs too late to limit the infection. The doctors have blamed delays and inconsistent responses at state and federal levels for undermining efforts to contain the disease in Australia, placing the nation on the front line of the world's first flu pandemic in more than 40 years.

The World Health Organisation conceded defeat early yesterday in global efforts to confine the novel H1N1 strain, upgrading its six-level warning system to full-blown pandemic. Despite the worldwide upgrade, Australia yesterday did not lift its own pandemic alert status to the highest level, on the basis that the disease remained a mild one for most of the population.

The number of Australians infected with the new H1N1 strain is, however, believed to be far higher than last night's official national tally of 1391 because Victoria has abandoned its daily caseload updates. The state last Wednesday cut back its laboratory testing for the virus from about 500 to 1000 samples a day to 50 to 70 a day, after acknowledging it could no longer contain the disease.

Even then, patients were falling through the cracks in the testing system, Melbourne GP Kirstin Charlesworth told The Australian. She said a 17-year-old boy who came to her Toorak practice two weeks ago with classic flu symptoms, including a 39C fever, had to wait for eight days for test results to confirm his diagnosis, by which stage he was back at school. The patient was initially refused priority testing because he fell outside Victoria's risk criteria, and could not be fast-tracked even after classmates tested positive to swine flu. "They said they couldn't do it - it was on the slow train to nowhere and had been sent interstate," Dr Charlesworth said. "I asked if I could at least have Tamiflu for the patient, for his household, and for myself - and they said, 'No, because he doesn't have swine flu at this stage'."

Thomas Lyons, a GP from Eagleby, southeast of Brisbane, said logistics were "falling over" in the fight to contain the virus, and likened the bureaucrats responsible for organising the national swine flu response to the generals in charge at Gallipoli. "There is a conspicuous lack of leadership at the state level here in Queensland," he said. Dr Lyons said a woman who had been a passenger on the Pacific Dawn cruise liner, which hosted a major swine flu outbreak, had told him hospital staff had promised that masks and other equipment needed for her quarantine would be sent to her home. "It arrived eight days later - much too late to be of any epidemiological or biological use whatsoever," Dr Lyons said. Pathology companies were quoting him testing turnaround times of between two and five days, yet the anti-viral Tamiflu commonly used for treatment was largely ineffective more than 48 hours into the course of the disease. "Giving it more than 72 hours after the onset of symptoms is a waste of time," Dr Lyons said.

Sydney GP Mike Moore, chief executive of the Central Sydney GP Network, said authorities could have managed the situation better. "If we had been more careful, we could probably have delayed entry of the virus into the country, and (if) various jurisdictions had been more co-ordinated," he said.

Federal Health Minister Nicola Roxon yesterday sought to head off doctors' concerns by announcing almost $4 million in new funding to provide extra support for GPs. [Irrelevant tokenism]

SOURCE




Australia: NSW government hospital freezes elderly patients for two weeks

While management sit in their warm offices ignoring the problem. It's only luck that there were no deaths

DOZENS of patients were left in freezing conditions, some so cold they could not eat, after one of Sydney's leading hospitals failed to fix a broken heating system as temperatures plunged during this week's cold snap. Prince of Wales Hospital, run by an area health service the Opposition says is almost bankrupt, admitted yesterday that heating on Level 7 was broken as temperatures fell to just 6C.

Orthopaedic patients struggled in the cold, with one 97-year-old woman suffering a broken hip unable to hold a spoon in her numb hands. Eva Lang's niece Marika Pogany took her a portable heater in a bid to keep her warm before she was finally moved to a rehabilitation hospital yesterday after two freezing weeks at Prince of Wales. There were another three patients in Ms Lang's room and her niece estimated another 30 patients were in the frozen wing of the hospital.

Mrs Pogany said nurses had told her the heating was supposed to be turned up on June 1 but was discovered to be broken.

"The patients are all elderly people after operations. They are freezing. At lunch time when I went there her hands were blue, (My aunt) could not even hold a spoon," Ms Pogany said. "They are fragile people. Hospitals should be warm. I don't know what they are spending the money on."

Opposition Health spokeswoman Jillian Skinner said the South Eastern Sydney Area Health Service was almost bankrupt. "It is deplorable, I suspect it all comes down to not enough money to fix the problem," Ms Skinner said. "To the Government, sitting in their warm offices, the patients are out of sight and out of mind, the hospital and area health service are absolutely on the brink. "It is lucky some of these people's health hasn't been compromised to the point where they died. When people are old and frail their condition can deteriorate very quickly."

The hospital claimed maintenance staff were only alerted to the problem on Thursday and workers would try to have the heating fixed by today. "If the hospital didn't know the heating was broken, they have some answers to provide," Ms Skinner said.

SOURCE





13 June, 2009

How to Stop Socialized Health Care

Five arguments Republicans must make

By KARL ROVE

It was a sobering breakfast with one of the smartest Republicans on Capitol Hill. We can fix a lot of bad stuff President Barack Obama might do, he told me. But if Mr. Obama signs into law a "public option," government-run insurance program as part of health-care reform we won't be able to undo the damage. I'd go the Republican member of Congress one further: If Democrats enact a public-option health-insurance program, America is on the way to becoming a European-style welfare state. To prevent this from happening, there are five arguments Republicans must make.

The first is it's unnecessary. Advocates say a government-run insurance program is needed to provide competition for private health insurance. But 1,300 companies sell health insurance plans. That's competition enough. The results of robust private competition to provide the Medicare drug benefit underscore this. When it was approved, the Congressional Budget Office estimated it would cost $74 billion a year by 2008. Nearly 100 providers deliver the drug benefit, competing on better benefits, more choices, and lower prices. So the actual cost was $44 billion in 2008 -- nearly 41% less than predicted. No government plan was needed to guarantee competition's benefits.

Second, a public option will undercut private insurers and pass the tab to taxpayers and health providers just as it does in existing government-run programs. For example, Medicare pays hospitals 71% and doctors 81% of what private insurers pay.

Who covers the rest? Government passes the bill for the outstanding balance to providers and families not covered by government programs. This cost-shifting amounts to a forced subsidy. Families pay about $1,800 more a year for someone else's health care as a result, according to a recent study by Milliman Inc. It's also why many doctors limit how many Medicare patients they take: They can afford only so much charity care.

Fixing prices at less than market rates will continue under any public option. Sen. Edward Kennedy's proposal, for example, has Washington paying providers what Medicare does plus 10%. That will lead to health providers offering less care.

Third, government-run health insurance would crater the private insurance market, forcing most Americans onto the government plan. The Lewin Group estimates 70% of people with private insurance -- 120 million Americans -- will quickly lose what they now get from private companies and be forced onto the government-run rolls as businesses decide it is more cost-effective for them to drop coverage. They'd be happy to shift some of the expense -- and all of the administration headaches -- to Washington. And once the private insurance market has been dismantled it will be gone.

Fourth, the public option is far too expensive. The cost of Medicare -- the purest form of a government-run "public choice" for seniors -- will start exceeding its payroll-tax "trust fund" in 2017. The Obama administration estimates its health reforms will cost as much as $1.5 trillion over the next 10 years. It is no coincidence the Obama budget nearly triples the national debt over that same period.

Medicare and Medicaid cost much more than estimated when they were adopted. One reason is there's no competition for these government-run insurance programs. In the same way, Americans can expect a public option to cost far more than the Obama administration's rosy estimates.

Fifth, the public option puts government firmly in the middle of the relationship between patients and their doctors. If you think insurance companies are bad, imagine what happens when government is the insurance carrier, with little or no competition and no concern you'll change to another company.

In other words, the public option is just phony. It's a bait-and-switch tactic meant to reassure people that the president's goals are less radical than they are. Mr. Obama's real aim, as some candid Democrats admit, is a single-payer, government-run health-care system.

Health care desperately needs far-reaching reforms that put patients and their doctors in charge, bring the benefits of competition and market forces to bear, and ensure access to affordable and portable health care for every American. Republicans have plans to achieve this, and they must make their case for reform in every available forum.

Defeating the public option should be a top priority for the GOP this year. Otherwise, our nation will be changed in damaging ways almost impossible to reverse.

SOURCE




NHS faces its biggest cash crisis, with £15bn shortfall, report warns

The National Health Service faces the biggest financial challenge in its history as a result of the economic downturn, with a £15 billion funding shortfall likely in the next decade, according to a report published today.

The NHS Confederation, which represents 90 per cent of NHS organisations, said the next two years would be “tough but manageable” but beyond 2010-11 it would be “very different and extremely challenging”.

Its report — Dealing with the downturn: The greatest ever leadership challenge for the NHS? — said the service should expect a funding shortfall of £15 billion in real terms as a result of the impact of the recession and rising costs. “With little or no cash increase, from 2011-12 the NHS will need to plan for real terms funding to fall by 2.5-3 per cent per annum,” the study said. “This is equivalent to a cut of between £8-10 billion over the next Comprehensive Spending Review and up to £15 billion over five years.”

The report called for immediate action if the service is to continue to keep to its founding principles of providing free care to everyone at the point of need. It warned against “diluting” the quality of patient care and extending waiting lists, or making cuts to training budgets. A solution to the crisis lies in NHS leaders embracing innovation, change and improving efficiency, it said.

Steve Barnett, chief executive of the NHS Confederation, said that with little or no cash increase from 2011-12, the NHS would need to make “hard decisions about which programmes to fund, how to reward staff and how to reorganise services now”. “If it does not, then the mistakes of the past could be repeated and shortages in funding will translate to the kind of across-the-board cuts which could see waiting lists lengthen, standards fall and dissatisfaction with the service grow among patients and staff,” he said. “The NHS needs to take the opportunity to find efficiencies and savings — I believe it has the people, the ideas and the capacity to meet this challenge but we should be under no illusions of the size of the task ahead.”

Nigel Edwards, the NHS Confederation’s director of policy and author of the report, warned against losing significant improvements in the NHS through “short-term cuts and crude approaches to cost control”. He added: “Quality improvements through greater efficiency and redesigning services can provide the budget savings necessary to navigate this crisis.”

The NHS budget in 2009-10 stands at £102.7 billion — a 7.5 per cent real terms increase on the previous year, according to the Department of Health. Next year, the budget will be £105.8 billion, which it said was a 1.6 per cent increase in real terms.

Hamish Meldrum, chairman of the British Medical Association, said that a funding crisis could be very dangerous for the NHS. “It has the potential to seriously threaten patient services,” Dr Meldrum said. “We agree with the NHS Confederation that difficult choices will have to be made.

SOURCE




Australia: Negligent NSW public hospital kills young woman

The death of a 29-year-old woman after the delivery of her third child could have been prevented if staff were better trained and more rigorous policies had been in place, a NSW coroner found today. Rebecca Murray died from hemorrhaging after an emergency caesarean at Bathurst Hospital in June 2007. She lost a litre of blood following the surgery, but the hospital had not previously checked her blood type and ensured it had adequate supplies, so blood had to be transported from Orange.

Deputy State Coroner Carl Milovanovich also found that the nurse in charge of her recovery had been inadequately trained, and did not alert medical staff in time when Ms Murray's condition rapidly deteriorated. Bathurst Hospital has since introduced a new policy which requires staff to do a full blood count on all women having elective or emergency caesareans and ensure there are supplies on hand.

Mr Milovanovich recommended that all hospitals in NSW be required to follow suit. "If the unexpected and avoidable death of a young mother at Bathurst Hospital justifies a change in policy at Bathurst Hospital, why should that policy not extend to statewide?" Mr Milovanivich asked. "Do we have to wait for another mother to die in similar circumstances ... before there is some change?"

Ms Murray's father, Lewis Furner, said outside the Westmead coroner's court that responsibility for her death lay with the hospital administration, and not the nurse who had not been properly trained. But he was not optimistic that any changes would be made to the health system. "The last health minister, Reba Meagher, had the hide to say in parliament that NSW has got one of the best health systems in the world,'' Mr Furner said. "Now while we've got a government that thinks like that I don't hink there's going to be any changes. It's from the top down, that it's failing. It's just disgusting.''

But Ms Murray's mother, Adrienne Furness, was tearful on behalf of the three children. "It's a shame that they're not going to know her, just a shame,'' she said.

SOURCE





12 June, 2009

British mother forced to deliver her own baby on motorway... after hospital turned her away for 'not being ready'

A new mother gave birth in a car as it sped along a motorway after being sent home twice that day by a hospital because she wasn't ready enough. Rebecca Longley, 20, was forced to deliver daughter Aaliyah herself as boyfriend Andrew Mildenhall desperately tried to stay focused on the road ahead. The couple had first gone to the hospital that morning and then again in the evening but were told both times that Rebecca wasn't ready to give birth.

Two hours later the beauty therapist's waters broke but when she phoned the same hospital, medics advised her to stay at home. Just ten minutes later Rebecca and Andrew decided to take matters into their own hands and head back to the Royal Hampshire County Hospital, in Winchester, Hants. But before they got there Rebecca went into labour and gave birth to the 6lb 1oz baby girl on the front passenger seat on the M3 motorway.

The couple have now called on the hospital to review its admissions procedures. Miss Longley, from Hamble, Hampshire, said: 'I really had no idea what to expect because it was my first child. I had a real mix of emotions.

'When it first started I was so scared and worried but that turned to relief and happiness when she was born and we realised she was OK. 'Andrew did a brilliant job to carry on driving even though he was feeling quite faint. 'I had no drugs and I was screaming with pain but my natural instincts kicked in as soon as I saw the baby's head pop out. I just knew what I had to do.'

Miss Longley and Mr Midenhall first visited the Royal Hampshire County Hospital at 7am but were turned away. They tried again at 8pm but were met with the same response. Two hours later Rebecca phoned the hospital's maternity ward and said that her waters had broken - but she was told to stay at home.

Baby Aaliyah ended up making her entrance just before 10.30pm in Mr Midenhall's Peugeot 206 car. Miss Longley added: 'We have been so lucky because Aaliyah is a healthy baby. 'But if there had been complications like if she had had the umbilical cord wrapped around her neck then I dread to think what could have happened. 'We hope the hospital reviews its procedures especially with first time parents. 'If I had stayed in on the second visit then I would have given birth two hours later in a safe environment.'

Carpenter Mr Midenhall added: 'She appeared so quickly so there was no time to pull over and stop - I just kept driving. 'It was such a relief when I heard her crying because I knew she was going to be alright.'

A hospital spokesman confirmed that Rebecca was sent home twice but said that the advice was given because of the slow progress of her labour. He added: 'Labour is different for every woman. We would describe Rebecca's labour as totally natural, albeit rapid once it had begun.'

SOURCE




Convenience Shopping Gets Healthy Boost: Walgreen and CVS Amp Up Clinic Care By Adding Healthcare Services

Amid the economic downturn and slow growth for retail and outpatient medical care services, pharmacy giants Walgreen and CVS are rolling out new specialized services at their in-store clinics, going beyond treatment of routine maladies. Launched over the last four years to care for such simple ailments as ear and sinus infections, strep throat or pinkeye, retail clinic operators now are training nurses to do specialized injections for such chronic conditions as osteoporosis and asthma, the LA Times reports.

In addition, they are offering treatments for advanced skin conditions that include removal of warts and skin tags or closing minor wounds. Care for minor "sprains and strains" also is being offered at some retailers, and pilot projects are underway for breathing treatments and special infusions of drugs derived from biotechnology. "We want to create a health corner — a real center that looks like you are walking into the doctor's office," Walgreen chief executive Greg Wasson said of the retailer's Take Care brand clinics, reports Chicago Tribune writer Bruce Japsen for the Times.

There is a business reason for adding services: Walgreens and CVS have slowed their expansion of clinics and are instead making attempts to boost revenue by adding new lines of business in their clinics. Typically staffed by advanced-degree nurses known as practitioners, most of the nation's more than 1,100 retail health clinics are open seven days a week, with no appointment needed. The model has been greeted by health insurers, employers and consumer groups as one way to address the rising number of uninsured Americans, estimated at more than 46 million.

Retail clinics not only market themselves as a convenience, they also can be less expensive, providing a competitive threat to primary-care doctors and even specialists. Costs for services for those paying out of pocket at retail clinics generally run $55 to $75 compared with $100 or more for a visit to a primary-care physician.

The physician community says consumers should look at the added services by clinics with skepticism, particularly when it comes to care for chronic ailments. And doctors say what a consumer may see as routine may turn out to be something worse. "A sprain could be a muscle tear or a break, for crying out loud, so how does a [retail] clinic know when the patient comes in that they are going to treat a sprain?" said Dr. James Milam, president of the Illinois State Medical Society. "When my nurse gives an injection, I am here. The patient needs a regular doctor who has a history with the patient, knows their history, their family history and their illnesses," he added, the Times reports.

But retailers say they are not going beyond "scope of practice" laws that regulate what nurse practitioners can and cannot do. The clinics are under physicians' supervision, though doctors usually are not on site. "These are new services we were not providing that our customers asked us to provide," said Chip Phillips, president of MinuteClinic, a CVS subsidiary. "We are slowly and gradually expanding our services," he told the Times.

SOURCE




Australia: Queensland's $6b hospitals plan full of holes

Governments can neither build nor run hospitals well

A DAMNING report has cast grave doubts over the credibility of the state's $6 billion hospital building program and exposed poor planning for the state's future health needs.

Auditor-General Glen Poole has revealed that planning surrounding the $100 million Townsville Hospital expansion was so inadequate that Queensland Health itself was concerned the result would be "dysfunctional" on an operational basis. Mr Poole identified a system which had no clear links between the health service plans drawn up by Queensland Health and the funding decisions the Government subsequently made.

His report follows a wave of controversy over the Government's decision to establish a $1.1 billion Queensland Children's Hospital near the Mater Hospital at South Brisbane, a move critics insist was done without adequate planning.

The Government's hospital infrastructure program, which it boasts is the biggest in Australia, also includes the $1.5 billion Gold Coast University Hospital, due to open in 2012, and the $1.2 billion Sunshine Coast Hospital, expected to open its doors in 2014.

Health Minister Paul Lucas admitted the Government had made health commitments before the proper planning had been undertaken. "I think that in the past what has happened is that there has been public pressure for something to happen, then an announcement is made and then off we go," Mr Lucas said.

Mr Poole said a case in point was the Townsville Hospital project, which the department admitted was announced three years ago without any supporting health services or capital infrastructure plan. The project was supposed to deliver 100 extra beds and double the hospital's emergency department by next year but Mr Poole's report reveals that nothing has been budgeted for the expansion of other parts of the hospital such as pharmacy and record-keeping services to cope with the extra load.

A business case for the entire project – which Queensland Health neglected to draw up until February this year – warned that unless more funding was found, the project would establish "a service that will be dysfunctional".

Queensland Health director-general Mick Reid admitted the report meant Queensland Health may have put services in the wrong place or provided infrastructure without recurrent funding to operate them. He said while the report exposed serious issues, it also highlighted how the department had already recognised these and taken action. "I think it is a fair cop that the department is criticised for its poor service planning functions," he said.

Mr Poole's report is yet another blow to Queensland Health, whose operations have been under intense scrutiny since the 2005 Bundaberg Base Hospital scandal. "I expected that with a focus on service planning since 2005, the department would have more advanced service planning systems in place," the report said. "Funding and resourcing implications were not identified in most plans reviewed."

SOURCE





11 June, 2009

Canada's ObamaCare Precedent

Governments always ration care by making you wait. That can be deadly.

Congressional Democrats will soon put forward their legislative proposals for reforming health care. Should they succeed, tens of millions of Americans will potentially be joining a new public insurance program and the federal government will increasingly be involved in treatment decisions.

Not long ago, I would have applauded this type of government expansion. Born and raised in Canada, I once believed that government health care is compassionate and equitable. It is neither.

My views changed in medical school. Yes, everyone in Canada is covered by a "single payer" -- the government. But Canadians wait for practically any procedure or diagnostic test or specialist consultation in the public system.

The problems were brought home when a relative had difficulty walking. He was in chronic pain. His doctor suggested a referral to a neurologist; an MRI would need to be done, then possibly a referral to another specialist. The wait would have stretched to roughly a year. If surgery was needed, the wait would be months more. Not wanting to stay confined to his house, he had the surgery done in the U.S., at the Mayo Clinic, and paid for it himself.

Such stories are common. For example, Sylvia de Vries, an Ontario woman, had a 40-pound fluid-filled tumor removed from her abdomen by an American surgeon in 2006. Her Michigan doctor estimated that she was within weeks of dying, but she was still on a wait list for a Canadian specialist.

Indeed, Canada's provincial governments themselves rely on American medicine. Between 2006 and 2008, Ontario sent more than 160 patients to New York and Michigan for emergency neurosurgery -- described by the Globe and Mail newspaper as "broken necks, burst aneurysms and other types of bleeding in or around the brain."

Only half of ER patients are treated in a timely manner by national and international standards, according to a government study. The physician shortage is so severe that some towns hold lotteries, with the winners gaining access to the local doc.

Overall, according to a study published in Lancet Oncology last year, five-year cancer survival rates are higher in the U.S. than those in Canada. Based on data from the Joint Canada/U.S. Survey of Health (done by Statistics Canada and the U.S. National Center for Health Statistics), Americans have greater access to preventive screening tests and have higher treatment rates for chronic illnesses. No wonder: To limit the growth in health spending, governments restrict the supply of health care by rationing it through waiting. The same survey data show, as June and Paul O'Neill note in a paper published in 2007 in the Forum for Health Economics & Policy, that the poor under socialized medicine seem to be less healthy relative to the nonpoor than their American counterparts.

Ironically, as the U.S. is on the verge of rushing toward government health care, Canada is reforming its system in the opposite direction. In 2005, Canada's supreme court struck down key laws in Quebec that established a government monopoly of health services. Claude Castonguay, who headed the Quebec government commission that recommended the creation of its public health-care system in the 1960s, also has second thoughts. Last year, after completing another review, he declared the system in "crisis" and suggested a massive expansion of private services -- even advocating that public hospitals rent facilities to physicians in off-hours.

And the medical establishment? Dr. Brian Day, an orthopedic surgeon, grew increasingly frustrated by government cutbacks that reduced his access to an operating room and increased the number of patients on his hospital waiting list. He built a private hospital in Vancouver in the 1990s. Last year, he completed a term as the president of the Canadian Medical Association and was succeeded by a Quebec radiologist who owns several private clinics.

In Canada, private-sector health care is growing. Dr. Day estimates that 50,000 people are seen at private clinics every year in British Columbia. According to the New York Times, a private clinic opens at a rate of about one a week across the country. Public-private partnerships, once a taboo topic, are embraced by provincial governments.

In the United Kingdom, where socialized medicine was established after World War II through the National Health Service, the present Labour government has introduced a choice in surgeries by allowing patients to choose among facilities, often including private ones. Even in Sweden, the government has turned over services to the private sector.

Americans need to ask a basic question: Why are they rushing into a system of government-dominated health care when the very countries that have experienced it for so long are backing away?

SOURCE




NHS Stroke patients facing unacceptable delays

Stroke patients are facing "unacceptable delays" in life-saving surgery, new research shows. Just one in five have operations to reduce their risk of another potential fatal attack within the two week target set by the National Institute for Health and Clinical Excellence.

A survey of 240 surgeons from 102 hospital trusts across Britain found of 5,513 patients who underwent surgery between December 2005 and December 2007, 83 per cent of whom had a history of stroke, three in 10 waited more than 12 weeks.

The common, procedure called carotid endarterectomy, is routinely used to remove the build up of fatty deposits in the main artery between the heart and brain. These deposits could cause blood clots that block the blood supply to the brain, leading to strokes.

The average delay from referral to surgery was 40 days. Twenty-nine patients (0.5 per cent) died while in hospital, while 48 (1 per cent) died 30 days after surgery, mainly from strokes.

Professor Alison Halliday, of St George's Hospital Medical School, University of London, and colleagues, called for major improvements in services to enable early surgery to prevent strokes in high risk patients. Prof Halliday, whose findings are published online in the British Medical Journal, said: "These findings show unacceptable delays between symptom and operation in the UK. "Such delays are associated with a high risk of disabling or fatal stroke before surgery, and the benefit of surgery consequently falls rapidly with increasing delay. "Major improvements in services are necessary to enable early surgery in appropriate patients in order to prevent strokes."

Previous research has shown the sooner surgery was performed after patients had their first symptoms, the more beneficial it was in reducing the risk of subsequent, and more serious, strokes. Surgery was particularly effective if performed within two weeks after their initial symptoms.

Every year in the UK, about 120,000 people have a minor stroke, known as a transient ischaemic attack, and up to 30 per cent die within a month. Stroke is also the single largest cause of severe disability in adults and costs the economy £7bn a year.

Prof Halliday added: "This large survey of carotid endarterectomy practice in the UK shows that the operation is underused compared with other similar countries. "Surgeons abroad might be driven by 'fee for service' and certainly perform many more operations for asymptomatic disease. "It is possible, however, that of the 120,000 people who have a transient ischaemic attack or stroke every year in the UK at least 10,000 might be suitable candidates for carotid endarterectomy yet only 4,500 procedures are being performed each year."

SOURCE





10 June, 2009

Health Care Bill Is the Ball Game

You might suppose that President Obama has his hands full running two wars, administering General Motors, "rescuing" the banking system, attempting to empower unions over management, hushing up whispers about hypocrisy regarding Guantanamo detainees, managing the mortgage crisis, imposing "clean energy" on the nation, handling nuclear North Korea and nearly nuclear Iran, "stimulating" the economy, reviving the "peace process" between Palestinians and Israelis, inaugurating a new relationship with Russia and with the Muslim world, and reversing the rise of the world's oceans, but no, he has one more agenda item -- overhauling U.S. health care.

The administration is hoping that a health bill will be voted on by early August, which may be overly optimistic but still means that this summer will be dominated by the health care debate. Its outcome will determine the overall success or failure of Obama's effort to torque America toward the European model of statism. It isn't just that the health care sector accounts for 17 percent of the U.S. economy. It is also the case that if enacted, a nationalized health service -- no matter how crushingly expensive or bureaucratic -- will vitiate arguments about the proper scope of government. All future pleas for reducing the size of the state will run into the accusation that the small government advocate is eager to take antibiotics from the mouth of a child or insulin from a diabetic.

Whereas the Clinton administration advertised the overhaul of American health care primarily as a means of covering the uninsured, President Obama is making the bolder claim that revamping health care is a way to save money. Really? Medicare is already the program that ate the government, scheduled to go into bankruptcy itself in 2019. As the trustees report put it, "while Medicare's annual costs were 3.2 percent of Gross Domestic Product (GDP) in 2008, or about three quarters of Social Security's, they are projected to surpass Social Security expenditures in 2028 and reach 11.4 percent of GDP in 2083." Or consider the Massachusetts health care reform introduced by Mitt Romney. Like every other government health care program, Romney's has vastly exceeded cost projections. Initially projected at $125 million per year, the program actually cost taxpayers $133 million in 2007, $647 million in 2008, $869 million in 2009, and could top $1.1 billion next year.

"Health care costs," President Obama intoned as he kicked off a summit on the subject, are "causing a bankruptcy every 30 seconds." Cord Blomquist on Openmarket.org observed that in 2008, a big year for bankruptcies, there were a total of 1.1 million bankruptcies. Adding up Obama's numbers -- 120 bankruptcies per hour times 24 hours in a day and 365 days in a year equals 1,051,200 bankruptcies per year -- would suggest that only 100,000 of those were for non-medical expenses. Does that make sense in the midst of a collapsing housing market? The study Obama based his numbers on was flawed in other ways as well, as ABC's Gary Langer posted on the ABC News website.

Beware of politicians bearing statistics. But what is even more galling than misleading (or outright false) statistics is to watch politicians rail about the expense of health insurance without once acknowledging their own role in jacking up the price. Health care is expensive of course -- though it also delivers value (improved quality and length of life). But our jerry-built system has made buying insurance much more expensive than it should be. State mandates require insurance companies to cover a variety of specialized medical services (usually at the behest of lobbyists for the relevant service providers) including: in vitro fertilization, marriage therapy, smoking cessation classes, hormone replacement therapy, chiropractor visits, and so on. That makes it impossible for companies to offer cheap, no-frills, high-deductible plans for the young and healthy. As Sally Pipes notes in "The Top Ten Myths of American Health Care" (Pacific Research Institute), there were only 252 mandates in force 30 years ago. Today there are 1901, an average of 38 per state.

Government involvement in the health care system, through mandates, reduced competition (such as forbidding shopping for insurance across state lines), and a skewed tax deduction that permits only employers and not employees to deduct the cost of health coverage, has made health care more expensive than it ought to be. Yet President Obama proposes that hair of the dog -- vastly more government involvement -- will bring down costs and improve quality.

If he follows the lead of Great Britain, Canada, or other systems he admires, he can definitely bring down costs. He can do it the way they have, by rationing care. But Americans should bear in mind this summer that when the president promises to get health care costs under control he is really promising less care. There is a better way. More competition, not less. More market discipline, not less. This will affect every American for generations to come. The stakes could hardly be higher.

SOURCE




Patients with suspected cancer forced to wait so NHS targets can be hit

Patients rushed to hospital with suspected cancer are having their treatment delayed so that managers can meet Government targets, an NHS investigation has found. And an appalling case of negligence below. Getting anything seriously wrong with yourself sure is risky in Britain

People arriving at Accident and Emergency departments with symptoms which could indicate the aggressive spread of the disease are waiting weeks for diagnosis and treatment while “routine” cases are prioritised. Hospital managers told researchers that treating desperately sick patients more quickly would “reflect badly” on their performance against Government cancer targets which only cover those referred to specialists by GPs. Doctors, patients groups and politicians were appalled by what one described as a “breathtaking admission” which confirmed their “very worst fears” about how far the NHS target culture has gone in distorting clinical priorities.

Although most people with suspected cancer are referred to hospitals by their GPs, more than 30,000 people diagnosed with the disease each year are first alerted to tumours by violent symptoms, such as seizures, vomiting and jaundice, which cause such alarm that patients go straight to their local A&E departments.

The report by the NHS Institute for Innovation and Improvement, an official health service agency which issues advice to hospital managers, says that many of these emergency patients waited six weeks or longer for basic tests. It said they were “often” not given the same priority as patients who had been referred by GPs, who were covered by two targets, ensuring that they see a specialist within two weeks, and start treatment, following diagnostic tests, within two months. “As a result, they can end up with a very poor experience before finally receiving a diagnosis and the right care,” it warns. The report, due to be published tomorrow added: “Many trusts recognised the need to get some patients in this group onto the same pathway as people on the cancer two week wait [target] but were concerned this would reflect badly on their cancer figures”.

Some A&E departments failed to recognise the risk of cancer in seriously ill patients. In cases where the disease was suspected, patients were sent home to wait six weeks or longer for diagnostic tests. Others waited weeks on wards before seeing a specialist or having scans, the report, which is endorsed by the Government’s cancer tsar, found.

Nigel Beasley, the NHS Institute’s lead for cancer, and head and neck surgeon from Nottingham University Hospitals said: “Targets are very effective, but they do have side-effects. The risk is that these patients are not being prioritised because of the focus on the two-week target for patients referred by GPs.” He said anxious patients admitted as an emergency were often trapped in hospital for weeks waiting for scans, and to see a specialist, and should learn from good hospitals, who carried out investigations quickly, often using outpatients appointments. Mr Beasley said: “Patients can be stuck in hospital for a long time, waiting for scans, and other diagnostic tests. Once they are in hospital, they can end up waiting two, three, or even four weeks before there is a diagnosis and any decision to treat.”

The admission about the effect Government targets were having on emergency cancer patients horrified clinicians and patients groups. Shadow health secretary Andrew Lansley described it as “one of the clearest examples yet of how Labour’s tick-box targets are failing NHS patients”. He said decisions about which patients should be seen first must be taken by doctors, based on the patient’s clinical needs, not by managers following Government diktats.

Katherine Murphy, from the Patients Association, said the report provided “breathtaking” evidence of a confidence trick being played on the public, repeatedly told that waiting times for patients with suspected cancer are falling, while desperate cases were forced to the back of the queue. She said: “This confirms our very worst fears, and exposes the scandal of what pernicious targets are doing to patients. We have seen other targets being used in ways that damage patient care, but of everything we have seen, this really is the cruellest of the cruel”.

Leading cancer specialist Prof Karol Sikora said: “I think it is absolutely horrifying that hospital managers are playing around with targets that can delay treatment for people who may well be at an advanced stage of the disease.” “I know of many cases where people who have been admitted to NHS hospitals as an emergency have languished for weeks before even seeing an oncologist,” added Prof Sikora, Medical Director of independent company CancerPartnersUK.

The British Medical Association said many trusts were bullying doctors into delaying urgent referrals. Dr Jonathan Fielden, chairman of the BMA’s consultants committee, said: “A number of our members have already expressed fears about the two-week cancer target, because it means all the cases referred by GPs are given the same priority, regardless of whether they are expected to be benign or high risk. When this same target is delaying patients who have been admitted as an emergency that is an even greater cause for concern”.

Several oncologists said they supported two-week waiting time targets for cancer patients referred by GPs, but called for the target to be widened to include all patients.

Ian Beaumont, from charity Bowel Cancer UK said it “beggared belief” that anyone would value statistics over efforts to save lives. Dr Jane Maher, chief medial officer at Macmillan Cancer Relief described the revelation in the report as worrying, but said the biggest obstacle to getting the right care for patients admitted to hospitals as an emergency was getting the right diagnosis, as cases were often complex, meaning cancer could be mistaken for other conditions.

Among those who have experienced the problem is Melissa Matthews was 28 when she went to the Accident and Emergency department of her local hospital. For several days, she had been suffering abdominal pain which had left her feeling so uncomfortable that she was unable to eat. She told her family doctor, who advised her not to worry, unless she began vomiting, in which case she should go immediately to A&E.

When she began being sick, her partner took her to the casualty unit of Norfolk and Norwich Hospital. The couple mentioned concerns about bowel cancer, having recently watched a programme about its symptoms, but the doctor reassured her: “You are far too young to have bowel cancer; when the blood tests come back they will show that”. The tests did not indicate a problem; Miss Matthews was sent home to Norwich and told she was probably suffering from irritable bowel syndrome.

But the pain and vomiting continued. A week later, when she was unable to even swallow water, she returned to A&E, and was admitted to a ward for five days, but sent home once more. One week later, after she collapsed in agony at home, she was admitted to hospital again. This time, X-rays revealed a blockage. During an eight-hour operation, surgeons found a tumour so large they were forced to remove her womb and 36 inches of her bowel. The blood tests which Miss Matthews had undergone in A&E, she later found out, were not a clear indicator of bowel cancer, or its absence after all.

Six months of chemotherapy followed Miss Matthews’ operation, after which she was given the all-clear. However, since then the cancer has returned. On Tuesday, Miss Matthews, now 30, will undergo a second operation to remove a tumour. The mother of two girls, aged 11 and 13, says her focus now is on survival. “I don’t feel angry about this any more, my concern is about what happens next, but I did feel very frustrated, and frightened. I thought going to A&E was the safest place to be, but I was just fobbed off”.

A hospital spokesman said patients were encouraged to complain if they were not satisfied with their care, and added that bowel cancer was rare in patients of Miss Matthews’ age.

More than 4,900 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.

SOURCE





9 June, 2009

Obama's Health Cost Illusion

The President's main case for reform is rooted in false claims and little evidence.

The main White House argument for health-care reform goes something like this: If we spend now on a hugely expensive new insurance program for the middle class, we can save later by reducing overall U.S. health spending. This "tastes great, less filling" theory could stand some scrutiny, not least because it is being used to rush through the greatest social spending program in American history.

What if this particular theory turns out to be a political illusion? What if the speculative cost savings never report for duty, while the federal balance sheet is still swamped with new social obligations that will be impossible to repeal? The only possible outcome will be the nationalization of U.S. health markets, which will mean that almost all care will be rationed by politics.

Since Medicare was created in 1965, U.S. health spending has risen about 2.7% faster than the economy and on current trend would hit 20% of GDP within a decade. Every public or private attempt to arrest this climb has failed: wage and price controls in the 1970s, the insurance industry's "voluntary effort" in the '80s, managed care in the '90s.

Now the White House -- especially budget chief Peter Orszag -- claims there is new cause for hope. The magic key is the dramatic variations in per patient health spending among U.S. regions. Often there is no relationship between spending and the quality of care, according to a vast body of academic research, most of it coming out of Dartmouth College. If the highest spending areas could be sanded down to the lowest spending areas, about 30% in "waste," or $700 billion each year, would be saved. More than enough to pay for ObamaCare. Or so the theory goes.

But -- how? Mr. Orszag's ideas include more health information technology; emphasizing prevention and healthy living; rejiggering reimbursement policies so doctors and hospitals are paid more for quality care; and funding federal research that compares the effectiveness of medical treatments. These are the lovable bromides of all politicians, and some of them may or may not improve health overall. But there's scant evidence that any of them will ever save real money. There's a reason the Congressional Budget Office can't score them.

Think about comparative effectiveness. Why is low-cost, high-quality Minnesota, say, already making more rational decisions than high-cost, lower-quality Texas? It's ridiculous to suggest that doctors in Rochester have access to clinical information that isn't available in Houston. If it's because the former are simply better physicians, well, medicine isn't Lake Wobegon, where everyone is the Mayo Clinic.

The reality is that after three decades of economic research, the reasons that spending varies are still highly uncertain. As in politics, everything is local in health care. Most of the variation is due to the use of services and mix of care that patients receive, while some relates to labor costs and local prices. The abiding mystery is why practice patterns oscillate so widely, even among hospitals in the same city.

Not surprisingly, variation is greatest when doctors don't agree on the best treatments -- as with back injuries, for example. Another part is technology. New therapies are developed at an astonishing pace. Consider the stent, which props open arteries after a heart attack and was barely used in 1994. By 1998 stents were used in a majority of coronary surgeries. Constant innovation means that there must be trial and error, and thus regional spending variation.

Such technological change is the most important driver of health spending. Modern medicine can do so much more than it could in the past, but this costs a lot even as it has bought a lot in extending and improving lives. In a 2001 study, David Cutler (an Obama adviser) and Mark McClellan (a Bush adviser) found that the benefits of lower infant mortality and better treatment of heart attacks "have been sufficiently great that they alone are about equal to the entire cost increase for medical care over time."

No less an authority than Mr. Orszag admits that stomping out regional variation means constraining this experimentation. "Future increases in spending could be moderated if costly new medical services were adopted more selectively in the future than they have been in the past and if the diffusion of existing costly services was slowed," Mr. Orszag told Congress last year, when he was CBO director. He was careful to note that "savings are possible without a substantial loss of clinical value," but how does he know? Even if health planners in Washington could arbitrarily reduce spending in high-cost areas, low-value treatments may not be what go over the side.

Another complication is that the Dartmouth research shows spending variation in Medicare, for which uniform, common data are available. But similar data don't exist for the entire health system. Richard Cooper, a professor of medicine at the University of Pennsylvania's Wharton School, has studied regional variation in aggregate health spending, rather than Medicare-only. He found that the areas with the highest quality spend the most on medicine, whatever the mix of private and government funding. Areas with disproportionately high Medicare spending, generally in the South, correlate with the lowest quality -- but at the same time, with very low private spending.

Mr. Cooper's assault on the Dartmouth Atlas is controversial but compelling. He argues that the less-is-more theory is based on the flawed premise that when a region's outcomes did not improve as spending increased, the difference is simply classified as "waste" -- even if it isn't. That's the 30% figure Mr. Orszag likes to cite.

In any case, Medicare reflects the entire practice of medicine only as a funhouse mirror. It simply fixes the prices for thousands of services and procedures, usually well below those of private payers. There is no way of knowing if these administered prices are the "right" level, and, either way, marginal costs adapt to what is paid, creating perverse incentives of their own. Congress also regularly uses Medicare to skew the distribution of medical resources, such as extra payments to teaching hospitals or rural areas.

Above all, Medicare is an ocean of money surrounded by people who want some. It is not only an entitlement to beneficiaries, but a de facto revenue entitlement to hospitals, physicians, nursing homes, durable medical equipment suppliers and the rest. Even a tweak to the Medicare fee schedule is the small-scale equivalent of closing a military base or trimming farm subsidies. The system will never be as rational as Mr. Orszag desires unless it is severed from politics.

A far better alternative is to increase individual responsibility for medical decisions. In 1965, the average American paid more than half of his health care out of pocket. Spending has since increased sevenfold, but the amount that consumers pay directly hasn't even doubled. When people aren't exposed to the true cost of their care -- though it is paid in foregone wages and higher taxes for public programs -- they consume more care. The research of MIT economist Amy Finkelstein suggests that roughly half of the real increase in U.S. health spending between 1950 and 1990 is due to Medicare and the spread of third-party, first-dollar insurance.

Increasing cost-sharing would discipline the health spending curve and give it a more rational bent. As societies grow richer, it makes sense that people will invest more in their own well-being. Health is a superior good, while the utility of wealth is fairly low if you're dead. The U.S. health cost "crisis" is that we spend so much without incentives to weigh the costs against the benefits.

Yet the entire Obama agenda is about increasing political, rather than individual, control of the health markets. Ted Kennedy's draft health-care bill offers insurance subsidies up to 500% of the poverty line -- for a family of four, that's $110,250. In that kind of world, all costs will climb even higher as people use far more "free" care and federal spending will reach epic levels. Bureaucrats watching the bottom line will try to ration care while simultaneously locked in a death match with interest groups guarding their turf. Congress will join the fray and make things worse, as it always does. Caught in the political crossfire will be patients, as they always are.

None of the complexities surrounding regional health spending variation would matter as much if the Obama Administration were merely trying to defossilize Medicare and save the federal fisc. But instead it is exploiting the looming bankruptcy of our current entitlements as a pretext to pass the largest entitlement expansion since 1965. And it is selling this agenda with a phony cost-control "plan" that doesn't even exist.

The now-famous Obama-Orszag mantra -- "entitlement reform is health-care reform" -- really means that when they're done, all health care will be an entitlement.

SOURCE




Another huge NHS disgrace

The bureaucratic British mind: A stroke victim died after an ambulance driver decided to stop work instead of taking the critically ill patient to the hospital

A stroke victim died after an ambulance driver who had finished his shift drove to his depot to clock off instead of going to hospital. The driver complained to a colleague that he had worked 15 minutes’ overtime already and wanted someone else to take over. The condition of the patient, Ali Asghar, 69, from Stockton on Tees, in Cleveland, deteriorated during the journey and he died of a suspected heart attack after arriving at North Tees Hospital.

The driver, a paramedic, and an advanced technician, who was in the back of the vehicle attending to Mr Asghar, have since been suspended as health chiefs investigate the incident.

Ambulance controllers received a 999 call at 3.52pm on May 18. The crew were alerted to a Category A life-threatening incident and arrived at Mr Asghar’s home, just three miles from the hospital, at 3.57pm.

After assessing his condition, they left for the hospital at 4.13pm. The journey should have taken around 10 minutes. Instead the driver went to his ambulance station, where he got out leaving the patient in the back with the technician until a new driver turned up. It is alleged that he failed to tell his replacement that there was a critically ill patient in the ambulance.

The vehicle finally arrived at the hospital at 4.27pm. Doctors administered Cardiopulmonary resuscitation straight away, but were unable to save him. The detour, which added half a mile to the journey, was reported by the new driver, who was just starting his shift.

A spokesman for the North East Ambulance Service said: “This incident was immediately reported to us by another member of staff. As soon as we were notified, we acted to suspend a paramedic and an advanced technician from duty. “We appointed a senior officer to carry out a full investigation and have notified the North East Strategic Health Authority, Stockton-on-Tees Teaching Primary Care Trust and the Health Professions Council of our actions. “We have also been in touch with the family of the patient to give them our condolences. Patient care is our number one priority and we treat any action which falls short of the high standard expected of our staff extremely seriously. “Both the paramedic and advanced technician are now being dealt in line with the trust’s disciplinary process.”

Mr Asghar was a father of four. His youngest son, Mohammed, 33, said: “If you have a patient in an ambulance, you don’t worry about your bloody shift finishing. “The driver should not get away with it. The time he took to detour could have saved my father’s life.”

SOURCE




BBC's hatred of private medicine costs it big

BBC's £1m backdown in libel fight with IVF doctor. Taranissi was the most successful IVF practitioner in Britain but his clinics were private so the BBC tried its best to tear him down

The BBC is facing a legal bill of well over £1million after settling a libel battle with top IVF doctor Mohamed Taranissi. Mr Taranissi, who is said to have helped mothers give birth to 2,300 babies in seven years, had accused the Panorama programme of making defamatory allegations. Yesterday it emerged that the BBC has come to a settlement with the Egyptian-born doctor, with the corporation paying both sides' legal bills.

Legal experts said this could cost up to £6million, but the BBC said Mr Taranissi's costs were around £900,000. The Corporation's own costs have not been revealed but they are likely to be a sizeable six-figure sum. It was unclear if Mr Taranissi has received any damages. Last October the High Court ordered the BBC to pay him an estimated £500,000 costs after it 'threw in the towel' over one part of its defence. But BBC bosses decided to fight on in what became one of the most bruising legal battles in its history.

The decision to settle with Mr Taranissi comes just over a week after the broadcaster offered to pay £30,000 and apologise to the Muslim Council of Britain over claims that it encouraged the killing of British troops.

Mr Taranissi, who has been described as one of the country's richest doctors, launched his action after the Panorama broadcast in January 2007 suggested that one of his central London clinics, the Assisted Reproduction and Gynaecology Centre, offered 'unnecessary and unproven' treatment to an undercover reporter posing as a patient. The show also alleged that a 26-year-old journalist was offered IVF treatment costing thousands of pounds despite neither she nor her partner having a history of fertility problems. One of the therapies involved a blood transfusion that an independent expert suggested could harm an unborn child.

The programme also claimed that Mr Taranissi was running a second clinic, the Reproductive Genetics Institute, without a licence and was sending his older and harder-to-treat patients there to maintain higher success rates at the ARGC. The IVF investigation was used to relaunch Panorama on a new Monday night slot on BBC1.

Mr Taranissi, who was represented by top libel lawyers Carter-Ruck, called the programme 'biased and irresponsible'. He said producers had information that showed 'a different side and a different argument', but chose not to use it. He has said Panorama sent at least two other undercover reporters to his clinics and they were given legitimate advice - but this was left out of the show. There have also been claims that the show's researchers used fake GP referral letters to target Mr Taranissi.

The programme generated 150 complaints to the BBC, a sizeable number of them said to have come from Mr Taranissi's former patients. His supporters claimed that the Human Fertilisation and Embryology Authority, the fertility watchdog, had colluded with Panorama as part of a 'witch hunt' against the doctor. Leading fertility expert Lord Winston later wrote to Panorama accusing it of trial by television and letting the HFEA 'off the hook'.

Last night a BBC source said: 'Both parties have agreed to settle the case and consider the matter now closed.' But critics of the Corporation are astonished that it let the case run on so long, increasing the costs, and are angry that such an extraordinary amount of licence fee cash is being spent on legal costs rather than on TV shows at a time when money is short.

SOURCE





8 June, 2009

Senate committee to hear about VA mistakes in southeast

A U.S. Senate committee will ask Department of Veterans Affairs officials how mistakes at three hospitals in the Southeast possibly infected patients with HIV and hepatitis.

The Senate Committee on Veterans Affairs has set a June 24 hearing for VA officials to talk about mistakes with endoscopic equipment that possibly exposed patients to infectious body fluids at Murfreesboro, Miami and Augusta, Ga. A House Committee on Veterans' Affairs subcommittee last week set a June 16 hearing on the VA mistakes.

The VA has warned that more than 10,000 former patients at the three hospitals to get follow-up blood checks. Five have tested positive for HIV and 43 have tested positive for hepatitis.

SOURCE




Scans showing possible cancer not passed on for months at scandal-hit NHS hospital trust

Scans showing possible cancer were not passed on to consultants for months at scandal-hit Mid-Staffordshire NHS Foundation Trust, MPs have heard. Forms detailing serious incidents also ended up in the waste paper bins of senior managers or in a "black hole", the Commons Health Select Committee was told.

A report from the Healthcare Commission in March condemned "appalling" and "shocking" standards of care at the trust, which led to some patients dying.

Between 400 and 1,200 more people died than would have been expected in a three-year period, with the poorest examples of care at Stafford Hospital. Families described "Third World" conditions at the trust, with some patients so thirsty they drank water from vases and others left screaming in pain.

The Mid-Staffordshire NHS Trust was awarded Foundation Trust status just before the investigation into the scandal began and Ben Bradshaw, Health Minister, told MPs that legal changes are under consideration to allow the status to be removed and thus bring failing trusts back under the control of Whitehall. Mr Bradshaw also appeared to soften the Government's opposition to a public inquiry into the scandal, saying ministers remained open to persuasion but were not currently convinced it was necessary.

Dr Peter Daggett, a consultant physician and endocrinologist at the trust, who has worked there since 1982, told the committee that a cardiologist submitted forms detailing serious incidents which were "downgraded" to minor incidents by nursing managers or were not investigated at all.

Another colleague, a gastroenterologist, warned that there was a dangerous lack of nurses on the wards but nothing was done. However Dr Daggett said although nurses had apologised over the failings, doctors had not because "they had nothing to apologise for".

SOURCE




Australia: More government means less healthcare

This week the headlines announced that Australia’s ‘free’ health system was in danger of being replaced with a ‘US-style’ user pay system because out of control growth in the cost of the NSW public hospital system will drain the State’s coffers. So NSW Health has come up with a new and radical plan (it is neither) to save Medicare.

When we think about the coming crisis of Medicare, we usually think of the impact of new medical technology that can do more things for more patients, especially elderly patients. But in relation to public hospitals, the crisis is now and more fundamental. Despite ever escalating government funding for the system, bills are not paid, patients are not properly fed, and there aren’t enough beds to treat emergency patients, let alone elective patients, in a timely manner.

We know who and what is to blame for the ‘hospital crisis.’ Like all government bureaucracies that are responsible for delivering public services, NSW Health and the area health services that run public hospitals are incapable, of controlling costs, increasing efficiency, or improving quality.

So the bureaucracy is now looking for a financial bail-out – using a dishonest scare about ‘US-style’ health and jokes about ‘slashing red tape’ to grease the political wheels.

NSW Health’s plan to save Medicare is for all Commonwealth and state hospital and health funding, including the money used to fund bulk-billed GP care, to be cashed out, ‘pooled,’ and distributed to regional health authorities (a.k.a. the area health services) that would be responsible for the planning and provision of all health services within a designated region.

Based on ‘reforms’ introduced in United Kingdom, this plan would transform the health system for the worst. Because it would involve the elimination of fee-for-service general practice, GP services would end up being ‘rationed,’ just like public hospital care. People who wait months now on elective surgery waiting lists would end up waiting for days and possibly weeks before they could even see a GP.

We do need to find a cure for the coming crisis of Medicare. But a plan that would give the bureaucracies that operate public hospitals without enough beds even greater control of our precious health dollars should be dismissed out of hand.

The above is a press release from CIS





7 June, 2009

Public plan threatens bipartisan health deal

Employers would be required to offer health care to employees or pay a penalty - and all Americans would be guaranteed health insurance - under a draft bill circulated Friday by Sen. Edward M. Kennedy's health committee.

The bill would provide subsidies to help poor people pay for care, guarantee patients the right to select any doctor they want and require everyone to purchase insurance, with exceptions for those who can't afford to.

Insurers would be supposed to offer a basic level of care and would be required to cover all comers, without turning people away because of pre-existing conditions or other reasons. Insurance companies' profits would be limited, and private companies would have to compete with a new public "affordable access" plan that would for the first time offer government-sponsored health care to Americans not eligible for Medicare, Medicaid or other programs.

It all adds up to sweeping changes in how America's health care system operates and aims to achieve President Barack Obama's goal of holding down costs and extending health coverage to 50 million uninsured Americans.

It's already been known that Kennedy's health committee was planning to pursue most of the concepts outlined in the draft of the bill, called the "American Health Choices Act." But it's the first actual bill language to circulate since Congress began working on Obama's health care overhaul.

Congressional and interest groups officials cautioned that the language in the document was not final.

"It's a draft of a draft. HELP Democrats are still actively talking amongst themselves and their Republican colleagues," said Anthony Coley, spokesman for the Health, Education, Labor and Pensions Committee that's chaired by Kennedy, D-Mass.

Kennedy's committee is scheduled to begin voting on legislation later this month, as is the Senate Finance Committee, which has jurisdiction over tax issues. The House also will get to work soon to meet Obama's goal of passing legislation through both chambers by August, so the president can sign a bill in fall.

The draft bill sets up a system of state-level "exchanges," where people would go to shop for insurance plans and which would also oversee the marketplace. The federal-state Medicaid program for the poor would be greatly expanded.

Insurers would be required to pay for preventive care, and a new Medical Advisory Council would make recommendations on required health care benefits that would take effect unless Congress rejected them all at once - similar to how military base closures are handled.

The draft doesn't address how this would all be paid for. That remains a major sticking point.

The bill language became public on the eve of the kickoff of a national campaign to rally support for health care legislation that's being orchestrated by Obama's campaign team. Thousands of community events are scheduled around the nation Saturday where tens of thousands of people are supposed to discuss health care issues with their neighbors and create a groundswell for congressional action.

Yet many hurdles remain. Republicans are strongly opposed to a new public plan, especially the way Kennedy's bill designs it. Under Kennedy's bill the "affordable access plan" would pay providers 10 percent over Medicare rates, which would make it cheaper for patients, but harder for private insurers to compete with. Private insurers fear such a construct would drive them out of business, and there's even division within Democratic ranks.

That was underscored Friday in the House, as the liberal Congressional Progressive Caucus released a set of principles for how the public plan should operate that directly contradicted principles released Thursday by the Blue Dog Coalition of conservative Democrats.

SOURCE




Obama's Voodoo Health Economics

Cutting our medical care is bad science

On Monday President Barack Obama's Council of Economic Advisers released a report called "The Economic Case for Health Care Reform." The report argues that Americans must curb their consumption of medical care in order to avoid soaring federal deficits, unsustainable burdens on family budgets, and damage to the economy. All of these claims are untrue.

- Federal deficits. The White House report makes the argument that there must be controls on what all Americans spend on health care in order to avoid government programs running huge deficits. Secretary of Health and Human Services Kathleen Sebelius uses the same faulty logic, warning that "the only way to slow Medicare spending is to slow overall health system spending through comprehensive and carefully crafted legislation."

In truth, Medicare can be fixed without subjecting the nation to medical scarcity. Telling all Americans they have to cut back on health care because Medicare is fiscally unsound is like ordering all Americans to go on diets because the food stamp program is in trouble.

It would be safer to reduce government's share of the health-care bill rather than lowering the standard of care for everyone and depressing the nation's largest industry. The nonpartisan Congressional Budget Office has suggested alternatives such as asking wealthy seniors to pay more or inching the eligibility age upward two months a year until it reaches age 70 in 2043.

- Skyrocketing costs. The White House report warns that "health care costs have risen rapidly over the last two decades and are projected to rise even more rapidly in the future." The truth is that health-care spending is increasing at more moderate rates than in previous decades. Spending increased by 10% in 1970 and 13% in 1980. But over the last five years, spending increased less than 7% each year, and reached a low of 6% in 2007. It's true that premiums are increasing rapidly. But the White House report incorrectly blames health costs. The real cause is the declining share of care paid for out of pocket (down to 15% today from 33% in 1975). Auto-insurance premiums would also skyrocket if coverage suddenly included oil changes and tune-ups.

- Burdening families. The report depicts families straining under the burden of health spending and unable to purchase other goods and services. But U.S. Department of Commerce data show that food and energy together have taken up a declining share of Americans' spending each year since 1960, while housing has consumed a steady share. The result is that Americans have been able to spend more on health care. In fact, these four necessities together use up about the same share of Americans' spending now (55%) as they did in 1960 (53%). As further evidence, American families are increasing the share of their budget that they spend on recreation.

Averages don't tell the whole story, and families that can't afford coverage should be helped. But most Americans can afford the current level of health-care spending. The White House report points to Europe's skimpier health spending as an example Americans should follow. But 90% of the difference in per capita health spending between Europe and America is due to higher per capita incomes in the U.S. Americans spend more because they earn more, and they get more for it.

- Copying Europe. Women in the U.S. are more likely to have regular mammograms, so their breast cancer is detected sooner and treated faster. As a result, they have higher survival rates than women in Europe according to the Concord 2008 Five Continent Study and the Commonwealth Fund. These figures reflect the experiences of all American women, not just those with insurance.

Two-thirds of annual health spending increases are the result of the rapid development and use of new medications and devices, according to the CBO. But, as the CBO reminds us, these innovations "permit the treatment of previously untreatable conditions." If you had a heart attack in the 1980s and made it to the hospital you had only a 60% chance of living a year. Now your chance is over 90%. No one wants 1980s medicine at 1980s prices. And in 10 years, no one will want 2009 care.

- Endangering jobs. Cutting annual increases in health-care spending by 1.5% a year, as the Obama administration is suggesting, will affect jobs too. At a time when the economy is ailing and the president is bailing out industries to protect jobs, his advisers recommend shrinking the health-care industry. It currently provides 1.4 million jobs -- 10 times the U.S. work force of General Motors and Chrysler.

Slowing the flow of dollars into the health-care industry while extending coverage to 46 million more people will create a European-like system where medical care is limited. Hospitals will face budget cuts, nurses will be spread even thinner, and equipment will be in shorter supply. You may be able to keep your health plan -- as politicians have promised -- but you'll find a lower standard of care when you need it.

SOURCE





6 June, 2009

Fight government encroachment into healthcare

By Congressman Ron Paul, R-Texas

With a faltering economy, and skyrocketing costs, healthcare continues to be a critical issue for all Americans. Unfortunately government encroachment into the doctor/patient relationship is poised to exacerbate our problems with healthcare.

As an OB/GYN with over 30 years of experience in private practice, I understand that one of the foundations of quality healthcare is the patient's confidence that all information shared with his or her healthcare provider will remain private. And yet, the Federal Government plans to undermine this trust with establishment of mandatory electronic medical records collections and “unique health identifier” numbers assigned to all Americans. Funding for this program was among the numerous provisions jammed into the stimulus bill rushed through Congress earlier this year.

Electronic medical records that are part of the federal system will only receive the protection granted by the federal “medical privacy rule.” This misnamed rule actually protects the ability of government officials and state-favored special interests to view private medical records without patient consent.

Aside from those concerns, the government’s ability to protect medical records is highly questionable. After all, we are all familiar with cases where third parties obtained access to electronic veteran, tax, and other records because of errors made by federal bureaucrats. We should also consider the abuse of IRS records by administrations of both parties. What would happen if unscrupulous politicians gained the power to access their political enemies’ electronic medical records?

For these reasons I have introduced the Protect Patients’ and Physicians’ Privacy Act, HR 2630, which allows patients and physicians to opt out of any federally mandated, created, or funded electronic medical records system. The bill also repeals sections of federal law establishing a “unique health identifier” and requires patient consent before any electronic medical records can be released to a 3rd party.

I have also introduced the Coercion is Not Health Care Act, HR 2629. This legislation forbids the federal government from forcing any American to purchase health insurance, or conditioning participation in any federal program on the purchase of health insurance. Forcing Americans to purchase government-approved health insurance is a back door approach to creating a government-controlled healthcare system. Congress would define what policies and coverage requirements satisfy their mandate. Does anyone then doubt that what conditions and treatments are covered would be determined by who has the most effective lobby? Or that Congress would be capable of writing a mandatory insurance policy that fits the unique needs of every individual in the United States?

With these conditions in place, I foresee the eventual imposition of price controls and limitations on what procedures and treatments that are covered. This will result in an increasing number of providers turning to “cash only” practices, making it difficult for those relying on the government-mandated insurance to find healthcare – the exact opposite of the desired result! Consider the increasing number of physicians who are already withdrawing from the Medicare program because of the low reimbursement and constant bureaucratic harassment from the Centers for Medicare and Medicaid Services.

Congress should put the American people back in charge of healthcare by expanding healthcare tax credits and deductions, increasing access to Health Savings Accounts, respecting privacy and the doctor/patient relationship. Further politicizing and bureaucratizing of healthcare will only increase costs and reduce quality, as demonstrated by most other countries with socialized medicine.

SOURCE




Patients’ Choice Act -- A Better Prescription

by Dr. Donald P. Condit

In late May, Senators Tom Coburn and Richard Burr, and Representatives Paul Ryan and Devin Nunes, all Republicans, offered a new prescription for health care reform that is a vast improvement over what we’ve seen previously from Washington. The “Patients’ Choice Act” (PCA), as its sponsors refer to the proposal, honestly confronts the unsustainable and unjust realities of our current medical system.

Despite good intentions, many reform proposals increase the role of government, place additional burdens on business, and interfere with medical decision making between the patient and doctor. Yet, without substantial health care reform, the United States will suffer from a greater financial disaster than is anticipated in the current crisis, and will unconscionably burden our children and grandchildren with debt and inflation. The PCA represents a more promising approach.

Our government is already responsible for 50 percent of health care spending. It has failed to control spending and promote quality. The Medicare trust fund will be insolvent by 2017 (Part A or hospital insurance). The combination of aging baby boomers and increasingly expensive treatments has led to medical spending exceeding the growth in our Gross Domestic Product year after year. This cannot continue. Yet many reform proposals advocate expanding Medicare, Medicaid, or new public health care programs, when our government is already fiscally failing to handle half of America’s health care.

As those of us who live in Michigan know all too well, job-providing businesses are having trouble competing in global markets when competitors are not handicapped with similar benefit package requirements. Where will jobs come from if employers have to bear greater responsibility for health care expenses, as many reform proposals suggest? Furthermore, we have also learned we would rather have health insurance obtained outside the workplace, so that when businesses close or move, or we become unable to work, our health insurance is not jeopardized. Anyone who has lost a job and learned how much COBRA insurance costs—without a paycheck—understands the value of affordable and portable health insurance.

Furthermore, many reform proposals interfere with the doctor-patient relationship. The heavy hand of government is already leading to shortages of physicians, particularly in primary care specialties. Michigan is likely to be short-handed by 6,000 physicians by 2020. Three-quarters of health care spending and two-thirds of deaths are due to chronic conditions such as diabetic, heart, and lung disease. Preventive medicine and patient responsibility for personal decisions affecting health care can make a tremendous difference in health and health care spending. Rules, regulations, and bureaucracy contribute to patients’ losing both their greatest ally in understanding complex medical issues and their best advocate in promoting a healthy lifestyle.

The PCA will enhance patient and family ability to afford health care insurance and incentivize healthier lifestyles. As the name suggests, patients will have freedom of choice for health care insurance. This proposal would more justly allocate the current $300 billion tax subsidy for employer provided health care. In addition, it would surpass other options in fulfilling our social responsibility to the poor and vulnerable.

Sixty percent of working Americans obtain health care insurance through their employer. Both employee and employer benefit from a significant tax break, whether they realize it or not. Wages are lower when employees receive health care benefits, whether they realize it or not, too.

The 40 percent of workers who pay out of pocket understand that they pay dearly for health insurance. These individuals may resent that they are paying taxes to subsidize those receiving the $300 billion federal tax subsidy for employer based health care, particularly when those making more money get a bigger tax break.

People who take care of themselves with healthy diet, regular exercise, and avoidance of harmful habits are probably over-insured. Most workers would be better off if they received the tax break themselves, received a bigger paycheck, and could purchase lower cost insurance directly. This would certainly be fairer for those paying taxes but missing out on the tax break.

The PCA replaces the unfair ‘at work’ tax subsidy to give people an ‘at home’ tax break for health care expenses. For those who need help affording insurance there will be assistance in the form of refundable tax credits for individuals and families. State insurance exchanges are proposed to increase competitive pressures on insurance companies, which often possess monopolistic power, and ensure people with chronic illness receive help.

The PCA is not only fiscally responsible, it also fulfills our social responsibilities.

Human dignity is respected when we fulfill our duty to improve access to health care through reforms that increase affordability and quality of care. Personal responsibility is promoted by enabling patients and families to assume greater responsibility for their health care. Immigrants and Native Americans’ needs are considered in this plan. Veterans who sometimes may be better served outside the Veteran’s Health Administration are provided this opportunity.

Market-oriented changes to improve the allocation of $2.4 trillion in annual health care spending can advance the common good more effectively than can increased third party decision making. Mandates, often prompted by special interest lobbying efforts rather than patient demand, have increased the cost of insurance beyond affordability for many citizens. More mandates mean more expensive health insurance, and fewer people able to buy it.

The poor and vulnerable would benefit more from subsidized access to the health care market-place than from expanding government health care authority. Medicaid reimbursement for doctors and hospitals does not cover the cost of providing care. As a result, patients on Medicaid have difficulty with access to providers and rely on costly emergency rooms for care. The safety net for those with chronic disease can be maintained at the state level by insurers of last resort.

Facilitating health care by those closest to those in need, rather than government or employer, begins with the family and doctor-patient relationship. Churches, community organizations, and employee associations should be helped to care for their members rather than higher, and less personal, levels of society.

But, as the language of the PCA warns, expanding the reach of government would create a health care system displaying “the compassion of the IRS, the efficiency of the post office, and the incompetence of Katrina.” The proposed PCA bill will instead empower patients, with the helping hand of their doctors. It prescribes reform with financial responsibility and without bankrupting our children and grandchildren. Finally, the PCA would fulfill our social responsibility to those in need while increasing the competitive ability of American business. This is the right prescription for health care reform.

SOURCE





5 June, 2009

Obama sets August deadline for destruction of American medicine

President Barack Obama called the next few months a “make-or-break period” for health-care legislation in Congress, as his aides left the door open to a tax on benefits to pay for overhauling the U.S. system. Democratic senators, who met with the president at the White House yesterday, promised they would meet the deadline even as two contentious issues -- taxing employer-paid health insurance and setting up a government plan -- are unresolved. “Soaring health-care costs are unsustainable for families, they are unsustainable for businesses, and they are unsustainable for governments,” Obama said before the meeting with lawmakers. “This is the time where we’ve got to get this done.”

The administration is kicking off a campaign to push Congress to meet Obama’s deadline of finishing work on drafting a measure before Congress leaves for its August recess. That would give lawmakers time for final negotiations and passage after they return to Washington in September. Top Democrats in the House and Senate said they would meet that timetable.

Democrats, who control both the House and Senate, are considering proposals that would require employers to cover all full-time workers or pay a penalty to the government; create a “health exchange” to allow consumers to buy insurance at lower, group rates; set up a new government-run plan to cover some of the uninsured; and levy new taxes to pay for universal coverage.

Max Baucus, Democrat of Montana and chairman of the Senate Finance Committee, made it clear yesterday that he wants to consider taxing at least some portion of employer-provided health-care benefits for workers. He said lawmakers should consider “an appropriate limit” on benefits that are free to employees, and beyond that, there should be a tax to help pay for health-care overhaul legislation. Obama aides said the president, who opposed such a plan during his election campaign, is focused on paying for his proposals through other means. Still, they refused to rule out he would sign legislation that included such a tax.

“The president has serious concerns about taxing benefits,” Linda Douglass, the communications director for the White House Office of Health Reform, said in an interview today. “He doesn’t like it.” “While all options should be considered while they are talking about the different components of health reform,” Douglass said, “he believes that those options should include the revenue proposals that he had in his budget.”

In the meeting with senators, Obama reinforced his support to help finance a health-care overhaul by reducing itemized deductions for charitable contributions and limiting deductions on mortgage-interest payments for the wealthy, past of the administration’s budget package. “That is a proposal that he’s very serious about, and that is what he was pushing,” Douglass said.

Baucus got a key ally on the tax issue in Republican Senator Judd Gregg of New Hampshire. Gregg, the senior Republican on the Health, Education, Labor and Pensions Committee, offered a measure that would pay for the overhaul by capping the tax exclusion for employer-provided benefits. His legislation would include in employees’ taxable income any contributions employees and employers made for health-care coverage that, taken together, exceed $11,500 a year for family coverage or $5,000 a year for individual coverage.

Even with the differences over how to pay for the health- care plan, Baucus said lawmakers will meet Obama’s deadline. “We will pass a comprehensive, meaningful health-care reform bill this year,” the Montana Democrat said. Representative Charles Rangel of New York, chairman of the House Ways and Means Committee, said he expected the House legislation would be finished in July and that a bill could be on the president’s desk by Oct. 1.

Another point of debate is whether to establish a government-run insurance plan to make sure coverage is universal. Senator Sherrod Brown, an Ohio Democrat, said the “sentiment in the room at the White House meeting was that Democrats want a strong public plan. Senator Bernie Sanders, a Vermont independent, said Obama expressed support for a public option. “He understands that in order to at least police the private insurance companies we need a strong public plan,” Sanders said.

That will run into strong opposition from Republicans. Charles Grassley of Iowa, the top Republican on the Senate Finance Committee, said any attempt to win Republican votes on a compromise will be tough if Democrats push through a public insurance system that will compete with private insurers.

Grassley said he was dismayed that Republicans weren’t invited to this afternoon’s White House meeting. Grassley said that, at a lunch he had with Obama a month ago, the president indicated he wanted support from both parties. Obama said he would rather get 85 percent of what he wants to achieve if it has bipartisan backing, rather than win everything with only Democratic support, according to Grassley. “I think this president, when he says he wants bipartisanship, is very sincere,” Grassley said. “But he’s got people of his party in Congress who have been out of power for 14 years, and they know what they want and they’re going to get it and disregard their president.”

Grassley said the meeting today provides a “fork in the road,” where Democrats can decide to proceed with a bipartisan plan, or to go it alone on legislation.

SOURCE




South Wales NHS chiefs told to apologise in person for fatal blunder

The heads of an NHS trust were told to apologise in person to the parents of a cancer patient who bled to death after a breathing tube was inserted incorrectly in his neck. The Public Services Ombudsman for Wales, Peter Tyndall, criticised the Cwm Taf NHS Trust severely, saying that the actions of its staff “directly resulted” in the premature death of Myron Hall, a 47-year-old electrician. Mr Hall’s parents called for the police to investigate whether the trust, in South Wales, or any individuals should face criminal charges.

Mr Hall was referred to the former North Glamorgan NHS Trust in September 2006 by his GP because of a suspicious lump in his neck. It took three months to diagnose a malignant tumour and doctors decided the best way to treat him was to remove half his tongue. A tracheostomy tube was put in his windpipe to help him to breathe, but surgeons stopped the operation when they found that the tumour had spread too far.

Mr Hall later began bleeding from a replacement tube that was inserted in the wrong place while he waited to be transferred to a specialist cancer centre for chemotherapy. The wound was stitched when it was noticed the tube was not in the right place, but four days after returning to the ward Mr Hall suffered a “catastrophic bleed” caused by the tube wearing through the wall of an artery. He died despite the efforts of staff at the Royal Glamorgan Hospital, in Llantrisant, to resuscitate him.

His parents, Denzil and Janet Tilley, of Porthcawl, arrived at the hospital seconds before he died. In the report, Mr Tilley compares the scene at his son’s bed to a “horror movie”.

The report says the initial investigation of Mr Hall’s tumour was “slow and inadequate” and the nursing he received in relation to his tracheostomy “fell below a standard one could reasonably expect”. Although he was admitted to hospital with a very serious and potentially life-threatening condition, Mr Tyndall says he has “no doubt whatsoever that the actions of the Trust directly resulted in Mr H’s premature death”. “Not only was Mr H’s death avoidable, it occurred as a direct result of the action (or inaction) of Trust staff and should not have happened,” the report adds.

Mr Tyndall said: “Whilst no amount of apologising can compensate a parent for the loss of a son in such horrendous circumstances, I have nevertheless recommended that both the chair and the chief executive of Cwm Taf Trust should provide Mr H’s parents with an unequivocal apology for the failings that occurred during the care of their son.” Cwm Taf Trust, which took over from North Glamorgan and the former Pontypridd and Rhondda Trust, told the Ombudsman it could not meet his request for an apology in person but would write to Mr Hall’s parents — a stance he calls “unreasonable”.

Mr and Mrs Tilley’s solicitor, Astrid Coates, said: “Failures by the trust led to the death of Mr Hall and his family want to know that this will not happen to someone else’s son. “We will be calling upon the coroner to ascertain exactly what action has been taken by the Trust to prevent similar fatalities and to withhold this information when it may assist Mr and Mrs Tilley in dealing with their grief is inexplicable.”

SOURCE




Australia: Public hospital paperwork kills woman

So much paperwork, the nurse missed the important bit

A nurse caring for a woman who died from excessive bleeding after undergoing a caesarean section had been too busy to read an operation report that identified a tear in the woman's uterus, an inquest has heard.

Rebecca Murray, 29, died a day after giving birth to her third child at Bathurst Base Hospital on June 24, 2007. She had lost about one litre of blood - enough blood to soak through two pads, sheets and bed linen - and was forced to wait almost 20 minutes after nurses observed the blood loss before being given any fluids or before nurses called a doctor.

At Westmead Coroner's court today, Jane Thompson, an anaesthetic nurse who was present during Mrs Murray's caesarean and was responsible for her in recovery, said she had not been aware that Mrs Murray's uterus had torn during the procedure or that she had a low platelet count, which could result in severe bleeding if such a tear had occurred. She said she did not "have time" to read completely a set of post-operative notes that included details about the tear. "If I had time to sit down and read the notes I wouldn't attend to the patient," she said.

"I suggest to you, nurse, that the word 'tear' would have leapt to your eye ... and would have concerned you, being responsible in recovery for the patient," counsel assisting the inquest, Gail Furness, said.

Ms Thompson said part of the problem was that she had not been told about it. She would have read the operation report in full "if I had time".

"Are you suggesting that with one patient in recovery you didn't have time to read eight additional lines?" Ms Furness asked.

"I had my own paperwork to complete," Ms Thompson replied.

SOURCE





4 June, 2009

Free public medicine struggling; Australia headed towards user-pays system

And the proposed solution? A bigger bureaucracy! It would be funny if it weren't so serious. Amusing that Australia is heading towards the current American system while America is heading towards the Australian system. Australia and the USA are very similar countries so it is sad that America cannot learn from the unsustainability of the Australian system

THE Australian system of free universal healthcare is set to disappear in as little as five years, prompting a radical plan for a new federal-state partnership to take control of hospitals and patient care. It comes amid a push by the Australian Medical Association for hospital specialists to treat patients only four days a week, potentially placing further pressure on a system already hamstrung by work restrictions among emergency physicians.

In a startling warning, NSW Health director-general Debora Piccone has told The Daily Telegraph that Australia is hurtling towards a US-style user-pays system due to an ageing population and out of control costs. "We are really on the edge of losing the universal healthcare system that this country has," she said. "I would have (previously) said we'd had 10 years to run. It's now looking like we've got five years to run because the cost escalations are so significant and we haven't prepared ourselves."

Under the US system there is no free health care. Even an employer-subsidised insurance premium costs more than $3000 a year and if you are uninsured you are likely to have to pay several thousand dollars deposit just to be admitted to a hospital.

Professor Piccone and Health Minister John Della Bosca are now working on a plan to pool all state and federal health funding and have it redistributed by a joint partnership between the two governments. The $13.2 billion state hospital budget - set to grow into almost $50 billion by 2025 - would be integrated with Commonwealth funding towards Medicare, the pharmaceutical benefits scheme and aged care and jointly administered so as to slash red tape and eliminate overlap.

Mr Della Bosca said the overhaul - the biggest since universal health care was introduced under Gough Whitlam - would deliver "a single mandate" of patient care. "We need a new governance model which takes the massive pool of funds available," he said. "We need to find a forum to co-ordinate that more effectively and you can only see that as some kind of joint commonwealth-state operation. "I know the next step is right there and we've got to take it."

More HERE




Increase in women doctors ‘will put strain on the NHS’

Women doctors will outnumber their male colleagues in a decade but the change is likely to place a strain on the health service, according to a new report.

More than half of all new medical students are women but they are far more likely than men to work part-time and choose specialties where they have set hours, according to the study by the Royal College of Physicians. This could lead to a shortage of surgeons and doctors in obstetrics and gynaecology, paediatrics or public health, and a need to recruit more doctors overall, the report suggests.

At present women account for 40 per cent of all doctors, 42 per cent of GPs and 28 per cent of consultants. However, they are forecast to make up the majority of GPs by 2013 and the majority of the medical workforce some time after 2017.

“Across the NHS, 43 per cent of all women doctors are under the age of 35, so many will not yet have started families,” it adds. “And the proportion of women of child-bearing age will rise sharply in the next decade as the larger cohort of women medical students graduates.”

Compared with the early 1960s, the number of men entering medical schools each year has doubled, but among women it has risen tenfold.

Most NHS doctors, both men and women, still work full-time, with only about 15 per cent on part-time contracts. But in hospitals, 21 per cent of women are on part-time contracts, compared with 8 per cent of men. At senior consultant level, 30 per cent of women are working part-time.

Only 8.4 per cent of consultant surgeons are women — and women make up only 27 per cent of those opting for a specialty in surgery.

The study adds that there are very few women working as consultants or at the top of the NHS as medical directors and very few chairing professional executive committees.

The Women and Medicine report — which follows a two-year review — said there was no evidence that women were more likely than men to leave medicine entirely. However, a 15-year follow-up of doctors after graduation shows that, on average, and after career breaks and part-time working is taken into account, women fulfil 60 per cent of the role of a full-time doctor while men fulfil 80 per cent.

Sir Liam Donaldson, the Government’s Chief Medical Officer, welcomed the report. “The NHS benefits enormously from the diversity of its staff and the ways in which they reflect the community more widely,” he said. “We will work with the leadership of the medical profession to ensure that women have every opportunity to realise their aspiration when they choose a career in medicine.”

SOURCE





3 June, 2009

Have gout, will travel

In the ongoing argument over health delivery in this country, whether it's going to be called FedMed or GuvLuv or Nationalized Healthcare or Mandated Medical Management or Dictatorial Doctoring or Motherland Medicinal Monopoly or the benign-sounding Obamian euphemism Public Insurance Plan, the forgotten people in this dysfunctional delusion are the actual bringers of wellness.

No, that does not refer to the professional administrators aptly known as Medicrats, those management power-wielders found in the academies, associations, boards, colleges, organizations, and societies like the American Medical Association and the American Nursing Association and the National Gonad Gangliographery Society and the Institute of Erectile Massage Therapy and about a thousand or so other such self-serving wellcare groups.

These are essentially medicine unions. Like all such bureaucracies, they exist primarily to benefit the politically connected cronies who run them. Their primary functions are to control entry into these cozy, closed clubs, thereby creating personnel shortages and guaranteeing greater profits.

No, the forgotten people in the Grand Government Care Con, the doctors and surgeons and nurses and anesthesiologists and bone & joint specialists and hip replacement practitioners and eye, ear, nose, sinus & empty brain socket pathologists and all the other real people who do the real healing.

Who will be our future caregivers once everyone figures out that medicine is a closed government monopoly and its healers are slaves of the state? Answer: only two kinds, the altruists and the incompetents. Each, in his or her own way, is dangerous – the do-gooder who thinks emoting is a valid substitute for reason, and the screw-up who can't make it on merit. And what will become of all the competent and experienced people-menders who refuse the authoritarian's leash? Expect experts to become expats.

You've already heard of Medical tourism. Today when people stuck in public health plans need real medical attention they chuck their nationalized health hoaxes and flee in search of real treatment. Need dental work or an orthopedic tune-up at an internationally accredited hospital? Cruise off to Costa Rica. Aiming for abdominplasty? Buzz off to Brazil. Need something trifling like open-heart surgery? India is in.

But once Obamacare kills off private practice America's caregivers, or at least the ones with any inkling of self-respect, will hang out their shingles to treat your shingles in Mexico. And Thailand and Singapore. And South Korea and Taiwan and Malaysia. Some of these countries may be small or poor or both but they're not stupid like the United Socialist States of America. Good doctors bring needy patients. Needy patients bring money and family members who become tourists and spend more money. And bad service means a bad rep that means not getting the word-of-mouth advertising that keeps new patients and their money rolling in.

As America destroys its free markets the developing world is developing them. And the only ones left in the scary GovCare clinics back home will be the poor and downtrodden, both as practitioners and as the practiced upon.

Rank and file progressives don't get it. Their hard left political leaders do but don't care. That's because, like all other juggernaut government mega-missions, healthcare isn't about health. Think about it. Drug control is about control, gun control is about control, war on poverty is about control, war against terror is about control. What do you think war against private healthcare is really about? Health?

So while your pancreas crashes and your kidneys curdle and your rectum rots off while you're whiling away your last days on the three-year government-care waiting list don't shed a tear for the ruling classes. They and their loved ones will be well cared for. Don't wonder how. Don't ponder the loopholes and exceptions and rulings and policies and special clauses hidden in the depth of the thousands of unreadable and unread pages of legislation that put you where you are but allows them the benefit of world-class medical care at taxpayer expense.

The ruling class always looks out for itself. Except, that is, when rank-and-file pie-in-the-sky starry-eyed liberal no-nothings take to the streets and demand a system that does the looking out for them for them. That leaves everyone in between, meaning whatever is left of the middleclass, with the option of selling their cars, mortgaging their homes, siphoning their savings, and piling up credit card debt just to get real healthcare abroad.

As for you poor misguided conservatives, don't think the Republicans are going to save you. They don't believe in freedom and individualism like they pretend to. They believe in power, and they'll play along with the healthcare killers to gain and keep that power.

But there is good news for all you card-carrying collectivists who fought for the idealized politicalized bureaucratized bastardized healthcare. You may end up prematurely dead but by God you'll all be equally dead!

SOURCE




Europe's 48-hour working week will be 'catastrophic' for patients, says UK's top surgeon

Patients’ lives will be put at risk and hospitals forced to close because of new European rules which limit doctors’ working hours, according to the country’s top surgeon. John Black, president of The Royal College of Surgeons, has warned of an impending ‘catastrophe’ in the NHS if all doctors are forced to comply with a directive which limits them to working a 48-hour week.

Most doctors – and particularly those still in training – work considerably longer than 48 hours and Mr Black says restricting their working week will lead to a ‘shortage of surgeons’, with not enough staff to keep hospitals open. He said it is ‘not an exaggeration’ to say that the new rules, which come into force on August 1, will lead to operations being cancelled and wards closed down. He said patients’ lives are already being endangered as doctors’ hours are driven down in advance of the legislation taking effect.

He believes that there is a ‘scandalous lack of political will’ to address the problems. Writing in The Mail on Sunday tomorrow Mr Black says: ‘Unless the Government comes to its senses, the result will be catastrophic for the NHS with patient safety on a knife edge, surgeons not being properly trained, waiting lists going up again and even hospitals closing. ‘We have already reached the point where patients’ health has been endangered.

'There is a serious risk of units in hospitals having to close to emergencies, with resulting chaos, not to mention the danger and inconvenience brought about by patients going long distances to a hospital that has enough staff to stay open. 'This is truly a nightmare, and I despair that the Government will not take action.’

Hospitals have been told they face steep financial penalties for failing to comply with the new regulations. The European Working Time Directive, drawn up by Brussels, is designed to limit the working hours of all employees in the EU to an average of 48 hours a week. It has applied to most employees since 1988 with the exception of doctors in training. In August 2007 junior doctors’ hours were limited to 56, which will be reduced to 48 on August 1 this year. Many EU countries are ignoring the directive, while the UK has been working towards implementing it for ten years.

Mr Black said junior doctors will be ‘worse off’ because they will work shorter but busier hours and have less time to train. Trainees will have to spend more time dealing with emergencies, rather than spending time with senior surgeons. Some fear it could lead to a shortage of newly qualified specialists including cardiologists, neurologists, plastic surgeons and obstetricians.

Mr Black adds: ‘Having one doctor where there should be three makes an already difficult job much more difficult. It is chaotic and frankly dangerous.’ He is calling for the Government to agree to junior doctors voluntarily working a 65-hour week but Health Secretary Alan Johnson has described that plan as ‘mission impossible’.

He said the NHS is prepared to comply with the directive by the August deadline. However, he said that Government has notified the European Commission that it plans to operate a ‘derogation’ of the rules in places where there is a shortage of trainee doctors. This will allow them to work a 56-hour week.

A Department of Health spokesman said: ‘Everyone’s overriding objectives is the quality and safety of patient care. Where there are problems we will work together with the professions and staff on the ground to implement sustainable solutions.’

SOURCE





2 June, 2009

Three health care myths

While advocates of big government continue to speak of the need for "universal health care," those who understand the free market have pulled away the curtain to reveal the truth behind it.

For all its window dressing, "Universal health care" is merely a code word for socialized medicine. With leadership in both major parties shouting about the "health care crisis", it is vitally important that freedom loving-Americans know the facts and prepare themselves to counter the falsehoods that are being spread on this topic. Let us tackle some of the health care myths used by the proponents of big government in their advocacy for government run health care.

Myth #1 There are 47 Million Uninsured Americans in Crisis Today

Perhaps the most often quoted and thereby misleading statistic by the advocates of big government is the sheer number of people in America who currently have no insurance. The numbers have been used and misused by politicians in both major political parties.

While the number of Americans without insurance is 47 million at first glance, more than nine million are not American citizens. Taking this into account, the number drops to approximately 38 million. Of those now remaining, an additional nine million people make over $75,000 a year, nearly double the median household income in the United States.

If they desire it these individuals should be able to afford basic health insurance. Adjusting for this factor, the number slides to approximately 29 million.

With an additional eight million Americans making between $50,000 and $75,000 a year, still more than the average American, these individuals should be able to afford basic health insurance if they choose to purchase it. This drops the number even further to just over 20 million people.

And yet the "new" number of 20 million uninsured Americans may even be too high.

The number of true "uninsured" Americans could perhaps be lowered again with the estimation that almost half of those uninsured will have insurance within four months. Many individuals not covered due to transitional periods between jobs will receive insurance through their employer and would be covered upon taking the new position. It is estimated that 45% of those without insurance will have it within four months.

So where do the exact numbers stand? There is no way to be certain, although some estimates put the number as low as eight million people; a significant difference from the "47 million" the proponents of big government would have you believe.

Myth #2: Switching to Electronic Records will Save Lives

The idea of shifting from paper records to electronic records is not a new concept. The idea has been implemented by countless clinics and hospitals already, and numerous politicians encourage the practice.

The problem arises from bureaucrats' pledge to have government mandate the program for health care providers. Contrary to what the advocates of socialized medicine suggest, changing the way records are kept will not save lives.

According to a study published in the July 9th edition of the Archives of Internal Medicine, records being kept electronically had little impact on the overall quality of care when it came to walk-in doctor visits. "In clinic visits in which doctors did use and didn't use electronic health records, we didn't find clear evidence that EHR [Electronic Health Record] use was associated with better quality," said study lead author Dr. Jeffrey Linder.

To test the effectiveness of electronic health records, Linder and his staff evaluated visits to physicians' offices that only required outpatient care. They then cross-referenced the visits against 17 factors they determined were most important to the quality of the care. Overall, the study determined that electronic health records were not directly associated with a better quality of care. In some cases, such as the prescription of statins to patients with high cholesterol, the study found that electronic health records actually provided a lower quality of care.

Myth #3: U.S. Health Care is Inferior to the Rest of the World

One of the major arguments used by the proponents of socialized medicine is the substantial cost of health care in the United States as compared to other industrialized countries, mainly Canada and Europe. Advocates of socialized medicine constantly assert the superiority of other nations over the US based on the false belief that health care is inexpensive to citizens of these countries. Many even claim that health care in those countries is universal or "free."

In reality there is nothing free about it. The Health Care system in France is funded through a 13.55 percent payroll tax, a 5.25 percent income tax and other taxes on tobacco, alcohol and drug-company revenues. And the system is still running a deficit equivalent to more than 15 billion dollars.

In the United Kingdom we see more of the same: perceived low costs with hidden expenses that increase price and decrease quality. The UK's National Health Service (NHS) serves as a reminder of what can happen when competition begins to fade and socialized medicine takes over.

When it comes to the medical field, private industry leads to new and effective treatments and medicines. With no competition, government control over health care would lead to higher prices and a massive decline in quality. Some hospitals in Great Britain are being forced to cut services in order to cut costs. Controlled by the NHS, some hospitals have resorted to asking patients to bring drugs in from home, or removing every third light bulb from hallways. One government-controlled hospital even encouraged staff to save money on laundry costs by flipping over dirty bed sheets between patients instead of washing them.

Merely saying that people have health insurance is meaningless. Many countries provide universal insurance but deny critical procedures to people who become nothing more than numbers in a database. In Sweden some patients have had to wait more than six months for heart surgery, a procedure that from start to finish would take a matter of days in the U.S.

Private companies are responsible for the medical innovations we see today. The private sector gives us flat screen televisions and digital cameras while the government gives us the Post Office and the Department of Motor Vehicles. Private industry generates healthy competition that leads to better quality products and a reduced cost for consumers.

Government control limits the choices people have when looking for care and it prevents patients from receiving the best care possible. By allowing the free market to work we produce the best available products and the best service possible. The benefits of government intervention in the health care sector are grossly exaggerated and based solely on myth, not on fact.

SOURCE




Don't get old in Britain

Elderly left at risk by NHS bidding wars to find cheapest care with reverse auctions

An online auction system developed for councils to buy cheap wheelie bins and stationery is being used to buy end-of-life and dementia care for vulnerable elderly people. The NHS in London has held a series of 30 “reverse e-auctions”, where bids are driven down instead of up, for £195 million worth of contracts for palliative and dementia care for patients leaving hospital.

Reverse auctions to buy care for the elderly are relatively new and The Times has found that standards and quality have deteriorated rapidly where they have been used. In one case a company that won a local authority’s reverse auction in the North East of England was struck off the national register of approved providers weeks later because the palliative care it offered was of such poor quality. The results of another auction in South Lanarkshire to buy domiciliary care were so disastrous for elderly people that the Scottish Parliament is to hold an inquiry into whether they should be banned.

Companies who took part in the London NHS auction told The Times that they were asked hardly any questions about the quality of palliative or dementia care that they provided, beyond whether they complied with minimum standards.

During the e-auction, companies were invited to reduce their prices for one bed with round-the-clock specialist care for one week by £8 a time.

The NHS and local authorities are under increasing pressure to drive the hardest bargain they can for services, such as care for the elderly, which they buy in from the private sector. Reverse e-auctions, though, were intended to be used to drive down prices for basic goods such as office furniture, IT or stationery, which have limited and exact specifications and where quality is not a serious concern. Critics of care e-auctions say that those who hold them are aware that driving prices down affects the quality of care.

Richard Jones, director of adult social services for Lancashire County Council, said that he would never use an auction to buy care. “If you put your providers into an auction, pushing them to a lower and lower price, somebody is going to lose out, and the losers in this case are vulnerable elderly people and their carers,” he said.

Information given to The Times by the BBC programme Panorama showed that four local authorities — Walsall, Bedfordshire, South Lanarkshire and Edinburgh — had used the system to buy care for elderly people.

In Walsall, the Working Together Specialist Care Agency won a contract to provide palliative care to elderly people in the last few months of their life. Within weeks, the local authority stopped the company taking on any new cases, and then terminated the contract after it emerged that dying people were not receiving the pain relief and help with feeding and washing that they required. The Care Quality Commission (CQC), the health regulator, confirmed that the agency had been deregistered after an investigation. The agency could not be reached for comment.

Walsall said that price was not the sole consideration in awarding the contract to Working Together. Sue Ryder Care, the specialist charity that held the palliative care contract before the auction, said that it could not even afford to start bidding at the opening price because it was so low.

In South Lanarkshire, Panorama found that services deteriorated sharply when Domiciliary Care, the company that won the reverse e-auction, started work. The half-hour appointments for elderly people were reduced routinely so that workers could make all their calls, and one man was fed on crisps and sandwiches. Domiciliary Care has since been taken over by Choices Care Group, which said that it was appalled by what Panorama found and had apologised for the shortcomings. The Scottish Parliament has started a cross-party investigation into the use of reverse e-actions with a view to having them banned for purchasing care.

In England, the CQC warned NHS purchasers and local authorities that it would examine closely what happened to standards of care in areas where e-auctions were used. “We’ll be keeping a very close eye on standards across the health and adult social care sector. Where we see standards slipping, we won’t hesitate to act,” a spokesman said. Martin Green, chief executive of the English Community Care Association, has written to Alan Johnson, the Health Secretary, to alert him to the practice.

The London Procurement Programme, which ran the NHS reverse e-auction, defended its use of the system. Stuart Saw, chairman of the steering board, said: “We are confident the framework will deliver consistent high-quality standards in nursing home care across the capital. Quality has been embedded throughout the procurement process while making the most of taxpayers’ money.”

SOURCE





1 June, 2009

MA: Those nasty costs snarling health insurance brainstorm

And it's only just beginning. Wait until it gets more and more bureaucratized. Costs grow in such systems; they don't decline

Soaring healthcare costs, combined with the recession, are threatening to undermine the gains from Massachusetts' 2006 healthcare overhaul, according to the third annual "Update on Health Reform in Massachusetts" published today. The survey of roughly 4,000 adults found that, after seeing initial gains in affordability, an increasing percentage of residents are now reporting problems paying medical bills. It also found that a rising number of residents, especially those with lower incomes, are reporting that they did not get needed care because of costs, which are rising faster than inflation.

The cost factor is likely to be central to a discussion today as healthcare leaders come to Boston, in part for a briefing on the findings. Massachusetts' pioneering experiment is being closely watched as a potential model for a national health insurance mandate. "You can see Massachusetts as a kind of crystal ball for what some of the implementation challenges might look like in national health reform . . .," said Drew Altman, chief executive of the Kaiser Family Foundation, a California-based nonprofit that researches healthcare trends.

While the state is facing cost challenges, he said, implementation of near-universal coverage in 2006 still put consumers here in a better position than in other states. "We should be lucky enough to have those problems [nationally]," Altman said of the challenges outlined in the Urban Institute survey. "If we get to a point where everyone is insured, then we can move on to worry about the affordability of care."

The survey was conducted by the Urban Institute, a social policy think tank, and funded by the Blue Cross and Blue Shield of Massachusetts Foundation, Robert Wood Johnson Foundation, and the Commonwealth Fund. It found that public support for the state's healthcare initiative is holding strong. Overall, about 70 percent of those surveyed in 2006 through 2008 said they back the first-of-its-kind law.

The survey, published in the health policy journal Health Affairs, identified many bright spots in the state's massive new system, which requires nearly everyone to have health insurance or pay a hefty tax penalty. In the United States, Massachusetts now has the lowest percentage of uninsured residents, less than 3 percent, compared with an average of about 15 percent elsewhere. That coverage helped fuel a significant boost in the percentage of people who have been able to visit doctors and dentists, the study found.

Roughly 91 percent of residents said they have a regular healthcare provider, compared with 86 percent in 2006, when the health law went into effect. And three quarters of those surveyed said they had been to a dentist in the past year, up substantially from 68 percent just three years ago. The study compares results from 2006, when many of the key elements of reform were just getting underway, to the fall of 2007 and 2008. Overall, it reveals striking gains in access to care and affordability in the first year of the state's near-universal coverage plan.

But by the fall of 2008 - when the recession started taking a toll in Massachusetts - the gains began to erode. The latest survey shows that 17.9 percent of residents reported that they had medical bill problems in 2008, up from 16.5 percent in 2007. Still, access to care is "generally good in Massachusetts and health reform made it better," said study author Sharon Long.

The affordability problems that have started to resurface, she said, can not be blamed on the state's overhaul, but on a much larger and troubling national trend. "Healthcare costs, in general, are increasing faster than inflation," Long said.

One number that remained unchanged, the report found, was the roughly 15 percent of Massachusetts residents who reported throughout the surveys that they used hospital emergency rooms for nonurgent care. One key goal of the state's initiative was to drive down ER use - which can be expensive - by extending insurance to nearly everyone, so they could regularly visit their family physicians. When asked why they used ERs for nonemergency conditions, roughly 55 percent of the adults reported going because they were "unable to get an appointment as soon as one was needed," the report found.

Difficulties finding a physician were much more common for low-income than higher-income residents. And adults with state-subsidized health insurance were much more likely to be told that a physician was not taking their type of insurance - 24 percent - compared with those with private insurance, 7 percent. [Isn't that precisely what the whole scheme was supposed to eliminate?]

But cost remained the overarching concern. A special state commission, created last year, is racing to identify ways to slow soaring healthcare costs in Massachusetts, where spending is growing by more than 8 percent annually, driven largely by the high price and heavy use of hospitals.

The high price of healthcare is a hurdle the Boston-based Access Project hears about daily from families who increasingly find that medical bills are eating larger portions of their budget. Yet the project's executive director, Mark Rukavina, said that while the percentage of Massachusetts residents reporting problems is creeping up toward 20 percent, again, that figure is closer to 28 percent nationally. "We have a much more generous safety net here in Massachusetts than is the case in most other states," he said.

That safety net, expanded during the state's healthcare overhaul, extended help paying insurance to more working poor families and also provided more money to community health centers and, until recently, urban hospitals that typically serve poorer neighborhoods.

"At the same time," Rukavina said, "the fact that nearly one in five people in Massachusetts are accruing medical debt in such a large, insured population is unacceptable. [Isn't that precisely what the whole scheme was supposed to eliminate?] It certainly is a measure that policy makers in Massachusetts should pay attention to, to ensure those medical debt numbers are declining and not increasing."

SOURCE




Patients forced to wait hours in ambulances parked outside British hospital emergency departments

Ambulance chiefs have warned that lives are being put at risk "on a daily basis" by long delays allowing patients into Accident and Emergency units

An investigation by The Sunday Telegraph has found that thousands of 999 [emergency] patients are being left to wait in ambulances in car parks and holding bays, or in hospital corridors – in some cases for more than five hours – before they can even join the queue for urgent treatment. Experts warn that hospitals are deliberately delaying when they accept patients – or are diverting them to different sites – in order to meet Government targets to treat people within fours hours of admitting them.

The extent of the problems have been revealed in correspondence between senior health officials, obtained under the Freedom of Information Act, which also show their serious concerns about the dangers the delays pose to patients. A letter by Sir Graham Meldrum, chairman of West Midlands Ambulance Service, sent to hospital chief executives last November warns that patients are "being put at risk on a daily basis", with 7,600 patients a month facing delays of more than 30 minutes – a situation which has since deteriorated, with more than 8,000 such delays in March.

The documents also reveal an investigation into the death of a patient who waited three hours to be seen by A&E staff after being taken by ambulance to The Royal Wolverhampton Hospitals Trust.

On two occasions in January, ambulances took more than five hours to unload patients at Queen's Hospital in Romford, Essex. In the same month, journeys to Weston-super-Mare hospital in Somerset were repeatedly held up, with more than a dozen waits of two hours, including delays of four and five hours.

Dozens of A&E units refused all 999 arrivals for periods of several hours, on hundreds of occasions, forcing crews to take desperately sick patients on lengthy journeys, and shifting pressures to other hospitals, the documents show. In the course of six months, hospitals in the West Midlands ordered a "divert" on more than 450 occasions, closing A&E units to all 999 arrivals for hours at a time. During a six-week period last autumn, hospital chiefs in the north east of England closed casualty units to 999 arrivals on 34 occasions, for up to 19 hours at a time.

Internal documents from the London Ambulance Service reports of extensive delays throughout December: "Ambulances have queued in large numbers for up to five hours to unload, and two hour delays were relatively common," it says.

The briefing note, written in January, says hospitals were so short-staffed that ambulance staff were regularly forced to look after multiple patients simultaneously, so that colleagues could respond to 999 calls.

Delays to patients arriving to A&E by ambulance are increasing in many parts of the country as hospitals struggle to cope with a massive increase in the number of emergency hospital admissions since family doctors stopped providing routine out-of-hours care. Since the changes were made five years ago, the number of emergency hospital admissions has risen by 30 per cent, while the number of beds fell by more than 20,000. More than 100,000 ambulance journeys were delayed at casualty units by more than 30 minutes in the month of March alone – an increase of 18 per cent in 12 months.

Mike Penning, the shadow health minister, said: "Labour's tick box culture is forcing staff to prioritise the four hour target ahead of ensuring patient get the treatment they need. "It is madness that all of this has happened at a time when the number of people being admitted to A&E units is soaring."

Ambulance staff and patients groups said hospitals were routinely ignoring NHS guidance which says the "clock" for the A&E four hour wait should start 15 minutes after an ambulance arrives on site. Katherine Murphy, from the Patients Association, said: "We are hearing increasing numbers of stories of seriously-ill patients lying in pain in ambulances, worried out of their mind, while others are taken on long journeys because casualty units have been closed. "The guidance may say they should not be delayed, but the A&E target is the one that comes with financial penalties attached, and it is the one hospitals care about."

Most ambulance trusts measure delays by "turnaround time" – the time between the ambulance's arrival at A&E and its availability for the next call. It includes any time cleaning or restocking the vehicle, which should take no more than a few minutes. Research by one ambulance trust found three quarters of delays occurred before the patient was handed over to staff, and that 84 per cent of those cases were connected to bed shortages.

Sam Oestricher, ambulance representative for trade union Unison, said ambulances were being treated "as mobile waiting rooms". He said: "Our members are spending hours effectively babysitting patients, who have been rushed to A&E departments because they need to be seen urgently. "It leaves patients and crews in a terribly anxious, frustrating situation, and it greatly increases the risks."

Jim Wardrope, A&E consultant at Sheffield Northern Hospital and past president of the College of Emergency Medicine said: "The whole system is running hot, so that when the pressure comes, it backs up quickly and we end up desperately searching for trolleys."

Health Minister Ben Bradshaw said "severe action" would be taken against any hospitals found to be keeping patients in ambulances in an attempt to cheat on the A&E targets. He added: "The vast majority of hospitals up and down the country are meeting the four hour target without keeping people waiting in ambulances."

More than 4,800 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.

SOURCE