Quis custodiet ipsos custodes? Britain's hospitals may be bad but the regulators are worse
Another week, another hospital scandal. The story is beginning to be all too familiar: dozens of patients dying needlessly, in filthy conditions that would shame a Third World country.
It emerged on Thursday that inspectors making unannounced checks in October on Basildon and Thurrock University Hospitals NHS Foundation Trust discovered a collection of horrors: blood spattered on floors and curtains, mattresses soaked with foul-smelling stains, contaminated equipment, a high rate of pressure sores among the elderly, long waiting times in the accident and emergency department and, worst of all, poor nursing care, with old people deprived of food, attention and dignity. As a result, about 70 people in the care of the Basildon and Thurrock trust may have died needlessly: its mortality rate is a third higher than the national average.
Ministers and media expressed shock and horror, but within hours there was news of another scandal of just the same sort. On Friday the regulator Monitor, which supervises NHS foundation trust hospitals, announced it had sacked the chairman of the Colchester Hospital University NHS Foundation Trust: Colchester also has higher than average mortality rates. Monitor charges the trust with poor leadership, long waiting times, poor infection screening, poor children’s services and worsening patient satisfaction. It is not often that someone gets sacked these days — something must be really bad.
That makes three hospital horror stories this year, counting the reports in March about conditions at the Mid Staffordshire NHS Foundation Trust; 400 people died there needlessly. Monitor has concerns about a further eight trusts.
What on earth is going on? It is bad enough that we have some — perhaps many — dreadful hospitals, even though the NHS budget has tripled in the past decade. What is even worse is that it seems difficult to have any confidence in the many people and organisations responsible for overseeing hospitals and anticipating these problems — not just bad hospitals but bad supervision. Why has it taken so long for these bad practices and poor outcomes to be noticed? The mortality figures have been available for more than 10 years.
In the case of Basildon and Thurrock, the Care Quality Commission (CQC), the new independent regulator for all health and social care in England, was the body that inspected the trust and published the dreadful findings. Yet last month it posted on its website a glowing report on the trust, giving it 13 out of 14 for cleanliness and 5 out of 5 for keeping the public healthy. This report, astonishingly, is still there.
The CQC knew this information was wrong; it must have realised the report would be misleading to the public who went to the site to check hospitals’ performance. Yet it has left the report on its site. One can only wonder about the information on other hospitals. Why should one trust any of it?
Baroness Young, the chairwoman of the CQC, found herself in an impossible position last week, confronted with this inconsistency. Wriggle as she would under the probing of the Today programme, she could do no better than to say her organisation is only eight months old and the report on the website was done months ago under the previous regime — the Healthcare Commission — and things are going to be much better now. She failed to deal with the problem of public trust.
She also failed to inspire confidence in her strange attack on the methodology of hospital mortality figures provided by Dr Foster Intelligence, an organisation the public might actually be able to trust. It is a partnership between the NHS and the Dr Foster unit at Imperial College; it provides monthly and carefully adjusted mortality figures across the NHS, which are known for their reliability and which have directly prompted all the recent investigations into problem hospitals. Dr Foster now makes a point of writing to all NHS hospital chief executives to warn them when their mortality rates begin to rise.
I wonder what Baroness Young thinks is wrong with the figures or their methodology. The rest of the CQC seems to think they are all right and a useful tool for looking at hospital performance. In fact, everyone seems to accept the Dr Foster figures apart from a few ministers. On Saturday morning, for instance, Andy Burnham, the health secretary, called for an investigation to uncover high death rates across the NHS.
But that information exists already, in neat monthly packages from Dr Foster Intelligence; there can be no point in calling for it, other than wearisome politics.
Altogether this government’s NHS policies bring to mind an interfering child with attention deficit hyperactivity disorder. Since 1997 we have had six secretaries of state for health. That means an average of two years in post. It is impossible for anyone to understand the essentials of our byzantine health service in such short fits of attention.
As for the regulators, including the one Baroness Young seems to think was not up to snuff, we have had at least three upheavals of regulations under Labour — the Commission for Health Improvement, then the Healthcare Commission and now the CQC. Such constant change must be at odds with good management.
It is hardly surprising that the public has become so suspicious; there may not be many data about the death of trust in this country, but the anecdotal evidence is overwhelming. Who monitors the monitors? Not only hospital regulation is at issue.
All around us this question keeps emerging.
To the weary citizen, the Chilcot inquiry into the Iraq war looks just another attempt to avoid any awkward truths. No one is to be on trial; no one is to be blamed. No one has to appear, either, and Macavity Brown, to his shame, won’t be anywhere to be seen. Who is there to insist on what’s right?
The Ofsted report last week was deeply depressing for its cautiously expressed findings — failing schools, illiterate children and poor teaching. What’s worse is that Ofsted and its predecessors have been inspecting and reporting fairly cheerfully for decades, while standards have fallen lower and lower. The Walker inquiry into banking is yet another affront to an angry public. Who is there to insist on public probity? That is the question, sadly. Who will guard the guards themselves?
Twelve NHS hospital trusts have been identified as “significantly underperforming” on a range of safety measures according to new research which has ranked every general hospital in England.
The low performance conclusions came despite overall patient care at eight of these trusts rated as good or excellent last month by the Care Quality Commission (CQC), the health service regulator.
The critical research conducted by Dr Foster, a consultancy that collates independent league tables on NHS trusts, also identified 27 trusts with unusually high death rates involving the deaths of 5,000 more patients in the past year than had been expected. The new data are contained in The Dr Foster Hospital Guide 2009 which contains a league table of NHS trusts across England with their performances rated on patient safety.
Basildon and Thurrock University Hospitals NHS Foundation Trust, Scarborough and North East Yorkshire Healthcare NHS Trust and Lewisham Hospital NHS Trust in south London are identified as the poorest overall performers. Basildon and Thurrock, Royal Bolton Hospital NHS Foundation Trust and Tameside Hospital NHS Foundation Trust in Greater Manchester are also named by Dr Foster as having the highest mortality rates.
The report includes incidents of 209 foreign objects such as drill bits left inside patients after surgery; 82 incidents where the wrong part of the body was operated on; and 848 patients under the age of 65 admitted with low-risk conditions who subsequently died.
Barbara Young, who chairs the CQC, last night assured Andy Burnham, the health secretary, there was no evidence that direct intervention was needed in other hospital trusts, apart from Basildon, despite the Dr Foster data.
The NHS boss in charge of Basildon and Thurrock had received an 11% pay rise in the past year. Alan Whittle, chief executive of the trust, who was paid £150,000 during 2008-9, also saw the value of his pension pot increase by nearly £500,000 to £1.5m over the same period.
Details of Whittle’s pay emerged after a CQC report found that poor nursing, dirty wards and a lack of leadership had contributed to an estimated 400 avoidable deaths at the Basildon hospital last year.
A CQC spot check last month had uncovered soiled mattresses, poor clinical practices, mould growing in suction machines and out-of-date medical equipment.
Katherine Murphy, director of the Patients Association, a pressure group, criticised a culture of “rewards for failure” within the National Health Service. “Surgeons and doctors who fail patients can be struck off and the same should be true of NHS executives,” she said.
Michael Large, the trust’s chairman, said Whittle’s 11% pay rise reflected the hospital’s higher turnover and greater responsibilities for executives.
Yesterday it emerged that Whittle is having a relationship with Karen Bates, a hospital safety manager who also serves on the hospital’s board of governors.
British woman dies after cancer screening blunder at NHS hospital
And the blunder was covered up
One woman has died and hundreds of other cancer patients put at risk after a crucial machine used to test for the best way to treat the killer disease developed a fault that was not repaired for at least a month. The NHS hospital at the centre of the blunder failed to tell patients their results may have been wrong due to the broken equipment. It also did not report the incident to the medical authorities – an apparent breach of Department of Health rules designed to protect patients and alert doctors to problems.
Last month, mum Tracey Kindley, 43, died of breast cancer after learning her treatment had been based on inaccurate test results. She was being treated at a private hospital in North London after she discovered a suspicious lump in March 2005.
Her doctors performed a biopsy and sent it to a local NHS Trust’s pathology department, which confirmed her cancer. But one of the machines used at the Queen Elizabeth II Hospital, in Welwyn Garden City, crucial in assisting her doctors in deciding the best treatment for the cancer, was not working correctly. The machine – used to test hormone levels – gave a ‘false negative reading’ for oestrogen, meaning she was not prescribed certain life-saving drugs because it was thought they would have no effect on her cancer.
Her doctors spotted the error only when she failed to respond to treatment and the cancer spread. The doctors ordered new laboratory tests on the original biopsy and these results showed very high oestrogen levels in the cancer cells, alerting them to a major error. Health service managers at the Queen Elizabeth II ordered checks and discovered the machine had developed a fault around the time of the tests on Mrs Kindley.
A service report on the equipment shows a ‘critical repair’ was carried out on May 6, 2005. The managers claim the machine was ‘fixed within days’ of the problem being identified, but crucially Mrs Kindley’s tests were carried out on April 8 – almost a month before the fault was spotted. The East and North Herts NHS Trust, which oversees the hospital, re-examined the results of other patients whose samples were tested on days either side of Mrs Kindley’s.
However, an internal investigation concluded the incident was a ‘one-off’ and that despite testing hundreds of patients during the period, no other patients could have been affected. The conclusion meant patients tested when the machine is known to have been malfunctioning – a period of around four weeks – were never alerted that they, too, may have been given the wrong results.
In the weeks before her death, Mrs Kindley began a legal action against the hospital. Her lawyer Hugh Johnson, of Stewarts Law, believes that had she been given the right treatment, she would have had a 70 per cent chance of making a full recovery.
In his letter to the Trust, Dr Nihal Shah, Mrs Kindley’s consultant clinical oncologist, wrote that she ‘had concerns that a similar scenario does not arise for other patients’.
Mrs Kindley died on October 28. Yesterday, her husband said he blamed the test errors for his wife’s death. ‘I believe they robbed me of my wife. The right results would have opened up other forms of treatment and I believe she would be with me and her son Max now.’
Last night, the Trust acknowledged the tests carried out had given a ‘partial false negative result’ and it has apologised that this should have happened. It admitted that the problem had not been reported to the Medicines and Healthcare product Regulatory Agency. ‘That decision is now being reviewed.’
Australia: Government hospitals chase away the sick by long delays and then call them "treated"
The "DNW" racket. Australian government hospitals are clearly just as good as British ones at "fudging" their statistics, and that is saying something
ALMOST 70,000 sick or injured Queenslanders walked out of emergency departments at the state's largest public hospitals in the past year, mostly because they became fed up waiting to see overworked doctors. And they were not only people with runny noses or sore throats – thousands needing urgent attention also left.
A Right to Information (RTI) search by The Sunday Mail and The Courier-Mail has uncovered the numbers of "Did Not Waits" previously hidden by Queensland Health. The Did Not Waits registered upon arrival but left before they saw a doctor, mostly because of the exasperating wait in overstretched emergency departments.
More than 100 people classified as "emergency" – requiring attention within 10 minutes – left. Another 10,700 classified as "urgent" (within 30 minutes) did not wait. The figures came from the state's 27 largest hospitals.
The 69,800 people who did not wait in the past financial year were not mentioned in the quarterly hospital performance reports published by a department which Health Minister Paul Lucas has praised for its openness. Instead, they were included as "treated". [What a fraud!!] "Queensland reports more than 1800 (health) statistics every quarter – more than any other state," he said. "There are talks at a national level about how other states can implement similar reporting standards."
Doctors have told The Sunday Mail that they believe Queensland Health keeps quiet about the figures simply to make itself look better. The newspaper has been told about two recent occasions where doctors walked into crowded waiting rooms at major hospitals and told patients who were not critically ill that they would not been seen for at least six hours. One doctor, who asked for his name to be withheld, said he advised patients who thought they could hold off seeing a doctor that they should consider going home and taking with them any medication, such as Panadol, that might help them recover from their ailment.
One doctor conceded that, while most left because they were tired of waiting, there were some who took off for other reasons, including that they were scared that their injuries were part of a potentially criminal incident.
The RTI search was done as part of the Critical Condition series, which will continue this week in The Courier-Mail. It will look into public hospital bed numbers and the strain on emergency departments.
ObamaCare has nothing going for it anymore. With unemployment touching double digits, its economic timing is bad; with polls showing tanking support in every group outside of the narrow sliver of die-hard liberal reformers, its political timing is bad; and with the Center for Medicare and Medicaid Services last week saying that it'll add billions to the already out-of-control deficit, its fiscal timing has gone from bad to awful.
So how are Comrades Pelosi, Reid, and Obama able to march ahead with their grand designs undeterred? One reason is that Republicans have done precious little to seize the moral high ground from them. By insisting on the removal of the public option—instead of the individual mandate—as the price of doing business, Republicans have missed a major opportunity to put Democrats on the defensive and change the terms of the debate.
Republicans threw down the gauntlet on the public option—a government-funded, Medicare-style insurance plan that will compete with private insurance—in a June letter to Obama. "Washington-run programs undermine market-based competition through their ability to impose price controls and shift costs to other purchasers," they said. "The end result would be a federal government takeover of our health care system, taking decisions out of the hands of doctors and patients and placing them in the hands of a Washington bureaucracy."
True. But the problem is that Democrats don't need the public option to engineer a "federal takeover of our health care system." All they need is the power to force Americans to purchase insurance.
A mandate will fundamentally alter the relationship between Americans and their government. Instead of the government being accountable to them, they will become accountable to their government. No less than the Congressional Budget Office—a non-partisan government agency—once admitted as much. "A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action," it noted. "The government has never required people to buy any good or service as a condition of lawful residence in the United States."
If the government can force Americans to buy coverage on the threat of fines or even imprisonment—an option that Nancy Pelosi has pointedly refused to rule out—every other government diktat becomes small potatoes by contrast. In fact, it becomes necessary. If uninsured Americans must buy coverage, why shouldn't other Americans be taxed to subsidize them? Why shouldn't the insurance industry be required to sell them coverage? Why shouldn't government set insurance prices to ensure affordability? Why shouldn't doctors and hospitals be asked to charge only "reasonable" rates—or offer only government-sanctioned treatments? Nothing about ObamaCare fundamentally changes so long as the individual mandate remains intact.
Therefore, instead of wonkishly droning about the public option, Republicans should counter Democrats' grand appeals for "universal coverage for all" with equally grand appeals for "medical freedom for all." They should stand together on the Capitol steps and issue the health care equivalent of Reagan's Berlin Wall ultimatum: "Mr. President: Tear up this mandate."
During the campaign, Obama himself successfully stopped poor Hillary dead in her tracks by reminding voters at every turn of her tyrannical plans to force them to purchase coverage. So why aren't Republicans doing the same to Obama?
The main reason is that they themselves are deeply conflicted about the mandate. On the one hand, every Republican on the Senate Finance Committee voted against it—except, of course, for Maine's Sen. Olympia Wavering-Heart Snowe. On the other hand, many Republicans, led by their intellectual lights at the conservative Heritage Foundation, among others, have long accepted—no, championed—the notion that unless people are forced to carry insurance, freeloaders who land in emergency rooms will cripple the health care system. Legislate personal responsibility, in other words. It was a Heritage plan for forced coverage that formed the blueprint for the Massachusetts universal care debacle that the then Republican Gov. Mitt Romney enacted.
Thus Republicans have no leg to stand on now that Obama, pulling one of his many switcheroos, has embraced the individual mandate. Heritage folks are trying to pull their own switcheroo by opposing Obama's mandate, saying what they had originally proposed for Massachusetts was not really a mandate but actually a self-insurance scheme under which an uninsured person would have to post a personal bond before being treated in an emergency room.
But countering mandates with bonds doesn't exactly make for a rousing rallying cry. Indeed, both ideas are based on the mistaken diagnosis that the central cause of our health care woes is the cost of uncompensated care that the uninsured get. The fact of the matter is that this care accounts for no more than $40 billion of the country's $2.26 trillion health care bill—or less than 3 percent of total health care spending. This is less than what department stores lose to shoplifting every year. Several private hospitals that I visited in India last month make a fraction of the profits that American hospitals do but still reported treating up to 10 percent of their patients for free.
The mandate barring American hospitals from denying treatment to anyone who lands in emergency—the root of the supposed freeloader problem—certainly imposes a heavy burden on some hospitals, especially in inner cities. But it is far from clear that it forces American hospitals as a whole to provide more charitable care to the uninsured than what they would have without it. It would certainly be worthwhile at some point to consider policy options to replace this mandate with mechanisms to strengthen voluntary charity by hospitals and others. In the meantime, however, there is zero evidence to suggest that this mandate is imposing a crippling enough burden on hospitals to warrant mandates on everyone else as well.
The Republican strategy for defeating ObamaCare consists of notifying: seniors that they will face rationing and loss of private Medicare options; the uninsured that they will face fines and possibly jail; the young and healthy that they will have to subsidize the old and sick, etc. Alerting Americans to the personal dangers they will confront under ObamaCare is certainly a legitimate part of the political process.
However, the downside of a strategy based entirely on fear is that even if it succeeds now, it won't help to define the proper terms for a genuine solution in the future. For that, Republicans have to offer a principled critique of ObamaCare that delineates the sharp moral choices that Americans face. The current health care battle is the domestic policy equivalent of the Cold War. Democrats are on the side of command-and-control mandates that deprive individuals of choice. Republicans should position themselves on the side of market-based solutions that empower—not enchain—patients.
Why tragedy will be result of Dems rush to victory on health reform
House Speaker Nancy Pelosi begged, cajoled, and threatened health care legislation to a successful vote in her chamber, albeit by a razor thin margin of 220-215. The administration and House leadership touted this as a landmark vote, which it is, but only if you ignore the fact that the bill achieves almost none of President Obama's promised health reform goals. In fact, it is very likely to explode the deficit, drive up health care costs, and inflict massive new taxes on middle-class Americans.
Watching events unfold in Washington at first hand, it's become clear that health reform has become the Democrats version of "Moby Dick," as party leaders embrace the premise that they must pass something this year and declare victory, no matter how flawed the final product is. Unfortunately, they may sink the economy along the way.
If clearer heads prevailed, Congress would scrap these partisan bills and start over:
Both the House and Senate bills will cost well over $1 trillion over the next ten years. The CBO scores the Senate bill at $829 billion and the House bill at $1.055 trillion, but only because of the most transparent budget gimmicks. The Senate Budget Committee puts the fully-implemented price tag at roughly $2.5 trillion for the first decade - demolishing the president's promise that reforms would not cost more than $900 billion.
The cost curve for spending gets bent...up. The CBO says spending in both bills rises at 8 percent annually as far as the eye can see and CMS actuary Richard Foster says that national health spending gets worse, not better. So much for the president's repeated assurances that reform would slow the rate of health care inflation.
New entitlements plus cost growth equals taxes, and debt, debt, debt. The CBO only scores the bills as reducing the deficit because Democrats pretend that Medicare docs will get slashed by over 20 percent in two years. Reality says Congress will borrow about $240 billion for the "doc fix". Democrats pretend they will cut over $400 billion out of Medicare through more vigorous price controls - cuts that will never live to see the light of day. Get ready for a bubble in health entitlement debt.
What isn't borrowed in these plans is inflicted on drug companies, diagnostic companies, private health insurance companies, "Cadillac" health plans, and individuals and businesses that don't buy government mandated coverage. These taxes and fees, roughly 90 percent of which fall on families making under $200,000 a year, must grow even faster (10 percent annually) to keep up with the new spending spree.
Private insurance: expensive or off-limits. Taxes, fees and ill-conceived insurance reforms raise the specter of double-digit premium inflation for the majority of Americans with insurance. Millions will find their policies don't pass muster with the bill's insurance czar, driving them to more costly policies. The rest? Fifteen million will be thrust into Medicaid as eligibility rises to 150 percent of poverty.
It's not too late for moderates and conservatives in Congress to force Nancy Pelosi and Harry Reid to chart a safer, bipartisan course. Here are five fundamental, commonsense reforms that will cost less, improve health care quality, and expand coverage:
1. End the tax exclusion for health care and replace it with a standardized tax credit or tax deduction. Economists from (Obama adviser) Jason Furman to Martin Feldstein know that the tax exemption for employer-provided insurance is regressive (the rich benefit more), arbitrary (why tie insurance to employment?), and drives up health care inflation. End it - the largest tax break in the code - and use the proceeds to expand private insurance.
2. Expand existing state high-risk pools to address pre-existing conditions. Today, 35 states have high risk pools that they use to subsidize coverage for Americans who might go without coverage because they have pre-existing health conditions that make coverage very expensive or unavailable in the individual insurance market. Federal dollars should go to states that embrace model high risk pools offering affordable premiums and disease management plans that help keep beneficiaries in better health.
3. Create real interstate insurance competition through a transparent national market. The president and Congress talk a lot about competition. But forcing consumers to choose among three or four expensive government designed plans - bronze, silver, gold or platinum, stacking the deck in favor of public plans, and hamstringing private insurance isn't real competition. Could we limit consumers to four choices of cars, computers, or colleges and call it competition? Congress should allow interstate sale of insurance, but mandate transparency and standardized coverage descriptions so that consumers always know what they are buying and can easily compare different coverage options.
4. End waste fraud, and abuse in the Medicare and Medicaid program. Experts estimate that Medicare alone may lose up to $60 billion (about 10 percent of total spending) in fraud annually, but the government spends almost nothing on tracking and uncovering fraudulent schemes in federal health programs. Congress should switch to the best practices models use to detect fraud in the credit card industry by relying on real time algorithms to detect fraud at the point of service and stop it in its tracks.
5. Enact real tort reform that will end lawsuit abuse and reduce defensive medicine. Former DNC chairman Howard Dean admitted his party's allegiance to the plaintiff's bar precludes backing tort reform. So the president has acknowledged that lawsuits "may" drive up health care costs - but hasn't offered any serious solutions. Bipartisan malpractice reforms do exist - from expert health courts to a "safe harbor" for doctors who embrace best practices - that could reduce lawsuit abuse. The CBO estimates that tort reform could save $54 billion over ten years.
Republicans and Democrats agree that health care reform is a critical issue for the nation's future. But the Democrats have developed deeply flawed, partisan reforms that expand coverage without fixing any of the systems' underlying problems. Unless they chart a new, bipartisan course soon their rush to declare victory will result in a national tragedy.
Investigation into NHS deaths after hospital scandals
An immediate investigation to uncover the true extent of death rates across the NHS has been ordered by the Health Secretary after scandals at two hospital trusts. Amid claims that patients are dying due to poor care in at least 27 hospitals around the country, Andy Burnham said that patient safety was paramount and must take precedence above all else.
His comments come after the head of a foundation trust in Colchester, Essex, was sacked over concerns about high death rates, leadership and waiting times. Failings in patient care had previously been linked to the deaths of between 70 and 400 patients at Basildon and Thurrock NHS Foundation Trust, also in Essex.
Mr Burnham used a speech at the Royal College of Midwives conference in Manchester to promise tougher action, saying that he had told the Care Quality Commission (CQC) to “establish immediately whether there are any other trusts at which similar issues demand immediate investigation”.
Monitor, which oversees NHS foundation trusts, removed Richard Bourne as chairman of Colchester Hospital University NHS Foundation Trust yesterday after the trust failed to meet waiting time targets for nine months. A taskforce of senior doctors and nurses was also sent to force improvements at Basildon and Thurrock after a damning report found poor hygiene and standards of care. The death rate at the trust was about a third higher than the national average, while at Colchester it was about 12 per cent higher.
Dozens of trusts could now be investigated by the CQC, which monitors data on mortality rates for all trusts in England. Overall, there have been 121 alerts on high death rates over the past two years that have required investigations. The alerts, based on information from the Dr Foster Unit at Imperial College London and the CQC, are triggered if numbers of deaths among hospital patients are significantly higher than expected.
The Conservatives claimed that at least 25 other hospital trusts had death rates higher than the national average last year, with at least 3,100 more deaths than would have been expected in 2007-08.
Cynthia Bower, the chief executive of the CQC, welcomed Mr Burnham’s request. She said: “We are constantly vigilant about safety on behalf of patients. This includes monitoring death rates across the NHS as well as other quality of care issues. “Statistics can raise questions but cannot always provide answers. You need to follow up by carrying out inspections, talking to staff and listening to people who use the services and that is what CQC does. We can and do act swiftly wherever we find reasons for concern.”
The Patients Association said that people had been appallingly let down by standards of care at the two trusts in Essex.
The Colchester trust, which serves about 370,000 people in northeast Essex, had slipped from “excellent” to “fair”, according to the CQC’s rating last year. Sir Peter Dixon has been appointed interim chairman of the trust.
At Basildon and Thurrock, CQC inspectors had found blood-splattered equipment and soiled mattresses. Equipment that should have been used once was being used repeatedly and resuscitation room equipment was past its use-by date.
Only the market can make health system person-centred
Vouchers needed, says Dr Jeremy Sammut
According to the NHHRC, the most important health reform recommendations in the Bennett Report will make the health system person-centred by reorienting the system around stronger primary care. This will supposedly allow health consumers to have access to the services they need rather than only have access to the current mix of ‘hospital-centric’ health services that governments want to offer.
The idea of a person-centred rather than government-centred health system is borrowed from the market-based principles associated internationally with the consumer-directed health care movement. The aim of consumer-directed health care is to reform the old-fashioned ‘command-and-control’ arrangements that limit choice and prevent competition in the government sector of the health system.
Right now, the type, amount and mix of taxpayer-funded health services that are or are not provided to Australians are determined by federal and state governments, whose crucial yet often imperfect policy decisions frequently overlook the actual needs of patients.
Health departments allocate taxpayer subsidies in the form of population-based, capped global budgets to public hospitals and community health services, which are expected to deliver an unquantified and indeterminate amount of health services to the community. For consumers, this is well described as a ‘take what you’re given’ system.
Consumer-directed health care would improve the responsiveness of hospital and other health services by the application of quasi-market mechanisms. The key reform is to make funding flexible, responsive, and far more accountable. The taxpayer subsidy should be tied directly to the delivery of services and only be paid at the point at which each occasion of care is provided.
Funding should follow patients by means of a taxpayer-funded voucher, and patients, subject to clinical referral, should be allowed to purchase appropriate services from competing public or private providers.
In the long run, empowering consumers and tying funding to patients based on clinical need and choice of competing providers would reduce costs, while increasing access, quality, productivity, and allocative efficiency. Most importantly, governments would no longer centrally plan the type, amount and mix of health services as the supply would be set by the actual health needs of individual patients.
Market-based structural reform that promoted the efficient use of scarce resources would therefore establish a truly person-centred health system.
The above is a press release from the Centre for Independent Studies, dated November 27. Enquiries to cis@cis.org.au. Snail mail: PO Box 92, St Leonards, NSW, Australia 1590.
Government health agency gets criticism of its incompetence censored
Another botched and dangerous attempt at computerization
The University of Sydney removed from its website an extremely critical essay about a new multimillion-dollar emergency department IT system after pressure from the NSW Health Department. Doctors, nurses and administrators at four area health services heavily criticised the system - which tracks patients - as posing an "unacceptably high risk" to patient safety because it was so slow, cumbersome and inefficient. Some hospitals have boycotted Cerner FirstNet and reverted to paper to record clinical notes because it is too difficult and too time-consuming to retrieve critical patient information from the system, the essay said. "In a number of cases we know senior clinicians have shut down the use of FirstNet within a few days of it coming online," it said.
This flies in the face of the recommendation last year from Peter Garling's inquiry into public hospitals for full electronic medical records to improve efficiency and patient safety.
The essay, by a medical IT professor, Jon Patrick, said several hospitals also reported it "doubled the delay" before emergency patients were first seen by a clinician. He also said the Cerner contract proposal suggested it was giving a "cheap price" on the proviso of a "speedy finalisation of the contract" which left NSW Health with such an "incredibly tight schedule" it stymied proper clinical consultation.
The essay was published late last month but NSW Health asked that it be removed, Professor Patrick said on his website. The university then published it again two weeks later. "I have been able to establish confidently that NSW Health phoned my head of department and asked him to remove the article without giving a specific complaint," Professor Patrick wrote on November 5. On Wednesday, he wrote: "The university has affirmed my right to publish my critical essay and the attempt to censor me has been mitigated."
The Deputy Director-General of NSW Health, Tim Smyth, told the Herald that the acting chief information officer, Craig Smith, contacted the university about the essay but did not ask for it to be removed. "That's entirely a matter for the university but my personal view having read the article is that I don't believe it's balanced, it's certainly not accurate and it certainly misrepresents reality," Dr Smyth said. The assertion of a cut-price deal was "just wrong", he said.
One doctor said: "I prefer looking at a paper result than the counter-intuitive waste of my time trolling [sic] through the system." Another said: "Every single user *hates* it with a passion … ENTERING the data is a pure nightmare."
Cerner FirstNet follows emergency patients and includes test results and statistics such as beds available. It is part of a massive three-year electronic records project due by June.
Professor Patrick has worked on IT projects with permission from area health services but was not asked to assess Cerner FirstNet.
Grim treatment of patients in government mental hospitals in Western Australia
A psychiatric patient claims to have been raped while in the care of WA's mental health system, according to a new report. The disturbing claim was contained in a report by the WA Council of Official Visitors, which includes allegations of serious breaches of mental health patients’ rights.
The patient claimed to have raped by a guest of another resident while staying at a mental health hostel. The Council of Official Visitors supported the rape allegation and the claim led to an upgrade of security at the hostel. The alleged victim has since left the hostel.
Other claims of neglect include allegations that some patients were being tied down and forced to spend the night soaked in their own urine. Food served in mental health facilities was often described as poor by patients. Meanwhile, parents of patients have complained that they are searched before they can see their children as if entering a jail. An elderly female patient said she was not allowed to keep personal belongings like a toothbrush. Some patients had been dumped in maximum security wards for up to six years when they should be cared for in the community.
According to the council, life for patients in these wards was grim. “They live in an artificial locked ward environment, not receiving the type of care which would best enhance their recovery potential,” the report said. “They don’t get to choose when to eat, how much coffee to drink, who to associate with, or if and when to smoke.”
Council of Official Visitors head Debora Colvin said some mental health patients were not given access to the toilet while they are "secured" in a locked ward. Patients are still being forced to travel in the back of a “paddy wagon” for long distances without a break. The report said there were major concerns that second opinions weren't being properly conducted throughout the WA mental health system.
Mental Health Minister Graham Jacobs said there was some good news in the report. Dr Jacobs said it was the first time in 11 years there was a 20 per cent reduction in the number of people who contacted the council to make a complaint. “The natural assumption is we’re doing a little better,” he said.
Dr Jacobs said there was a need for more community supported accommodation for people with a mental illness, which his Government was establishing. “Instead of large cluster homes on hospital grounds we want small home-like facilities in the community,” he said. Dr Jacobs said there had been improvements to secure wards at hospitals in Graylands and Joondalup.
A Mental Health Commissioner is also expected to appointed early next year for WA.
The House and Senate health care legislation resembles a game show more than deliberate exercise in public policy. As confusing and confused legislation language is translated into dollars and cents, how much Americans will find themselves paying for health care? It looks more and more like a giant game of chance.
Not only is Congress leaving the current inequities created by the federal tax treatment of health insurance in place, it is busy creating new ones.
Family Premiums. The Congressional Budget Office (CBO) estimates that under the House bill, the average premium in 2016 will be $15,000 and the average cost sharing will be $5,500 for a family policy or a total of $20,500. Under the Senate bill, the average premium will be $14,100 and the average cost sharing will be $5,000 for a family policy or a total of $19,100. Is the higher cost House plan better? How do we know? If the Senate can come in $1,400 lower than the House, could the price tag be lowered by another $1,400? If not, why not?
Under the House bill, a family of four with income of $30,000 will receive the $20,500 value for just $1,100, or less than $100 per month. The family will receive premium and cost sharing subsidies from their neighbors worth $19,400. Under the Senate bill, a family of four with income of $30,000 will receive premium and cost sharing subsidies worth $16,800, still quite generous. These subsidies are so generous in fact, that the House and Senate leaders don’t want millions of Americans to have them to buy private health insurance.
The Medicaid Solution. So, instead of providing these taxpayer subsidies, the House and Senate will put 15-20 million people into the Medicaid program where they are not eligible for the subsidies at all. It is “cheaper” for Congress to put people into Medicaid program, a welfare program, which pays doctors and hospitals at least 20-25 percent less than private health plans. Moreover, as the Chief Actuary of the Centers for Medicare and Medicaid Services warns, the cost will be lower under Medicaid because access to care will be more limited than under private coverage. Don’t expect the same level or quality of medical services.
New Inequities. Millions of low-income Americans who are insured through their employers will not be eligible for these new subsidies either. What do we suppose will happen when they find out that their neighbors- who make more money than they do- are receiving these huge taxpayer subsidies courtesy of Congress while they are locked into an employer plan with no choices and higher cost sharing?
For a family of four with income is above $78,000, the Senate bill, at least superficially, looks better. This family’s total premium and cost sharing will be $12,900 compared to $13,800 under the House bill. For a family of four with income of $90,100, the family’s costs under the Senate bill is $14,200 or $2,400 less than under the House bill.
Mass Dependency. If the Senate manages to pass its 2074 page bill, the House and Senate leadership will somehow split the differences behind closed doors. If this massive legislation passes both Houses again and becomes law, health policy becomes a powerful new political tool for the congressional redistribution of health care. In a few years, more than half of all Americans will be receiving direct subsidies from government through Medicare, Medicaid, and the new subsidies. Politicians will be able to add disposal income to a family’s budget by increasing the subsidies. By making more Americans dependent on government, the congressional champions of this style of governance are betting that this legislation will keep them in power for many years to come.
But they are also gambling on probability models to predict behavior. But, like all central planning schemes, people do not always behave the way the central planners expect. In fact, referring to the provisions of the House bill (H.R. 3962), the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS) the patterns of behavior are “impossible to predict.” Costs will explode if CBO has underestimated the number of employers that will drop their private health coverage. If just one state figures out the windfalls that could be realized by dropping out of Medicaid, and saving itself billions by escaping the collateral federal mandates, others will surely follow. States Are already strapped with rising Medicaid costs, costs aggravated by the provisions of the House and Senate bills. A state-based Medicaid meltdown would shift more than a trillion dollars of cost to the federal taxpayers.
The health care legislation headed for the Senate floor next week is not sound public policy. It is a giant game of chance. Millions of Americans stand to lose. A lot.
The United States has the best health care in the world -- but because of its inefficiencies, also the most expensive. The fundamental problem with the 2,074-page Senate health-care bill (as with its 2,014-page House counterpart) is that it wildly compounds the complexity by adding hundreds of new provisions, regulations, mandates, committees and other arbitrary bureaucratic inventions.
Worse, they are packed into a monstrous package without any regard to each other. The only thing linking these changes -- such as the 118 new boards, commissions and programs -- is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony. The result is an overregulated, overbureaucratized system of surpassing arbitrariness and inefficiency. Throw a dart at the Senate tome:
-- You'll find mandates with financial penalties -- the amounts picked out of a hat.
-- You'll find insurance companies (who live and die by their actuarial skills) told exactly what weight to give risk factors, such as age. Currently insurance premiums for 20-somethings are about one-sixth the premiums for 60-somethings. The House bill dictates the young shall now pay at minimum one-half; the Senate bill, one-third -- numbers picked out of a hat.
-- You'll find sliding scales for health-insurance subsidies -- percentages picked out of a hat -- that will radically raise marginal income tax rates for middle- class recipients, among other crazy unintended consequences.
The bill is irredeemable. It should not only be defeated. It should be immolated, its ashes scattered over the Senate swimming pool. Then do health care the right way -- one reform at a time, each simple and simplifying, aimed at reducing complexity, arbitrariness and inefficiency.
First, tort reform. This is money -- the low-end estimate is about half a trillion per decade -- wasted in two ways. Part is simply hemorrhaged into the legal system to benefit a few jackpot lawsuit winners and an army of extravagantly rich malpractice lawyers such as John Edwards.
The rest is wasted within the medical system in the millions of unnecessary tests, procedures and referrals undertaken solely to fend off lawsuits -- resources wasted on patients who don't need them and which could be redirected to the uninsured who really do.
In the 4,000-plus pages of the two bills, there is no tort reform. Indeed, the House bill actually penalizes states that dare "limit attorneys' fees or impose caps on damages." Why? Because, as Howard Dean has openly admitted, Democrats don't want "to take on the trial lawyers." What he didn't say -- he didn't need to -- is that they give millions to the Democrats for precisely this kind of protection.
Second, even more simple and simplifying, abolish the prohibition against buying health insurance across state lines. Some states have very few health insurers. Rates are high. So why not allow interstate competition? After all, you can buy oranges across state lines. If you couldn’t, oranges would be extremely expensive in Wisconsin, especially in winter. And the answer to the resulting high Wisconsin orange prices wouldn’t be the establishment of a public option -- a federally run orange-growing company in Wisconsin -- to introduce "competition." It would be to allow Wisconsin residents to buy Florida oranges.
But neither bill lifts the prohibition on interstate competition for health insurance. Because this would obviate the need -- the excuse -- for the public option, which the left wing of the Democratic Party sees (correctly) as the royal road to fully socialized medicine.
Third, tax employer-provided health insurance. This is an accrued inefficiency of 65 years, an accident of World War II wage controls. It creates a $250 billion annual loss of federal revenues -- the largest tax break for individuals in the entire federal budget. This reform is the most difficult to enact, for two reasons. The unions oppose it. And the Obama campaign savaged the idea when John McCain proposed it during last year's election.
Insuring the uninsured is a moral imperative. The problem is that the Democrats have chosen the worst possible method -- a $1 trillion new entitlement of stupefying arbitrariness and inefficiency. The better choice is targeted measures that attack the inefficiencies of the current system one by one -- tort reform, interstate purchasing and taxing employee benefits. It would take 20 pages to write such a bill, not 2,000 -- and provide the funds to cover the uninsured without wrecking both U.S. health care and the U.S. Treasury.
A hospital trust’s “systemic failings” have led to neglect, poor nursing and deaths, regulators have found. Problems at Basildon and Thurrock University Hospitals NHS Foundation Trust, Essex, included patients being left on dirty trolleys, high rates of infection and bedsores caused by poor hygiene and a lack of basic nursing care. Those contributed to an estimated 71 extra deaths last year among accident and emergency patients.
The Care Quality Commission (CQC), an NHS watchdog, said that the trust had reported “persistently high mortality rates” which had not improved, despite warnings. The commission’s inspectors, who conducted unannounced visits to Basildon and Thurrock over the past year, noted blood on floors, curtains, equipment trays and a child’s blood-pressure cuff, mould on life-support machines and resuscitation room equipment that was out of date. The trust was also found to be making patients wait up to ten hours in its emergency department rather than the national target of four hours.
The mortality rate for emergency admissions was 6.1 per cent last year. The national average is 4.4 per cent. Based on about 4,200 patients seen in A&E at the trust last year, this would have led to 255 deaths, an increase of more than 71 deaths compared with what would be expected according to average mortality rates.
The high death rate prompted comparison with the larger Mid-Staffordshire NHS Foundation Trust, where an official report published in March found that appalling emergency care had led to between 400 and 1,200 patients dying needlessly.
Care at Basildon and Thurrock was rated as “good” by the commission in October. But it said that it had lost confidence in the ability of Basildon and Thurrock trust’s management to address the failings that it found on subsequent checks. It believes that the trust could be in breach of its foundation trust authorisation, and therefore has asked Monitor, the independent regulator of foundation trusts, to use its powers to take action. Monitor has the power to dismiss the board of the organisation or take further control.
Most of the inpatient care at the trust is provided at Basildon University Hospital, which has 777 beds. Outpatient care is provided at Orsett hospital.
The trust was one of the first in England to be granted foundation trust status in 2004, which affords it the freedom to manage its finances and a degree of independence from NHS control.
Cynthia Bower, the commission’s chief executive, said: “The trust has taken our concerns seriously but improvements are simply not happening fast enough.”
Norman Lamb, the Liberal Democrats’ health spokesman, said: “People have a right to know how on earth a hospital can be rated ‘good’ a few weeks before such serious failings come to light. “This Government has set up a labyrinth of bodies and inspectors which are meant to ensure high quality standards in our hospitals but it simply isn’t working. This is yet another case where a hospital has passed the test on paper but where real patient safety has clearly been compromised.”
Andrew Lansley, the Shadow Health Secretary, said: “It is unforgiveable if any lives have been needlessly lost. We need to know what happened after the Government found out about the tragedy at Stafford Hospital. Other hospitals with high mortality rates, such as Basildon and Thurrock, should have been looked at rapidly and effectively by regulators and ministers to ensure that patients were being treated safely.”
Mike O’Brien, a health minister, said that Monitor would rigorously oversee progress on the issues raised by the commission. “We expect these issues to be dealt with quickly and effectively to ensure high quality, safe care for patients,” he said. Michael Large, the trust chairman, said: “I want to reassure our local community that the safety and well-being of our patients is our highest priority. Monitor acknowledge that we have an effective programme in place to make further improvements.
“We welcome the opportunity to work with advisers to specifically focus on the areas where we need to make rapid changes. We have had expert independent clinical advice and nothing has pointed to a fundamental problem with clinical care.”
Maternity funding still not being delivered, British midwives claim
Millions of pounds of government funding intended to improve maternity care is still not reaching frontline services, midwives say. Despite a rising birthrate, nearly a fifth of the heads of midwifery said that their budget had been cut, and almost a third had been asked to reduce their budgets. Last year the Government promised £330 million of extra funding for maternity services, but this has not been ringfenced.
The results, from a survey across Britain by the Royal College of Midwives (RCM), come as the Health Secretary is due to speak at the union’s conference in Manchester. Andy Burnham will today announce a new “Start4life” campaign highlighting the importance of breastfeeding and healthy eating from infancy.
The RCM said that 5,000 more midwives were needed to provide safe and quality care to new mothers. Ann Keen, a health minister, said that it was up to NHS trusts how to invest the additional money. “Where funding is not reaching maternity services I call on Heads of Midwifery to challenge their PCTs,” she said. “We recognise there are concerns around staff morale and attrition rates and we are working with the Royal Colleges and the NHS to address these areas.”
Australia: Another man dies because of an incompetent government ambulance service
No funds for a GPS in each ambulance but plenty of money for a metastasizing bureaucracy
A NEW South Wales man suffering from a heart attack died before ambulance officers reached him because they got lost and did not have GPS, his wife says. The man's wife of 54 years, Velma McFadden, phoned emergency services from a property on the outskirts of the village of Cullen Bullen, near Lithgow west of Sydney, on September 28, she told Macquarie Radio. She waited for the ambulance to arrive, only to be told it was lost. "He was alive when I started CPR," Mrs McFadden said.
Mrs McFadden said a man waited at the local pub for the ambulance so he could direct it to Mrs McFadden's property, two kilometres from the pub. She received a call advising the ambulance was lost. "I was told they haven't got GPS in their ambulances," she said. "That they would have them up here in a couple of years time in the western area."
By the time the ambulance arrived Mrs McFadden's husband was dead.
In a separate incident in far northern NSW this week, an emergency services operator hung up on a man who needed help at a remote property near Boomi. Stuart Jamieson dialed triple zero to get help for a local man who had become seriously unwell after working in the heat. The call was terminated because Mr Jamieson was unable to provide a street number and the operator could not find his location on a map.
The incident followed an inquest earlier this year that found triple zero operators bungled their response to calls for help from Sydney schoolboy David Iredale because they did not have a street address. The 17-year-old died after he became separated from his two classmates on Mount Solitary during a three-day trek in 2006.
Australia: Man waits six years to see a public hospital doctor
TOWNSVILLE man Bill Edwards has waited six years to see a specialist at the Townsville Hospital. Mr Edwards was diagnosed with tinnitus, or ringing in the ears, by his family doctor on November 25, 2003 and was referred to see an ear, nose and throat specialist at Townsville Hospital. But on Wednesday, six years later to the day, Mr Edwards said he was more likely to win the lotto than see an ear specialist. "To me it's more ludicrous than upsetting," he said. "Waiting six years for an appointment is just ridiculous."
Townsville Health Service District executive director of medical services Dr Andrew Johnson yesterday said the six-year wait wasn't good enough. "Waiting six years for a specialist appointment is clearly not good enough and we apologise unreservedly for this regrettable delay," he said.
Mr Edwards, now 54, was diagnosed with tinnitus after taking the drug Zyban to help him stop smoking in 2003. The condition is a possible side-effect for a small portion of the population who take the drug. "I've still got ringing in the ears and it seems like I'm stuck with it," Mr Edwards said. "I just want to have it physically checked out and I need the advice of a specialist on how to proceed. "I'm fairly sure that once you've got it, you can't get rid of it but I would still like to know one way or the other."
Dr Johnson said the Townsville Hospital only had one full-time ear, nose and throat specialist on its staff, who saw around 15 patients a week. Another specialist was due to start in January. "We've had difficulty recruiting ear, nose and throat specialists as we're in competition on a global basis for skilled staff," Dr Johnson said. "Unfortunately, this has affected patients who need to see such specialists." He said the hospital had 1692 referrals for appointments with ear, nose and throat specialists so far this year.
Mr Edwards was admitted to Townsville Hospital twice since 2003, for a back operation in 2006 and for an eye problem in 2008. He said the staff were faultless. "It seems once you are in there it's fine but getting in there is the hard part," he said. "I'm on the lowest scale of urgency but ... even if they saw 10 patients a day - that's 50 a week - I'd have more chance of winning the lotto. "I'm on a disability pension and ... I am entitled to medical help."
Dr Johnson said the hospital had scheduled an appointment for Mr Edwards within the next three months. [Big of him!]
Opposition Health spokesman Mark McArdle said Queensland's hospital waiting lists were the worst in the country. "Queenslanders are putting themselves at risk when they place themselves at the mercy of a health system which is pathologically incapable of meeting their needs," Mr McArdle said.
Senate Democrats say their reform bill will cost $848 billion over 10 years. They're misleading the public by starting the count in 2010. The true cost would be $1.8 trillion over a decade. The $848 billion figure is based on a 10-year run beginning in 2010 when there will be little, if any, spending ? even though the taxes that fund the new welfare state program will begin the next year. In fact, only 1% of the spending will come in the first four years of the 10 years the Democrats are counting, according to the Congressional Budget Office.
To understand the real 10-year cost, the clock needs to be started in 2014. It's the first true year of spending. After four years of minimal activity, almost $50 billion will be spent in 2014. The spending roughly doubles in the next year and jumps by about 50% in 2016. By 2023, the real 10th year of the program, the federal government will spend nearly $270 billion. Add up all 10 years, and the price tag is $1.5 trillion, nearly twice as costly as the Democrats' bogus estimate.
And that's a humble beginning. The five years after that, which are not shown on the accompanying chart, would cost an additional $1.7 trillion, says Jeffrey Anderson of the Pacific Research Institute. "Thus," Anderson wrote Monday in National Review Online, "the true first-15-year costs of the bill would be a cool $3.5 trillion -- according to the CBO's projections."
But let's not stop there. As long as we're discussing real costs, we should mention the estimate made by the Cato Institute's Michael Cannon. He projects that the House bill, passed Nov. 7, will cost $2.5 trillion over the decade that the Democrats are using for their estimate. His assessment includes the $250 billion that's been removed from the health care bill to be voted on in separate legislation. This is the "doctor fix" that's supposed to ensure that Medicare reimbursements for physicians won't be sharply cut.
Cannon also prices in the cost of the individual mandate -- the requirement that those who don't have health insurance buy it for themselves -- because the costs of the premiums are not included in the CBO's estimates.
Democrats did this because they learned from a previous mistake. The CBO included the cost of individual mandate premiums in the Clinton 1994 health care plan, and it was a primary reason why that legislation failed. This time, though, with the help of White House Budget Director Peter Orszag, who was CBO director in 2007 and 2008, they were able to hide the costs.
Supporters of health care reform simply haven't been honest about the cost of either bill. The Washington Post editorialized a week ago about "fantasy savings" in the Senate plan. Republican Sen. Kit Bond of Missouri says the entire reform effort is "a trillion-dollar scam." Cannon calls the House's muddying of the facts "the biggest fiscal obfuscation in the history of American politics." "The current leadership," he wrote in National Review Online the day before the Nov. 7 vote, "has rigged the legislation so that 60% of its total cost will not be made public by the CBO in advance of the House vote."
Though accurate, those are all mild descriptions of what the Democratic leadership is trying to do to the country. If it successfully forces its expensive agenda on an ostensibly free people, it will have committed an act that some will justifiably consider to be a crime.
As it becomes increasingly clear in the light of day that the bill passed by the U.S. House in the dark of night cannot find the necessary votes in the Senate, it is time for leaders to explore alternatives that have the support of the American people and will set us on a path to contain costs and achieve our goals without massive tax hikes and ever more spending.
Last month my firm surveyed 500 nationally representative registered voters about competing visions for health care reform. The results were clear: voters want a plan in line with what GOP leaders offered as their alternative on Saturday night. Voters preferred a comprehensive, step by step, common sense restructuring of the health care system over the massive, incredibly expensive, one size fits all, all at once plan offered by Speaker Pelosi. Voters were especially drawn to reforms which reduce the costs to consumers without adding to the deficit, create no new government agencies, and are less costly than the Democrat’s plan.
This should be welcome news to wary Legislators, especially those from red states and red districts. The public is not ready for a rapid and radical transformation of the health care system – they prefer a step by step solution to accomplish meaningful reforms. A strong plurality of voters believe that the President and Congress are trying to accomplish too much when it comes to healthcare and an overwhelming 63% of voters agree that “my health care is too important to risk on one gigantic piece of legislation rushed through Congress. I would rather see Congress take a more thoughtful step by step approach, focusing on common sense reforms.”
Support for this step by step approach grew as we added more components of the Republican and Democrat plans: support for the GOP plan soared when a “no new tax” pledge coupled with an incremental approach was tested against a comprehensive reform plan that includes tax increases. Indeed a clear consensus emerged from the data: Americans believe that if we make the right decisions, we can reform our health care system without raising taxes.
Our survey also shows that liberals are misreading the American public with their overwhelming emphasis on coverage, to the exclusion of cost reductions. Americans are indeed concerned about access to care (83% say “finding a way to provide health insurance coverage to most Americans” is an important part of health care reform), but there is greater concern and demand for solutions that lower costs. A nearly universal 97% deem “making insurance more affordable” an important part of reform, with 69% rating it extremely important.
Even when we asked voters to make direct tradeoffs between increasing coverage, lowering costs, and improving the quality of care, their preferences were clear. Respondents were asked what percentage of a health care reform plan should be focused on each of these three goals - 55% of voters assigned more weight to cost than they did coverage, and on average they assigned cost seven times the weight and importance they gave to coverage. The Democratic plan, with its myopic focus upon coverage while doing almost nothing to decrease health care premiums for most Americans, misses what Americans feel is the most crucial part of the debate.
Ultimately, when asked to choose between complete descriptions of the Republican and Democratic plans (without labeling them such), voters chose the GOP plan: 63% chose “a limited, incremental, step-by-step approach to reform, which has no new taxes. This plan would lower premiums; but would not do anything to address the number of uninsured Americans. This plan would go into effect immediately;” and only 37% preferred “one comprehensive reform bill that would include multiple tax increases, would minimally impact premiums, but would provide insurance to most Americans. This plan would not go into effect for three years, though the tax raises would occur immediately.”
We have worked closely with Congressman Dave Camp as he helped forge this alternative plan and it is clear to us, clear to Congressman Camp, clear to congressional Republicans, and clear to 39 moderate Democrats, America is ready for health care reform – just not a sweeping re-creation of the entire system. Far from acting as the party of “No”, Republicans are showing a way forward on this debate that fits the prescription required for our ills. We hope in the coming days that a majority of the US Senate will also come to understand this as well. If they do, we can achieve meaningful reforms that the American people can agree on, and take a stop toward restoring their confidence in the legislative process and their elected representatives.
British Meningitis victim wins £3.2m compensation after hospital turned him away for 'misusing emergency services'
Once again: "Diagnostic tests? Who needs 'em?"
The family of a man left severely brain damaged after being turned away from hospital were awarded £3.2million yesterday. Doctors failed to spot that a simple ear infection had spread to the brain of Mark Thomas when he was 12.
Antibiotics could have treated the illness, but they missed tell-tale signs of meningitis including a stiff neck and severe tiredness and sent him home. The blood test which flagged up the spread of the meningeal infection was only reviewed after Mr Thomas's parents took him back to the hospital the following week for a second opinion - by which time it had attacked his brain.
Before the eventual diagnosis, a nurse had lectured the family about ' inappropriate use of A&E services'.
Mr Thomas, now 20, has the mind of a child and virtually no short-term memory. He used to be a keen footballer, but now goes to fixtures and forgets the score within minutes of a match finishing. He suffered a stroke which damaged the right side of his body and will never be able to work, instead needing round-the-clock care from his parents Elaine, 49, and David, 51.
Mr Thomas, from Blakenhall, Walsall, suffered a series of ear infections which refused to clear up in the six weeks before contracting meningitis in February 2002. He saw his GP several times but by February 9 his condition deteriorated so much that his parents took him to Walsall Manor Hospital for a blood test. The schoolboy had the classic signs of meningitis, including a stiff neck, aversion to bright lights and extreme lethargy, which should have rung alarm bells for doctors. But he was sent home and the blood test results - which revealed the infection had spread to his brain - were not passed on to his parents.
Five days later his illness had worsened and his desperate parents took him back to A&E only to be told by a nurse his condition was not sufficiently serious and they were 'using emergency A&E servicesinappropriately'. But Mr and Mrs Thomas refused to take their son home and demanded a second opinion. It was only then that the blood test results from February 9 were reviewed and meningitis was finally diagnosed.
Bosses at Walsall NHS Hospital Trust admitted liability for the errors and a settlement was approved by the High Court in Birmingham yesterday. The £3.2million pay-out will fund a lifetime of future care for Mr Thomas.
Mrs Thomas, a housewife who cares full time for her son, said: 'My son had to learn to walk again, eat, it was just like having a baby again. If the doctors had done their job properly and acted more quickly, Mark would now be living a completely normal life.' Sue James, chief executive of the Trust, said: 'We wish to apologise again to Mark and deeply regret the delay in diagnosing his condition.'
Gifted Cambridge-bound student who died after two-year anorexia battle 'let down by NHS'
Anorexia is an OCD. She should have been given anti-psychotic drugs
A gifted teenager who died after suffering a severe eating disorder for two years was let down by health chiefs, an inquest heard today. Alice Rae, who scored 9 A*s in her GSCEs and had been offered a place at Cambridge University, was found dead in her bed by her mother on January 14. An inquest into the 18-year-old's death was told the 'highly intelligent and determined' college student was sent home from hospital within hours of her admission - and a chance to help her battle her condition was lost.
Her father, company director Peter Rae, told the coroner sitting at Winchester, Hants, that there were some occasions when his daughter 'simply ate and vomited all day every day.'
The inquest heard that just weeks before she died Alice, who suffered from anorexia and bulimia, had been admitted to hospital in December when her blood potassium levels were at life-threatening levels - she but was discharged within hours. The family turned to the NHS believing that experts would be able to help her out.
Mr Rae said: 'This was an obvious and clear point of possible intervention where the medical team saw that here was a girl with critically low life-threatening potassium levels. 'These were brought about by an illness and affecting behaviour. She was discharged in 20 hours and was given no advice other than to resume the treatment programme that clearly had not been working.' He added: 'We were told it would be quite some number of days (that she would be in there). We were surprised that she was discharged so quickly.'
Alice had repeatedly said she was unhappy with the treatment at the NHS Eastleigh Eating Disorder clinic and had made no progress in her recovery. He said that treatment at the Eastleigh clinic had been 'completely useless' in tackling her condition. She would gorge on meals and throw them straight back up - and at her weakest was able to walk no more than 50 yards.
Mr Rae added: '(Staff at) the meetings would usually ask 'have you vomited this week?' and she saw this as how they were failing to understand her condition.' Mr Rae said that his daughter was overcome by her condition and unable to help herself.
Alice was a keen debater and horserider who had two older brothers - William and Tom - and a younger sister Georgina. However, she had battled with the eating disorder since 2006, the inquest was told.
Dr Carol Ward, the GP who saw Alice in the weeks leading up to her death, said that her condition had improved after her hospital admission - but that she was a very ill young woman. 'She was extremely bright and extremely intelligent and could discuss her care in great detail but this is a condition that is so devastating that it does affect your ability to make decisions about your care,' she said. 'Young girls with this condition are very, very difficult to help.'
She added that she expected Alice to be kept in hospital longer following her December 29 admission. 'I was surprised she was discharged as early - I did ring late morning (on December 30) and speak to medical admissions and there were no plans for her discharge,' she said.
A post mortem examination on Alice's body revealed no obvious cause of death - but it was ruled that on the balance of probabilities, low potassium levels were the most likely factor.
Dr Neil Joughin, a private consultant psychiatrist based in Chichester, West Sussex, saw Alice in the days before her death - and said she had a new motivation to get better after winning a university place. He said: 'If Alice had gone back into a general hospital or been sent to an eating disorder unit she would likely be alive today.'
She did not tell him about her hospital admission - and he would have treated her differently if she realised her problems.
Low potassium levels can cause the heart to beat irregularly - and doctors at the Royal County Hospital had suggested fitting a pacemaker in the hours before her hasty discharge. She was seen at the Eastleigh clinic by treatment co-ordinator Dr Isabel Lewsey for seven months of cognitive behavioural therapy at the start of 2008 - before it was discontinued because it was not working.
Coroner Sarah Whitby, the Assistant Deputy Coroner for Hampshire, recorded a narrative verdict. She ruled: 'Alice Rae died from an unascertained cause on the night of the 13 to 14 of January 2009 at her home. 'She had been suffering from anorexia from at least May 2006 for which she had been receiving treatment.'
Australia: Will they ever learn? Another government ambulance bungle over lack of street address
How many people do they have to kill before they get their act together? These phone helplines where some know-nothing just sits in front of a computer screen are a disaster. They usually fail completely when something non-routine comes up. I have experienced it many times with Telstra and have only got action by writing a letter to the Telstra boss. But writing letters is no help in an emergency. Emergency services should have somebody with local knowledge that they can call on if their computer data is inadequate. With Telstra, I have had arrogant and ignorant operators hang up on me too. That's just how computer-driven helplines deal with non-routine problems
Six months after an inquest found NSW triple-0 operators bungled a series of calls from a dying schoolboy lost in the Blue Mountains, the service has been accused of failing another person in need of help. Stuart Jamieson called the emergency line from a remote property near Boomi in far northern NSW on Monday to get help for a man who had become seriously unwell after working in the heat. An operator ended the call because Mr Jamieson could not provide a street number.
"I gave the road that went past [the location]," Mr Jamieson told Fairfax Radio network today. "They said they wanted a house number. I said there's no house number." Asked what road his property was on, Mr Jamieson said: "The Boomi-Goondiwindi Road. They couldn't find Goondiwindi on a map because ... it's in Queensland. "They said they could not find the Boomi-Goondiwindi Road."
AAP found the road in seconds, with two clicks on Google. Because the operator could not locate Mr Jamieson on a map, she terminated the call. "We were quite prepared to meet the ambulance at the road," Mr Jamieson said. An ambulance eventually arrived after he contacted a local stock and station agent who found help by knocking on the door of the Goondiwindi ambulance service, he said.
The emergency services operator who disconnected his call has since been stood down, The Daily Telegraph reports.
The incident followed an inquest earlier this year into the death of Sydney schoolboy David Iredale. The 17-year-old became separated from his two classmates on Mount Solitary during a three-day trek in 2006. The inquest found three triple-0 operators bungled a series of calls for help he made to them before he died - because they did not have a street address.
As the debate over a health care bill enters a critical stage, a new USA TODAY/Gallup Poll finds Americans inclined to oppose congressional passage of the legislation this year. The survey, taken Friday through Sunday, finds 42% against a bill, 35% in support of it. Despite nearly a year of presidential speeches, congressional hearings and TV ad campaigns by interest groups, more than one in five still doesn't have a strong opinion.
When pressed about how they were leaning, 49% overall said they would urge their member of Congress to vote against a bill; 44% would urge a vote for it.
The findings underscore the difficult battle ahead as President Obama presses Congress to enact the legislation by the end of the year. The House passed its version this month, and Senate debate on its health care bill is slated to start in earnest next week. A sharp partisan divide in public opinion helps explain the mostly party-line votes in Congress.
Those Democrats surveyed were overwhelmingly in favor of a bill: 76% to 17%. By an even wider margin, 86% to 12%, Republicans were opposed. Independents were against it by 53% to 37%.
Obama has seen his approval rating on handling health care policy slide a bit since the summer. Now, 40% approve, 53% disapprove, down from a 44% approval rating in July.
Double-digit. That hyphenated adjective has been used most often recently to describe October's 10.2 percent unemployment rate. But it can also be used to describe the federal budget deficit as a percentage of the gross domestic product. That precise number is not yet known, but it may turn out to have a more dire effect on our national life than October's unemployment rate.
In the fiscal year just ended, federal spending was nearly 25 percent of GDP while federal revenues slipped below 15 percent because of the financial crisis and recession. We have not seen a budget deficit of this magnitude since World War II, which surely was a greater challenge than recent economic troubles.
Apologists for the Obama administration argue that some 2009 spending, like that on financial bailouts, is nonrecurring. True, but as the Congressional Budget Office has reported, the trajectory of administration spending and revenue is pushing the annual deficit toward $1,000,000,000,000 -- that's $1 trillion -- for the next decade.
Congressional Democrats' health care bills threaten to add to that. The bill currently before the Senate is advertised as costing less than $1 trillion. But significant spending doesn't kick in till 2014 and over the ensuing 10 years adds up to $1.8 trillion, nearly double that.
Thanks to current low interest rates, servicing the debt costs the government only $200 billion this year. But the White House estimates that debt service will exceed $700 billion in 2019. "In a few years," the Economist editorializes, "the AAA rating of Treasury bonds, the world's most important security, could be in jeopardy."
It's not only Republicans who decry this prospect. Examining the Democrats' health care proposals, William Galston, domestic policy adviser in the Clinton White House, writes, "We're already facing an unsustainable fiscal future."
Looking further ahead, Scott Winship notes in the Progressive Policy Institute's progressivefix.com blog that federal spending is on course to exceed 40 percent of GDP because of scheduled spending on entitlements -- Social Security, Medicare, Medicaid -- within the lifetime of today's children.
Yet the congressional Democrats who are pressing to expand federal health care spending do not seem much fazed by the prospect that, as Winship writes, "the level of taxation it would require to meet projected spending needs is far higher than anything the country has ever seen-slash-tolerated."
That suggests that, at least for some Democrats, huge looming budget deficits are not a bug but a feature.Just as Ronald Reagan hoped that cutting taxes would force politicians to cut spending, these Democrats hope that increasing spending will force politicians to increase taxes to levels common in Western Europe. Never mind that those economies have proved more sluggish and less creative than ours over the long haul.
The instrument they may have in mind is the value added tax, which operates as an invisible sales tax on goods and services. Back in May, Budget Director Peter Orszag's spokesman mentioned the VAT as a "credible idea" that he did not want to rule out. In June, House Ways and Means Chairman Charles Rangel suggested a VAT as "a point of discussion."
In September, John Podesta, head of the Obama transition team, spoke of how a VAT would "create a balance" with other economies, and White House adviser Paul Volcker cited a carbon tax and a VAT as ways to raise lots of revenue. In October, Speaker Nancy Pelosi said, "Somewhere along the way, a value added tax plays into this."
These statements are noteworthy, because American politicians are ordinarily skittish about saying we should imitate Europe's high-tax and high-spending policies. These policies seem more unpopular than ever 10 months into the Obama presidency. Pollster Scott Rasmussen reports that 53 percent of voters worry that the federal government will do too much in response to economic problems, while only 37 percent worry it will do too little.
That mirrors voters' current opposition to Democratic health care bills. Democratic leaders nonetheless want to jam one through before their current majorities are eroded, as they seem likely to be, in the 2010 elections. This is politically risky, but makes sense if your goal is to expand government.
So the battle over health care is not just about health care. It's about whether government will permanently gobble up more of the private-sector economy and slow it down in the process.
Will Medical Tourism Industry Realize Benefits From Passage of Government-Run Health Care Bill?
Bob McCarty is a touch cynical below
Recently, a friend shared a prediction that prompted me to wonder whether or not the medical tourism industry will experience a boom if government-run health care becomes a reality in the United States.
In case you’re not familiar with the concept of medical tourism, it typically involves people from one country traveling to an exotic foreign locale to have a medical procedure performed at a lower cost. The “medical tourist” label applies to those who opt to spend some of their procedure-related savings by incorporating sightseeing and leisure activities into post-operative travel plans.
Considering the possibilities, I conceived that the most likely ObamaCare-induced scenario would involve cruise ships that would otherwise have found themselves in dry dock as a result of Obama’s massive wealth-redistribution schemes pulling the plug on the domestic cruise industry.
Reconfigured as floating hospitals, the ships would cruise in international waters barely 12 miles off the coast of the United States. They would be staffed by skilled doctors, nurses and other professionals who see tremendous benefit in being able to make a decent living as health care professionals unencumbered by bureaucracy-choked government panels. Their patient rosters would be comprised of people hoping to realize both the financial benefits that stem from saving money and the psychological benefits that would result from avoiding an experience with a government-run health care system.
Seems simple enough until liberalism — or, more accurately, socialism — enters the picture. That’s when I concluded that it will not work — not for very long anyway — due to efforts the Obama Administration will launch to thwart their success. Those efforts will include the following:
* The Obama Administration will refuse cruise hospitals entry into U.S. territorial waters and, in turn, access to U.S. ports. Why? Because their operations do not comply with federal health care guidelines and regulations.
* The Department of Homeland Security will step up screenings of American citizens who attempt to travel outside of the United States while not in the best physical condition. I can just imagine Janet Napolitano saying, “We wouldn’t want to burden other nations with our sick or inform citizens.”
* Both the Coast Guard and the FAA will deny applications for operating permits made by land, air or sea transportation companies hoping to be able to ferry patients to or from cruise ships. Of course, President Barack Obama will describe the denials as being “part of a larger anti-terrorism effort about which I cannot offer more details.”
* Congress will raise the tax rate on income earned by medical professionals while working outside the United States to a level high enough to make it unprofitable for them to make a living. President Obama will describe this as “only fair to those who grew up poor and could not afford medical school.”
If the measures above fail to sink the niche cruise hospitals, I’m certain Obama Administration officials will seek international assistance — perhaps from the United Nations and/or the World Health Organization — to make them illegal and to make those behind them subject to prosecution from the International Criminal Court. Their justification: “Those ships are needed to serve as floating prisons to house the thousands of Americans who refuse to sign up for government health insurance.”
Third of new mothers left alone after birth by over-stretched midwives in Britain
More than one in three mothers are left alone and worried during labour or shortly after giving birth, a poll shows today. Almost a third received no free antenatal classes on the NHS, while a quarter had very little help with breastfeeding despite it being a Government priority.
Critics say the Health Service is struggling to cope with a massive shortage of midwives because officials failed to foresee huge rises in birth rates.
Sushma Cherion, 37, said she was left alone in a delivery room for two hours after giving birth for the first time. Mrs Cherion, of Hemel Hempstead, Hertfordshire, gave birth to Leia-Rose, who is now two, at King George Goodmayes Hospital in Essex. The software test engineer, who is married to Gilles, 39, said: 'When I was transferred to a ward, I was not seen by a midwife until eight hours later. 'There were no midwives on the ward and I was not greeted by anyone. I was a first-time mum and did not know that I was supposed to wake up and feed my baby.
'There was no guidance from midwives about breastfeeding. 'I wanted my soiled sheets changed but I couldn't and started crying, so I ended up changing them myself.'
The Royal College of Midwives says there is a shortage of at least 5,000 midwives. It commissioned the survey of more than 3,500 women visiting the Netmums website, which found that 35 per cent of new mothers say they were left alone during labour or just after, at a time when they felt worried.
Sally Russell, of Netmums.com, said: 'This survey's results should demonstrate to the Government just how stretched maternity services are. 'Some mums have told us that the lack of postnatal care has led them to suffer with postnatal depression, which can have dramatic impacts on the whole family.'
Socialist Britain too poor to afford cancer research?
If they fired just one percent of their bureaucrats, they would have a mint to spend on research
Research into cancer and dementia will come under threat from government plans to fund social care, experts warned last night. Andy Burnham, the Health Secretary, told The Times that millions of pounds would be “reprioritised” from health research and development to pay the costs of the Social Care Bill, published today. Money will also be diverted from public health campaigns such as those on swine flu, sexually transmitted diseases and obesity.
The Bill, a key plank of Gordon Brown’s pre-election legislative agenda, has been condemned by Labour peers, scientists and health campaigners. It would guarantee free care at home or other support for up to 400,000 elderly and disabled people from next October, at a cost of £670 million a year.
Mr Burnham, disclosing for the first time how he planned to pay for the proposal, said that £60 million would be diverted from the health service’s research and development (R&D) budget and £50 million from public health promotions. Cutting spending on management consultants in the NHS would provide £60 million.
Further funds will be sought as part of a “major productivity drive”, he said. The NHS is expected to make up to £20 billion in efficiency savings over the next four years. Hospitals could see their income tied to levels of patient satisfaction on matters such as the quality of maternity care.
Scientists warned of the consequences of cutting research budgets, which help to support the clinical trials of new medicines. Nick Dusic, director of the Campaign for Science and Engineering, said: “This is extremely disturbing as the NHS budget was supposed to be ringfenced to protect long-term investment into the health needs of this country. In any department any raid on the R&D budget is supposed to be discussed first with the Government’s Chief Scientific Adviser. If they’ve breached this process it’s an extremely worrying development that needs to be looked into.”
Health ministers are expected to be interrogated in detail about which elements of the R&D budget should be cut to pay for social care as part of a continuing inquiry by the Lords Science and Technology Committee. Lord Warner of Brockley, the Labour peer and former Health Minister who last week described the social care proposals as “totally misjudged”, said: “I will be looking at the Bill very carefully to see if my worst fears are confirmed and whether the figures really do add up.”
Mr Burnham defended the Bill from claims that it amounted to “an admiral firing an Exocet into his own flagship”. He denied that any cuts would affect patient care or compromise major research projects. “I’m not saying [the Social Care Bill] is perfect, but in the interim it makes the system a bit fairer now,” he said.
Asked to account for the reallocation of funds, he said: “It’s always a question of priorities. I’m not cutting into vital projects. I’m moving stuff out of lower-priority, backroom spend towards direct public benefit. All I want to say is we are being tough about that. I’m interested in really squeezing so that we get as much benefit directly to the public as quickly as we can. “I’ve got to be ruthless about that and I will be ruthless about that. We will spell it out when the Bill comes to Parliament.” He added: “I don’t think anyone can accuse us of underfunding R&D.”
The NHS research budget for 2010-11 is more than £1 billion. It funds a multitude of projects ranging from the diagnosis of brain tumours in children to reasons why patients’ immune systems are lowered after kidney transplants. Academics and research scientists expressed concern that funding to find cures for conditions such as cancer or Alzheimer’s disease could be hampered in the case of longer-term cuts to training and research.
Peter Dangerfield, co-chair of the BMA medical academic staff committee, said that budget cuts were already becoming commonplace in medical schools and that in some cases research and teaching posts were not being filled as staff retired. “There are worries and concerns here,” he said. “Research, training and education budgets are usually the among the first to go when the health service is asked to make savings. We do fear that patients could suffer quite a hard hit in the long term, missing the benefits of new medicines and expertise.”
Harpal Kumar, chief executive of Cancer Research UK, said: “The NHS research and development budget funds vital infrastructure that supports cancer clinical trials. These trials have been instrumental in driving the improvements in cancer outcomes we have seen over the past 20 or 30 years. We would be very concerned to see cuts that affected these budgets given that they are an integral part of improving health outcomes for patients. This government investment ultimately benefits everyone.”
Andrew Lansley, the Shadow Health Secretary, said that Labour’s sums did not add up. “The amount of money they are cutting from the NHS budget doesn’t even begin to cover what they claim the cost of the policy will be, which most experts agree is already a gross underestimate.
Anna Dixon, director of policy at the King’s Fund, said: “Ministers should think hard about the likely impact of reducing budgets for research and development at a time when we are asking the NHS to step up and find projects and solutions to make efficiency savings. The suggestions in the Social Care Bill are rather short-term and what we need is a more substantial and long-term solution to social care funding that will be accessible to everyone who needs it.”
Norman Lamb, the Liberal Democrat health spokesman said: “The Government’s plans are so vague as to be incredible. It’s fantasy politics and the full costing of this has to be revealed.”
Senate healthcare bill: The five paragraphs you must read
Buried in the Senate's 2,074-page health reform bill are provisions that undermine your health freedom and privacy
"There is no such thing as a little freedom," said Walter Cronkite. "Either you are all free, or you are not free."
Whether you're for or against federal efforts to help people buy health insurance, you should know that the reform bill before the Senate would mandate a healthcare system that is definitely "not free."
What most of us know about the Democratic bill is that it requires nearly all Americans to have health insurance. What most of us don't know is that it requires us to buy a minimum level of insurance approved by the federal government, and forces health plans and providers to share our personal health information with the federal government and other entities.
If this bill becomes law, we could each be assigned a national beneficiary ID number or card (possibly an electronic device). And our personal health information will flow electronically to the US secretary of Health and Human Services (HHS) – and many others – without our consent.
Sound farfetched? Buried in the Senate bill's 2,074 pages are provisions that actually permit and foster such things. Freedom and privacy are often lost in the fine print – which is why we've been studying the Senate bill since it was released Nov. 19 to help uncover the facts. Here are five highly invasive provisions Americans should know:
1. Mandatory insurance
Bill text: "Sec. 1501. Requirement to Maintain Minimum Essential Coverage.... An applicable individual shall for each month beginning after 2013 ensure that the individual, and any dependent of the individual who is an applicable individual, is covered under minimum essential coverage for such month."
Translation: Uncle Sam will now serve as your national insurance agent and force you to buy "minimum essential coverage" – or else you'll have to pay an annual fine. However, what Congress considers "minimum essential coverage" and "essential health benefits requirements" includes comprehensive coverage that many neither need nor want. Plus, those who prefer to carry catastrophic-only coverage won't have a free range of options for such coverage.
Bottom line: In a free society, the government should not force citizens to buy any product nor should the government mandate citizens' level of health-insurance coverage. Rather than imposing penalties to coerce people into government-sanctioned health insurance, Congress should offer incentives to help those who wish to buy insurance but find it unaffordable.
Congress could allow everyone to deduct the full cost of health insurance (and provide tax credits for those with no tax liability), while offering assistance to those who can't afford insurance and subsidize high-risk pools for those with preexisting conditions.
Helping those in need is a much better way to reform our nation's healthcare system than overhauling the entire system and putting Big Brother in charge of deciding what is acceptable coverage for nearly every American.
2. Electronic data exchanges
Bill text: "Sec. 1104. Administrative Simplification…. (h) Compliance. – (1) Health Plan Certification. – (A) Eligibility for a Health Plan, Health Claim Status, Electronic Funds Transfers, Health Care Payment and Remittance Advice. – Not later than December 31, 2013, a health plan shall file a statement with the Secretary, in such form as the Secretary may require, certifying that the data and information systems for such plan are in compliance with any applicable standards (as described under paragraph (7) of section 1171) and associated operating rules (as described under paragraph (9) of such section) for electronic funds transfers, eligibility for a health plan, health claim status, and health care payment and remittance advice, respectively."
Translation: Requiring everyone to buy federally sanctioned health insurance, and then forcing qualified plans to comply with Administrative Simplification requirements, provides the government and health industry with power they would not be able to exercise in a free market.
Administrative Simplification rules are a product of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. They lay the foundation for a nationally linked database of personal health information. A federal "Nationwide Health Information Network" (NHIN) is well under way in the United States, without assurances that individuals will control their personal health data.
Bottom line: Americans should be able to contract privately with the insurance companies of their choice. Patients should be able to decide whether to have electronic or paper medical records, and not have the government require electronic records, which are then included in a nationally linked database.
3. Real-time health and financial data
Bill text: "Sec. 1104. Administrative Simplification…. (4) Requirements for Financial and Administrative Transactions. – (A) In General. – The standards and associated operating rules adopted by the Secretary shall – (i) to the extent feasible and appropriate, enable determination of an individual's eligibility and financial responsibility for specific services prior to or at the point of care.... (i) Eligibility for a Health Plan and Health Claims Status. – The set of operating rules for eligibility for a health plan and health claim status transactions shall be adopted not later than July 1, 2011, in a manner ensuring that such operating rules are effective not later than January 1, 2013, and may allow for the use of a machine readable identification card."
Translation: Administrative Simplification rules are being expanded to gather real-time financial and health data on individuals through a tracking ID, possibly a "machine readable" ID card (electronic device).
Bottom line: Moving forward with real-time data collection without an ethical patient consent provision means everyone loses their health-privacy rights. Congress needs to enact strong patient consent provisions for all health data, especially data collected "real-time."
4. Health data network
Bill text: "Sec. 6301. Patient-Centered Outcomes Research.… (f) Building Data for Research. – The Secretary shall provide for the coordination of relevant Federal health programs to build data capacity for comparative clinical effectiveness research, including the development and use of clinical registries and health outcomes research data networks, in order to develop and maintain a comprehensive, interoperable data network to collect, link, and analyze data on outcomes and effectiveness from multiple sources, including electronic health records."
Translation: Your personal health information may soon be studied by government scientists. Washington is creating a new research center that plans to use patients' electronic health records for conducting research and creating disease registries. The data network is comprehensive and includes use of electronic health records.
Bottom line: Federal funds should not be used to collect data electronically and conduct research on patients' personal health information without their consent.
5. Personal health information
Bill text: "Sec. 6301. Patient-Centered Outcomes Research…. (B) Use of Data. – The [Patient-Centered Outcomes Research] Institute shall only use data provided to the Institute under subparagraph (A) in accordance with laws and regulations governing the release and use of such data, including applicable confidentiality and privacy standards."
Translation: Think your health privacy is protected? It's not. This language refers to "applicable confidentiality and privacy standards," but HIPAA's so-called privacy law permits individuals' personal health information to be exchanged – for many broad purposes – without patients' consent (See 45 CFR Subtitle A, Subpart E – Privacy of Individually Identifiable Health Information; section 164.502(a)(1)(ii) "Permitted uses and disclosures").
Bottom line: Trust is a must for ensuring quality healthcare. Thus, as stated above, Congress needs to pass a strong, ethical patient consent law that ensures patients have control over the flow of their personal health information. What about the consent of the governed?
All told, the national mandatory health-insurance bill puts the federal government in charge of individuals' insurance choices and data privacy. This philosophy of governing is the opposite of America's founding principle: consent of the governed. Without health freedom and privacy rights, Congress is opening the door for many wrongs to be committed – all in the name of covering the uninsured.
New Medicare rules designed to reduce waste and fraud in medical-equipment reimbursements are driving some home-oxygen suppliers out of business and leaving patients scrambling to find new providers. The new payment rules, effective Jan. 1, affect the more than one million people who rely on Medicare to pay for oxygen services, which relieve the symptoms of conditions such as emphysema and chronic obstructive pulmonary disease.
"It's totally penny-wise and pound-foolish," says Barbara Renzullo, a nurse and case manager at Massachusetts General Hospital in Boston. Some patients, unable to find a new supplier because their reimbursement rate has fallen so far, "wind up in the hospital."
Under the new rules, Medicare pays suppliers at the prevailing rate —an average of $200 a month, paid 80% by Medicare, 20% by patients—for the first three years after a patient begins coverage. Suppliers are then required to continue providing oxygen services to patients for an additional two years, but at a sharply reduced payment rate. After that, patients are entitled to receive new equipment, and Medicare will resume paying suppliers at the higher rate.
The changes are part of broader efforts by Congress and the Centers for Medicare and Medicaid Services, or CMS, which oversees the federal insurance programs, to address waste and fraud in reimbursements for so-called durable medical equipment, which includes things like home-oxygen machines, wheelchairs and walkers. CMS says it expects to save about $220 million in the fiscal year that began last month. The agency says it had been paying too much for oxygen equipment, and that payments for the first three years should cover service costs for the two-year gap.
Suppliers say those calculations don't account for how much it actually costs to provide services, such as delivering oxygen tanks. Some are balking at accepting new patients who are near or have already reached the three-year limit on full payments. The companies would have to provide oxygen services for the next two years while getting minimal payments for follow-up visits and other services.
Ms. Renzullo, at Massachusetts General, said she has seen patients forgo using oxygen when their suppliers closed and no other company would take them. In January, one terminally ill patient wanted to move to Virginia to live with her daughter, Ms. Renzullo says. But the patient had reached the three-year oxygen payment cap, and no supplier in Virginia would accept her. The patient spent extra days in the hospital while Ms. Renzullo tried to sort out the situation. Ultimately, a Massachusetts supplier mailed an oxygen concentrator to Virginia.
Some smaller, independent oxygen providers, which account for much of the industry's business, say they are being driven out by separate Medicare rules that took effect Oct. 1 and require durable medical-equipment suppliers to be accredited and to post a surety bond.
The changes are supported by many in the industry, but some small suppliers say they can't afford them. It costs $2,500 to $3,500 for a company to go through an accreditation survey, says Wayne Stanfield, president of the National Association of Independent Medical Equipment Suppliers. But a supplier may spend tens of thousands of dollars to comply with the stringent requirements.
Respiratory therapist Bob Sherman is job hunting after his company, Family Pharmacy and Valley Medical Supply in Stevensville, Mont., decided to exit the durable medical-equipment business. The costs for accreditation and a surety bond, coupled with lower reimbursements, cut too far into profits, he says.
A CMS spokesman said the agency has heard of one supplier filing for bankruptcy recently, but is unsure whether it was caused by the new rules. He also said the amount paid to suppliers to maintain equipment was increased last month.
Anxious to avoid raising taxes too much to pay for their health care proposals, the Obama administration and its congressional allies hit on a great new idea: Make the states raise their taxes to fund the program, instead.
Both the House and the Senate bills require that states cover a larger percentage of their people under Medicaid -- a joint state and federally funded program. The idea was to force states to raise their taxes to cover a big part of the health care bill for treating poor people. Since the Feds can simply charge any increase in spending to their already overdrawn bank account, but the states have to balance their budgets, the increased state spending for Medicaid will cause sharp increases in state taxes. And the governors will get the blame, not Obama and not the Congress.
The House bill requires states to give Medicaid to those whose incomes are less than 150 percent of the poverty level, while the Senate will settle for only 125 percent. For most states, this is a hefty increase.
In some states, like New York, where Medicaid covers everyone making 150 percent of the poverty level already, there will not be any extra required spending. But not so in California, which only covers 100 percent of the poverty level. Were the House bill to pass, the already fiscally beleaguered state would have to increase its Medicaid spending on poor people by 50 percent, at least an extra $2 billion a year and perhaps more.
In many Southern states, the Medicaid program only covers a portion of those living below the poverty level. For these states, the requirement to cover all those in poverty and then 50 percent more will cause enormous increases in taxes. In Arkansas and Louisiana, where swing-Senators Pryor, Lincoln and Landrieu come from, the cost could exceed $1 billion for each state each year.
Unfunded mandates for state spending imposed from on high in Washington have always rankled governors. The senators and congressmen in Washington get the credit for spreading largesse, but the governors in the states get the blame for the taxes that are needed to pay for it. Since Democrats currently control the vast majority of governorships, this process of making their own party members take the rap for raising taxes is politically self-destructive in the extreme. But Obama is so desperate to pass his health care legislation that he doesn't care what havoc in his party he reaps in the process.
The question now is whether the governors of the 50 states, particularly the Democrats, are going to sit idly by and let their budgets be destroyed by the health care bill.
When the Republicans in Congress insisted on tacking big cuts in aid to legal immigrant benefits for disability and other areas onto the welfare reform bill, it was the Republican governors who forced them to repeal the pernicious cuts the very next year. They did not want to have to raise taxes to make up for the withdrawal of federal funding.
Now, the Democratic governors face the same situation. If Obamacare passes with its expansion of Medicaid benefits -- but with no federal funding of the extra spending -- it is these Democrats and their legislatures that will have to bite the bullet and pass new taxes to pay for it.
Since states are already facing mammoth financial problems as a result of dwindling revenues and swelling expenditures in the recession, these additional burdens could be politically fatal. Unless Democratic governors want to avoid the fate of one of their late brethren, former Gov. Jon Corzine of New Jersey, whose political career was ended in a blaze of new taxes, they might want to call their buddies in Congress and ask them to lay off the unfunded mandates, particularly during this recession.
The article below is by respected journalist, David S. Broder, writing in a Left-leaning paper
It's simply not true that America is ambivalent about everything when it comes to the Obama health plan. The day after the Congressional Budget Office (CBO) gave its qualified blessing to the version of health reform produced by Senate Majority Leader Harry Reid, a Quinnipiac University poll of a national cross section of voters reported its latest results. This poll may not be as famous as some others, but I know the care and professionalism of the people who run it, and one question was particularly interesting to me.
It read: "President Obama has pledged that health insurance reform will not add to our federal budget deficit over the next decade. Do you think that President Obama will be able to keep his promise or do you think that any health care plan that Congress passes and President Obama signs will add to the federal budget deficit?"
The answer: Less than one-fifth of the voters -- 19 percent of the sample -- think he will keep his word. Nine of 10 Republicans and eight of 10 independents said that whatever passes will add to the torrent of red ink. By a margin of four to three, even Democrats agreed this is likely. That fear contributed directly to the fact that, by a 16-point margin, the majority in this poll said they oppose the legislation moving through Congress.
I have been writing for months that the acid test for this effort lies less in the publicized fight over the public option or the issue of abortion coverage than in the plausibility of its claim to be fiscally responsible. This is obviously turning out to be the case. While the CBO said that both the House-passed bill and the one Reid has drafted meet Obama's test by being budget-neutral, every expert I have talked to says that the public has it right. These bills, as they stand, are budget-busters.
Here, for example, is what Robert Bixby, the executive director of the Concord Coalition, a bipartisan group of budget watchdogs, told me: "The Senate bill is better than the House version, but there's not much reform in this bill. As of now, it's basically a big entitlement expansion, plus tax increases."
Here's another expert, Maya MacGuineas, the president of the bipartisan Committee for a Responsible Federal Budget: "While this bill does a better job than the House version at reducing the deficit and controlling costs, it still doesn't do enough. Given the political system's aversion to tax increases and spending cuts, I worry about what the final bill will look like."
These are nonpartisan sources, but Republican budget experts such as former CBO director Douglas Holtz-Eakin amplify the point with specific examples and biting language. Holtz-Eakin cites a long list of Democratic-sponsored "budget gimmicks" that made it possible for the CBO to estimate that Reid's bill would reduce federal deficits by $130 billion by 2019.
Perhaps the biggest of those maneuvers was Reid's decision to postpone the start of subsidies to help the uninsured buy policies from mid-2013 to January 2014 -- long after taxes and fees levied by the bill would have begun.
Even with that change, there is plenty in the CBO report to suggest that the promised budget savings may not materialize. If you read deep enough, you will find that under the Senate bill, "federal outlays for health care would increase during the 2010-2019 period" -- not decline. The gross increase would be almost $1 trillion -- $848 billion, to be exact, mainly to subsidize the uninsured. The net increase would be $160 billion.
But this depends on two big gambles. Will future Congresses actually impose the assumed $420 billion in cuts to Medicare, Medicaid and other federal health programs? They never have. And will this Congress enact the excise tax on high-premium insurance policies (the so-called Cadillac plans) in Reid's bill? Obama has never endorsed them, and House Democrats -- reacting to union pressure -- turned them down in favor of a surtax on millionaires' income.
The challenge to Congress -- and to Obama -- remains the same: Make the promised savings real, and don't pass along unfunded programs to our children and grandchildren.
Leftist British PM accused of bowing to unions by freezing private companies out of NHS
Gordon Brown is facing a damaging rift with his party after slowing the pace of reform in the NHS, The Times has learnt. Private companies and charities are being frozen out of the NHS, prompting accusations that the Government has bowed to pressure from the unions. Andy Burnham, the Health Secretary, is facing a Cabinet backlash, criticism from the former ministers John Hutton and Alan Milburn and attacks from the CBI and charity groups over proposals to limit outside involvement in the NHS.
The Department of Health will publish new guidelines shortly that limit private companies and charities to providing services not already offered or in areas where the existing NHS is failing. A draft obtained by The Times says: “Only if there was insufficient improvement within a reasonable timescale and the scale of under-performance was significant would the PCT [primary care trust] consider engaging with other potential providers or other solutions (eg, franchising).”
This is regarded as a dramatic shift from the policy set out by Alan Johnson when he was Health Secretary. His document, Necessity Not Nicety, suggested that primary care trusts should become more competitive and commercial, but Mr Burnham is understood to think that this unsettled the health service.
Mr Burnham’s change is regarded as a political manoeuvre, with both the Conservatives and the Liberal Democrats pledging to make it easier for outside organisations to provide work for the NHS. Civil servants have said privately that sections in the new guidelines referring to the NHS as the “preferred provider” have been pre-negotiated with unions and should be regarded as untouchable. Some NHS trusts are not waiting for the new guidance, though, and are already abandoning plans to use outside providers.
The move has caused tensions at Cabinet level, prompting a disagreement in one Cabinet sub-committee during which Mr Burnham was accused of going back on new Labour’s modernising agenda. Blairites suggest that attempts to “buy off” Unison and Unite, which together provided £6.6 million to Labour — around 30 per cent of its income — in the year to June, are damaging the party.
Documents uncovered by Norman Lamb, the Liberal Democrat health spokesman, suggest that Mr Burnham has met union representatives more than any other group since he became Health Secretary in June. The Department of Health is refusing to release the notes of one meeting that took place September, claiming that they are subject to “Chatham House” rules that secure anonymity. In a letter to Brendan Barber, TUC General Secretary, Mr Burnham appeared to acknowledge that TUC staff were involved in helping to draw up the policy by thanking them for their work.
“This is a perfect illustration of the corrupting influence of big money in politics,” Mr Lamb told The Times. “This move will undermine the efforts to improve efficiency and productivity in the NHS.”
Representatives of the NHS Confederation, CBI and Acevo, which represents charities, are still battling to water down the guidelines before publication, asking why the outside groups should only be be approached when the NHS has failed.
Stephen Bubb, chief executive of Acevo, said: “This is a clear breach of the Government’s manifesto promise that the third sector will be treated as an ‘equal partner’ in providing services.” Susan Anderson, CBI director of public services, said: “These are more designed to assuage the demands of trade unions than to meet the needs of patients.”
There is also tension within Labour, with concerns expressed by at least two Cabinet ministers and pressure on Lord Mandelson to overturn the shift on the grounds that it might break government competition guidelines and EU competition law.
Mr Hutton told The Times: “I would be concerned about any policy that turned the clock back because you can’t.” Mr Milburn has already attacked the plans, saying: “There should be no preferred provider. Quality should be the only yardstick, not the type of provider.”
Two former government advisers, professors Julian Le Grand and Paul Corrigan, have also criticised the move.
A spokeswoman for Mr Burnham denied that they were bowing to pressure from the unions. “When services are performing well, and we’ve invested a lot of money in them, why would you pull the rug from under the NHS and put services out to tender?”
She strongly denied any accusation that the party was doing the bidding of the unions, and said that the new rules could mean that outside providers received more work from the NHS rather than less. “We are not bound by either the unions or outside groups and we want to have a good relationship with all of them.”
Another cancer drug too dear for Britain: Bowel cancer victims denied life-prolonging care that's free in Europe
Bowel cancer sufferers are to be denied a life-prolonging drug on the NHS which is available to patients across Europe and beyond. Trials show Avastin can extend life by almost two years. But the Government's rationing body, Nice, says it is not cost-effective.
In what has been dubbed 'passport prescribing', Britain does not allow routine use of the drug while patients in virtually all other EU countries get the drug paid for. France, Germany, Italy and Scandinavian nations, as well as Australia and Canada, all meet the cost of treatment.
Around 35,000 Britons develop bowel cancer each year, of which 4,000-5,000 with advanced cancer could benefit from the drug. Avastin, also known as bevacizumab, costs around £18,000 for a course of ten months' treatment given as intravenous infusion with chemotherapy. The price is similar to that in other countries.
But the complex formula used by the National Institute for Health and Clinical Excellence, which looks at quality of life and overall cost effectiveness, says the annual cost is £36,000. This breaks the maximum limit set by Nice of £30,000 - a figure which has not changed in ten years despite inflation.
Although the manufacturer Roche devised a subsidy scheme to reduce an original Nice estimate from £62,000 in an attempt to get it approved, this was not good enough. Nice's decision, which is preliminary, puts Britain in the same category as Latvia, Poland, Albania and Macedonia in not paying for sufferers to use the drug.
Last night patient groups and experts voiced their dismay. Kate Spall, of the Pamela Northcott Fund, which assists cancer patients denied new therapies, said: 'This is another bad day for cancer patients and another good day for accountants.'
Professor Will Steward, of the Department of Cancer Studies and Molecular Medicine at Leicester University, also said he was disappointed. 'Having Avastin would bring new hope to the many patients for whom this offers a proven increased chance of living longer with a better quality of life,' he said.
Dr Rob Glynne Jones, chief medical adviser of the Bowel Cancer UK charity, called for Nice, the manufacturer and the Department of Health to find a compromise that would allow the drug to be used. 'The clinical efficacy of bevacizumab and its benefit to patients with metastatic colorectal cancer is well proven,' he said.
Patients waiting for a decision on Avastin are forced to plead for special funding from local health bodies or hope that a trial of the drug is running in their area.
Nice, which has been accused of spending more on spin than on evaluating drugs, has often been criticised for banning drugs from NHS use as too expensive. Last week it decided to reject NHS use of the liver cancer drug Nexavar, which gives patients six months' extra life. The decision is being appealed.
It contrasts with the fast-tracking of the breast cancer drug Herceptin after pressure from patients and the intervention of the then Health Secretary Patricia Hewitt. Ironically, Avastin also treats breast cancer but its use on the NHS is in limbo until the bowel cancer issue is settled.
Last year Professor Mike Richards, the National Cancer Director, called for greater flexibility between Nice and the pharmaceutical industry to make more treatments available to cancer patients.
Bowel cancer patient Barbara Moss, 54, from Worcester, spoke at a Nice review last month about how Avastin had transformed her quality of life. She was given just five months to live when diagnosed with bowel cancer in November 2006, but is convinced the drug has kept her alive and in remission. She fought to get back from the NHS almost £14,000 sent on ancillary care, but had to pay £9,000 for the drug itself. Yesterday she called on Nice to find a way to approve the use of the drug 'so that thousands can benefit from the drug like I did while avoiding financial hardship'.
Avastin works by blocking the blood supply to the tumour, starving it of oxygen and nutrients. Once it has shrunk it can be surgically removed.
Dr Carole Longson, director of the health technology evaluation centre at Nice, said its decision was preliminary. While it recognised that the drug 'may provide benefits in terms of clinical effectiveness', it concluded that 'the high cost of bevacizumab relative to the benefits it brings means that it is not a cost-effective use of NHS resources'.
British woman saw seven different government doctors but not ONE spotted her brain tumour
Diagnostic tests? Forget it! Sprinkle lavender oil on your pillow, she was told. She was even seen by a specialist but still no scan
When Nicole Witts complained to her GP about excruciating headaches she was told it was sinusitis. When, four months later, she asked why her arms were going into spasm she was told she probably had a trapped nerve. Over the course of five months, Nicole, 37, a mother of two, saw eight different doctors who came up with a range of diagnoses - including post-natal depression - but all of them failed to spot the truth: Nicole had a brain tumour.
By the time it was detected, in February 2008, the tumour was the size of an orange. Even then, doctors picked it up only because Nicole had had a massive fit and was rushed to hospital by ambulance. A brain scan revealed the tumour over her left ear.
'When the doctor told me what they'd found, I thought: "Oh God, I'm going to die",' recalls Nicole. 'I am not normally religious, but over the next few days I spent most of my time, when not in bed, in the hospital chapel. 'I was so frightened - not for me, but for my kids, wondering how they would cope without their mum.' Her daughters Megan and Ellen were then only four and eight months old
'I had suspected for some months there was something wrong with me, but the way the various doctors had repeatedly dismissed me had left me wondering if I was going mad. 'Yet despite the awful news, I was relieved to know that I hadn't been imagining it all.'
With brain tumours, early diagnosis can be a matter of life and death. Around 16,000 people in the UK develop a primary brain tumour each year and around 3,500 people die as a result, often because the tumour is detected too late for it to be treated effectively.
Many of these are not cancerous - which can spread elsewhere; instead, they are benign growths that have formed around vital areas of the brain. But though 'benign', these growths can cause irreparable damage to blood vessels, causing bleeding in the brain, or a build-up of fluid, or exert pressure on vital parts that control nerves and signals.
No one knows what causes primary brain tumours. The symptoms vary according the tumour's location. Although persistent headaches are the most well known - and the symptom that frightens patients most - they occur only in one in three cases. Nausea, balance problems, weakness in the limbs, pins and needles and concentration problems are among other possible symptoms. Tumours can also cause disturbance to vision, and are sometimes detected by opticians.
One of the most common symptoms is a fit, as in Nicole's case. This occurs when the tumour applies pressure to sensitive areas of the brain, interrupting the electrical and chemical messages that pass between the brain cells.
Nicole believes hers would have been diagnosed more quickly if she had consistently seen the same GP during her visits. But she belongs to a large surgery with nine doctors, of whom she saw seven. She also saw a hospital ear, nose and throat specialist. 'Each doctor I saw had a different theory about what was wrong with me. The range of possibilities they came up with was amazing. 'If we still had the old fashioned practice, where you see only your own GP, I think my tumour would have been picked up sooner.'
Nicole's experience is quite common. 'We get a lot of calls about this,' says Moira Dennison from Brain Tumour UK. 'This lack of continuity of care means tumours aren't picked up until later than they should be. 'People see one GP and then another and then another and no one is putting all the information together that points to a brain tumour.'
It's the system that is at fault, says Dr Steve Field, chairman of the Royal College of GPs, not GP training. He explains that it's designed so 'patients can quickly get to see a doctor', but this creates problems with lack of continuity of care. 'If, as a doctor, you see a patient repeatedly you build up a rapport with someone and get to know them. Then, you would most probably pick up a problem earlier than if you saw someone on a one-off basis. 'My advice is that if you have something persistent you should wait to see the doctor you saw before.
He adds: 'Headaches are far more common than brain tumours and, if anything, doctors over-diagnose the possibility of brain tumours and so a lot of people who don't have a brain tumour are referred for investigation.' However, this was not the case for Nicole - indeed, at one point a GP laughed about her symptoms when she tried to make an appointment.
Nicole, from Leighton Buzzard, Beds, first went to see the doctor in August 2007 when she found her hearing had become muffled and she was hearing whirring noises in her head. 'I didn't have a clue what was causing it, but when I saw the doctor I tapped the side of my head where I now know the tumour was growing and said: "It feels as if there is something in there",' Nicole says. 'However, the doctor thought it was sinusitis and gave me a nasal spray. I didn't think it sounded right - I didn't even have a runny nose. 'I used the spray for two weeks with no joy, so another doctor referred me to hospital because my hearing was still muffled.
'I was seen by an ear, nose and throat specialist who thought I had an infection that had caused a build-up of fluid behind the ear - and suggested I have an operation to have a grommet (a small plastic tube) to drain the fluid. 'I had that done and it did partially improve the muffled sensation, though no one is sure why.
'However, by the autumn I began to get headaches which were so severe I could hardly put my ear on the pillow at night. They were crippling. Later, I found out this was because the tumour was putting undue pressure on certain areas. 'However, when I went back to the surgery - and saw yet another GP - he thought it was maybe due to stress and suggested I try sprinkling lavender oil on my pillow to help. 'Looking back, it is laughable, but we are programmed to accept what doctors tell us and so I did.' ....
Nicole needed major surgery to remove the tumour and had to be transferred to the Royal Free Hospital in North London. 'The surgeon told me the tumour was almost certainly benign, but it was huge and would need a nine-hour operation to remove it,' says Nicole. 'I was relieved it wasn't cancerous, but I was still really worried. 'He told me if I didn't have it removed then I would be dead within six months - because although it was benign, it would cut off the blood supply or cause bleeding. The surgery had a one per cent risk of death and a five per cent risk of paralysis, but I knew there was no alternative.'
Nicole had the operation on March 14 last year. 'The surgeon came to see me afterwards and he was really excited because he had managed to get all the tumour out. 'It was a huge relief. Gary was there and I instantly recognised him. He was so relieved, not just that I had come through the operation, but also that I was still "me".' A week later, though still very fragile, Nicole was allowed out of hospital.
'There is a 30 per cent chance that the tumour will return. I will have to have an annual MRI scan for five years, but I prefer to think of it as there being a 70 per cent chance that it is gone for good.'
Meanwhile, Nicole is still living with the consequences of her late diagnosis. Her short-term memory has been affected because the tumour damaged the part of the brain which is responsible.
Rasmussen: Support for Health Care Plan Falls to New Low
Just 38% of voters now favor the health care plan proposed by President Obama and congressional Democrats. That’s the lowest level of support measured for the plan in nearly two dozen tracking polls conducted since June. The latest Rasmussen Reports national telephone survey finds that 56% now oppose the plan.
Half the survey was conducted before the Senate voted late Saturday to begin debate on its version of the legislation. Support for the plan was slightly lower in the half of the survey conducted after the Senate vote. Prior to this, support for the plan had never fallen below 41%. Last week, support for the plan was at 47%. Two weeks ago, the effort was supported by 45% of voters. Intensity remains stronger among those who oppose the push to change the nation’s health care system: 21% Strongly Favor the plan while 43% are Strongly Opposed.
Rasmussen Reports is continuing to track public opinion on the health care plan on a weekly basis. Next week’s Monday morning update will give an indication of whether these numbers reflect a trend of growing opposition or are merely statistical noise.
Only 16% now believe passage of the plan will lead to lower health care costs. Nearly four times as many (60%) believe the plan will increase health care costs. Most (54%) also believe passage of the plan will hurt the quality of care.
As has been the case for months, Democrats favor the plan while Republicans and voters not affiliated with either major party are opposed. The latest numbers show support from 73% of those in the president’s party. The plan is opposed by 83% of Republicans and 70% of unaffiliated voters.
Other recent polling shows that Democrats consider health care reform to be the top priority for the president. Republicans and unaffiliated voters see deficit reduction as most important.
Among the nation’s senior citizens, 34% favor the health care plan and 60% are opposed. A majority of those under 30 favor the plan, but a majority of all other age groups are opposed (Premium Members can see full demographic crosstabs).
Support for health care has declined along with President Obama's approval ratings. For the first time in the Obama era, the Rasmussen Reports daily Presidential Approval Index has been in negative double digits for nine straight days.
Despite the decline in support for the health care plan, 50% still say it is at least somewhat likely to become law this year. That figure includes 17% who say passage is Very Likely.
While Senate Democrats this weekend assembled enough votes to begin debate on the plan, many challenges remain. All Republican Senators and several Democrats, for example, have expressed opposition to the so-called “public option.” Sixty-three percent (63%) of voters nationwide say guaranteeing that no one is forced to change their health insurance coverage is a higher priority than giving consumers the choice of a "public option" government-run health insurance company. Most liberal voters say giving people the choice of a "public option" is more important. But most moderates take the opposite view and say guaranteeing that no one is forced to change their health insurance is the top priority.
Overall, 46% favor the creation of a government-sponsored non-profit health insurance option that people could choose instead of a private health insurance plan. However, if the plan encouraged companies to drop private health insurance coverage for their workers, support for the public option falls to 29%, and opposition rises to 58%.
As Scott Rasmussen, president of Rasmussen Reports, wrote in the Wall Street Journal: “The most important fundamental is that 68% of American voters have health insurance coverage they rate good or excellent. … Most of these voters approach the health care reform debate fearing that they have more to lose than to gain.”
Other challenging issues in the Senate debate include abortion and illegal immigration. Ever since the House's passage of the Stupak Amendment which says the "public option" would not cover elective abortions and that recipients of federal insurance subsidies could not use them to buy abortion coverage, the divide among Democrats has been visible.
Earlier polling showed that 48% nationwide favored the abortion ban, but most supporters of health care reform didn’t want to address the issue. Just 13% of all voters wanted abortion coverage mandated in the legislation.
On immigration, 83% say that proof of citizenship should be required before anyone can get health care assistance from a government program. Most Democrats while claiming the plan will not cover illegal immigrants are opposed to including a proof-of-citizenship stipulation.
Other polling shows that 47% trust the private sector more than government to keep health care costs down and the quality of care up. Two-thirds (66%) say an increase in free market competition will do more than government regulation to reduce health care costs.
While voters are skeptical of the plan working its way through Congress, 54% say major changes are needed in the health care system. Sixty-one percent (61%) say it’s important for Congress to pass some reform. Only 31% believe Congress has a good understanding of the proposed health care reform.
Surgeons angered by proposal for tax on plastic surgery
A tax on being unattractive? Where is the Democrat "compassion" in that?
Plastic surgeons are angry over proposals for a 5 per cent tax on their business. Although encouraged by politicians to put a brave face on it, plastic surgeons across America are outraged by proposals for a 5 per cent tax on their business. Senators hope that the tax, which was buried in a 2,000-page healthcare Bill released last week, will help to pay the $850 billion (£510 billion) cost of overhauling the country’s medical system.
However, doctors and medical product companies attacked it as discriminatory against women, who make up 86 per cent of cosmetic surgery patients, and likely to fail in its aims. They said that state tax auditors, not doctors, could end up deciding whether operations were necessary for cosmetic or medical purposes.
The Senate Bill contained scant detail on the proposed tax, other than that it would apply to procedures that were not treating deformities created by congenital abnormalities, injuries or disfiguring diseases. Nicknamed Bo-tax, it could raise $5.8 billion over ten years for the Government and would come into effect in January, paid by patients and collected by doctors.
Amit Hazan, an analyst at Oppenheimer, a financial adviser, said that the tax would collect about $60 million a year on Botox treatments alone, while breast implant surgeries would raise $110 million. Customers of Allergan, the maker of Botox, could be hit with about $120 million of tax in a single year, he said. A spokesman for Allergan described the tax as a “random hit on an easy target that is only punitive and not corrective. It has nothing to do with reducing healthcare costs or trying to change unhealthy behaviour.”
Jonah Shacknai, chief executive of Medicis, accused Democrat senators of making moral judgments about people who had cosmetic procedures.
Harry Reid, the Senate Majority Leader who introduced the Bill, appeared unrepentant. When asked to justifty the tax, a spokeman for his office said: “We needed money.”
With the introduction of Harry Reid's health care bill - talk will inevitably focus on whether the public option or the Stupak amendment will undermine the legislation. Yet, if the bill dies, I do not think either of these will be the primary cause of death. I think this will be the culprit:
This is the CBO's analysis of how the Reid bill will cut Medicare. The total reductions come out to $491 billion over 10 years when everything is factored in. The following has been said by other commentators, but I have to add my voice to the chorus: This is insanity, Democratic leaders. Why are you doing this?
Getting AARP's support might give you cover among the Washington crowd, but let's inject some common sense here. Lots of people are members of AARP, but that does not mean they are intensely committed to it, and will therefore follow its lead on such an important issue. AARP is not like the unions in that regard. Lots of people join to get discounts on auto insurance and movie tickets, meaning that affiliation with the organization is broader than it is deep.
Obama's current numbers among senior citizens demonstrate the validity of this point, not to mention the concern that Democrats should have heading into 2010. Gallup has him at 45% among those over 65, and at 49% among those between 50 and 64. Hint. Quinnipiac has him at 42% with those over 55. Hint hint. Rasmussen currently shows Democrats losing the generic ballot among seniors by 15 points; in 2008, Democrats split the senior vote with the GOP. Hint hint hint.
Let's review the political power that American seniors wield. In the Virginia gubernatorial election, people over 65 accounted for 18% of all voters. In New Jersey it was 19%. People over 65 accounted for 19% of all voters in the 2006 House midterm. And even in the "Yes We Can!" presidential election of 2008, when college kids supposedly overwhelmed the normal electoral process, the 65 and over crowd still accounted for 16% of the electorate (unchanged relative to 2004).
The 2006 House exit poll showed the Democrats winning the national vote by a margin of 54 to 46. If, however, we plug in Rasmussen's current generic ballot number among seniors in place of what the Democrats actually won from that cohort in 2006, their lead falls to 52-48. Note that this assumes no change among younger cohorts. That's seniors alone cutting the Democratic margin in half. This also assumes that seniors do not come out in greater numbers in 2010 to defend against perceived assaults on their Medicare benefits.
Blanche Lincoln knows what I'm talking about. When she won reelection in 2004, seniors made up 16% of the electorate and went 59-41 for her. In the 1998 midterm, seniors made up 26% of the electorate and went 60-37 for her. In both contests, they were her strongest supporters. I wonder what she thinks of Table 2 in the CBO's analysis of the Patient Protection and Affordable Care Act.
Bob Dole knows what I'm talking about, too. From January through September of 1995, Bill Clinton's job approval numbers were tepid, with a typical net approval rating of about +2.5. Things turned around for him in late 1995 when the budget battle heated up and Clinton took a stand against...GOP reductions in projected Medicare spending! I'll let Michael Barone finish the story. This is from the 1998 Almanac of American Politics:
[I]n August 1995 [Clinton] started running political ads against the Republicans' Medicare plan. All this was part of a strategy pollster Dick Morris called "triangulation," taking positions between liberal Democrats and conservative Republicans so as to elevate the president's stature above both...In November and December he negotiated on the budget with Speaker Gingrich and Senate Majority Leader Bob Dole, promising them agreement at times, but he ultimately vetoed most of their appropriations bills. That technically shut down non-emergency functions of the federal government, a step which many Republicans initially welcomed and thought would be popular. This was a stunning miscalculation, as was their lack of a strategy to deal with Clinton's vetoes...By the time Republicans backtracked and agreed to Clinton's terms, their ratings were down and they were running behind Democrats in the polls.
The President declared at the time the deal was struck that his proposal was a "sensible solution" that showed "you can balance the budget in 7 years, and protect Medicare and Medicaid, education and the environment and provide tax relief to working families." He cruised to reelection.
Not coincidentally, Dick Morris was the first to suggest that mucking around with Medicare would mean trouble for the Democrats. He knows what he's talking about, and in September he wrote:
"The Democratic Party, led by Obama, is systematically converting the elderly vote into a Republican bastion. The work of FDR in passing Social Security in 1937 and of LBJ in enacting Medicare in 1965 is being undone by the president's healthcare program. The elderly see [Obama's] proposals for what they are: a massive redistribution of healthcare away from the elderly and toward a population that is younger, healthier and richer but happens, at the moment, to lack insurance. (Remember that the uninsured are, by definition, not elderly, not young and not in poverty - and if they are, they are currently eligible for Medicare, Medicaid or SCHIP and do not need the Obama program.) The elderly see the $500 billion projected cut in Medicare through the same lens as they viewed Gingrich's efforts to slice the growth in the program in the mid-1990s.
Why are Obama, Pelosi, and Reid doing this? How could they be so foolish as to repeat the most egregious mistake of the Republicans of the 104th Congress? Why are they forcing their vulnerable members to vote on a bill that would cut Medicare in this fashion? Do they dislike their moderate colleagues? Do they find the chore of being the majority party too burdensome? Have they simply gone mad?"
High rates of obesity, smoking, absenteeism and poor mental health among NHS medical staff
Health trusts must do more to help doctors and nurses exercise and give up smoking and heavy drinking, says the Government. NHS organisations will be expected to improve access to intervention programmes such as counselling or gyms as part of a drive to reduce sickness absence, which costs £1.5 billion a year. The first national audit of staff habits has found that high rates of obesity, smoking, absenteeism and poor mental health were having a direct impact on the quality of patient care.
The Health Secretary is expected to accept all the recommendations of the final review, drawn up by Steve Boorman, a leading occupational health expert, in a written ministerial statement. The review found that more than 45,000 NHS workers called in sick each day — one and a half times the rate of absence in the private sector.
However, the Department of Health has suggested that health workers should be encouraged to set an example for patients and the general public when it came to promoting healthy lifestyles.
The review found that hospitals whose staff were in poorer health were less productive and had higher rates of patient mortality and superbug infection. More than three quarters of 11,000 staff polled acknowledged that the state of their health affected patient care.
Dr Boorman, a former GP and the chief medical adviser to Royal Mail, told The Times earlier this year that health awareness among NHS staff was “very inconsistent”. He said that a clear correlation had emerged between the performance of hospitals and staff health. His recommendations include cutting smoking rates in the NHS, which are the same as in the general population, and providing more time or opportunities for staff to exercise. Health workers with musculoskeletal and mental health conditions are also to be promised access to early interventions such as physiotherapy or counselling.
The review will call on trusts to appoint health and wellbeing leaders at board level to bring down rates of obesity, drinking and smoking, and on the Department of Health to devise and implement national standards and provide resources to ensure that these standards are given priority. It estimates that reducing the number of sick days taken by staff by a third would save the NHS £555 million a year.
A Department of Health spokeswoman said: “The NHS needs to be serious about the health of its staff if it is to improve the health of the nation. All NHS organisations should have a proactive and focused health and wellbeing strategy in place.”
Australia. No ambulance service for a Queensland country town: Uproar as patients must travel in the back of a truck
The interesting thing about this story is that it represents a deterioration of service. In earlier times, there was a regular railmotor service on which patients could be transported in some comfort. The railroad tracks are still there but are used for occasional tourist outings only. The budget of Queensland Health must have increased at least 100 times since then but the service is worse
THE sick and injured are being carted to the Mt Surprise airport on the back of trucks and utes [pickups] because the town does not have a helipad or suitable patient transfer vehicle.
The rural community, 290km southwest of Cairns, is demanding the State Government provide the basic services after a patient's trauma, following a serious accident, was increased because of the situation. In the most recent example, a patient was loaded on to the back of a ute and was subjected to an excruciatingly painful journey on the rough 5km trip. Open-sided trucks have also been used.
Outraged Mt Surprise resident Rick Tomkies told The Weekend Post these incidents highlighted the need for a suitable transfer vehicle and a helipad in the community. "Not only is the carriage of persons on the rear of a vehicle illegal but it could also cause further trauma to a seriously ill or injured person with serious consequences," he said. "Already there has been an occasion when an attending Royal Flying Doctor was injured by a flapping tarpaulin, used to shade a patient from the sun. And on another occasion, the legs of a patient became sunburnt."
Mr Tomkies said police figures showed the Mt Surprise area had a higher rate of medical evacuation rates compared with neighbouring communities and it was vital the standards were lifted to an acceptable and legal level.
A spokeswoman from Queensland Ambulance Service said the organisation recently held a community meeting at Mt Surprise to set up a first responder unit in the area. "The community were very supportive of the development of this group and several residents were identified as possible members for a first responder unit," she said. "QAS approved the application to develop a first responder unit in Mt Surprise in September and the establishment of the unit in the area will occur over the coming months."
A Department of Main Roads spokesman said: "The question of whether or not a helipad should be built at Mt Surprise is an issue for the Etheridge Shire Council". "Should Council decide to construct a helipad, the Department of Transport and Main Roads would be happy to discuss with them possible avenues for funding assistance," he said.
Australian government’s non-solution to hospital crisis a wasteful threat to private practice
By Dr Jeremy Sammut
Under the $275 million Super Clinics program, the Rudd government is funding the start-up costs involved in bringing together GPs and allied health professionals, such as physiotherapists and podiatrists, who want to amalgamate their practices into an initial 36 ‘one-stop shops.’
This move has the potential to nationalise Australian general practice, and the Doctors’ Action group is right to be worried about the impact of Super Clinics on the traditional family GP.
Why would young doctors buy into an established practice when they join a Super Clinic for free with the capital costs paid for courtesy of taxpayers?
The legitimate fear is that state-funded Super Clinics represent creeping socialism and will render private practice uncompetitive. Once it becomes too costly and difficult to establish a private surgery from scratch, future governments might force doctors to work in Super Clinics on a salaried basis.
The official rationale for Super Clinics is they will take the pressure off overcrowded public hospitals. But in reality, taxpayer’s money is being wasted on a non-solution for the hospital crisis.
Every credible study shows that public hospitals are dangerously overcrowded because of the national shortage of hospital beds, which forces over one-third of all seriously ill emergency patients to wait longer than eight hours to be admitted to a bed.
Yet the Rudd government maintains Super Clinics have already proven worthwhile. A Tasmanian Super Clinic has reportedly reduced the number of people with minor illness turning up at the nearby emergency department by 13%.
A number of previous studies have demonstrated that patients with minor conditions such as a cold or sore toe account for only between 10 and 15% of total emergency presentations.
The same studies have also shown that treating these patients constitutes a mere a fraction, 2 to 3%, of the total emergency workload, and that it is far cheaper to treat them in the emergency department rather than incur the capital and infrastructure cost of establishing alternative GP facilities.
In other words, diverting ‘GP-style’ patients into Super Clinics is imposing a huge cost per occasion of service on the federal budget. The Rudd government’s highly inefficient spending on Super Clinics makes a mockery of its supposed commitment to micro-economic reform.
Dr Jeremy Sammut is a Research Fellow at The Centre for Independent Studies and author of ‘The False Promise of GP Super Clinics’ and ‘Why Public Hospitals are Overcrowded.’
The above is a press release from the Centre for Independent Studies, dated November 20. Enquiries to cis@cis.org.au. Snail mail: PO Box 92, St Leonards, NSW, Australia 1590.
Splits widen for Democrats over health reform
President Barack Obama’s mission to reform US healthcare vaulted another legislative hurdle over the weekend, but the scramble to secure his own party’s votes sheds light on the messy compromises that may be needed to get it to the finish line.
Fissures between liberal and centrist Democrats cracked open on Sunday in the aftermath of a procedural vote, which paved the way for the estimated $848bn (€570bn, £514bn) draft Senate bill to be debated on the floor. Leaders hope there will be a vote on the bill by Christmas. If passed, the House and Senate versions will have to be mashed together.
If this weekend is anything to go by, it will not be a pretty process. All Democrats and Democrat-leaning independents voted to push the bill forward – creating a filibuster-proof majority of 60 – but some of those votes came far from quietly. A group of centrist Democrats, unhappy about elements of the bill such as a public insurance option, managed to wring concessions from the leadership in return for their acquiescence.
In what wags have already dubbed the “Louisiana Purchase”, Mary Landrieu was offered at least $100m in extra federal money for her state. Ben Nelson won the omission of a provision that would strip health insurers of their anti-trust exemption. Blanche Lincoln won more time.
The group’s disproportionate power in the debate has antagonised some liberal Democrats. “In the end, I don’t want four Democratic senators dictating to the other 56 of us and to the country, when the public option has this much support, that it’s not going to be in it,” said Sherrod Brown of Ohio on Sunday on CNN. “But in the end, I think that all four of our colleagues surveyed this . . . and I don’t think they want to be on the wrong side of history. I don’t think they want to go back and say, ‘You know, on a procedural vote, I killed the most important bill in my political career’.”
As the debate gets going, the centrists will face increased pressure at home, where they are vulnerable to losing their seats if they are seen to let their colleagues in Washington push them too far to the left. Lobbyists on both sides of the debate are well aware of this, and are blitzing their home states with adverts.
Ms Lincoln claimed that groups had spent $3.3m on advertising in her state of Arkansas. She said she would refuse to yield to either side, but was shocked by the “unbelievable type of threats” she had received. “These ad groups seem to think this is all about my re-election. I simply think they don’t know me very well,” she said on the Senate floor.
The group, which also includes independent senator Joe Lieberman, all said they wanted more changes made to the bill in the coming weeks. “When I saw the bill I said, ‘This can be amended, this can be improved’,” Mr Nelson said on Sunday on ABC. He said language on federal funding for abortion, which is softer than that of the House bill, was one problem. He did signal he was willing to compromise on a public option, but said it would have to be much weaker than the current version, which has already been watered down to allow states to opt out. “We could negotiate a public option of some sort that I might look at, but I don’t want a big government, Washington-run operation that would undermine the . . . private insurance that 200m Americans now have,” he said.
Mr Lieberman, though, was more intransigent. “[A public option] is a radical departure from the way we’ve responded to the market in America in the past,” he told NBC. “We rely first on competition in our market economy. When the competition fails then what do we do? We regulate or we litigate.”
The weekend’s vote was a victory for Harry Reid, Senate leader, but he acknowledged that it was simply an opening skirmish in a battle that is now set to break into full force. Much of that battle will take place within his own party. “Tonight’s vote is not the end of the debate,” he said on Saturday night. “It is only the beginning.”
Affordability, accessibility, quality?the hallowed trifecta at the center of the debate over health care reform. Proponents of reform argue that these three goals must be achieved for all Americans before any reform effort can be called a success. As a means to this end, supporters of market-based solutions to the health care problem are pushing to lift restrictions preventing the sale of health insurance across state lines. They maintain that allowing consumers to shop for insurance nationwide would increase competition, thereby lowering prices.
Critics of this measure warn, however, that overturning the current ban on interstate sales of health insurance will harm, not help, consumers. They argue that such a policy would enable out-of-state insurance companies to skirt strict consumer protection laws currently at work in states like California. Essentially, these laws mandate what kinds of services and treatments must be covered by all health insurance plans in their state; and, if the interstate ban was lifted, these states would have no power to regulate the content of policies purchased by their citizens from companies based out-of-state.
To put it another way, opponents of interstate insurance sales don't want consumers to be able to choose a policy that fits their specific needs; they want them to be required by law to purchase only those policies that government bureaucrats think is best for them.
This blatantly anti-choice position is, of course, couched in terms of "consumer protection." Politicians and consumer advocacy groups insist that mandates are necessary to protect vulnerable consumers from the unscrupulous machinations of greedy insurance companies. They fear that opening the market for insurance sales across state lines will result in a "race to the bottom," in which "insurers compete to sell bare-bones policies at the lowest price, lacking benefits such as maternity care."
This rationale is the equivalent of saying that consumers looking for a cell phone should not be allowed to purchase the Jitterbug because it lacks the features of the i-Phone, or that people should be prevented from buying the Ford Ranger because the Ford F-250 Super Duty is a bigger, better vehicle with superior towing capacity and greater horsepower. There are, undoubtedly, individuals out there who would like to be able to purchase a policy that meets their basic needs?a"Jitterbug" or a "Ranger"?and who don't want and can't afford coverage for maternity care, in vitro fertilization, reconstructive surgery, or tobacco cessation classes.
The issue in question boils down to an matter of choice. The bureaucrats have decided that the people need Big Brother to dictate their health insurance decisions because they can't be trusted to make good choices themselves. This is the height of paternalism: Government knows best and damn the torpedoes.
The flip side of this seemingly benevolent government coin is that when people are unable to afford the "Cadillac" plans mandated by state law and barred from purchasing lower priced alternatives, the rest of the taxpaying public is forced to subsidize the cost of the pricey state-approved plan in an attempt to achieve coverage for all. Meanwhile, companies willing to sell basic, affordable insurance are shut out of the market.
If our representatives at the state and federal levels are serious about securing affordable, accessible, and high quality health care options for every American citizen, they would do well to support reform efforts that include a wide variety of insurance options -- options generated by the market, not by regulators. Consumer choice should guide the health insurance market, not the dictates of know-it–all bureaucrats who presume to know what's best for the rest of us.
Latest political brainwave in Britain: NHS will provide free marriage guidance
Talking therapies are generally useless but so is the NHS on many occasions so I suppose it is a fit. They already support acupuncture. Getting real medicine -- like getting diagnostic tests done -- however, is often too hard. The NHS is run by politics not science or economics
Couples are to be offered marriage guidance counselling for free on the NHS, in a move which has drawn strong condemnation from patients and doctors' groups. Couples with relationship problems will be offered free sessions for up to six months, as part of a £270 million programme to increase the provision of "talking therapies" for the public, Andy Burnham, the health secretary, will announce this week.
Doctors and patients' groups said they were "horrified" by the use of NHS resources for relationship advice when patients with cancer and dementia were being denied treatment they desperately needed.
Mr Burnham will say on Thursday that "when couples hit a rocky patch, a bit of help and support can stop it spiralling out of control". He will instruct GPs to follow new guidance which says that if relationship problems are causing depression, up to 20 sessions of couples counselling can be offered, over the course of six months. Currently, most people seeking help from services like Relate pay between £45 and £60 per session, meaning the free counselling packages will be worth around £1,000 per couple. The NHS is expected to pay existing marriage guidance services, and newly-trained counsellors to provide the therapy.
Doctors and patients groups last night attacked the recommendation, contained in guidance by the National Institute for Health and Clinical Excellence (NICE). NICE has repeatedly come under fire for decisions to reject life-extending drugs for cancer and treatment to reduce symptoms of dementia.
On Thursday, NICE was accused by charities of "condemning patients" to an early death by rejecting the use of Nexavar, a drug which can extend the lives of liver cancer, arguing that its £9 million annual cost – £3,000 a month per patient – could not be justified.
Nick James, professor of clinical oncology at the Cancer Research UK Institute for Cancer Studies said: "I am horrified, in particular because of the way these decisions are taken without public debate. "I think most people would say treatment for those who are sick with cancer should be top of our list, and I would really question whether these kinds of efforts to preserve marriages are a matter for the state."
NICE has previously restricted the use of drugs to limit the effects of Alzheimer's, costing £2 a day, while provoking further controversy in May when it ruled in favour of alternative therapies like acupuncture for back pain, despite admitting there was little evidence they worked.
Michael Summers, Vice-President of the Patients Association, urged NICE and the Government to "get their priorities right". "If we had the luxury of untold sums of money, maybe we would think about paying for couples counselling," he said. "As things stand, people are still waiting for urgent treatment, being denied drugs for cancer, and dementia, and it seems inappropriate at the very least to start using public money in this way".
Indian entrepreneur shows that mass production applied to heart surgery drives costs way down with no loss of quality
HAIR tucked into a surgical cap, eyes hidden behind thick-framed magnifying glasses, Devi Shetty leans over the sawed open chest of an 11-year-old boy, using bright blue thread to sew an artificial aorta onto his stopped heart. As Dr Shetty pulls the thread tight with scissors, an assistant reads aloud a proposed agreement for him to build a new hospital in the Cayman Islands that would primarily serve Americans in search of lower-cost medical care. The agreement is inked a few days later, pending approval of the Cayman parliament.
Dr Shetty, who entered the limelight in the early 1990s as Mother Teresa's cardiac surgeon, offers cutting-edge medical care in India at a fraction of what it costs elsewhere in the world. His flagship heart hospital charges $US2000 on average, for open-heart surgery, compared with hospitals in the US that are paid between $US20,000 and $US100,000, depending on the complexity of the surgery.
The approach has transformed health care in India through a simple premise that works in other industries: economies of scale. By driving huge volumes, even of procedures as sophisticated, delicate and dangerous as heart surgery, Dr Shetty has managed to drive down the cost of health care in his nation of one billion. His model offers insights for countries worldwide that are struggling with soaring medical costs, including the US as it debates major healthcare overhaul.
"Japanese companies reinvented the process of making cars. That's what we're doing in health care," Dr Shetty says. "What health care needs is process innovation, not product innovation." At his flagship, 1000-bed Narayana Hrudayalaya Hospital, surgeons operate at a capacity virtually unheard of in the US, where the average hospital has 160 beds, according to the American Hospital Association. Narayana's 42 cardiac surgeons performed 3174 cardiac bypass surgeries in 2008, more than double the 1367 the Cleveland Clinic, a US leader, did in the same year. His surgeons operated on 2777 pediatric patients, more than double the 1026 surgeries performed at Children's Hospital Boston.
Next door to Narayana, Dr Shetty built a 1400-bed cancer hospital and a 300-bed eye hospital, which share the same laboratories and blood bank as the heart institute. His family-owned business group, Narayana Hrudayalaya Private, reports a 7.7 per cent profit after taxes, or slightly above the 6.9 per cent average for a US hospital, according to American Hospital Association data.
The group is fuelling its expansion plans through private equity, having raised $US90 million last year. The money is funding four more "health cities" under construction around India. Over the next five years, Dr Shetty's company plans to take the number of total hospital beds to 30,000 from about 3000, which would make it by far the largest private-hospital group in India. At that volume, he says, he would be able to cut costs significantly more by bypassing medical equipment sellers and buying directly from suppliers.
Then there are the Cayman Islands, where he plans to build and run a 2000-bed general hospital an hour's plane ride from Miami. Procedures, both elective and necessary, will be priced at least 50 per cent lower than what they cost in the US, says Dr Shetty, who hopes to draw Americans who are uninsured or need surgery their plans don't cover. By next year, six million Americans are expected to travel to other countries in search of affordable medical care, up from the 750,000 who did so in 2007, according to a report by Deloitte. A handful of US insurance plans now give people the choice to be treated in other countries.
Some in India question whether Dr Shetty is taking his high volume model too far, risking quality. "On one level, it's a damn good idea. My only issue with it comes from the fact that if you pursue wholesale volumes, you may give up something -- which is usually quality," says Amit Varma, a physician who serves as president of health-care initiatives for Religare Enterprises, a publicly listed financial services group in Delhi. Religare is part of a conglomerate that also owns Fortis Healthcare., a rival hospital chain.
"I think he has reached the point where if you increase volume any more, you could compromise patient care unless backed up by very robust standard operating procedures and processes," Dr Varma says.
But Jack Lewin, chief executive of the American College of Cardiology, who visited Dr Shetty's hospital earlier this year as a guest lecturer, says Dr Shetty has done just the opposite -- used high volumes to improve quality. For one thing, some studies show quality rises at hospitals that perform more surgeries for the simple reason that doctors are getting more experience. And at Narayana, says Dr Lewin, the large number of patients allows individual doctors to focus on one or two specific types of cardiac surgeries.
In smaller US and Indian hospitals, he says, there aren't enough patients for one surgeon to focus exclusively on one type of heart procedure. Narayana surgeon Colin John, for example, has performed nearly 4000 complex pediatric procedures known as Tetralogy of Fallot in his 30-year career. The procedure repairs four different heart abnormalities at once. Many surgeons in other countries would never reach that number of any type of cardiac surgery in their lifetimes.
Dr Shetty's success rates appear to be as good as those of many hospitals abroad. Narayana Hrudayalaya reports a 1.4 per cent mortality rate within 30 days of coronary artery bypass graft surgery, one of the most common procedures, compared with an average of 1.9 per cent in the US in 2008, according to data gathered by the Chicago-based Society of Thoracic Surgeons....
Democrats battle to keep Barack Obama health reform plan alive
The fate of President Barack Obama’s long-debated healthcare reforms hung in the balance last night as Democratic leaders in the US Senate scrambled to obtain a conclusive majority that would allow a draft bill to go forward. Failure to obtain the 60 votes necessary for the bill to survive would effectively force Obama’s supporters back to the drawing board and would severely set back the president’s hopes of an early resolution of an issue that has become bitterly divisive and has damaged his popularity ratings.
Democratic leaders expressed confidence yesterday that they would win over wavering senators who are worried that the healthcare battle might cost them their seats when they come up for re-election. At least three Democratic senators have expressed their doubts about the bill. It needs the votes of all 58 Democrats and two independents in the 100-member Senate to overcome Republican attempts to talk it out.
The House of Representatives has already passed its own version of the bill and a successful vote would pave the way for further negotiations. These would be on a Senate version to be merged with the lower house bill in a joint committee of both houses, before going to the White House for Obama’s signature.
Senator Ben Nelson of Nebraska is one of several moderate Democrats who was initially reluctant to support the draft bill. He has let it be known that he would vote to allow a full debate but would then insist on further amendments, especially on provisions for government intervention that critics have dubbed as “socialist” medicine.
Another waverer, Senator Mary Landrieu of Louisiana, has been driving a hard bargain as Democratic leaders agreed extra funding of up to $100m for her home state to secure her vote. Landrieu indicated that she was “leaning towards” a yes vote in order to allow further debate.
Senator Blanche Lincoln of Arkansas remained uncommitted and told reporters she might not make up her mind until just before the cliffhanger vote — scheduled for 1am UK time. Lincoln was reported to be nervous that moderate Arkansas voters would turn against her in next year’s election if she supported the $848 billion bill, which is intended to extend health coverage to 31m Americans who are uninsured.
Obama has spent much of his first year in office pressing for action on healthcare. The White House yesterday issued a statement of support calling the bill a “critical milestone in the effort to reform our healthcare system”.
Health care reform passed its first major test in the Senate tonight, and heads to the Senate floor for debate Nov. 30. President Obama earlier set an end-of-the-year deadline so sign the bill, which -- if you're the betting type -- it seems they'll probably miss. Senate debate is expected to last three weeks.
From the White House, a somewhat subdued statement from press secretary Robert Gibbs: "“The president is gratified that the Senate has acted to begin consideration of health insurance reform legislation. Tonight’s historic vote brings us one step closer to ending insurance company abuses, reining in spiraling health care costs, providing stability and security to those with health insurance, and extending quality health coverage to those who lack it. The president looks forward to a thorough and productive debate."
The Harry Reid-Senate version of ObamaCare will start operating at massive budget-busting deficits starting in 2015, according to an Americans for Limited Government analysis of Congressional Budget Office data. By 2019, the “public option” will have spent some $361 billion more than it took in via new taxes. So, how then does the bill earn the moniker, “deficit-neutral”? The same way the Pelosi-House version does: by rationing health care away from the nation’s elderly—cutting Medicare by some $436 billion.
But that will not pay for this new entitlement—the so-called “public option”—in the long run. Cutting Medicare has its political limits—which is a nice way of saying that cutting it too drastically is a good way for Congressmen to get thrown out on their tails.
Seniors might support entitlement reform where the federal government attempted to figure out a way to fix the broken Medicare entitlement. Under the worst-case scenario, the Medicare Board of Trustees reports that after 2012, the program will lose about $433 billion through 2019. After that, it could be broke as early as 2028.
Economists here is much that could be done to help the situation, including breaking Medicare up into smaller, privatized companies and allowing insurance competition across state lines. But that is not the case being made to the American people in the “HarryCare” bill.
Instead, Congress is attempting to expand health care spending to an additional 36 to 45 million people in an open-ended, taxpayer-financed, government-run takeover. The House version of the legislation goes even further than the Senate, proposing over $890 billion in new spending.
The fact is increasingly clear that Congressional Democrats can only hide the costs in the “public option,” which is what they have done in both versions. But between the numbers, the cover-up comes apart. It took Medicare more than 40 years to run into deficits based on revenue shortfalls. The “public option” will lose hundreds of billions within 5 to 7 years.
As the Independent Institute notes, Florida has tried a similar approach to hurricane property insurance, creating a “public option” to “compete” with private insurers. The proposal also capped how much private insurance companies could charge. This had two predictable results: private insurers fled the state, and the so-called Citizens Property Insurance Corporation “still doesn’t have sufficient reserves to weather a major hurricane. When one comes, Florida taxpayers will be on the hook for the bill.”
In other words, like “public option” health insurance, Florida’s state-run hurricane “solution” proved to be unsustainable and drove Floridians off of private insurance. In the end, it simply created an unfunded liability.
On Saturday at 8PM, the Senate legislation will face an important test vote—on whether or not to proceed to the bill. Reid now admits he is not certain he has the 60 votes necessary to continue pushing the unpopular measure. And if the majority of Americans have their way, by 9PM, the “HarryCare” will have been toe-tagged for the dead room.
With the introduction of Senate Majority Leader Harry Reid’s 2,074-page health insurance nationalization bill, we can be thankful for one thing at least. It will most likely be the last bill of its kind introduced this year. Who’d have time to wade through another? This doesn’t mean there is anything in the bill to be thankful for. Like its Senate predecessors and House counterpart, it should offend any advocate of liberty and good economic sense.
First and foremost among its defects is the individual health insurance mandate: Every individual would be forced to buy government-defined comprehensive medical coverage (or to have it bought by one’s employer). A fine up to $750 awaits anyone who defies the mandate. As Shikha Dalmia points out in Forbes this week, the individual insurance mandate is the major outrage in the whole “health care reform” scam. I would say it’s the keystone. Remove it and most of the rest crumbles to the ground.
Who do these politicians think they are? Our lives are not theirs to dispose of. Politicians love to sugarcoat their threats of force. So the Reid bill calls the mandate “shared responsibility.” To those who wonder by what authority the government can make us buy insurance against our will, the bill alludes to the Constitution’s Commerce Clause, which gives Congress the power to “regulate … commerce among the several states.” (For a fuller story on the clause, see this.) The bill says, “The individual responsibility requirement provided for in his section . . . is commercial and economic in nature, and substantially affects interstate commerce.”
How would an insurance requirement affect interstate commerce? The bill says that since without the requirement people wouldn’t buy insurance until they are sick, it therefore “will minimize this adverse selection and broaden the health insurance risk pool to include healthy individuals, which will lower health insurance premiums. The requirement is essential to creating effective health insurance markets in which improved health insurance products that are guaranteed issue and do not exclude coverage of pre-existing conditions can be sold.” In other words, for the sake of making the insurance market work better, we must be forced to buy coverage. How’s that for a justification?
It’s amazing how many fallacies can be stuffed into one argument. To begin, medical insurance isn’t really interstate commerce. One of the few sensible things proposed during the public discussion on medical care is that the federal ban on interstate purchase of coverage be repealed. Residents of California are not free to buy less-fancy, less-expensive policies offered in Arizona. They are stuck with policies made more expensive by California’s overbearing regulatory regime. Interstate sales would increase competition and lower prices, but the ruling party shows no interest in that idea. So how can this be about interstate commerce?
There’s more that is wrong with the argument. Typically, the Commerce Clause has been invoked against barriers to the free flow of interstate commerce. The Supreme Court has occasionally upheld the prohibition of activities (such as growing wheat for one’s own use in violation of an acreage-allotment program or dispensing medical marijuana) that were said to adversely affect interstate commerce. But the insurance mandate would represent the first time that individuals were compelled to buy product or service in the name of making interstate commerce more effective. The Congressional Budget Office calls it “unprecedented”: “The government has never required people to buy any good or service as a condition of lawful residence in the United States.”
Even under the most expansive reading of the Commerce Clause, how does compelling the purchase of insurance qualify as regulating interstate commerce?
The nub of the bill’s argument is that if healthy people are not forced to buy coverage, the insurance market won’t work properly. Why not? Because same bill would compel insurance companies to accept all applicants for coverage, sick or healthy, without price discrimination. That is, the bill creates the incentive for people to opt out of insurance until they are sick. Obviously, that would not be good for the insurance market.
The individual insurance mandate, then, is a solution to a problem the bill itself would create. The authors invoke the Commerce Clause to protect interstate commerce from a threat they themselves pose to it. They could avert the threat simply by not imposing guaranteed-issue on insurers. But of course the advocates of nationalized medicine wouldn’t do that. Guaranteed issue is at the center of their scheme. They want to proclaim that they brought universal coverage to America. Freedom must take a back seat to their objective, which is to disguise a welfare program as insurance and put us on the road to government-administered rationing.
The “reformers” are quick to point out that people without insurance go to emergency rooms for medical care and sometimes don’t pay their bills, shifting the costs to the rest of us. But Shikha Dalmia notes that uncompensated care accounts for less than 3 percent of the country’s total medical bill. To save $40 billion a year, we should spend more than $100 billion a year and lose more liberty? No thanks.
One reason for uncompensated care is that emergency rooms are forbidden to turn away patients (even in non-emergencies) who have no means of payment. Who imposed that prohibition? The government, of course. That may sound humane, but one unintended consequence is a likely contraction of charitable care. Why set up facilities for the indigent if they can turn up at any emergency room? Again we see Mises’s Law at work: Intervention begets intervention. Government action creates problems that politicians then use to justify more government action. Undoing the first intervention would help solve the problem, but politicians have little incentive to move in that direction.
Government has suppressed the free market in medical care both on the supply and demand sides. As a result, medical services and insurance are artificially expensive, pricing many people out of the market. Instead of removing the interventions and letting the free market—including mutual-aid associations and philanthropy—lower prices and create more widespread coverage, the politicians propose to pile on more market-suppressing measures. Freedom is the first casualty. But we can also anticipate an aggravation of the current system’s worst features.
Forcing individuals to buy insurance is an intolerable assault on our liberty—not to mention a massive subsidy to the insurance companies. (They’re mad the penalty is not greater.) How many more usurpations can we be expected to tolerate?
Reports critical of major British public hospital over child abuse
Whistleblower fired rather than heeded. "Rocking the boat" is the one unforgiveable sin in a bureaucracy. Too bad about the patients
Great Ormond Street Hospital failed to answer senior doctors’ justified concerns about the clinic which failed Baby P [who died of abuse from his carers], according to two secret reports. The hospital provided the doctors at the Haringey child protection clinic where Baby P was a patient, and was the “lead agency” for child abuse, running the clinic with Haringey Primary Care Trust.
The reports, seen by The Daily Telegraph, say that child safety at the clinic was a matter for “grave concern” and that Great Ormond Street managers failed to act adequately on “significant problems” identified by the most senior doctors at the clinic more than a year before Baby P’s death. Instead, the “most vocal” was removed from her job, they say. There was inadequate staffing at the clinic, and “the workload of the consultant team was excessive”.
One doctor, Michelle Zalkin, told the investigators that Great Ormond Street and Haringey managers created a “very hostile environment” which became “quite unbearable”. They communicated, she claimed, largely by “shouty emails and Post-it notes”.
In April 2006, the four most senior consultants at the clinic wrote a joint letter to managers warning of the “very high risk” of a tragedy without more staff. They said their concerns had been “trivialised”. Some action was taken, the reports say, but staffing was cut further and Dr Kim Holt, the consultant identified as “the most vocal,” complained of being “targeted” by managers. She was removed from her job and remains on “special leave” on full pay. Two other consultants resigned and the fourth, Dr Sukanta Banerjee, went off sick, though she has since returned.
By the time Baby P, identified as Peter Connolly, came to the clinic in 2007, there were no experienced consultants and he was seen by a locum, Dr Sabah al-Zayyat, who missed his broken back. Two days later, the 17 month-old was found dead in his cot with broken ribs, lacerations to his head, a finger tip missing, broken teeth, and scores of bruises.
One of the reports, commissioned by NHS London, the strategic health authority, into Dr Holt’s case, finds the consultants’ concerns were “genuine and well-founded”. It is a conclusion echoed by the other report, by Prof Jo Sibert and Dr Deborah Hodes, experts in child protection, into the appointment of Dr al-Zayyat.
The NHS London report says the concerns were “taken seriously” and some action followed but there was “no evidence” that the main worry, consultants’ workload, was “adequately addressed”. The number of consultant posts was reduced after the complaints, from four to three. Since Baby P, it has been increased to nine posts.
The report says the Great Ormond Street manager responsible for the clinic, David Elliman, claimed the problems did not affect patient safety. “We would not agree,” the investigators say. They describe Dr Holt as “highly committed” and say: “We do not consider Dr Holt has been directly targeted, but we do consider that she is entitled to feel aggrieved.”
Dr Holt, who has lodged a formal grievance against Great Ormond Street, refused to comment. A hospital spokesman denied victimisation and said they were keen to resolve any issues with her amicably but could not comment further.
Australia: Limited public radiotherapy services add to cancer trauma
Australians are given to believe that they can rely on their State government for "free" medical care. "Free" does not mean "available" or "high quality", however. What it DOES mean is that what you save in money, you pay in time
THE last straw for Angela Baines came when she arrived at school 45 minutes late and found the police had been called to collect her children.
The Umina single mother of four had struggled to Royal North Shore Hospital on the train every day for five weeks for radiation therapy after breast cancer because no public facility was available locally and she could not afford private treatment. But any wait for her radiation doses or a missed transport connection could scupper her tight timetable.
"I said, 'That's it. I'm going home. I'm pulling out. I cannot endure another day of this possibly happening again,' " said the 39-year-old of her experience two years ago. Ms Baines told the hospital she was cancelling her last week of treatment, but a doctor immediately called to promise that she would be treated the moment she arrived. She completed the course and is now in good health.
Inequitable provision of radiotherapy services across NSW is resulting in serious emotional trauma to patients already vulnerable from surgery, drug treatment and a potentially life-threatening diagnosis, according to a survey released today by the Cancer Council NSW.
Its Roadblocks to Radiotherapy report collects stories of the practical, financial and psychological hardships experienced by people who have to travel long distances for radiation or miss out on the treatment - which can prevent recurrence and is recommended for at least half of cancer patients but in NSW is received by only 36 per cent.
Based on a telephone call-in earlier this year, the survey found rural and regional patients were impressed and grateful for their treatment, but were distressed by practical difficulties. "We hope showing the human element adds urgency to the need for reform," the council's manager for policy and advocacy, Anita Tang, said.
The Auditor-General concluded in a June report that NSW Health needed to intensify its long-term planning for radiotherapy services, especially in high population growth areas including the Central Coast, Hunter, New England, Illawarra and Shoalhaven areas. The department has prepared a draft Radiotherapy Services Plan 2007-11, but has never released it.
In his landmark report on NSW public hospitals a year ago, Peter Garling identified services for patients outside cities as a major problem, recommending revitalised training for doctors outside urban centres and improved travel provisions for people treated far from home.
The Opposition spokeswoman on health, Jillian Skinner, said: "Labor has failed to match radiotherapy services with population growth, with the result that many families are undergoing extreme hardship just to get access to treatment. Cancer cases are predicted to grow by 30 per cent over the next 10 years … what is Labor waiting for?"
Senate Health Care Bill Is “A Disaster” for Small Businesses
After “many months of discussion” in which the National Federation of Independent Business was engaged in efforts to ensure that the high cost of health care was adequately addressed in reform legislation, the organization yesterday came out in full force against the Senate health care bill, declaring it a “disaster for small business:”
Small business can’t support a proposal that does not address their No. 1 problem: the unsustainable cost of healthcare. With unemployment at a 26-year high and small business owners struggling to simply keep their doors open, this kind of reform is not what we need to encourage small businesses to thrive.
We oppose the Patient Protection and Affordable Care Act due to the amount of new taxes, the creation of new mandates, and the establishment of new entitlement programs. There is no doubt all these burdens will be paid for on the backs of small business. It’s clear to us that, at the end of the day, the costs to small business more than outweigh the benefits they may have realized.
NFIB declared the Reid Bill to be unacceptable due to the “impact from these new taxes, a rich benefit package that is more costly than what they can afford today, a new government entitlement program, and a hard employer mandate” which together would cripple small businesses.
The organization’s conclusion is not surprising, given that the Reid Bill leaves small businesses in a lurch. The bill essentially acknowledges that it is terrible policy for small businesses, given that it includes a “small business tax credit” to minimize the impact of the job killing employer mandates and regulation-caused rises in private health insurance premiums.
The problem is that the tax credit only lasts two years and largely excludes small business owners, small businesses with high-average payrolls, and firms with 25 or more workers. After all exclusions, essentially the only eligible firms are those firms with 10 or fewer workers as well as those with low-income workers—the least likely to offer coverage even with a significant price reduction.
Project 21 Members Protest Jesse Jackson Linking Racial Identity to ObamaCare Vote
Members of the Project 21 black leadership network have risen to condemn Jesse Jackson for saying of Rep. Artur Davis (D-AL), "You can't vote against health care and call yourself a black man," calling Jackson's statement divisive and likening it to the mental tactics of a antebellum slaveowner.
Declining to respond in kind, Rep. Davis told The Hill newspaper, "The best way to honor Reverend Jackson's legacy is to decline to engage in an argument with him that begins and ends with race."
Project 21 members were less retrained. "Shame on Jesse Jackson for using the race card in an attempt to influence the views of another black politician," said Project 21 Fellow Deneen Borelli. "Ironically, Jackson is acting like a slaveowner trying to keep blacks on his ideological plantation, where they are required to support government programs that increase public dependency on a bureaucracy," Borelli added. "In Jackson's world, it appears a black man cannot have independent thought. They must follow Jackson blindly or face lashes from his tongue."
"What makes Jesse Jackson an authority on being black in America more than anyone else? Why is he able to determine how we must think?" asked Project 21 member Kevin L. Martin. "It's no mystery why Jackson consistently failed to win broad appeal for his goals and must instead resort to ugly racial politics." Martin added: "Blacks who have sought to exercise their free will are well aware of the disdain, disrespect and derision that comes with straying from the liberal plantation. Welcome to the club, Congressman Davis."
Jackson's smear was made during a Congressional Black Caucus Foundation reception held on November 18 to mark the 25th anniversary of his presidential campaign. Rep. Davis (D-AL), a black congressman, voted against the House version of Obamacare.
Omaha World-Herald to Sen. Nelson: "Just say 'no' to Reid plan"
The editorial board of the Omaha World-Herald makes a brilliant case calling on Senator Ben Nelson to vote no on a cloture vote for Harry Reid's Health Care plan. Nelson is one of the most closely watched swing votes. This should be an argument made coast to coast on why the plan should be stopped before it can make it to the Senate floor.
From the Omaha World-Herald: Sixty votes will be needed to send Sen. Harry Reid's health care proposal to the Senate floor for debate. Sen. Ben Nelson, one of the most closely watched swing votes, should vote no. Why? Because Reid’s proposal, like that approved in the U.S. House, would place immense burdens on small and medium-sized rural hospitals in the Midlands. It would not prevent further steep increases in health care costs.
It would, however, shunt billions in new costs onto state governments. And its budget savings at the federal level depend on empty, misleading promises of fiscal discipline that Congress has shown it’s utterly incapable of fulfilling.
If anyone doubts the threat to Nebraska, especially its rural areas, remember that it was Reid himself who tried to get a side deal to hold his own state of Nevada harmless from the increased Medicaid expenses that would raise costs steeply for state governments — and thus state taxpayers.
Those considerations need to occupy the very forefront of Sen. Nelson’s thinking as he ponders how to vote on the proposal. Is he more worried about making sure that the vital interests of Nebraska are protected, or about pleasing Reid and House Speaker Nancy Pelosi?
There ought be no question about what the proper answer should be. And that answer — making absolutely sure that health care legislation does not harm the interests of Nebraska — should lead the senator to vote “no” on sending the legislation to the floor.
If the legislation does win final passage in the Senate, it then would go to a conference committee with the House. The odds are that the conference committee would make the legislation even more heavy-handed and centralized, without proper consideration for the burdens placed on Nebraska. In the Senate, the conference committee’s proposal would need only 51 votes to win final approval. Nelson at that point could vote no and the legislation nonetheless would become law with the president’s signature.
No matter how much Nelson then said, “Look, everyone, I voted against it in the end,” the real-world harm to Nebraska would be gigantic and longlasting.
The state’s smallest and most vulnerable medical facilities would face enormous pressure. Major new expenses would fall on the state government. And judging from what Congress has decided so far, the legislation would do nothing serious to curb health care inflation.
Just this week, Jeffrey S. Flier, the dean of Harvard Medical School, wrote an opinion column on the nation’s health care debate, saying, “I’d give it a failing grade.” He added: “Speeches and news reports can lead you to believe that proposed congressional legislation would tackle the problems of cost, access and quality. But that’s not true. The various bills do deal with access by expanding Medicaid and mandating subsidized insurance at substantial cost — and thus addresses an important social goal. However, there are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform.”
If the Senate does take up the Reid proposal, Sen. Nelson’s fundamental obligation throughout the debate should be to focus on safeguarding Nebraska’s interests, particularly its rural areas. Nebraskans need to be watching and listening closely for the senator’s words and actions.
If Nelson can’t make the case right now that rural Nebraska would be safe under the Reid legislation, then he should not vote to allow it to go forward.
Otherwise, congressional procedures would likely produce an ultimate result that — regardless of the senator’s possible “no” vote at the end — would deliver a terrible blow to Nebraska communities. That is the kind of result from which a state finds it hard to recover. The same can be said of a lawmaker’s reputation.
Earlier today, I attended a panel discussion at the Cato Institute about one of the most important aspects of health care that has gotten very little coverage during the current debate -- medical innovation.
Raymond Raad, a resident in psychiatry at New York Presbyterian Hospital/Weill Cornell Medical Center and co-author of a new Cato study, presented evidence showing that the United States leads the world in the development of drugs, medical devices, and other advanced treatments. For instance, between 1969 and 2008, 57 of the 97 Nobel Prizes in medicine and physiology -- or nearly 60 percent -- were awarded to people who did their research in the U.S., and nine of the top 10 medical innovations between 1975 and 2000 were developed here. But these achievements aren't reflected in rankings of different health care systems that typically show the U.S. faring poorly and provide fodder to those pushing for government-run health care. This even though once these products are developed in the U.S., they become widely available and improve health care outcomes around the world.
Raad argued that one of the big dangers of health care legislation is that expanding the role of government and trying to impose price controls could change incentives to innovate. When the government is such a large consumer of health care, it has tremendous influence over whether some innovations succeed. As an example, Raad noted how government stunted the growth of specialty hospitals by not allowing Medicare money to spent at them. Specialty hospitals are smaller institutions formed by doctors to focus on one type of illness, such as heart disease. They can deliver better health outcomes and a more personalized experience for patients than giant factory hospitals that benefit from their tax-exempt non-profit status even as they rake in billions of dollars. Raad explained that some of the most common and important medical innovations --such as CT scans -- were quite controversial when first introduced, and thus putting more constraints on the market could prevent wider use of new products that may ultimately prove beneficial.
Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins University Bloomberg School of Public Health, described himself as the liberal on the panel. He emphasized the importance of universal access to new medical innovations, and argued that it was "naive" to talk about where innovations originated, since they all tend to be developed on a multi-national basis in many stages. He also showed that the pace of medical innovation has slowed in recent years, in both the U.S. and Europe, and said that it's important to do something to change incentives that are currently in place. Currently, large drug companies spend just 12 percent to 15 percent of their outlays on researching and developing new drugs, and 30 percent on marketing them.
John Calfee of the American Enterprise Institute suggested several reasons to worry about in the current health care bills. He said they would increase the costs to both the public and private sector well beyond what Congressional Budget Office is projecting. And he warned that it would be difficult for government to resist the temptation to impose price controls on products that were very expensive relative to their marginal costs. For instance, once drugs are developed, the cost to manufacture each additional pill is small relative to the price charged for the drug. But imposing such controls would reduce profits and thus the incentives of drug companies.
Tragedy of girl, five, struck by swine flu: Three NHS GPs and a hospital doctor thought she had tonsillitis
Diagnostic tests? Never heard of them!
A five-year-old girl suffering from swine flu died after doctors took two weeks to diagnose her illness, it was claimed last night. Nida Qureshi was seen by three GPs and a hospital doctor who told her parents she may have tonsillitis. By the time doctors discovered that she had the H1N1 virus, the youngster was on a life support machine, her family said. She died eight days later.
Last night relatives said Nida's parents - Zubair, 28, and Raheela, 30, who is pregnant with their second child - believe that their daughter may have survived if swine flu had been detected earlier. Nida's uncle, Jawaid Qureshi, said: 'Her mum, herself a child carer, and dad are very angry that doctors and GPs failed to diagnose it earlier. It's devastating. She may have lived if it had been diagnosed earlier.'
Mr Qureshi said Nida - a 'bright' girl without any underlying health problems - fell ill with a temperature and vomiting on October 19. The family phoned a GP, who advised paracetamol. The next day she went to her doctor and was prescribed antibiotics. Five days later, the family took her back but were told to carry on giving the antibiotics. On November 1, after her condition worsened, the family took her to A&E at their local hospital, Wexham Park, in Slough.
Mr Qureshi said: 'When she was breathing she was in agony. She was coughing a lot as well. The doctor at hospital said it might be tonsillitis but they did not take any blood or urine samples. They prescribed her with more medicine and said: "Go back to the GP if she continues not to feel well". It was a very bad decision to allow her to go home.'
Two days later she had a seizure and never regained consciousness. She was put on a life support machine and finally diagnosed with the H1N1 virus. Nida was transferred to St Mary's Hospital in London.
A spokesman for NHS Berkshire East said: 'We can confirm that a young girl from east Berkshire died at St Mary's Hospital, London, on November 11. She had tested positive for H1N1 swine flu.'
Professor John Oxford, professor of virology at Queen Mary School of Medicine, said her death could have been caused when the swine flu virus moved into her central nervous system. Normally, the virus attacks the lungs. But in extremely rare cases, often affecting children, it can attack the nerve tissue and cause a seizure. He added: 'Diagnosing flu in a five-year-old is extremely difficult. It is also impossible to say if Tamiflu would have made any difference in this case.'
Civility and honesty coming to Britain's National Health Service?
Doctors and nurses should be more honest and open when things go wrong and offer an apology to the patient or their family under new guidance to the NHS. Clinicians are often fearful of saying sorry when a patient has been harmed by a blunder because it may influence any future legal action, but it is the 'right thing to do, the head of the National Patient Safety Agency has said. When patients file complaints or litigation, their aim is often for the people involved to say sorry and to ensure the same thing does not happen to someone else, research has shown.
New guidance, entitled Being Open, has been issued to the NHS highlighting the importance of effective communication with patients. Martin Fletcher, Chief Executive of the NPSA, said: “Being open is the right thing to do. Making a genuine apology to a patient and their family after an error has occurred is a very hard thing to do for any clinician. “Saying sorry and following the principles of Being Open does have other benefits too. It can also enhance an open and fair safety culture and reduce costs associated with complaints and litigation.”
Mr Fletcher added: “Apologising after an incident has happened must not be about blaming others for errors. "Doing so would serve no purpose - it would only drive the issue underground and we would never get to the heart of the problem. This would mean that risks are not identified and future patients have the potential to be harmed in the same way."
The NPSA collects data from the NHS on instances where patients have been harmed or near misses in orderto identify patterns and issue warnings to the rest of the health service so similar problems can be avoided elsewhere.
Mr Fletcher said: “Discussing patient safety incidents promptly, fully and compassionately is the best way to support patients and staff when something does go wrong. Evidence from other countries shows that by following the principles of Being Open, formal complaints and litigation claims can also be reduced.”
Managers in the NHS needed to take the initiative for the principles to succeed he said. Senior clinicians should be identified in each organisation to support doctors and nurses when things go wrong the guidance said.
NHS Medical Director Professor Sir Bruce Keogh said: “Being open with patients should anything go wrong with their healthcare is the right thing to do. Support is vital during what is often a difficult time for both clinicians and patients. "I commend the introduction of senior clinical counsellors to support fellow clinicians.”
Peter Walsh, Chief Executive, Action against Medical Accidents (AvMA), said: “Being open when things going wrong is the most important thing for patients and makes sense from everyone’s point of view. "The Being Open training and materials make it easier to do what must be the hardest job that a health professional has to do.”
What does it take to get a wavering senator to vote for health care reform? Here’s a case study. On page 432 of the Reid bill, there is a section increasing federal Medicaid subsidies for “certain states recovering from a major disaster.” The section spends two pages defining which “states” would qualify, saying, among other things, that it would be states that “during the preceding 7 fiscal years” have been declared a “major disaster area.” I am told the section applies to exactly one state: Louisiana, the home of moderate Democrat Mary Landrieu, who has been playing hard to get on the health care bill.
In other words, the bill spends two pages describing would could be written with a single world: Louisiana. (This may also help explain why the bill is long.) Senator Harry Reid, who drafted the bill, cannot pass it without the support of Louisiana’s Mary Landrieu. How much does it cost? According to the Congressional Budget Office: $100 million.
Senate, Help Your President -- Deep-Six ObamaCare!
"The political risks of failure are pretty high." A former congressional aide offered this ominous assessment following the House of Representatives' passage of "health care reform." Warning to the Senate: President Obama and his party face political catastrophe if you fail to do your part so that the President can sign a bill! Nonsense.
The political risks of success are much, much higher. Taxes would go up -- and not just on "the rich." And since "the rich" provide jobs, they would hire fewer people, spend less on their businesses, and take fewer risks. Costs would explode beyond government estimates -- which conveniently limit the estimated price tag to only the first decade.
Expect insurance companies to deny requests for medical treatment at a greater rate than today. Why? The bill would require insurers to take people with pre-existing illnesses, so denying requests for treatment would be the only potent weapon to reduce costs. And since those with pre-existing illnesses could not be denied coverage, people would simply wait until they required care before getting insurance -- only to drop it and risk paying fines once they were treated.
Government eventually will start "controlling costs" by rationing care -- denying requests; imposing waiting times for treatment; and withholding treatment from those with "bad" lifestyles (e.g., those who smoke cigarettes or those who fail to exercise and eat "appropriately") and those considered too old to "sufficiently benefit."
President Franklin D. Roosevelt, during the Great Depression, launched the New Deal -- a blinding array of expansive and expensive government programs designed to "rescue" the economy. Obama, as did FDR, calls this expansion necessary in order to achieve economic recovery. Government expansion -- in this case, ObamaCare -- and economic prosperity supposedly go hand in hand.
Henry Morgenthau served as FDR's Treasury secretary. Thus Morgenthau, who served from 1934 to 1945, was to FDR what current Treasury Secretary Timothy Geithner is to Obama. Morgenthau wrote in 1939: "We have tried spending money. We are spending more than we have ever spent before and it does not work. I want to see this country prosperous. I want to see people get a job. I want to see people get enough to eat. We have never made good on our promises. ... I say after eight years of this Administration we have just as much unemployment as when we started ... and an enormous debt to boot!"
Political Armageddon if ObamaCare fails? No. A recent Rasmussen poll shows more "likely voters" opposed than in favor. Preventing Obama from being Obama is job security for both the President and the congressional Democrats.
The then-Republican-controlled Congress stopped President Bill Clinton from passing HillaryCare. People soon forgot about his "failure" and re-elected him by a larger margin than he received in his first term. Republicans also blocked his first-term attempt to pass a multibillion-dollar "economic stimulus package."
Because of Republican pressure or support, Clinton signed measures unpopular with his base -- the NAFTA and GATT trade agreements; a reduction in capital gains taxes (as part of a larger budget compromise); and 1996's welfare reform act, which, for the first time, refused recipients more money if they had additional children and imposed benefit time limits. Many congressional Democrats opposed these measures.
Though he successfully blamed the Republicans for temporarily shutting down the government over a budget impasse, Clinton signed a budget more modest and less expensive than he wished. For these reasons, among others, Clinton left office with a budget surplus that Democrats constantly brag about -- never, of course, giving Republicans any credit for restraining Clinton's desire to spend.
Besides, if ObamaCare fails in the Senate, watch Obama and the sycophantic media round up the "usual suspects" -- "anti-women" pro-lifers who reject government money for abortions; anti-illegal-alien "racists" who wanted some teeth in the legislation to stop illegal aliens from receiving benefits; "in-the-pockets-of-insurance-company" opponents of the noble "public option" (government-subsidized insurance designed to keep insurance companies "honest"); "evil and greedy" health insurance companies that "misled" the public about the wonders of ObamaCare; "the rich" who selfishly resisted tax hikes; and, of course, Republicans who "failed to offer an alternative."
The media will praise the President for his "heroic" effort, for "going down swinging," for getting the House -- for the first time in history -- to pass health care "reform," for going further than any president since President Harry Truman first proposed government-based universal health care.
After spending trillions to "save" our financial system, signing an $800 billion spending package to "stimulate" the economy, and pushing government takeovers of financial firms, banks and car companies, the President stands -- pen in hand -- ready to enact a dangerous government takeover of one-sixth of the nation's economy.
President Clinton survived -- not in spite of but, in part, because of his "failure" to "reform" health care. Obama will survive -- and benefit -- from this "failure," as well. So, Senate, do the President, yourself and the country a favor. Stop him.
Would a member of the House of Representatives vote to pass Obamacare if he or she knew it was going to lead to an electoral loss in November 2010? Even if a "yes" vote on Obamacare significantly increases the likelihood of a loss without guaranteeing it, would a member of the House still throw in with Nancy Pelosi and President Obama? Or would they brave the nasty e-mail from the left and the angry looks from Democratic leadership and vote instead to keep their job by voting in accord with the wishes of their district and thus voting no?
If at least three of the 220 House members who voted yes on Obamacare on November 7 fall into the category of those who would rather survive November 2010 than go down in a rush to single payer, then it will be possible to defeat the bill on its return engagement in the House. Possible, that is, if enough voters indicate to the House members that a yes vote on the government's takeover of health care means a "no" vote on their re-election in 50 weeks.
Which brings us to ReverseTheVote.org, a website launched this week by the National Republican Congressional Committee. ReverseTheVote.org identifies the 24 most vulnerable Democrats who voted for Obamacare, and it asks for contributions that will go into the war chests of the eventual GOP nominees against these 24 incumbents. Every dollar given gets split 24 ways. No money goes into a primary fight between Republicans. Every dollar gets spent to defeat a proponent of Obamacare.
The 24 Democrats who are targeted by ReverseTheVote.org come from across the country --from New Hampshire to Oregon and from New York to Arizona. Each one is listed by name at the web site. Each voted against the wishes of their district, and as serious public opinion shows, against the wishes of clear majorities of Americans.
If cash piles up in the common fund to defeat these two dozen Obamacare proponents, not only will they notice, so too will those Democrats who voted no the first time and are glad they are not on the list. When Democratic whips come round looking for new help to offset any defections, the ReverseTheVote.org list will be on the minds of every Democrat who voted no last time and stayed off the list. So too will the handful of Senate Democrats notice in whose hands Obamacare currently rests. If Arkansas' Blanche Lincoln sees a yes vote for Obamacare become the rallying cry of 2010, will she be more or less likely to vote for cloture when that key vote comes up.
Public opinion swung against Obamacare long ago, which is why the president and his Congressional allies are trying to rush it through now, as far in advance of next year's elections as possible.
But if vulnerable Democrats realize that the public has made up its mind and is now making a list and posting it on the fridge, the momentum behind the ill-conceived and gigantically expensive experiment in socialized medicine will evaporate.
If ReverseTheVote.org collects significant numbers of small donors, Democratic leaders won't be able to tell these 24 Democrats not to worry, that no one will remember this vote come next fall. Opponents of Obamacare have the opportunity to send the loudest message possible, one that even the most tone-deaf Democrat will hear.
Married couples face extra tax in Senate health care bill
Senate Democrats' health care bill would create a new marriage penalty by imposing a tax on individuals who make $200,000 annually but hitting married couples making just $50,000 more.
That's one of 17 new taxes imposed by the bill, which also creates a levy on elective plastic surgery - some call it "botax" - and places a 40 percent excise tax on those who have generous health care plans. "If you have insurance, you get taxed. If you don't have insurance, you get taxed. If you need a life-saving medical device, you get taxed. If you need prescription medicines, you get taxed," said Senate Minority Leader Mitch McConnell, Kentucky Republican, who is leading the fight against the bill.
The new taxes would be used to fund an expansion of government medical programs and to fund subsidies for lower-income individuals to buy insurance, extending health care coverage to 94 percent of eligible non-elderly Americans.
Democrats said the bill will offer lower health care costs for small businesses and families, and said the new taxes are aimed at upper-income earners, so costs would not go up for the middle class. They said that makes good on President Obama's campaign pledge not to increase taxes on families making less than $250,000 a year, which explains the reason for the new marriage penalty.
"We wanted to make this provision consistent with the president's pledge not to increase taxes on singles making under $200,000 and married couples making under $250,000," said Jim Manley, a spokesman for Senate Majority Leader Harry Reid, who wrote the Senate bill. "Yes, this structure can create a 'marriage penalty' for some couples. It also creates a 'marriage bonus' for others," he said. "A married couple with one wage earner can earn up to $250,000 without facing this higher tax, whereas a single person in the same job with the same pay would be hit by it."
But a married couple in which each earner makes $150,000 would be hit with the tax, whereas an unmarried couple living together with the same incomes would not.
Ryan Ellis, tax policy director at Americans for Tax Reform, said the new marriage penalty comes on top of an existing one that's always been part of the payroll tax, which funds Social Security and Medicare. He said when the payroll tax was created to fund Social Security during the New Deal, lawmakers didn't anticipate the freelance of two-income families, so there's always been a sort of marriage penalty for couples whose incomes topped the single-earner income taxation level.
Condemned to an early death: British rationing body tells liver cancer victims that life-prolonging drug is 'too costly'
Liver cancer sufferers are being condemned to an early death by being denied a new drug on the Health Service, campaigners warn. They criticised draft guidance that will effectively ban the drug sorafenib - which is routinely used in every other country where it is licensed. Trials show the drug, which costs £36,000 a year, can increase survival by around six months for patients who have run out of options.
The Government's rationing body, the National Institute for Health and Clinical Excellence (Nice) said the overall cost was 'simply too high' to justify the 'benefit to patients'. However, relatively few would be eligible for the treatment - around 700, or one in four of those diagnosed each year with primary liver cancer.
Nice had claimed it was approving more drugs under End of Life policies introduced in January meant to benefit small numbers of terminally ill people. So far two drugs have been approved for three cancers. But two drugs have been banned under the rules, with a ban pending on three further drugs including sorafenib.
Its treatment of sorafenib contrasts sharply with that of breast cancer drug herceptin, which has received far more funding and attention after successful campaigns. Herceptin, under separate Nice criteria, has been judged to be cost effective. It currently costs £22,000 to administer an annual course of the drug to around 7,000 women - around £154million.
In contrast, the treatment for sorafenib would potentially cost £25million a year. Sorafenib, also called Nexavar, was assessed on different rules but still failed to meet the Nice threshold.
Kate Spall, founder of the Pamela Northcott Fund, which assists cancer patients denied new therapies, last night said cancer sufferers had been sold down the river. She said: 'These policies were specifically designed to help patients with rarer cancer such as liver to access new treatments for a previously untreatable disease. 'This decision will condemn patients to an earlier death than was necessary.' Only 20 per cent of patients with primary liver cancer - where the tumour originates in the liver - are alive one year after diagnosis.
Bayer, which makes the drug and plans to appeal the decision, had offered a scheme where it would provide every fourth packet for free. Dr Harpreet Wasan, a cancer consultant at London's Hammersmith Hospital, said: 'This cancer is not like any other cancer. There is no alternative treatment. Every other drug that has been tried fails to work. 'British doctors were heavily involved in the trials of this drug yet NICE will say we can't prescribe it.'
Nice rates the cost-effectiveness of a drug using a complicated measurement called a 'quality adjusted life year' or QALY. This determines the cost of new treatment by working out how much it improves and extends a life compared with existing treatments. Andrew Dillon, chief executive of Nice, said: 'We have recently changed our approach to appraising high cost treatments which can extend life for terminally ill patients. 'This has meant that more of them are now recommended.'
Professor Jonathan Waxman, a cancer specialist at Imperial College, London, said: 'The only reason Nice has approved any drugs under End of Life rules is because of a High Court ruling and doctors' protests. 'We must have a public debate about how it treats cancer patients.'
The Nice guidance applies to England and Wales. Scotland's equivalent body is yet to make a decision on sorafenib but tends to follow Nice.
Tony Almond, 46, went to the doctor complaining of indigestion in September. Three days later he was diagnosed with terminal liver cancer and told he had a month to live. Mr Almond, a truck driver living in Brackley, near Northampton, and his long-term partner Sharon immediately got married by special licence on October 16. He said: 'We'd been talking about getting married at Christmas but now I was told I had two to four weeks to live. 'It was pretty horrendous, especially when I found I couldn't have the only drug that would help because it was too expensive.'
Cancer specialists applied to Northamptonshire Primary Care Trust for funding, which is a necessary procedure for such drugs prior to approval by Nice, the drugs rationing body. But the request was rejected. With the backing of an NHS consultant in Birmingham, however, he appealed the decision and won. Mr Almond has been taking the drug for two weeks. He said: 'I can honestly say I no longer feel ill. It's a wonder drug and I feel angry that others may be denied the chance we had to fight so hard for.'
Could the Herceptin victory offer hope? It is three years since Ann Marie Rogers won her famous court victory which forced the Health Service to give her - and other breast cancer victims - access to the wonder drug Herceptin. The drug had been turned down by rationing watchdog Nice but Health Secretary Patricia Hewitt told trusts that they could not deny the drug on grounds of costs.
Now another group of cancer sufferers are facing a similar battle but it is unlikely that we will see Andy Burnham, the current Health Secretary, taking a similar stance --because this time the drug that has been turned down, Nexavar, is one that helps against liver cancer. The problem for campaigners is that liver cancer is not as high profile as breast cancer. This is partly down to the fact that fewer people get cancer of the liver than are diagnosed with breast cancer - around 3,000 a year compared with 45,000.
But that is not the whole story. Breast cancer has two charities fighting its corner - Breakthrough Breast Cancer and Breast Cancer Care - both of which attract millions of pounds in donations, and help boost the profile. Other cancers tend to fade into the background. There is, for example, still no prostate cancer screening programme that compares to the major screening programme for breast cancer. Yet around 10,000 of the 35,000 men in the UK diagnosed with prostate cancer each year die from their disease - a similar number to the 11,900 breast cancer victims.
Remember when President Obama said that the goal of health-care reform was to save money? The bill that passed the House a week and a half ago, according to the Senate Budget Committee, would cost a whopping $3 trillion after being fully implemented--more than three times the $900 billion that the president had promised. It turns out that Obama's oft-stated pledge that reform would "bend the cost curve" was accurate: the House bill would bend the curve straight up. Expect more of the same from the Senate's version when Democrats' bill in that chamber emerges, probably later today--earlier drafts came equally loaded with budget gimmicks, phantom cuts, and taxes on the middle class to go along ! with massive subsidies to the uninsured to buy government-mandated health plans. The Congressional Budget Office scored the cost of the coverage expansions in an earlier Senate version as rising at 8 percent annually. President Obama has repeatedly promised that health reform would lower costs, yet independent observers, from the CBO to Richard Foster, the chief actuary of the Centers for Medicare and Medicaid Services, have repeatedly said just the opposite. What gives?
Part of the reason is that whenever Washington micromanages markets, the pleasing of interest groups tends to take priority over good policy. (Republicans are no more immune to the temptation than Democrats: President Bush and congressional Republicans passed a drug benefit for Medicare without paying for it and without reforming the broader Medicare program.) Declaring victory requires greasing lots of palms, like those of California congressman Dennis Cardoza. Politico reports that Cardoza wheedled $500 million for rural medical centers (including a promise to fund one in his district) from Nancy Pelosi and the White House in return for his "yes" vote on the House bill.
Giving congressmen pork is surely expensive, but more costly still is the billions of dollars in subsidies that the bill would direct to the uninsured to buy government-approved (read: expensive) health insurance. The bill would also create over 100 new commissions, boards, and committees to dictate (among other things) what benefits and services your health insurance must cover--including, by 2018, all employer-provided health insurance. That's 100 new committees for lobbyists to jostle for handouts from Uncle Sam.
Meanwhile, Obamacare does almost nothing to control costs or fundamentally reform the government's massive Medicare and Medicaid entitlements. In fact, Foster estimates that 60 percent of the expansion of coverage in the House bill would come from new Medicaid enrollments. (The earlier Senate version did contain a tax on unions' "Cadillac" health plans, a measure that might slow health-care inflation. But in deference to union complaints, Senate Majority Leader Harry Reid is likely to replace the tax with a new Medicare levy on upper-middle-class families.) When it comes to cost containment, Democrats tout the bill's hundreds of billions of dollars in cuts to reimbursements for doctors, hospitals, and nursing homes. But these will undoubtedly be lobbied out of existence. Medicare doctor payments have been slated for deep cuts under a "sustainable" growth formula since 2003, but every year since then, Congress has voted to rescind those cuts. In fact, Reid already tried to! pass just such an adjustment (for $200 billion) separately from the Senate's health-reform bill, so that it wouldn't be scored as part of the bill's cost. Thankfully, 12 Democrats and one independent voted with Republicans to kill the charade.
Democrats also rely on a "super-committee" that's supposed to pass more automatic changes to rein in Medicare spending--unless the president and Congress override it. Count on them to do so whenever it's politically convenient.
In the end, the problem with Obamacare is that the president and his allies assume that the way to drive costs down is through price controls and committees, rather than market preferences. And that's an assumption that a century's worth of failed statist experiments should have buried. Sure, markets aren't perfect; businessmen cheat, lie, and steal, just as politicians do. But markets have one virtue over command-and-control systems: where competition, transparency, and consumer choice drive markets, bad actors go out of business, prices decline over time, and quality improves. If I want your business, I have to sell you something that's worth buying, and at a good price.
Health care, we are told repeatedly, is different. But it's only different because the government has made it different. Our health-care "system" is based on an IRS ruling from World War II that confers tax-deductible status on health insurance only if it's purchased through an employer. Health insurance is regulated in 50 separate sclerotic state markets--rather than in one big, truly competitive national one--thanks to the 1945 McCarran-Ferguson Act. Medicare sets prices for thousands of physicians. Government decisions have transformed what could have been a price-lowering market like any other into an expensive, convoluted mess.
Such old systems are notoriously difficult to change. But they can change, and there are some promising templates. The Dutch are shifting from a command-and-control system to one in which insurers compete and prices for hospital care are allowed to fluctuate, driving innovation. Closer to home, in Indiana, nearly 50 percent of state employees have Health Savings Accounts--saving taxpayers $42 million to date. Companies like Safeway and Whole Foods have created insurance plans that reward healthy behavior and lower health-care costs.
Neither Congress nor the president seems to be paying much attention. But until every American gets control of his or her own portable, affordable, private health insurance--until, that is, a true market exists in health care--costs will continue to spiral upward. And voters will get more of the same, packaged as hope and change.
As President Obama and Congress craft the largest national health insurance program since the creation of Medicare and Medicaid in 1965, they insist that the final product will add "not one dime" to the federal deficit. But cost projections are notoriously unreliable, and history is filled with examples of federal programs - especially in health care - that cost far more than originally predicted.
In 1965, the House Ways and Means Committee estimated that the hospital insurance program of Medicare - the federal health care program for the elderly and disabled - would cost $9 billion by 1990. The actual cost that year was $67 billion.
In 1967, the House Ways and Means Committee said the entire Medicare program would cost $12 billion in 1990. The actual cost in 1990 was $98 billion.
In 1987, Congress projected that Medicaid - the joint federal-state health care program for the poor - would make special relief payments to hospitals of less than $1 billion in 1992. Actual cost: $17 billion.
The list goes on. The 1993 cost of Medicare's home care benefit was projected in 1988 to be $4 billion, but ended up at $10 billion. The State Children's Health Insurance Program (SCHIP), which was created in 1997 and projected to cost $5 billion per year, has had to be supplemented with hundreds of millions of dollars annually by Congress.
Barely two weeks in office, Mr. Obama signed a $33 billion bill that will add 4 million mostly low-income children to the SCHIP program over the next 4 1/2 years.
All of these numbers were assembled and published in July by the Senate Joint Economic Committee.
The White House and Democratic leaders insist that the proposed health care reform being debated on Capitol Hill will be different. They also note that the costs of some federal health care programs, including the Medicare prescription-drug program, have come in below projections. But the official arbiter of costs in Congress, the Congressional Budget Office, hints that comprehensive health care reform could go the way of most other health care initiatives from Washington.
Government Will Fail on Health Care Record Keeping
As the era of Big Government begins to wear on people, a multitude of evidence has come to the fore to show us just how inefficient and even dangerous the growth of government can be.
While many debate the role of Government in Health Care, one issue has emerged that should the argument to rest. Can the Government effectively manage the Health Care records of over 300 million people in an online database--as called for in the Obama Health Care bill?
This week we all learned that the Government couldn't keep track of the Stimulus spending on what they branded a revolutionary website, Recovery.gov. How, then, will they be able to keep track of all 300 million plus Health Care records in their “revolutionary” Health Care database? One must ponder this as we are being sold a bill of goods.
What will happen when the system inevitably collapses as the Recovery.gov system has? Will we simply get an explanation over Twitter? If that sounds outlandish, that’s exactly what they did yesterday when the buffoons behind Recovery.gov tweeted that “Unless an egregious error is noted, Recovery.gov posts data exactly as it is reported by the recipients.” Apparently no apparatus exists to provide the needed oversight. Troubling.
The current administration reminded us for the better part of the last year about a lack in oversight, a claim which is completely false. However, judging from the performance of the record keeping at Revovery.gov and by those in charge of the Stimulus spending, it’s hard to assert that there is oversight in any form. It appears that Government cannot provide quality oversight.
Fear of the new Health Care overhaul is natural. Claims that the Government will be able to provide accurate and efficient record keeping of our medical records is not natural in light of recent events.
The government paid more than $47 billion in questionable Medicare claims including medical treatment showing little relation to a patient's condition, wasting taxpayer dollars at a rate nearly three times the previous year.
Excerpts of a new federal report, obtained by The Associated Press, show a dramatic increase in improper payments in the $440 billion Medicare program that has been cited by government auditors as a high risk for fraud and waste for 20 years.
It's not clear whether Medicare fraud is actually worsening. Much of the increase in the last year is attributed to a change in the Health and Human Services Department's methodology that imposes stricter documentation requirements and includes more improper payments — part of a data-collection effort being ordered government-wide by President Barack Obama this coming week to promote "honest budgeting" and accurate statistics.
Still, the fiscal 2009 financial report — covering the first few months of the Obama administration — highlights the challenges ahead for a government that is seeking in part to pay for its proposed health care overhaul by cracking down on Medicare fraud. While noting that several new anti-fraud efforts were beginning, the government report makes clear that "aggressive actions" to date aimed at reducing improper payments had yielded little improvement.
In recent years, the suspect claims have included Medicare prescriptions from doctors who were dead, and requests for payment for medical supplies such as blood glucose strips for sexual impotence and diabetic shoes for leg amputees. Patients, many of them new citizens who barely speak English, are sometimes recruited by brokers who go door-to-door offering hundreds of dollars for use of their Medicare numbers.
Obama is expected to announce new initiatives this coming week to help crack down on Medicare fraud, including a government-wide Web site aimed at providing a fuller account of health care spending and improper payments made by various agencies. The Centers for Medicare and Medicaid Services also will launch a Web interactive next month that will allow users to track Medicare payment information by categories such as state, diagnosis and hospital.
According to the report, the Bush administration from 2005-2008 reported improper payments of roughly 4 percent in the fee for service program, or about $17 billion total in 2008. Government officials at the time, however, typically did not consider a Medicare payment improper if the medical documentation was incomplete or a doctor's signature was illegible. Since these were flaws that ordinarily bar payment, that methodology drew complaints from government auditors that the figures were understated.
For fiscal year 2009, the Obama administration began counting those claims as improper, but was unable to complete an official tally based on the new methodology. As a result, it officially reported improper payments for its fee for service program at 7.8 percent, representing a partial tally under the new formula. But it considers the unofficial tally of 12.4 percent to be more representative.
Beginning next year, the 12.4 percent figure — or a total of $47 billion in improper payments when counting both Medicare fee for service and managed care — will be used as the baseline estimate. The federal report sets a target of reducing improper payments in the fee for service program to 9.5 percent by next year, which would represent a savings of roughly $9.7 billion.
The findings come as the Obama administration is making Medicare anti-fraud efforts an important priority. In recent months, HHS has said it was multiplying by 10 the number of agents and prosecutors targeting fraud in Miami, Los Angeles and other strategic cities where tens of billions of dollars are believed to be lost each year. The new partnership seeks to have better sharing of real-time intelligence data on health care fraud patterns.
Officials say they also want to increase training and outreach among Medicare providers to reduce documentation errors, while proposed health overhaul legislation would increase background checks on Medicare claimants and impose stiffer penalties for false claims.
Other findings:
_In the Medicaid program for the poor, roughly $18.1 billion, or 9.6 percent of claims, are believed to be improper payments.
_Using a baseline of 12.4 percent in improper payments in the Medicare fee for service program, HHS is setting targets of reducing fraud and waste to 9.5 percent, 8.5 percent, and 8.0 percent, respectively, for fiscal years 2010 through 2012.
Records released in the past week showed that CMS for three years ignored internal watchdog warnings about swindlers stealing millions of dollars by scamming several Medicare programs. The agency received roughly 30 warnings from inspectors but didn't respond to half of them, even after repeated letters.
Setting up a historic year-end health care debate, Senate Majority Leader Harry Reid unveiled long-awaited legislation Wednesday night to extend coverage to all but 6 percent of eligible Americans and bar private industry from denying insurance because of pre-existing medical conditions. The Democrat's $849 billion measure is designed to remake the nation's health care system, relying on cuts in future Medicare spending to cover costs—as well as on higher payroll taxes for the well-to-do and a new levy on patients undergoing elective cosmetic surgery.
Aides said the mammoth, 2,074-page bill would reduce deficits by $127 billion over a decade and by as much as $650 billion in the 10 years that follow, citing as-yet-unreleased estimates by the Congressional Budget Office. "Tonight begins the last leg of this journey," said Nevada Sen. Reid, less than two weeks after the House approved its version of a sweeping remake of the health care system— and nearly 10 months after President Barack Obama's Inauguration Day summons to action.
Obama welcomed Reid's action, saying, "Today, thanks to the Senate's hard work, we're closer than ever to enacting solutions to these problems. I look forward to working with the Senate and House to get a finished bill to my desk as soon as possible." There was no mention of Obama's longtime goal of signing legislation by year's end.
Republicans vowed a protracted struggle to block the legislation and deny the president a victory that would cap a tumultuous first year in office. "This bill has been behind closed doors for weeks," said Sen. Mitch McConnell of Kentucky, the Republican leader. "Now, it's America's turn, and this will not be a short debate. Higher premiums, tax increases and Medicare cuts to pay for more government. The American people know that is not reform."
An early showdown on the Senate floor is expected by week's end.
Reid's Senate measure would require most Americans to carry health insurance and would provide hundreds of billions of dollars in subsidies to help those at lower incomes afford it. Medium and large companies would not be required to offer coverage, but they would be forced to pay fees if the government ended up subsidizing their employees' insurance.
Beginning in 2014, the bill would set up new insurance marketplaces—called exchanges—primarily for those who now have a hard time getting or keeping coverage. Consumers would have the choice of purchasing government sold insurance, an attempt to hold down prices charged by private insurers.
After weeks of secretive drafting, Reid outlined the legislation to rank-and-file Democratic senators at a closed-door meeting. "Everyone was positive," said Sen. Amy Klobuchar, D-Minn. That didn't mean there weren't problems—far from it. At his news conference, Reid pointedly refrained from saying he had the 60 votes necessary to propel the bill over its first hurdle.
Reid met privately earlier in the day with Sens. Ben Nelson of Nebraska, Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas, moderate Democrats who have expressed concerns about the measure. Nelson later issued a statement strongly suggesting he would vote with fellow Democrats on an initial showdown expected within days. Aides have said privately that Reid decided to retain an existing antitrust exemption for the insurance industry as a way of satisfying the Nebraskan's concerns.
Landrieu said, "I'm not going to be for anything that doesn't drive down costs over time." Lincoln, the only one of the three who faces re-election next year, told reporters, "We'll wait and see."
With the support of two independents, Democrats have 60 seats, the precise number needed to choke off any delaying tactics by the 40 Republicans who appear united in opposition to the bill in its current form.
In general, Reid proposed an outline that is similar to the House-passed bill, but there were important differences. He called for an increase of a half percentage point in the Medicare payroll tax for individuals with income over $200,000 a year, $250,000 for couples. He also included a tax on high-value insurance policies, meant to curb the appetite for expensive care. The House bill contains neither of those two provisions, relying on an income tax surcharge on the wealthy to finance an expansion of coverage.
Reid's measure also calls for hundreds of billions of dollars in cuts in future Medicare spending, an attempt to satisfy Obama's call to curtail the growth of health care spending that is fiercely opposed by Republicans.
On another controversial issue, Sen. John Kerry, D-Mass., told reporters Reid had decided to require the side-by-side sale of insurance policies that cover abortion services and do not, an attempt to satisfy both sides. That is far less restrictive than a House-passed provision that left liberal Democrats angry.
Ahead lie weeks—if not more—of unpredictable maneuvering on the Senate floor, where Reid and his allies will seek to incorporate changes sought by Democrats and repel attempts by Republicans to defeat the legislation and inflict a significant political defeat on the president.
Reid released his legislation more than a week after the House approved its version of the health care bill on a near party-line vote of 220-215. According to estimates from the Congressional Budget Office, that House bill, with a price tag of about $1.2 trillion, would result in coverage for tens of millions of uninsured, and provide 96 percent of the eligible population with insurance.
Two Senate committees approved different versions earlier in the year, and while Reid has said he would produce a blend of the two proposals, in fact he had a virtual free hand to come up with a plan that could command the 60 votes needed to pass.
Anticipating a major struggle, the White House deputized Interior Secretary Ken Salazar and former Senate Majority Leader Tom Daschle to join Vice President Joe Biden in trying to clear the way for the bill's approval over the next several weeks. Salazar, a former Colorado senator, is viewed as a bridge to moderate Democrats who are far outnumbered by liberals inside the Democratic caucus.
Daschle was Obama's first choice for secretary of health and human services, a position from which he was to try and oversee the administration's drive to enact health care legislation. He withdrew his nomination when it was disclosed he had not paid more than $120,000 in federal taxes over several years.
High dropout rates undermine stupid British plans for degree-only nursing
Plans to make nursing a degree-only profession could be thwarted by the high number of students who drop out before finishing training, the latest figures suggest. More than half of students on some nursing degree courses do not graduate because of pressures of time, money and the academic standards demanded. The figures, obtained using the Freedom of Information Act, show wide variations in attrition rates among England’s 10 strategic health authorities.
At one university, in the North West, 51 per cent of students fail to complete its degree programme in adult nursing. The highest attrition rates in London, the South West, West Midlands, Yorkshire and the Humber show more than a third of students dropping out.
The Department of Health is so concerned about the problem that it ordered an annual report on dropout rates from university nursing courses, Nursing Attrition National Aggregate. However, it has not published the findings.
The figures, obtained by Nursing Standard magazine,dropouts are even more common. One university lost 78 per cent of students on a children’s nursing degree course, and more than 54 per cent of students on a mental health nursing course failed to graduate.
The findings come a week after The Times reported on government plans to require those wishing to become a nurse to have a degree. Supporters claim that the move, which will be enforced from 2013, will improve the quality of patient care and raise the status of nursing.
Critics suggest that the changes will create an elitist profession and scare off recruits with the prospect of a long and expensive period of study. There are also concerns that some nurses would be “too clever to care” and refuse to carry out duties such as washing and feeding patients and helping them to the lavatory.
Norman Lamb, the Liberal Democrat health spokesman, said that the dropout rates cast degree-only plans into disarray. Concerns have also been raised about the millions of pounds of taxpayers’ money, given in bursaries, wasted on courses that were not completed. “These figures appear to massively undermine the Government’s new plans for nurses,” he said. “Such high dropout rates suggest there is something seriously wrong. Ministers are burying their heads in the sand by refusing to publish their own report into quit rates.”
Nursing education specialists said that financial difficulties and the high number of mature students who juggled families with their studies were among the main reasons for dropping out.
Nurses, who make up the largest part of the NHS workforce, now require the minimum of a diploma — a nursing course lasting two or three years — for trainee nursing positions. Under the new rules, candidates will require a degree in nursing or equivalent international qualification. The courses, lasting up to four years, will meet standards developed by the Nursing and Midwifery Council, the professional regulator.
Peter Carter, general secretary of the Royal College of Nursing, which helped to draw up the degree-only plans, said that losing potential nurses was “an entirely unnecessary waste of people who are willing to learn and want to care”. He added: “Of course, some people will not be suited to the demands of nursing, but with rates as high as 78 per cent, something is seriously wrong with the support offered to the nurses of the future. Financial support is very important but it is not the only kind of support that needs to be on offer.”
A Department of Health official said that an incentive scheme to pay universities with low attrition rates would start next year.
Teaching introductory logic for ten years made me vividly aware of the low average quality of reasoning among college students. It also showed me how little improvement can realistically be accomplished by only one semester’s training in the art of thinking clearly. By all rights, then, I should have severely pessimistic expectations about public discourse in this country. Nevertheless, whether I suffer from my own strain of bad induction or just unquenchable naïveté, pandemic outbreaks of illogical memes still catch me by surprise.
That’s why I’ve been so shocked at the widespread assertion that a national mandate requiring individuals to carry health insurance is legitimate (and even Constitutional) because we already require everyone to purchase auto insurance. There’s just one small error this idea seems to forget: the federal government does not actually have a law requiring individual drivers to carry such insurance. Only states do.
And since federalism is at the center of the Constitutional concerns surrounding Obamacare, I find it stunningly bold to claim the federal government has authority for a project because of something similar the states currently do. The argument seems to be, “Congress can do it because it’s just like something else that Congress doesn’t do.” Now, obviously, if we were debating whether individual states could mandate health coverage, at least the levels of government being analogized would be the same. But the leap from what states do to what Congress can do betrays vistas of ignorance concerning our system of government. A college freshman would be embarrassed to make such a weak argument, yet members of Congress have said precisely this.
Senator Burris, for instance, recently told CNS News that it’s okay to make individuals purchase health insurance because, “Under state law, we have every one required to have automobile insurance … so, that’s the same thing proportionally to automobile insurance. I mean, it’s comparable.” The good news here, of course, is that the former Illinois Secretary of State (hence, overseer of the DMV) rightly situated the law at the state level. The sad news is that this United States Senator has taken an oath of office to uphold a document he apparently has not read. But perhaps we can forgive his lapse, seeing as how he’s the Senatorial equivalent of a baseball September call-up put into office by a now-deposed criminal of a governor. What excuse do his colleagues have?
See, in some sense, those of us who live in states (like Illinois) which require minimum coverage might understandably forget that not all things “the government” requires are things “the national government” requires. But I’m especially surprised that inhabitants of New Hampshire and Wisconsin haven’t immediately exposed this line of reasoning since their states have no such requirement at all—a barely publicized truth which underscores the fact that there is no national car insurance law.
Still, let’s put aside the equivocation between federal and state authority and investigate whether the analogy would hold even if mandatory auto insurance actually were a federal law. In so doing, I must apologize in advance for marching over slightly more well-traveled territory.
The reason states require car insurance is because of the risks to other people and their property which driving so obviously entails. The underlying legal basis here is tort law, which holds me liable for any harm I cause to others. Since driving increases both the likelihood and extent of such torts, mandatory insurance (or proof of financial ability to pay in New Hampshire and Wisconsin) “insures” that I can restore my victims to wholeness. In a world without car insurance, every accident would lead either to a court ruling or a settlement. Insurance payouts are rooted in this and are simply a more expeditious way of resolving torts. But in basing health insurance on this model, I’m naturally led to ask about the underlying rationale. Whom, exactly, should I have sued when I caught the flu or broke my leg falling down the stairs if I hadn’t had health insurance?
Unless I was deliberately coughed upon or pushed, there is no one to blame. So there simply is no parallel with tort law to draw upon here. Moreover, the two possible types of auto insurance which would fit fairly well with a health insurance mandate (collision and medical payments) are specifically not ever required by the states.
Additionally, you should note that no state requires you to have liability insurance until you positively engage in some enhanced risk activity, like driving, performing surgery, or opening a restaurant. Even though any of us at any time could harm another person (bicycling, playing softball or even just tripping on a crowded escalator), no one is required by law to carry bodily motion insurance.
Taken together, all of this means that, far from being a good example to draw upon, current auto insurance laws are actually quite a robust counter-analogy to mandatory health insurance because the two are so starkly asymmetrical. The similarities between the two types of insurance seem to begin and end with their shared name.
But wait, there’s more. One of the most debated aspects of current health care reform proposals is the “public option,” or government delivery of health insurance. Once again we find a glaring disconnect in the comparison with auto coverage. Although 47 individual states make insurance a precondition of driving (Virginia will allow you to simply pay a $500 annual fee in lieu of having it), no state to my knowledge actually supplies the required insurance to anyone. Geico, Allstate, Country Companies and State Farm do not have to compete with “Vermont Casualty Group” or “The Florida Collision Underwriting Consortium.” Thus, if auto insurance is a good object lesson, it seems to urge us to specifically not involve the federal government as a provider.
Is there anything else we can learn from mandatory car insurance to guide us in the current debate? One thing is that the presupposition behind such mandates (where they exist) is the recognition of driving as a privilege rather than an entitlement. Driving prohibitions can’t be litigated as deprivations “without due process of law” because there is no fundamental right to endanger others through the operation of a motor vehicle. But what privileged behavior am I engaging in before I must carry health insurance? I must breathe.
Since I’m forced to take Congress seriously when they make their arguments, I am driven (sorry) to conclude their use of the auto insurance analogy means they consider some aspect of my behavior to be a privilege rather than a right. The only contenders are existence and breathing. Since they don’t appear to be meta-physicians (sorry again), I have to infer that Congress views breathing as a privilege rather than a right. And since they want to insure all breathers, should I also anticipate the parallel institution of breathing licenses for which we must visit the DMV and pass a proficiency test? Perhaps I should begin studying now. I’d hate to have to refrain from breathing pending a make-up exam.
Furthermore, the actual car coverage levels required by most states are extremely low. Although I suppose some people are satisfied with $25,000/$50,000 coverage (a common benchmark), most drivers understand that $100,000/$300,000 is much more prudent. But if the more robust protections are so obviously smart, why aren’t they required? It’s simple. Because all of the states recognize the need to balance the wisdom of carrying insurance against the restraint all levels of government must exercise when infringing upon the core value of individual liberty.
Since the right to property (in this case to not pay insurance premiums) is so fundamental in our system, it must be violated only for the most extreme of reasons and only to the most humble of extents. Thus, basing health care reform on this same pattern would require at most only some sort of minimum catastrophic coverage. Suffice it to say that current proposals which cover every form of health care down to the most routine are not modeled on the same recognition of liberty and property rights.
So, having taken a more diligent look at whether mandatory automobile insurance justifies the imposition of health insurance, we now have a much better sense of its validity. In order to make the comparison justify current health care proposals, Congress (not the states) would have to currently require that all people (regardless of personal wealth or actual car ownership) owned an insurance policy provided by Congress itself that covered routine maintenance, periodic breakdown, and collision repair to their own cars, even ones they acquire with pre-existing defects (like from a junkyard).
Since not one single element of this hypothetical currently exists, and since breathing is not a privilege, my request is simple. During the two weeks that are fair to allow this column to circulate through society, simply boo anyone who makes the car insurance argument in public. Thereafter, I recommend noogies. It’s what one does to recalcitrant freshmen.
AP Poll: Americans fret over health overhaul costs
It's the cost, Mr. President. Americans are worried about hidden costs in the fine print of health care overhaul legislation, an Associated Press poll says. That's creating new challenges for President Barack Obama as he tries to close the deal with a handful of Democratic doubters in the Senate.
Although Americans share a conviction that major health care changes are needed, Democratic bills that extend coverage to the uninsured and try to hold down medical costs get no better than a lukewarm reception. The poll found that 43 percent oppose the health care plans being discussed in Congress, while 41 percent are in support. An additional 15 percent remain neutral or undecided. "Well, for one, I know nobody wants to pay taxes for anybody else to go to the doctor _ I don't," said Kate Kuhn, 20, of Acworth, Ga. "I don't want to pay for somebody to use my money that I could be using for myself."
There's been little change in broad public sentiment about the overhaul plan from a 40-40 split in an AP poll last month, but not everyone's opinion is at the same intensity. Opponents have stronger feelings than do supporters. Seniors remain more skeptical than younger generations.
The latest survey was conducted by Stanford University with the nonprofit Robert Wood Johnson Foundation. When poll questions were framed broadly, the answers seemed to indicate ample support for Obama's goals. When required trade-offs were brought into the equation, opinions shifted _ sometimes dramatically. In one striking finding, the poll indicated that public support for banning insurance practices that discriminate against those in poor health may not be as solid as it seems. A ban on denial of coverage because of pre-existing medical problems has been one of the most popular consumer protections in the health care debate. Some 82 percent said they favored the ban, according to a Pew Research Center poll in October.
In the AP poll, when told that such a ban would probably cause most people to pay more for health insurance, 43 percent said they would still support doing away with pre-existing condition denials, but 31 percent said they would oppose it. Costs for those with coverage could go up because people in poor health who'd been shut out of the insurance pool would now be included, and they would get medical care they could not access before. "I'm thinking we'd probably pay more because we would probably be paying for those that are not paying. So they got to get the money from somewhere. Basically I see our taxes going up," said Antoinette Gates, 57, of Atlanta.
The health care debate is full of such trade-offs. For example, limiting the premiums that insurance companies can charge 50-year-olds means that 20-year-olds have to pay more for coverage. "These trade-offs really matter," says Robert Blendon, a professor at the Harvard School of Public Health who follows opinion trends. "The legislation contains a number of features that polls have shown to be popular, but support for the overall legislation is less than might be expected because people are worried there are details about these bills that could raise their families' costs." If the added costs _ spread over tens of millions of people _ turn out to be small, it may not make much difference, Blendon said. But if they're significant, Obama could be on shaky ground in the final stretch of his drive to deliver access to health insurance to most Americans.
More than 4 in 5 Americans now have health insurance, and their perceptions about costs are key as Obama tries to rally his party's congressional majority. In the House, Democrats came together to pass their bill. In the Senate, Democratic liberals and a smaller group of moderates disagree on core questions even as Majority Leader Harry Reid, D-Nev., prepares to take legislation to the floor.
The poll suggests the public is becoming more attuned to the fact that in health care, details can make all the difference. For example, asked if everyone should be required to have at least some health insurance, 67 percent agreed and 27 percent said no. The responses flipped when people were asked about requiring everybody to carry insurance or face a federal penalty: 64 percent said they would be opposed, while 28 percent favored that.
Both the House and Senate bills would require all Americans to get health insurance, either through an employer, a government program or by buying their own coverage. Subsidies would be provided for low-income people, as well as many middle-class households. And there would also be a stick _ a tax penalty to enforce the coverage mandate. "I think it's crazy. I think it infringes on our rights as a citizen, forcing us to do these things," said Eli Fuchs, 26, of Marietta, Ga.
Among Democrats, only 12 percent oppose the broad goal of requiring insurance. But 50 percent oppose fines to enforce it.
The poll found a similar opinion shift on employer requirements: 73 percent agreed that all companies should be required to give their employees at least some health insurance. Yet when asked if fines should be used to enforce such a requirement on medium and large companies, support dropped to 52 percent. Uninsured workers are concentrated in small companies.
New CF&P Foundation Study: Government Run Health Care Will Be A Fiscal Train Wreck
The Center for Freedom and Prosperity Foundation (CF&P) today released a paper entitled "Government-Run Health Care Means Higher Deficits and Debt: Realistic Assumptions Show 10-Year Deficits Easily Could Exceed $600 Billion ." Authored by Dan Mitchell of the Cato Institute, the study explains the dangerous fiscal consequences of the House and Senate health care proposals. The study is a companion to a CF&P Foundation mini-documentary video on the same topic.
The paper notes that if current congressional forecasts are modified to be more realistic, deficits and debt will climb by at least $600 billion – and perhaps more than $850 billion – over the next 10 years if government takes over the health care system. Additionally, the paper examines the history of congressional spending projections and finds that almost all federal health care program over the past 50 years has been under-budgeted.
"We are not talking about trivial errors," said CF&P Foundation President Andrew Quinlan. "Medicare was 10 times more expensive than first forecast and a part of Medicaid cost 17 times more than taxpayers were led to believe. No wonder the American people do not trust Congress and its supposed forecasting experts," added Quinlan. The paper makes several key observations:
* Congressional estimates do not properly measure how people and businesses change their behavior in response to government handouts.
* The spending estimates also are far too low because they do not recognize that politicians in the future will be tempted to expand subsidies as part of routine vote-buying behavior, similar to what happened with Medicare and Medicaid.
* If revenues and offsets are 25 percent below the forecast and spending is 50 percent higher than estimated (and that almost surely is still too optimistic), the 10-year deficits will be $602 billion to $860 billion higher
The paper also explains that the federal government has a long history of under-budgeting and over-spending on health care programs.
* The federal government's ability to predict health care spending leaves much to be desired. When Medicare was created in 1965, the long-run forecasts estimated that the program would cost about $12 billion by 1990. In reality, it cost more than $100 billion that year (and now costs $500 billion).
* Medicaid was also created in 1965 and was supposed to be a very small program with annual expenditures of about $1 billion. It has now become a huge $250 billion entitlement.
* Medicaid's disproportionate share hospital (DSH) program is a sobering example. Created in 1987 to subsidize hospitals with large numbers of Medicaid and uninsured patients, the programs was supposed to cost less than $1 billion in 1992, but the actual cost that year was a staggering $17 billion.
Executive Summary:
The health care proposals in the House and Senate are bad news for taxpayers and would permanently damage the American economy with more spending, taxes, and debt. While the details differ, both plans add about $1 trillion to the burden of federal spending over the next 10 years according to congressional estimates. Some of this spending is financed with higher taxes, and both plans also promise to finance a portion of the new spending by curtailing the growth of other programs, particularly Medicare.
Supporters of a government take over of health care argue this approach is fiscally responsible because the higher taxes and promises of future spending restraint supposedly exceed the amount of proposed new spending. Making government bigger, however, is not fiscally prudent – especially when the estimates put together by the congressional forecasters are deeply flawed.
In reality, the proposals on Capitol Hill will make government more expensive and increase deficits. Government programs almost always cost more than the preliminary estimates, and projections for health care spending have been notoriously inaccurate. Moreover, tax increases will not collect as much revenue as politicians want because of "Laffer Curve" effects. Last but not least, the promised spending restraint is a farce. If congressional forecasts are modified to be more realistic, deficits and debt will climb by at least $600 billion – and perhaps more than $850 billion – over the next 10 years.
Health-Care Reform: The Government Run Public Option is Rooted in the Intellectual Laziness of Congress and the Administration
Comment below from a practicing physician
Consider the following syllogism:
(1) To ignore (or refuse to consider) alternative solutions to health-care reform* is intellectual laziness.
(2) Other than expanding the government’s role in health-care, (public option, Medicare for all), the US Congress and Administration ignore alternative solutions to health-care reform.
(3) The US Congress and the Administration are intellectually lazy when they fail to consider alternatives to their government expanding health-care reform proposals.
* or any other problem for that matter
What are the purported purposes of the government run public option (GoRPO)?
The administration and Congress are correct when they point out that, to reduce individual costs for health-care and to insure the uninsured, we must have competition among health insurance companies. You’ll get no argument there from me or just about anyone else on this. Many members of congress, with clandestine support from the administration, declare that the only way to achieve these goals is through the GoRPO. That is, the GoRPO with lower insurance premiums because there is no profit motive, will serve as the prime nationwide competitor to all private health insurance providers. What government run program is known for efficiency and cost containment? Having worked for the federal government for 27 years, I can attest to the inherent inefficiencies and wasteful monetary practices. Sure, it would be simple to add another entitlement program further bloating the federal budget with attendant cost escalation (more government run health-care will never be budget neutral; is Medicare?). To expand federal government involvement in our health-care system while ignoring not only failures of state run systems but also the efficacy of alternatives is nothing less than intellectual laziness. Moreover, the intended and unintended consequences have severe repercussions for the future US health-care and the very fabric of US society.
In addition to desiring to insure the uninsured and reduce costs of health-care, a key intended (though rarely discussed) consequence of the GoRPO is the progression to a single-payer (government managed) health-care system for Americans (this has been stated publicly as desirous by some members of Congress). How can this happen? At the present time, the federal government manages or provides insurance for 33% of the US population. It would only be a matter of time, through GoRPO mission creep, that the government will be responsible for over 50% of US citizens. With this majority stake, the federal government will have the power to dictate rates and services for most Americans, effectively controlling all aspects of US health-care.
The unintended consequences of a GoRPO are numerous and include, but not limited to: cost overruns (as example – the government program Medicare will be bankrupt by 2017; the Massachusetts program is $9billion in debt), rationing (the only way to reduce escalating costs), higher taxes (income tax rates in western European countries range from 40% to 60% for the middle class), fewer new drug and device developments (from a decline in medical research and development – the government will be unwilling to pay for costly new products; e.g. the U.K. refuses to offer certain effective anti-cancer drugs because of cost), reduced citizen productivity (from loss of work while awaiting procedures), slowed or arrested progress in medical advances (e.g. fewer clinical trials testing new drugs or devices), dissolution of the private insurance industry, demise of private medical practices (all health-care providers will essentially be de facto government employees), government will be forced to pay for all medical education as is done in western Europe because individuals will no longer be able to repay loans for their medical education (the President seemed astonished this past summer when a Georgetown University medical student informed him that her debt after graduation will be $300,000), reduced quality of individuals seeking to enter medicine (in the UK for example, many physicians refuse to works nights and weekends), more claim denials (Medicare already denies a higher percentage of claims than any private insurer) and destruction of the medical profession as we know it.
Are there non-governmental alternatives to the GoRPO? Sure there are. We can insure those without access to insurance (6 to 14 million people by most reasonable estimates) by creating a privately managed member-owned pool consisting of the 6 to 14 million combined with employees of small businesses. Furthermore, such a large pool will have substantial clout in negotiating rates with insurance companies, thereby lowering costs. Another way to reduce cost is to allow companies and individuals to select insurance across state lines as is done for auto insurance. This approach will provide the needed competition and reduce health insurance costs. Proof that this is effective already exists. The 9 million participants of the Federal Employees Health Benefits Program have over 250 options from which to select and have enjoyed a lower rate of rise in insurance premiums when compared to the industry as a whole. Lastly, tort reform is an essential ingredient to reduce costs in any health-care reform proposal and must be applied across the country; billions of dollars will be saved annually.
Government intrusion into the American way of life must be the absolute last resort for resolving the issue of health-care reform, not the first solution we consider. An April 1959 memo from the Department of Health, Education and Welfare to congress is germane today: "In our society the existence of a problem does not necessarily indicate that action by the Federal Government is desirable. The basic question is: Should the Federal Government at this time undertake a new program to help pay the costs of medical care…, or should it wait and see [first if other options are effective]?"
How many Nobel Prize recipients in Physiology or Medicine have been from the US? Since 1950, 58%. With a single payer system, future advances may never see the light of day in clinical practice. What nation other than the US can boast being responsible for bringing significant new technologies and drugs from the bench (laboratory) to the bedside (clinic or hospital)? That other nation doesn’t exist. The US has the distinct and singular honor for the primary development of new medical technologies not only for the US but for the entire human population.
The administration and congress have a mandate to establish health-care reform. But we want it done right, the first time. You know, sometimes neither the easy nor the get-it-done quick ways are the right paths. Don’t mess this up. Don’t be lazy.
They're calling it the legislative equivalent of the Bataan Death March. Majority Leader Harry Reid says he's willing to force the Senate to work through every weekend in December to get a health care bill passed before the Christmas holiday. "Long nights, weekends -- constantly, from then until right before Christmas, when I think we'll have the votes, hopefully, to pass the bill," is how Iowa Democrat Tom Harkin described Mr. Reid's plans.
But some Senate Democrats are balking not just at such a schedule but at Mr. Reid's demand that the bill be delivered to the floor this week in the absence of final legislative language or a cost estimate from the Congressional Budget Office.
One Senate Democrat who finds herself in political hot water on health care is Blanche Lincoln of Arkansas. She trails some potential Republican challengers in polls and has said she's leery of supporting a procedural motion to bring a health care bill to the floor unless she can see the final bill.
Senators Ben Nelson of Nebraska and Mary Landrieu of Louisiana are also balking at forcing a health care debate so early. On the other hand, Senators Joe Lieberman and Evan Bayh have both indicated that, while they have problems with the health care bill, they will vote with Mr. Reid on a motion to proceed with debate.
Mr. Reid will need every single one of his 60 caucus votes to overcome a filibuster threat, since all 40 Republicans appear ready to oppose the legislation. But 91-year-old West Virginia Senator Robert Byrd is ill and has missed 130 Senate roll call votes this year, so any vote to begin the health care debate may hinge on his availability.
British Alzheimer’s patients neglected and come out of hospital 'worse than when they went in'
Half of Alzheimer’s patients come out of hospital in worse health than when they went in because of poor care, a hard-hitting new report warns. One in three never go back to their own homes and are discharged to a nursing home instead, the Alzheimer’s Society found. More than three-quarters of relatives say that they are dissatisfied with the treatment dementia patients receive in hospital and one in three has made an official complaint.
Poor care leads them to spend weeks or even months longer than necessary in hospital, according to the charity, which called for a target to cut the average time to discharge by a week.
The report come just days after an independent investigation found that almost 2,000 dementia patients a year are being killed by ‘chemical cosh’ drugs given to keep them quiet. A survey of relatives and NHS staff shows that almost half, 47 per cent, of dementia patients left hospital in worse physical health than when they went in. In an even greater number of cases, 54 per cent, the patients’ dementia was judged to have deteriorated while in hospital.
The charity warned that patients were being left unfed, with nothing to drink or sitting in their own urine because staff did not realise Alzheimer’s patients need extra help with simple tasks. Patients suffered weight loss, dehydration, pressure sores, incontinence and were even left unable to walk because they had been confined to bed for too long. One distressed patient was found beside a written note telling her “Don’t bang the table”, despite the fact that her condition meant she could no longer read.
Neil Hunt, chief executive of the Alzheimer’s Society, said: “We are talking about an issue that is vast and staring the NHS in the face. “We believe that the NHS is failing disgracefully on this. “And it is creating very serious outcomes for people with dementia and their families.”
People with dementia occupy up to one in four NHS hospital beds at any one time, the charity estimates. Cutting the average length of hospital stay by one week could save the NHS at least £80 million a year.
Official figures show that while the average length of stay for a hip fracture was one week, almost one in eight dementia patients with hip fractures stayed in hospital for more than two months.
The charity insisted that while in some cases it was right that patients with the condition should spend longer in hospital in many there were being delayed unnecessarily, harming their health. The charity surveyed 1,291 friends and relatives caring for a patient with dementia, 657 nursing staff and 479 ward managers.
Around 700,000 people in Britain have dementia, 400,000 with Alzheimer’s, the most common for, of the condition. That figure is predicted to increase to 1.7 million by 2051, in part because of an ageing population.
Dr Peter Carter, general secretary of the Royal College of Nursing, said: “For the majority of patients with dementia to leave hospital in a worse condition than when they arrived is simply unacceptable. "It is vital that the government invests in better dementia training for all healthcare staff to ensure these patients receive good quality care."
Rebecca Wood, chief executive of the Alzheimer’s Research Trust, said: “This is a wake-up call for a health system that has failed to take the challenge of dementia seriously. “We must tackle dementia by investing in research to find new preventions, treatments and cures, as well as reforming the way hospitals deal with dementia patients.”
A spokesman for the Patients' Association said: "The findings in this report are scandalous. "Not enough help with eating. Not enough help with drinking. Not enough help with personal hygiene. Not enough help with continence. “There is now an overwhelming amount of evidence that elderly patients are being neglected in hospitals across the NHS. "Whether they have dementia or not, if they are in need of help with personal care many of them won’t get it. “Ensuring patients receive essential personal care doesn’t tick any of the target boxes. Is it any surprise that it has slipped so dramatically?”
Phil Hope, the care services minister, said: "We have set priority areas for all hospitals to take urgent action, including appointing a senior member of staff to improve quality of care for people with dementia, proper training for all staff, and specialist older people's mental health teams working in hospitals.”
Bureaucratic madness: British IVF couples face disease tests before each cycle
Couples undergoing IVF could face higher bills after European regulators said they should be screened for diseases between each treatment cycle. The EU Commission wants couples to be screened before each treatment cycle instead of just when they start their course. British doctors said it was extremely unlikely new cases of infections like HIV and syphilis would be picked up between cycles and it will add to the cost of treatment, which is currently around £4,000 for IVF. The move could mean couples needing to be tested every one or two months for HIV, hepatitis, Human T-lymphotropic virus and syphilis.
Dr Luca Gianaroli, chairman of the European Society of Human Reproduction and Embryology (ESHRE), said that at a recent meeting, the EU Commission had said all patients must be tested before each treatment and that all European countries "must comply with this and that it was not open for national interpretation". He has written to ESHRE members urging them to take action over the "quite alarming signals" over interpretation of its 2004 tissue and cell directive.
He said after 30 years of IVF, 15 million treatments and around three million children born, there had been no examples of viruses being transmitted in the areas covered by the directive. In Dr Gianaroli's letter he added: "All in all, this implies a major additional allocation of resources. "The consequence of this testing practice is that many couples living intimately together at home will have to be tested every one to two months."
At present, couples are generally tested for HIV and hepatitis before they undergo their first treatment but are then considered virus-free for the rest of their course.
Professor Peter Braude, head of the Department of Women's Health at King's College London, said: "This new interpretation of the EU directive is of extreme concern to fertility practitioners, as it will have substantial implications for the costs of fertility treatment to individual patients and for the NHS.
"Whilst we already comply with the bizarre EU idea that sperm samples from couples who have been married or cohabiting for many years are treated as 'partner donation', and men have to have infection screens done at least annually, this interpretation would mean that both partners in the relationship would now have to be tested for HIV, hepatitis, HTLV and syphilis every time they underwent an IVF or even an IUI (insemination) procedure, which could be two or three times a year or even more often. "Repeat infection or new infection during or between treatments would be extremely rare, if ever."
Dr Allan Pacey, secretary of the British Fertility Society and senior lecturer in andrology at the University of Sheffield, said: "The British Fertility Society (BFS) has some concerns about this interpretation of the EU directive and the impact it may have on infertility treatments within the UK and across Europe. "Whilst there are a number of reasons to screen patients for some infectious agents, including HIV, it is important that the timing, frequency and screening strategy is evidence-based. "A blanket screening policy applied uncritically is unhelpful and inappropriate."
Canadian Patient Flies to India for immediate treatment of painful disability
Flying to a faraway country for medical care did not seem too outrageous an idea for Canadian Raghav Shetty - at least, in comparison to the alternative. The 61-year-old Calgary, Alberta man's bum hip had effectively immobilized him. Yet he faced several years of waiting in distress for surgery in Canada's "universal" Medicare health system.
Shetty had developed severe osteoarthritis in his left hip joint. He was in so much pain that, even with the aid of painkillers, each step was tormenting. "I'm in extreme pain," he admitted. "I'm stuck at home, I can't work. It is difficult for me to provide financial support to my family and the quality of my life is very bad." "He can barely walk. He drags his legs everywhere he goes," added daughter, Shilpa Shetty.
Shetty, a 20-year resident of Calgary, discovered the wait for partial hip replacement surgery would be up to two years. At the time, in 2004, some 25,000 patients were on waiting lists for surgery or diagnostic scans in Calgary's hospitals.
Facing a bedridden wait on Medicare [Canada's public health system], Shetty and his wife, Prema, looked elsewhere for quicker treatment. They discovered a private facility in Chennai, India offering immediate care. The entire out-of-pocket cost for the operation and for both to fly to India would be $15,000 (CAD), but the couple believed waiting up to two years for care locally was not a realistic option. "I had no choice but to try elsewhere for my surgery due to the long waiting period and severe pain in my hip joint," Shetty said. "I could not walk more than a few meters. Under these conditions, waiting for one to two years was simply not possible for me."
In September 2004, the Shettys traveled to Apollo Specialty Hospital for a successful five-hour surgery. Shetty, an Indian immigrant, said returning to his native country for a medical procedure was not something he would have considered had it not been for the excessive wait. "Of course, my first choice would have been always Canada," he said. "However, in recent years, the waiting period for major surgeries is too long for patients suffering from severe pain and serious medical conditions."
Daughter Shilpa objected to the tedious wait her father would have endured if he stayed in Canada. "We've given up on our health care system. Why don't they understand that some people are in so much pain that they just can't wait?" she asked. "We don't have any options and can't wait anymore."
Though the long wait forced Shetty to look outside Canada, the health department in the province of Alberta rejected his claim for reimbursement for his care in India. Generally, the government reimburses only such patients who go abroad when treatment is unavailable locally or if the patient's life would be in jeopardy while waiting.
As published in a 2007 Fraser Institute survey, an estimated 5,029 people in Alberta were waiting for hip or knee replacement surgery as of March 31, 2007. According to the same report, nationwide some "estimated 523,600 Canadians had difficulties getting to see a specialist, 200,000 had difficulties getting non-emergency surgeries, and 294,800 had difficulties getting selected diagnostic tests."
On Saturday, November 7th Nancy Pelosi secured the votes she needed to pass ObamaCare by allowing the controversial Stupak Amendment--which made it illegal for taxpayer-subsidized insurance plans to cover abortions--to be included in the bill.
More than 30 House Democrats had signed a letter stating they would not vote for the bill if it contained even a cent of federal funding for abortions. In the end, more than 60 members voted to strip the funding from the bill.
Unfortunately, when the Stupak Amendment passed, it provided enough political cover for vulnerable Democrats, many of whom are running in districts with strong pro-life constituencies--to then vote for the overall bill.
Given the success of the tactic, the Senate now appears poised to try the maneuver again as debate unfolds there. This leaves Senate Republicans and fiscal hawks like Senator Joe Lieberman with a daunting challenge.
To prevent Senate passage of the bill, they must effectively communicate to their colleagues—and the American people—that the Stupak Amendment is not the issue. Because even with the Stupak Amendment, this is still a bad bill. A very bad bill.
It still is a government health care takeover that will dismantle the finest health care system on the face of the Earth. It still opens the door for a single payer system. It still rations care away from seniors. It still would increase health premiums. It still would put bureaucrats between doctors and patients. It still would break the public treasury and leave taxpayers with a deepening debt that can never be paid.
Most Americans oppose this legislation, which Americans for Limited Government estimates will cost more than $2.1 trillion over ten years once fully implemented. According to Rasmussen Reports, 52 percent of voters want their representatives to vote “no.”
In order to overcome “public option” proponents, opponents of ObamaCare must be wary of political maneuvers that make it easier to pass this abomination. There is too much at stake.
That is not to say that pro-life Senators should not move to strip out abortion funding. But the Senate majority should not be allowed to use that maneuver to provide cover for the bill’s final passage. Their Senate colleagues—and their constituents—must hold their feet to the fire to hold the line on a successful filibuster. The point is to kill the bill, not just a single provision.
If government dismantles America’s health care system, it’s not just the lives of the unborn at stake. It’s the lives of the young and old, as well.
If mandatory health insurance goes through, it will turn me into a criminal. I don’t have health insurance. I don’t want it. And I will refuse to buy it even though I can afford it. Before they lead me to the cells, perhaps the prisoner may be allowed to say a few words in his defense.
It’s understandable that politicians are eager to eliminate the medically uninsured. For years they’ve been told that we are the flies in the ointment of health care policy. It is said we are either a) wrecking the system by using services we don’t pay for, or b) we are deprived of needed medical care and therefore objects of pity and subsidy.
These points may apply to some uninsured but not to all. Some of us belong in what might be called the “successfully uninsured” category. We are not freeloaders. We believe we have an obligation to pay for the medical care we receive, and we always pay for it. I put no financial burden on doctors, hospitals, or taxpayers, and politicians are wrong to assume I am part of the country’s health care problem.
Politicians are also wrong to assume that I am an object of pity. Like many Americans, I have significant savings and can afford medical expenses out of pocket. (Census Bureau figures for 2000 show that over 18 million households had assets in excess of $250,000). Our savings make it possible for my wife and me to decline both private insurance and Medicare (we are 70). Those without savings are in a different situation: They probably need insurance, or a subsidy, or charitable help. My point is that if you can handle your own medical bills through savings and personal responsibility, this is a sound approach. Politicians should encourage this state of self-reliance, not make it a crime.
There are many advantages to being insurance-free. The first is flexibility. Several years ago, my wife had a serious bout with cancer. The successful treatment involved surgery and local radiation therapy. After much study she refused the more massive radiation treatment recommended by the doctor and pursued alternative therapies, including acupuncture, nutritional therapy, massage, and naturopathic medicine. Every decision was made in terms of what seemed best to treat this illness. We were not drawn into using inappropriate therapies because they were “free,” nor did we pass up desirable therapies because they were “not covered.”
The second advantage of being insurance-free is we avoid bureaucracy. We don’t fill out insurance forms; we don’t make phone calls trying to find out what’s covered; and we don’t play games (with the collusion of doctors) trying to get things we need paid for by someone else. If an aching back suggests the need for a different mattress, we go out and buy one and don’t waste time and money trying to prove to some clerk that it’s covered. When the government offered a new piñata of benefits in the form of prescription drug coverage, we entirely escaped the frustration of figuring out how to deal with its staggering confusion. While other seniors were closeted with lawyers and sons-in-law trying to decide what to sign up for, we went hiking.
Refusing health insurance may have advantages, but what will happen if I face a medical problem that requires more than my savings? To understand my answer, consider a parallel question about some other commodity, say, housing. I announce that I believe in paying for housing from my own financial resources. Someone points out there might be a house I want that costs more than I can afford. That’s just too bad: I don’t get to buy it. I limit my housing consumption according to my resources.
I look at medical care the same way: If something costs too much, I do without. This position, so obvious and sensible in other areas, is considered untenable when it comes to medical care. In this realm the prevailing assumption is that everyone is entitled to all the health services he needs or wants.
It’s one thing to announce this entitlement as an ideal, but quite another to make it work. In the real world medical resources are limited, and therefore all approaches to healthcare funding employ rationing.
In tax-based systems administrators establish waiting lists so that some patients die before their opportunity for treatment comes up. They ban the use of expensive treatments and alternative therapies. And, without exactly saying so, they underfund medical facilities, so that patients wait in the halls of emergency wards, for example. In commercial insurance plans rationing is implemented by restricting coverage to specific procedures and specific doctors — and by setting upper limits to coverage.
Paying your own medical bills is simply another way of limiting consumption: If a treatment costs too much, you don’t buy it. The advantage of self-rationing is it is frank and open, and thus avoids the whining and blaming that characterize bureaucratic systems.
Paying your own medical bills also lets you see that there are more socially constructive ways to use funds than spending on health care. Suppose that to fix your limping gait requires complicated care costing hundreds of thousands of dollars. If others pay for this care, you might accept it. But suppose you are paying for it with your own savings. Now you might think twice about spending the money on yourself. You might know of a school for autistic children that could put the money to good use. Or you might have a grandchild who needs the money to start a business.
Such decisions are indeed difficult, but we need to face them if we are to make sensible choices about health care. Today we are not facing them. We are hiding behind the confusion of a tangled government/corporate system that pretends we can have all the medical care we want.
Spending my own money on health care helps me set a rational limit to medical spending, even on spending to preserve my life. Not buying health insurance and not allowing politicians to force others to fund my needs helps me keep my consumption of medical resources within fitting bounds.
This way of looking at health insurance may be old fashioned, but should it be a crime?
Meet the unelected body that will dictate future medical decisions
As usual, the most dangerous parts of ObamaCare aren't receiving the scrutiny they deserve—and one of the least examined is a new commission to tell Congress how to control health spending. Democrats are quietly attempting to impose a "global budget" on Medicare, with radical implications for U.S. medicine.
Like most of Europe, the various health bills stipulate that Congress will arbitrarily decide how much to spend on health care for seniors every year—and then invest an unelected board with extraordinary powers to dictate what is covered and how it will be paid for. White House budget director Peter Orszag calls this Medicare commission "critical to our fiscal future" and "one of the most potent reforms."
On that last score, he's right. Prominent health economist Alain Enthoven has likened a global budget to "bombing from 35,000 feet, where you don't see the faces of the people you kill."
As envisioned by the Senate Finance Committee, the commission—all 15 members appointed by the President—would have to meet certain budget targets each year. Starting in 2015, Medicare could not grow more rapidly on a per capita basis than by a measure of inflation. After 2019, it could only grow at the same rate as GDP, plus one percentage point.
The theory is to let technocrats set Medicare payments free from political pressure, as with the military base closing commissions. But that process presented recommendations to Congress for an up-or-down vote. Here, the commission's decisions would go into effect automatically if Congress couldn't agree within six months on different cuts that met the same target. The board's decisions would not be subject to ordinary notice-and-comment rule-making, or even judicial review.
Yet if the goal really is political insulation, then the Medicare Commission is off to a bad start. To avoid a senior revolt, Finance Chairman Max Baucus decided to bar his creation from reducing benefits or raising the eligibility age, which meant that it could only cut costs by tightening Medicare price controls on doctors and hospitals. Doctors and hospitals, naturally, were furious.
So the Montana Democrat bowed and carved out exemptions for such providers, along with hospices and suppliers of medical equipment. Until 2019 the commission will thus only be allowed to attack Medicare Advantage, the program that gives 10 million seniors private insurance choices, and to raise premiums for Medicare prescription drug coverage, which is run by private contractors. Notice a political pattern?
But a decade from now, such limits are off—which also happens to be roughly the time when ObamaCare's spending explodes. The hard budget cap means there is only so much money to be divvied up for care, with no account for demographic changes, such as longer life spans, or for the increasing incidence of diabetes, heart disease and other chronic conditions.
Worse, it makes little room for medical innovations. The commission is mandated to go after "sources of excess cost growth," meaning treatments that are too expensive or whose coverage will boost spending. If researchers find a pricey treatment for Alzheimer's in 2020, that might be banned because it would add new costs and bust the global budget. Or it might decide that "Maybe you're better off not having the surgery, but taking the painkiller," as President Obama put it in June.
In other words, the Medicare commission would come to function much like the National Institute for Health and Clinical Excellence, which rations care in England. Or a similar Washington state board created in 2003 to control costs. Its handiwork isn't pretty.
The Washington commission, called the Health Technology Assessment, is manned by 11 bureaucrats, including a chiropractor and a "naturopath" who focuses on alternative, er, remedies like herbs and massage therapy. They consider the clinical effectiveness but above all the cost of medical procedures and technologies. If they decide something isn't worth the money, then Olympia won't cover it for some 750,000 Medicaid patients, public employees and prisoners.
So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer. It will also rule on routine ultrasounds for pregnancy, which have a "high" efficacy but also a "high" cost.
Currently, the commission is pushing through the most restrictive payment policy in the nation for drug-eluting cardiac stents—simply because bare metal stents are cheaper, even as they result in worse outcomes. If a patient is wheeled into the operating room with chest pains in an emergency, doctors will first have to determine if he's covered by a state plan, then the diameter of his blood vessels and his diabetic condition to decide on the appropriate stent. If they don't, Washington will not reimburse them for "inappropriate care."
If Democrats impose such a commission nationwide, it would constitute a radical change in U.S. health care. The reason that physician discretion—not Washington's cost-minded judgments—is at the core of medicine is that usually there are no "right" answers. The data from large clinical trials produce generic conclusions that rarely apply to individual patients, who have vastly different biologies, response rates to treatments, and often multiple conditions. A breakthrough drug like Herceptin, which is designed for a certain genetic subset of breast-cancer patients, might well be ruled out under such a standardized approach.
It's possible this global budget could become an accounting fiction, like the automatic Medicare cuts Congress currently pretends it will impose on doctors. But health care's fiscal pressures will be even stronger than they are today if ObamaCare passes in anything like its current form. And that is when politicians will want this remote, impersonal and unaccountable central committee to do the inevitable dirty work of denying care.
The only way to take the politics out of health care is to give individuals more power to control medical dollars. And the first step should be not to create even more government spending commitments. The core problem with government-run health care is that it doesn't make decisions in the best interests of patients, but in the best interests of government.
Thousands of British Parkinson's disease sufferers wrongly diagnosed
Around 6,300 people in the UK who believe they are suffering from Parkinson's disease could have been wrongly diagnosed, a new study has claimed. Researchers in Scotland, who assessed patients on anti-Parkinson's medication, found that five per cent had little more than stiffness or hand tremors.
A report published in the Movement Disorders journal warned that millions of pounds was being wasted on unnecessary drugs each year. While the wrongly prescribed medication was not thought to have any adverse side effects, patients were subjected to years of anxiety.
Dr Keiran Breen, one of the authors of the report said Parkinson's was a notoriously difficult disease to diagnose accurately in its early stages, but recommended all suspected sufferers should be referred to specialists regularly. He said: "No two people with Parkinson's disease will have the same diagnosis. The three main characteristics are tremors, slowness of movement and stiffness, but not everyone will have all three symptoms. The patients should be referred to neurologists with more expertise and they will make a much more accurate diagnosis."
There are around 120,000 sufferers in the UK but during the study more than five per cent were found to have been misdiagnosed. Dr Breen said: "We didn't find evidence that taking drugs caused harm to the patients without Parkinson's but it could mean people were denied the correct drugs to improve their actual condition."
Controversial electronic medical records to be rolled out across Britain
Anybody who trusts the British bureaucracy with their personal information has not been listening. There have been dozens of instances of "lost" records -- and the computer system concerned has long been full of bugs
Every patient in the country will have sensitive medical information uploaded to a controversial central database within two years. Ministers insist that the records will allow patients to be treated more efficiently no matter where they are in the country. But critics have warned that the centralised database could be open to abuse.
Experts said that patients could also feel “forced” to allow highly sensitive material on the system because ministers have decided to include all patients across the country unless they specifically opt out. Patients in London will have their confidential records uploaded by the end of next year on to the NHS computer network known as the Spine. Family doctor practices across every party of the country will be transmitting the data by the end of 2011.
The records will contain vital basic medical information including illnesses, medications and vaccination history. They could also include past conditions patients had suffered and previous medication they were given. Age and address would also be included but not other personal information, such as marital status. Ministers have admitted that extra medical information could also be added in the future, including controversial do not resuscitate orders.
In May, the Government performed a u-turn when they announced that patients would be allowed to delete electronic summaries of their treatment records from the new database. Previously, they had insisted that to do so would be too costly. Doctors have to ask a patients’ permission every time they wish to view their records, except in emergency circumstances, such as when they feel a patient may be at risk. Only medical staff directly involved in a patient’s care will be allowed to look at the information. But all patients will be added on to the database unless they specifically refuse.
Ministers insist that the records will improve care as doctors no longer have to rely on patient’s memories, which can often be incomplete or inaccurate. They claim that elderly and more vulnerable patients, including those who do not have English as a first second language will benefit the most. Pilot projects trialling the Summary Care Records scheme have taken place across the country in recent years and more than 700,000 patients currently have their records uploaded.
Mike O’Brien, the Health Minister, said: “Having the right information at the right time can make all the difference to patients’ experience of urgent care. “Summary Care Records can improve the quality and safety of treatment provided as well as increasing people’s comfort and reassurance. “We are particularly interested in the experience at Bury which has incorporated End of Life wishes for a substantial number of patients. “Moving the NHS from good to great needs improvements such as this.” Ruth Carnall, chief executive of NHS London, said: “Getting hold of health records for London’s highly mobile population often presents real challenges to doctors and nurses when patients need out-of-hours and emergency care.”
But Dr Grant Ingrams, chair of the British Medical Association's GP IT committee, warned that patients could feel that they were being forced to put highly confidential information on the system. He said: “Electronic Summary Care Records have the potential to improve both quality and safety of patient care but it is critical for the programme’s success that all patients receive balanced information and are made aware of their option to opt out. “If patients feel they are being coerced, or have a summary care record created without their knowledge or understanding, it will damage the credibility of the project.”
Far from providing "affordable" care for everyone, ObamaCare would come at a painful price - higher insurance premiums, more and higher taxes, fewer jobs, lower wages, a reduced standard of living and an erosion of privacy and individual liberty. Here's the real cost of ObamaCare.
Higher Premiums - Billions in new taxes and fees would be imposed on health insurers and companies to pay for ObamaCare - costs which would be passed on to the consumer as higher premiums.
Higher Taxes - Government cannot provide free or subsidized care for someone without taking money from someone else - and that someone else may be you. The Wall Street Journal puts it bluntly: ObamaCare will be paid for with "huge tax increases." How huge? According to Jeffrey H. Anderson, Ph.D, Senior Fellow of Health Care Studies at the Pacific Research Institute, one ObamaCare proposal would "raise taxes by $2.3 trillion" over the next two decades. Yes, trillion.
Lower Wages/Fewer Jobs - New taxes and fees imposed on businesses by ObamaCare would "discourage companies from hiring or continuing to employ low-income and moderate-income workers," according to the Heritage Foundation. And it won't just be low-income workers who see a smaller paycheck - according to FORTUNE magazine's Shawn Tully, ObamaCare would lead to "a steep, shocking decrease" in the incomes of middle-class workers.
Standard of Living - The massive government spending required to finance national health care would explode the federal deficit with ruinous consequences for every American's standard of living. According to the Congressional Budget Office, "Large budget deficits would reduce national saving, leading to more borrowing from abroad and less domestic investment, which in turn would depress income growth in the United States. Over time, the accumulation of debt would seriously harm the economy."
Medicare Benefits - ObamaCare would pay for itself, in part, with hundreds of billions of dollars in cuts to Medicare and Medicare Advantage. But the Congressional Budget Office warns that cuts to Medicare Advantage "could lead many plans to limit the benefits they offer, raise their premiums, or withdraw from the program," devastating seniors' health-care options. The Wall Street Journal confirms, "cuts in Medicare's price controls will cause many doctors to quit the program."
Privacy - ObamaCare regulations would result in a larger, more powerful IRS, and ensure that more of your personal information is shared with more people.
According to the Washington Examiner's Byron York, ObamaCare would mean "an expanded and more intrusive IRS," which would be empowered to target and punish violators of the new law. Additionally, an ObamaCare tax on employers would necessitate your boss knowing your family's entire income from all sources, information which would then be shared with the insurance company.
Your Freedom - Think you have the right to decide whether you even want insurance? Guess again. ObamaCare would require, under threat of penalty, every American to have insurance, fundamentally altering the relationship between citizen and state. As the CBO puts it, ObamaCare "would establish a requirement for [legal U.S. residents] to obtain insurance and would in many cases impose a financial penalty on people who did not do so." So much for 'land of the free.'
ObamaCare won't save us money, nationally or individually. Instead, it will increase insurance premiums, raise taxes, depress wages, siphon jobs, explode the deficit, reduce our living standard, rob us of privacy and erode our personal liberty.
That's the kind of "free" care we just can't afford.
Our ongoing debate about government’s role in health care is proving worthwhile because it forces people to focus on the real tradeoffs in a system mandated - if not directly operated - by government, rather than one selected by individuals or their employers. Today, our system is a dysfunctional hybrid.
To the extent that we cannot choose the health care coverage we want today, those restrictions are almost always the result of previous government interventions - tax incentives that make it easier for employers to buy insurance than for employees to purchase their own or laws requiring us to purchase coverage we may not need or cannot afford.
President Obama says all insurance policies will be required to cover preventive care and early screening for various maladies, as if he can force insurance companies - or doctors - to give us something for nothing.
Well, he can’t do that anymore than he can require restaurants to serve a free lunch every Thursday. Even under Barack Obama, Americans cannot be compelled to do business at a loss; they always have the right to lock the doors and close up shop.
That’s why there’s no free lunch - or free health care. Politicians aren’t “giving” us these services; they are forcing us to buy them - and to pay more than the actual cost.
It never ceases to amaze when politicians who demagogue against “greedy” insurance companies will, in their next breath, require us to buy things through an insurance company that we could purchase less expensively if we simply paid out of pocket.
If both you and your doctor know that you need a colonoscopy, how can it possibly be cheaper for you to send your payment to an insurance company, while the doctor files a claim with that insurance company, and the insurance company processes the claim and issues payment - rather than for you to simply pay the doctor?
Yet ObamaCare would establish a mandatory list of insurable procedures as well as maximum deductibles. For those with money-saving high-deductible plans and health savings accounts - like the one I’ve had for 12 years - the President’s promise that we can keep the plan we have just doesn’t wash.
Americans who are understandably frustrated by health care costs are recognizing that the more control you give to government the more control you give to government.
Today, if you, your doctor and your insurer agree on a procedure, you make an appointment and “get ‘er done.” And if you can’t agree, you are free to pursue other procedures that you can pay for yourself. (After all, what good is an extra $50,000 in your retirement account if you’re dead?) But if no one practices those alternative procedures because omnipotent health care bureaucrats won’t pay for them, you are out of luck.
The larger point is this: Why is it government’s business how much you pay, what doctor you see, or what treatment you receive, so long as you are paying the bill?
Health care, like any commodity or service, will always be limited by economic reality. Government health care programs are responsible for more cost-shifting than all of the “uninsured.” Yet despite paying below-market prices, Medicare will be insolvent in just seven years and has amassed all by itself a deficit of $37.8 trillion.
If the government is empowered to supervise everyone’s health care, then only two outcomes are possible: either everyone’s health care is rationed to control costs or no one’s health care is rationed and the cost of government health care finally breaks the camel’s back, ushering in a worthless dollar, runaway inflation and skyrocketing interest rates.
In either case, our impoverished children and grandchildren will forever curse our self-centered, shortsighted generation. There can be no health care utopia any more than everyone can enjoy all they want to eat or live in the home of their dreams. Sooner or later, someone must choose between what we want and what we can afford. Who do you want to make those tough choices - yourself or someone in government?
Proponents of the current healthcare reform proposal in congress like to accuse critics of not offering any alternatives, of only opposing without offering anything. While that accusation is completely not true, it serve proponents of the fascist system well as a big lie, just as calling it socialist instead of fascist serves as another convenient lie.
Rather than dissect any particular part of the fascist bill, a refutation of the false charge that critics offer nothing is also useful. The reason the proponents say that critics offer nothing is because only big government solutions are allowed to be considered. Anything else is not a "constructive proposal" and thus they can get away with that big lie.
In spite of the psychological block against small government proposals being considered, it is always useful to suggest as many small government solutions as possible. That way the next time someone says that critics of fascist health care never offer solutions the critics can respond with "look at all the solutions I've offered that you refuse to consider."
Given the large number of problems, any single solution fails to address the full problem and appears short sighted. But one aspect is all that can be addressed at once.
One of the problems with the current system is that the patient is not the customer. When a doctor treats a patient, the patient isn't the customer. The insurance pays for the visit, and so the insurance is the customer. And who is the insurance company's customer? Since most people get their insurance through their employer, the employer is the customer and not the employee. It is true that sufficient employee complaints can cause an employer to switch companies, but the customer of the insurance company is the employer.
For a truly responsive insurance company, the patient needs to be the customer of the insurance company. For truly responsive health care, the patient needs to be the customer of the doctor. The only remaining question of this particular solution is how to make it possible. As proponents of fascist health care are quick to point out, the average person cannot afford a catastrophic illness.
The first part of the solution is to transfer the tax incentive for the purchase of health insurance from the employer to the employee. That way, unlike the Obama plan, people have a positive encouragement to purchase insurance instead of a punishment for failure to purchase insurance. Persuasion always being preferable to force, encouraging people to purchase insurance instead of punishing them for failure to purchase insurance is a better solution.
To make insurance affordable enough for a person to purchase it, the price needs to be brought down. That can be done through coercion or through encouragement. To do it through encouragement the best way to do it is through removing the rules that prohibit insurance companies from competing across state lines. Putting individual insurance policies in the hand of the customers while simultaneously increasing the number of companies and policies available, while giving people a tax break for purchasing insurance, will drive down the cost to the point where most people can afford it.
Another way to make insurance affordable is to remember that insurance is supposed to be for the unusual event. The way health insurance currently operates is absurd - it is comparable to using automobile insurance to pay for basic tune-ups, or even to pay for putting gas in the car.
Analyzing a standard insurance statement or doctor's visit statement, one finds that in general a large portion of a standard bill is an insurance negotiated adjustment. Another large portion is the patient co-pay. The smallest part is the payment the insurance company makes to the doctor. Ask most doctors what their cash price is and it turns out it is actually lower than the stated price for a visit.
People need to pay directly for office visits, and a good way to do that is through tax deductible healthcare savings accounts. But not the HSAs currently in use, that have an end of year use-or-lose for the funds. What is needed is a roll-over HSA, that allows people to put in more funds than needed while healthy so that the funds will be there many years later when people need more healthcare funds. This is similar to using a retirement savings account. In order to encourage use of a roll-over HSA account funds put into it should be tax free, just as in the current annual HSA.
That will give our current healthcare system another thirty years of operation before it gets as bad as it currently is.
Woman too fat for operation is too thin for weight loss surgery. Expect similar bureaucratic catches to affect YOU under Obamacare
A woman who was considered too fat for a hernia operation has now been told she is not heavy enough to be given weight loss surgery. Jo Thompson, who is 5ft tall and weighs nearly 18 stone, has found herself in the Catch 22 situation after years of failed dieting. “I have always had a problem with my size,” she said today. “I have tried every diet going to lose weight. “In the last two years I’ve cut down on my portions, and although I can’t afford to go to the gym I do a lot of walking.”
Miss Thompson, 37, from Parson Cross, Sheffield, recently complained to her doctor about heartburn and indigestion. He referred her to a specialist at the city’s Royal Hallamshire Hospital, telling her he thought she needed a hernia operation. However, the consultant there said she was too big to undergo the procedure and instead recommended the gastric bypass. This, he said, would help her lose weight and thereby ease the hernia problem.
“But when I saw another doctor I was told I could not have the bypass surgery because I am not heavy enough. “It’s a crazy situation and I just don’t know what to do. I’m not obese enough to have a gastric bypass, but I’m too big to have the hernia operation. Miss Thompson, whose body mass index is 46, went on: “It seems I must reduce my body mass index to 40 to have the hernia operation or increase it to 50 to have gastric bypass surgery. It’s a crazy situation and I seem to be caught in the middle”.
The refusal by staff at Royal Hallamshire to carry out the bypass operation while Miss Thompson’s BMI remains below 50 has been criticised by a specialist health group. Dr Matt Capehorn, of the National Obesity Forum, said: "Under National Institute for Clinical Excellence (NICE) guidelines, patients who have unsuccessfully tried other weight loss methods should be considered for surgery if their BMI is above 40. "Sheffield NHS have been very short-sighted in their view of the funding for this operation because the surgery would pay for itself within three years.” He added: “They are not following NICE guidelines and are therefore leaving this woman in a state of limbo."
A spokesman for NHS Sheffield confirmed that the trust had turned down Miss Thompson’s request to have the operation. Its criteria on the issue had been set by the Yorkshire and Humber Specialised Commissioning Group and was therefore in line with the rest of the county. The procedure was always used as a last resort “because it is a very serious operation.”
Australia: Ambulances sit waiting for hours before public hospitals can take patients from them
Too bad that patients arriving by ambulance are generally seriously ill
MORE patients than ever are waiting over 30 minutes in ambulances "ramped" outside busy Queensland public hospitals because doctors and beds are not available. State Government figures reveal a 26 per cent increase in the number of sick and injured people being forced to wait before being seen by an emergency department doctor. Queensland Ambulance Service staff reported waits of three to four hours were not uncommon before they could hand over a patient.
In 2007-08, the cumulative hours spent waiting in the back of an ambulance were 10,528 across the state's 27 public hospitals. That jumped to 13,269 in 2008-09. Brisbane experienced the biggest jump, from 3879 hours to 5823 – a 50 per cent increase.
Opposition emergency services spokesman Ted Malone described the waiting as disgraceful and said it was costing taxpayers millions of dollars every year. "The Bligh Government's own statistics prove just how serious this issue has become," Mr Malone said yesterday. "Public hospitals have been in crisis for years and I have repeatedly questioned the Bligh Government to detail the costs of hospital ramping. "Emergency Services Minister Neil Roberts has arrogantly brushed my questions aside and refused point blank to detail what the considerable cost is to the QAS."
Mr Malone said the union representing ambulance officers had kept a tally of hours spent ramped outside southeast Queensland hospitals. He said Mr Roberts should have access to the information, but suggested it would embarrass the Government. "This is a critical issue and Queensland taxpayers deserve to know what the dollar cost of ramping is to the QAS," he said.
The Liquor Hospitality Miscellaneous Union said that on one day in September, 11 ambulances were ramped at Logan Hospital for more than two hours.
In an answer to an Opposition question, Mr Roberts said the average off-stretcher time across Queensland was 13 minutes. He said 92 per cent of all patients were in hospital beds within 30 minutes and it was not possible to work out the cost of what officials termed "access block".
Harry Reid can pass a bill in the Senate that has no public option or an easy opt out, shallow subsidies for the uninsured, a low total cost, weak penalties for not having insurance, no coverage for abortion and no general tax increase (except for the premium and medical device taxes). And Nancy Pelosi can pass a bill in the House (on final passage) that has a public option with no opt out, steep subsidies for the uninsured, harsh penalties if they don't buy insurance, a higher cost, full abortion coverage and a surcharge income tax increase. The question is: Can either one's bill pass the other's chamber? Probably not. So here's how all this is likely to unfold:
Pelosi's bill is dead on arrival in the Senate. Reid is going to have to give up his insistence on the public option and pass a bill in the Senate very much like the Max Baucus bill that came out of the Senate Finance Committee. After extensive negotiations with his liberal wing on the one side and the moderates in the Senate on the other side (led by Joe Lieberman), he will eventually strike a deal.
He'll let the bill pass with no public option or with a generous opt-out provision. Meanwhile, he will placate his liberals by telling them that the final version that the conference committee will report back to the Senate will have a robust public option, not to worry. (Just as Pelosi told her liberals that the final bill would not ban payments for abortions, not to worry.)
After weeks of negotiations, the Senate will probably pass its version of the bill as a Christmas present to America. But ... in the course of all of these negotiations, Barack Obama and the Democrats are going to look worse and worse, more divided and less focused on the ultimate objective. Public antipathy to the bills will mount, and the worst-case scenario of each possible variation in the legislation will spark its own storm of opposition. By the time the Senate acts, the feminists will be angry, the uninsured will be angry, the senior citizens will be angry and the fiscal conservatives will be angry. Support for the bill will drop week after week during November and December.
By the time Congress reconvenes in January to wrestle with the two competing versions, support for the bill will have dwindled to a perilous point. This reduced level of support will just serve to make senators and congressmen more intransigent in the negotiations. Since the bill will need 60 votes in the Senate after the conference report, Lieberman, Maine's Olympia Snowe and Susan Collins, and a handful of other moderates will each have a veto. And, collectively, the liberals in each chamber will have onem as well. Weeks and months of wrangling will ensue. The result could be the defeat of the bill or its amendment in positive ways (for those opposed to it).
Our task is to reduce public support for the bill by publicizing its provisions, notably:
1. The $400 billion cut in Medicare.
2. The inevitable scarcity that will result from the addition of 35 million new patients with no new doctors or nurses.
3. The fine on the uninsured of 2.5 percent of their income if they don't buy insurance.
4. The high cost of these mandatory insurance policies ($15,000 per family).
5. The low level of subsidy available for the uninsured (only after they pay 8 percen to 12 percent of their incomes).
6. The likelihood of a $1,700 increase in the average family's premiums.
7. The possibility of up to five years in prison for failing to buy insurance or pay the fine.
8. The taxation of medical devices like pacemakers, wheelchairs, prosthetic limbs, hearing aids, etc.
9. The tax on sick people (increasing the threshold for deducting medical expenses from 7.5 percent to 10 percent of income.
10. The additional fiscal burden on the states of the increase in Medicaid eligibility.
11. The 40 percent tax on health insurance premiums that will effect households earning more than $75,000 by the fifth year of the plan.
The House-approved healthcare overhaul would raise the costs of healthcare by $289 billion over the next 10 years, according to an analysis by the chief actuary at the Centers for Medicare and Medicaid Services (CMS).
The CMS report is a blow to the White House and House Democrats who have vowed that healthcare reform would curb the growth of healthcare spending. CMS's analysis is not an apples-to-apples comparison to the cost estimate conducted by the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) because CMS did not review tax provisions, which help offset the price tag of the Democrats' measure.
However, the CMS analysis clearly states that the House bill falls short in attaining a key goal of the Democrats' effort to reform the nation's healthcare system: "With the exception of the proposed reduction in Medicare... the provisions of H.R. 3962 would not have a significant impact on future healthcare cost growth rates."
Republicans immediately seized on CMS's conclusions. The long-awaited report should serve as a "stark warning to every Republican, Democrat and Independent worried about the future of this nation," Ways and Means Committee ranking member Dave Camp (R-Mich.) said in a statement on Saturday.
Though House Republicans pressed to have this analysis completed before the lower chamber voted on the Democrats' sweeping healthcare reform bill last week, it was not ready until late Friday. Chief CMS Actuary Richard Foster, who prepared the report, recently told The Hill that he and his staff had only a few days to review the bill before it was voted on.
Brendan Daly, communications director for Speaker Nancy Pelosi (D-Calif.), said, "The report shows that our health reform bill will extend the life of the Medicare trust fund by five years -- significantly longer than any proposal in recent years," adding, "Medicare actuaries estimate $100 billion more in savings than CBO from Medicaid and Medicare."
Minority Leader John Boehner (R-Ohio) highlighted the CMS report on Saturday in a written statement. "This report once again discredits Democrats’ assertions that their $1.3 trillion government takeover of health care will lower costs, and it confirms that this bill violates President Obama’s promise to ‘bend the cost curve.’ It’s now beyond dispute that their bill will raise costs, which is exactly what the American people don’t want."
Republicans predicted that if the CMS numbers were available last Saturday when the House voted on the Democrats' healthcare bill, the measure would not have passed. “This report confirms what virtually every independent expert has been saying: Speaker Pelosi’s healthcare bill will increase costs, not decrease them. I hope my colleagues in the Senate heed CMS’ findings and refuse to rush ahead until any bill under consideration can be certified to actually reduce healthcare costs," Camp said.
According to the 31-page report, the House-passed bill would increase costs, cut Medicare and expand Medicaid. “In aggregate, we estimate that for calendar years 2010 through 2019 [national health expenditures] would increase by $289 billion," the report notes. "About three-fifths" or more than 60 percent of the uninsured would gain coverage by an expansion in Medicaid eligibility.
Medicare would be cut by "more than one-half trillion dollars ($571 billion), ... possibly jeopardizing access to care for beneficiaries," according to the report, and smaller companies would be "inclined to terminate their existing coverage."
Camp said that the nonpartisan analysis demonstrates that the Democrats' bill "does the opposite of everything they've been wanting to do" in terms of reducing overall health costs. He added the CMS report shows that "this is not healthcare reform, this is entitlement expansion."
A Democratic aide said the CMS and CBO findings are not that different: "While the actuaries do not show tax increases, adding those amounts from JCT would also illustrated that the proposal reduces the deficit over the next 10 years."
In an interview with The Hill on Saturday afternoon, Camp pointed out that CMS actuarial numbers were cited by Democrats back in 2003 during the Medicare prescription drug debate. CMS estimated at that time that the GOP-crafted Medicare bill would cost more than $550 billion over 10 years while CBO estimated its pricetag at $395 over the same period. The CMS cost estimate did not emerge until after the final conference bill was approved by Congress.
CMS's findings are not binding on Congress, however. Congress must abide by CBO and JCT estimates.
Of the 1,990 pages in the healthcare reform bill passed by Congress Saturday night, page 206 is especially touted – and little understood. That's the page that creates a federal Consumer Operated and Oriented Plan (CO-OP) to establish not-for-profit, member-run health insurance cooperatives.
Supporters say these health cooperatives, or HCs, will reduce costs by giving smaller buyers of insurance (such as small businesses) the ability to act as a large buyer. HCs will level the playing field, giving the "little guy" much more leverage to negotiate lower prices. They won't. What they will do is put the United States on a track toward nationalized healthcare even faster than the government-run insurance plan called the public option.
The reason HCs won't lower costs has nothing to do with politics or economics but a simple error of logic called the "fallacy of composition." Senators should take a refresher course in logic before they review page 206 and the rest of the legislation in coming weeks.
What, exactly, is a fallacy of composition? The basic idea is that if something is true for the part, it is not necessarily true for the whole. For example, if the Red Sox improve their batting average next year, they'll probably win more games. But if all major-league baseball teams improve their batting average next year, will all teams win more games? Of course not.
Yet proponents of HCs are making a similar mistake in judgment. Their fallacy results because market power is a relative concept. The advantage of being a large buyer comes at the expense of small buyers, so it is a fallacy to expect that any benefit currently derived from large buyers can be enjoyed by everyone if everyone becomes a large buyer.
Suppose, for example, that a pencilmaker sells one pencil per month to 10 separate buyers. Each pencil costs $1 to make and overhead is $10. The pencilmaker needs at least $20 in revenue per month to stay in business, so the average price per pencil must be at least $2.
Now suppose some buyers form a cooperative and use their newfound market power to negotiate a price below $2. To continue generating $20 in revenue, the pencilmaker must now charge the remaining buyers more than $2 because overhead has to be paid by someone.
If the remaining buyers also form a cooperative they may to able to negotiate the pencil price back down to $2, but only if pencil buyers in the first cooperative experience a price increase. Once everyone is large, the advantage of being large disappears.
Similarly, if "Jane" switches from a non-HC plan to a HC plan, she will probably get to pay a lower premium because the HC plan can negotiate lower reimbursement rates. But that also means that she will now be contributing less to her healthcare providers' overhead expenses than before. This forces them to make up the difference by charging non-HC plan patients more.
So if we reform the system to make small buyers large ones, then as the number of small plans declines, the large plans will run out of small plans to shift costs to, so the benefit of being large will disappear.
Some liberals find HCs appealing because they believe them to be a first step toward nationalized healthcare. Most conservatives oppose them for that very same reason. Some conservatives, however, find them appealing because they appear to be less risky than having a government-run public option that competes with private policies.
It is true that a public option carries the risk of driving all private insurance out of existence because it can set terms and rates that no private plan can actually compete with. But if a public option plan began to drive private insurers out of business, then it is at least conceivable that political pressure could emerge to correct course.
Once government-supported HCs take effect, however, they would almost certainly mean the end of private plans, because forthcoming insurance regulations will leave non-HC consumers with added costs and subtracted benefits – nudging everyone into HCs. So by establishing HCs as the centerpiece of reform and then regulating them directly, lawmakers may end up providing a faster path to de facto nationalized healthcare than a public option, which is also included in the House bill.
Indeed, what makes the House bill especially galling is that it has both HCs and a public option. Either provision, on its own, would overwhelm private healthcare. That's why voters shouldn't take much comfort in the speculation that the Senate might exclude a public option. If the Senate's version of the bill includes a provision for HCs, then reform would ultimately nationalize healthcare in America.
Those who are serious about making sure everyone has health insurance need to stop adding more layers of complexity to an already complex system.
The solution is to abolish Medicare and Medicaid, abolish the favorable tax treatment of employer-provided insurance, impose a one-price rule on procedures, and issue a voucher to every single American citizen. The creation of a voucher program would certainly take less than 1,990 pages of legislative language. This will solve the problem of the uninsured completely, immediately, and permanently in a transparent way that works with, rather than against, competition. The big losers will be special interest groups because a transparent voucher system will rob them of their ability to manipulate the system. They know this all too well, which is why they oppose it.
Insurance perks for healthy habits spur opposition
Who could object to rewarding people who quit smoking, lose weight or start to exercise? The American Cancer Society and the American Heart Association, for starters. Some companies now charge lower insurance premiums to workers who meet benchmarks for healthy living. The Senate's health-care overhaul legislation would expand the trend.
But instead of cheering the proposal, some patient-advocacy and health groups are worried that it would mean higher rates for less-fit Americans, possibly pricing them out of their employers' insurance plans. "It is a way of cherry-picking," said Dick Woodruff, senior director of federal affairs for the American Cancer Society. "We are all for workplace wellness, but when you tie it to the insurance-pricing system, it's a real problem."
Critics of the Senate proposal also say that giving special treatment to those who meet a company's fitness standards could undercut one of the marquee promises of the Democrats' proposed overhaul: preventing employers and insurers from discriminating against people on the basis of their health status and pre-existing medical conditions.
Under current law, companies can discount insurance premiums by 20 percent if employees meet benchmarks for weight, smoking or other aspects of their health. Earlier this year, two Senate committees, as part of the health-care overhaul, voted to allow such cuts to go as high as 50 percent.
Leading the charge for the idea is Safeway, the giant grocery-store chain, which already has adopted an incentive program that includes health-premium reductions. Last year, the company began to offer a 20 percent premium discount to its non-union workers who quit smoking, went on a diet, brought down their blood pressure and cut their cholesterol.
Jo Chiti, a Safeway employee who has lost about 30 pounds over the last year, said she has been swayed by Safeway Chief Executive Steve Burd's argument that health insurance should be more like car insurance. Just as good drivers should be rewarded with lower premiums than reckless drivers, Burd says, people who maintain a healthy lifestyle should pay less for coverage than people who do not.
A lobbying blitz by Burd, who has traveled to Washington 11 times this year, was instrumental in the two Senate committees' decision to include the idea in their health-care bills. Senate leaders are putting together the final version of a bill they will take to the Senate floor. "We believe that personal responsibility and financial incentives are the path to a healthier America," Burd said in a newspaper column.
Critics in the labor movement say the incentive scheme is a backdoor way for companies to cut their costs by driving less-healthy workers out of the insurance group. Indeed, most of Safeway's union workers, who are represented by the United Food and Commercial Workers and make up about 95 percent of the company's workforce, have not embraced the idea in their own health plan, which is established in a multi-employer contract.
What is more, critics worry that the program will unfairly penalize people whose health status is not solely the result of behavior they can easily control, such as a genetic predisposition to obesity or the weight gain that often accompanies smoking cessation.
Ken Schachmut, a Safeway senior vice president, says the company has a system for making exceptions if people bring a physician's note to explain why they cannot safely or wisely achieve the set goals. "We do not discriminate," he said. Opponents hope to water down the Senate provision in the legislative maneuvering ahead.
NHS whistleblower 'sacked for revealing dumped x-ray scans'
A NHS whistleblower who claims that he was sacked because he revealed a leading hospital was dumping x-ray scans will take his case to an employment tribunal next week. Dr Otto Chan, a consultant radiologist, believes that he was labelled a troublemaker after the revelations about the Royal London. He claims that hospital bosses decided to get rid of him and that his dismissal has left him unable to get another job in the health service. He is suing the hospital for loss of earnings, future earnings and pension. But he says that he also want to set a precedent that could help protect future NHS whistleblowers.
Dr Chan, 52, said that problems began after he warned that 10,000 packets of films and scans had built up because the Barts and the London Trust, which runs the Royal London, had neither the people nor the money to analyse them. He also raised concerns about junior doctors treating patients unsupervised. “After that the Trust decided they were going to get rid of me,” he said. He claims he was then accused of causing “disharmony” within the department and was dismissed by the hospital in 2006.
Since then he has been unable to find a permanent job in the NHS since. Dr Chan said that he hoped his case would offer greater protection to other NHS whistleblowers, who he said had a responsibility to expose problems in the health service. He said: “As doctors we have a responsibility to protect our patients. If we do not report them then theoretically we should be taken to the GMC.”
The case, which will start in Stratford on Monday, is being supported by the Medical Protection Society and is already estimated to have already cost between £2 and £3 million.
A spokesman for the trust said: “Dr Chan worked as a consultant radiologist at Barts and The London NHS Trust between January 1993 and his dismissal in June 2006. His dismissal is now the subject of an industrial tribunal. “It would be inappropriate, therefore, to comment further until the conclusion of that process. Dr Chan’s dismissal followed a 19-month investigation, which included a formal hearing by an independent panel. "The panel concluded that there were grounds for dismissal. The dismissal was in no way connected with issues with our radiology processes."
NHS hospitals treat Alzheimer’s patients so badly 'one in three carers complain'
Hospitals are treating Alzheimer’s patients so badly that one in three sufferer’s families have complained about their loved one's care. Even greater numbers of relatives and friends said they wanted to complain but had not, a new report by the Alzheimer’s Society shows. The figures are released just days after an independent review warned that 1,800 dementia patients are being killed every year by controversial ‘chemical cosh’ drugs given to keep them quiet.
Carers told the charity of sufferers left to sit in their own urine and nurses who complained that they had too many patients to look after. The report also heard of patients going hungry because they were not helped to eat or drink and many were generally treated with a lack of basic dignity and respect. One carer said that when nurses were asked for help with cleaning her mother they responded “that’s someone else’s job”.
The charity said that the situation was a “disgrace”. The study also found that almost eight in 10 carers, 77 per cent, were dissatisfied with the quality of dementia care in hospitals. The same number think that hospital staff do not understand the illness. Yet figures show that people with dementia occupy up to one in four hospital beds in England at any one time.
Neil Hunt, chief executive of Alzheimer’s Society, said: “It is a complete disgrace that so many families are receiving such poor care that they are being forced to complain. “People expect and deserve better but these new figures suggest that is far from the case. “As the numbers of people with dementia increase almost exponentially pressure on the NHS will also increase – we need to sort this problem out now.”
Earlier this week an independent report warned that four in five of the 180,000 dementia patients in hospitals and care homes on antipsychotic drugs were being wrongly prescribed the medications, which kill many of them.
Ministers have announced plans to try to cut the number of the drugs prescribed by two-thirds within three years.
More than 700,000 people in Britain suffer from dementia, of which around 400,000 have Alzheimer’s, the most common type. Experts warn that one in three people currently aged over 65 will die with dementia. The disease is also predicted to become increasingly more common in coming decades, as the population ages.
More than 1200 carers of people with dementia took part in the survey, which forms part of a major report the Society will launch next week on the huge variation of treatment of dementia patients on hospital wards across the country. A spokesman for the Patients Association said: "This survey confirms our fears that there is a widespread and disturbing failure in the hospital care of elderly patients."
A spokesman for the Department of Health said: "We have set priority areas for all hospitals to take urgent action, including appointing a senior member of staff to improve quality of care for people with dementia, proper training for all staff, and specialist older people's mental health teams working in hospitals."
Britain's National Health Service Denied Sight-Saving Medicine to Its Own Employee
An employee of Britain's government-run National Health Service was denied medication that could save her from going blind in one eye. Sylvie Webb, a widow from Salisbury, England, worked for 18 years as a secretary at Salisbury District Hospital. Yet, despite her situation, Webb discovered that medical treatment under the public health service is anything but universal.
In February 2007, doctors diagnosed Webb, then 58, with the "wet" type of age-related macular degeneration (ARMD) in her left eye. If not treated in a timely manner, wet ARMD "can lead to blindness in as little as three months and people need prompt treatment if they are to minimize the risk of permanent sight loss," according to a statement by the Royal National Institute of Blind People in London. As such, Webb's medical consultant sought rapid treatment for Webb because her sight was "deteriorating 'day by day,'" as Webb explained, and an infection in one eye can spread to the other good eye.
But to Webb's dismay, for nearly a year her local public health authority, Dorset Primary Care Trusts, refused to provide Webb with the expensive "anti-VEGF" drugs she desperately needed to save her sight. Though two such effective drugs, Macugen and Lucentis, are licensed for general NHS use, the Dorset Trust, which controls funding prescriptions, dragged its feet. Dorset Trust said it has yet to formulate a policy in a "fair and equitable way" to treat Webb's condition and thus it could not provide her with the VEGF drugs.
As Webb explained at the time, "At the time, the PCT [Dorset Primary Care Trusts] said it hadn't got a policy and it would address the situation in April [2007] - but it has now postponed this until June. I'm extremely worried that time is running out for me and other patients." The prospect of going blind terrified Webb:
"I'm a young woman and want to carry on working, and then I'd like to do all the things I had planned for my retirement. I'm also worried about the health of my other eye. I know I'm at increased risk of getting wet AMD in that eye and this could mean I end up losing my sight. The women in my family live into their 90s; I can't accept the possibility of being blind unnecessarily for the next 35 years."
In May 2007, the Trust agreed to review Webb's case on an urgent basis. But for Tom Bremridge, CEO of the Macular Disease Society in Andover, UK, there is no excuse for Webb being without the available sight-saving drugs she needs. "It is outrageous that in this day and age Mrs. Webb faces losing her sight owing to bureaucratic idleness," he said. Steve Winyard of RNIB echoed Bremridge's outrage:
"This is disgraceful... It's little comfort for Mrs. Webb that she can't get treatment simply because her PCT has yet to decide a policy. The PCT needs to get its act together and ensure these drugs are available to patients now and without a struggle... There is a moral imperative to save the sight of people where we can."
Finally, in 2008 new health guidelines permitted Dorset Trusts to prescribe Lucentis for Webb. The guidelines published by the National Institute for Clinical Excellence, the government's health advisory authority, allow for funding for the first 14 injections of Lucentis once wet ARMD is diagnosed in one eye. If additional injections are necessary, the drug's manufacturer, Novartis, will pay for additional treatment.
Webb was delighted that she would at last receive the sight-saving drug. "I'm so relieved that Dorset PCT has finally realized the long-term benefit to me of this treatment and has agreed funding," she said. "I only hope that all patients are given treatment to help save their sight because while this is good news for me, there may be hundreds of others with wet AMD who cannot get the funding they desperately need."
"The number of US veterans who died in 2008 because they lacked health insurance was 14 times higher than the US military death toll in Afghanistan that year, according to a new study," Agence France-Presse reports, in a dispatch titled "Lack of Health Care Killed 2,266 US Veterans Last Year: Study."
Now, you can get a list of names of soldiers who died in Afghanistan last year. There is no such list here, because this is where the number comes from:
The analysis uses census data to isolate the number of US veterans who lack both private health coverage and care offered by the VA.
"That's a group that's about 1.5 million people," said David Himmelstein, an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program who co-authored the study.
Himmelstein and co-author Stephanie Woolhandler, also a Harvard medical professor, overlaid that figure with another study examining the mortality rate associated with lack of health insurance.
"The uninsured have about a 40 percent higher risk of dying each year than otherwise comparable insured individuals," Himmelstein told AFP.
Garbage in, garbage out. Even a reporter should be smart enough to realize that you can't derive a precise number like 2,266 from hazy ones like "about 1.5 million people" and "about a 40% higher risk." This is junk science with an obvious political agenda.
Obamacare is a devastating tax on the working class
Given the recent announcement that the government's measure of unemployment has hit 10.2 percent, and given that the official House version of Obama's healthcare plan, HR 3962, has now passed, a close examination of the effects of "Obamacare" on the labor market is important. It will be no surprise to readers of this site to learn that the Democrats' bill will seriously harm precisely those poor and uninsured citizens it is ostensibly designed to help. The harm will come by compounding mass unemployment and depriving these citizens of consumption choices.
According to pages 269–273 of the gargantuan bill,Download PDF employers of full-time workers will be required to cover at least 72.5 percent of the premium of the least expensive health-insurance plan available that fulfills the bill's minimum criteria of "acceptable coverage." In cases in which family coverage is provided, 62.5 percent of the premium is to be borne by the employer. Depending on the specific plan and other variables such as location, this amounts to a direct labor tax of approximately $300 per month for an individual, or nearly $700 for family coverage.Download PDF
The implication of this increased cost is that workers whose revenue productivity is less than $300 per month higher than their wages will be laid off, or have their hours cut to the level that will classify them as part-time. Ignoring established labor law, the bill leaves the definition of part-time and full-time to the discretion of the Commissioner of Obama's massive new health bureaucracy. The lower the new "Health Choices Commissioner" sets the threshold in an attempt to maximize the number of people receiving the employer contribution, the more hours of production employers will have to shave off to push their employees under the threshold, and the less those workers will take home in wages each week.
Unfortunately, the bill also requires employers to cover a (smaller) percentage of the premium of the same minimum plan for part-time workers. The effects here are even worse than above, because they weaken the ability of an employer to escape the labor tax by employing his workers for fewer hours. Instead, with a labor tax on part-time workers as well, some low-productivity workers who are currently only working a few hours per week will be forced out of work entirely.
The Burden of Obamacare
We can say, as a mathematical certainty, that this labor tax is a regressive tax. Because the tax is defined as 72.5 percent of the same premium for all workers, that absolute tax will fall more heavily on workers for whom the tax represents a higher percentage of their wages or salary.
To understand this better, we will apply a $300 monthly labor tax to the differences between wages and revenue production for two different workers. If we make the simplifying assumption that a laborer is paid 99 percent of his revenue productivity, we can see that the absolute difference between productivity and wages is larger for high-income workers.
For example, a worker producing $50,000 of revenue per month will be paid $49,500 over the same period, delivering $500 in profit to his employer. A worker producing $10,000 in revenue monthly, meanwhile, will receive $9900, for a difference of only $100. Despite the differences in their absolute return, in a free economy, both laborers are profitable hires and thus employed.
In a post-Obama America, however, only the high-wage worker will be employed, leaving the low-productivity worker out of employment. When a $300 per month charge is added to the cost of employing either worker, it is plain to see that only the high-wage worker's absolute profit will remain positive.
The firm will continue to make $200 by employing the high-productivity worker, while it will be forced to lay off the low-productivity worker rather than lose $200 by employing him. The Obamacare health tax thus will fall directly on the same employees who are hurt by minimum wage increases: teenagers, the disabled, and disadvantaged minorities.
If they do not wish to be laid off or cut to part-time, these low-productivity workers will accept a lower salary to keep their position and work schedule. Thus, the worker who produces $10,000 monthly will offer to accept a salary of $9700 or less to save himself from a complete loss of employment or cut to part-time. These workers will offer to shift the cost directly onto themselves rather than burdening the employer with it, which would result in their unemployment.
Predictably, though, the Democrats fully intend to "protect" workers from the choice to save their jobs by working for less. Page 273 of the bill stipulates that any amount pledged for the minimum-health-insurance plan that corresponds to a fall in salary or wage will not be considered a contribution at all. Page 310 establishes a $100 per day, per case fine for any privately negotiated fall in wages. Thus, salaries will be locked in at current rates, with any cuts being considered an attempt to subvert the labor tax, and thus being subject to financial penalties.
In reality, this clause is no favor to workers, and instead acts as a wage floor to ensure that the unemployment effect will be immitigable and widespread. Because any drop in wages during the months following the bill's enactment would be considered a violation of the employer-contribution mandate and therefore would carry heavy fines, literally all wages will be prevented from falling below their current levels.
Implementing these indirect wage floors in literally every industry during a recession is downright ludicrous. During a recession, wages rise and fall in different lines of production to align producers' demand for laborers with consumers' demand for the goods each type of labor produces.
In a dynamic market — that is, any market in which people are free to change their minds — different workers' wages must rise and fall every day to accommodate changing consumer preferences. To prevent this process from taking place is to prevent the structure of production from being corrected.
These wage floors will also hasten the decline of industries that are less valuable to consumers than they were at an earlier time, but that may still be a productive use of resources at a lower price. Businesses in these industries will be unable to legally cut their labor costs to lower their prices and satisfy consumers who are less eager to buy their goods. Without this option, such firms will need to either lay off part of their labor force, or simply go out of business entirely.
Destroying Real Production
It is equally important to consider the other end of the production chain, which is to say the actual output of goods and services. By destroying the demand for marginally productive labor, Obamacare's labor tax will necessarily destroy that labor's end product, which is of course marginally-valued goods and services. Thus, it is rational to expect fewer late-night fast food options, less-cleanly hotel rooms, fewer sales associates at retail outlets, and the like.
While these effects may not be as easily visible as a plant closure, they are real losses of consumable utility. Free-market firms produce convenience and extra quality until the point at which it is no longer profitable to do so. Destroying the production of these goods and services would destroy the niceties that capital accumulation and progress allow Americans to take for granted.
The effect of Obamacare on the prices of produced goods is obviously inflationary. Increasing the cost of employing every single laborer by $300 a piece is certain to increase the price of all produced goods. Combining price increases with rising unemployment is hardly a laudable strategy for improving the lives of poor citizens.
Conclusion
The historic passage of HR 3962 by the House of Representatives is not an event to be celebrated. Obamacare will exacerbate the nation's rising unemployment and will prevent wages from fluctuating according to market demand. Just as with other sectors, a supposedly beneficial social policy hurts the poorest and least-able citizens the most.
At least 1,800 dementia sufferers die each year from 'chemical cosh' drugs they shouldn't even be given, a report has found. Just one in five of the 180,000 dementia patients prescribed the anti-psychotic drugs benefit, meaning nearly 150,000 are given them needlessly. But one in 100 is condemned to an early death, while many more suffer debilitating side-effects, leading critics to claim the risks outweigh the benefits.
Experts believe the problem has grown worse since NHS funding was restricted to patients with 'moderate' cases of dementia in 2006. They suggest that the lack of alternative medicines for those whose symptoms are classed as 'mild' or 'severe' has increased reliance on anti-psychotic drugs. The drugs are used to sedate patients if they grow agitated, to make life easier for their carers.
These 'chemical cosh' drugs are not licensed to treat dementia but are prescribed to control associated problems such as delusions, sleep disturbance and aggressive behaviour. But the Government-commissioned report confirms fears that their long-term use aggravates other medical conditions, accelerates mental decline and causes premature death. Care services minister Phil Hope yesterday backed an action plan to cut the 'unacceptable' use of anti-psychotics by two-thirds over the next three years.
The report's author, Sube Banerjee, professor of mental health and ageing at the Institute of Psychiatry, King's College London, said up to a quarter of people with dementia are on the drugs at any time, with only 36,000 deriving any benefits. He said they should be used as a 'last resort' for three months at the lowest dose, with a review at the end of this period. He said it was a 'major NHS issue' that many people got 'relatively small' benefits compared with the potential dangers. Professor Banerjee said that 20 or 30 years ago, 30 per cent of those living in care homes had dementia, whereas 80 or 90 per cent of residents were now affected.
Pointing to the growing burden of elderly patients with Alzheimer's and similar diseases, he said: 'What we have here is an overall failure of health and social care systems to adjust to a changing world.' Professor Banerjee recommended more psychological therapies and an audit of how many prescriptions are written, as well as improved training for staff looking after dementia patients to stop them simply relying on drugs.
Mr Hope said these ideas would all be implemented, as well as the creation of a national clinical director of dementia. Neil Hunt, chief executive of the Alzheimer's Society, said: 'This goes beyond quality of care - we see it as a fundamental human rights issue. Almost 150,000 people are being inappropriately prescribed these drugs as a chemical restraint. 'The scandalous over-prescription of anti-psychotic drugs leads to an estimated 1,800 deaths a year. It must end.'
Nadra Ahmed, chairman of the National Care Homes Association, said GPs were not spending enough time visiting care homes to review medication.
Liberal Democrat MP Paul Burstow, who has led a ten-year campaign on the issue, said: 'This review comes much too late for thousands of elderly people whose lives have been cut short by the reckless prescribing of anti-psychotic drugs. 'The evidence that anti-psychotic drugs do more harm than good has been mounting for years.'
Britain is now mandating degrees for all new nurses -- but how will a degree help a frightened patient?
I see no evidence that graduates make better nurses. My fear is that too much theory risks making them ‘too posh to wash’
Nursing is one of the most admirable of all professions. I was very lucky, in my 35 years as a doctor, to work with some extraordinarily gifted nurses. They were knowledgeable, dedicated and hardworking, of course; but, on top of this, they had compassion, empathy, common sense and a 360-degree awareness of what was going on around them. And grace under pressure. It is not easy to keep your cool when several people at once are asking you questions, one or more phones are ringing, and you are reassuring a patient about to undergo an operation, trying to keep the drug round to time and making sure the medical team knows what is going on.
But there are some nurses who are simply not up to the job. And there are wards where leadership is lacking. Patient information gets lost, practices are sloppy and patients, treated with inappropriate familiarity, call in vain for bedpans. The staff appear too busy to care, and spend more time chatting to each other than talking with anxious patients.
The Patients Association receives many complaints of such inadequate, and sometimes outright negligent, treatment. Its report Patients not Numbers, People not Statistics, published in August, documented appalling cases of mistreatment.
A speech given yesterday by Ann Keen, the Health Minister, announcing a measure that would “raise the quality of patient care” should therefore be welcomed. But the measure she described may not have been precisely what the patient ordered. By 2013 anyone wishing to be a nurse will have to take a degree course lasting up to four years.
The reasons given for this — the most radical change in nurse trainingsince the NHS was founded — are not entirely persuasive or encouraging. It is designed “to raise the status of nursing”. This, alas, is a story that we have heard many times before to justify reforms in the profession but it no longer seems relevant. The ghost of the nurse as “the doctor’s handmaiden” has long since been exorcised — not least because an increasing proportion of nurses are male and the medical profession as a whole is becoming increasingly female. In many cases, nurses are the leaders of the multidisciplinary team.
Christine Beasley, the Chief Nursing Officer, has argued that, as more young people than ever are studying for a degree, this will make nursing more attractive. The logic of this escapes me. A four-year course may put off individuals who have all the necessary qualities for nursing either because they do not feel academically inclined or because they may not wish to accumulate large debts. Besides, one would hope that people would enter nursing because they are motivated to care for others rather than because they want to enter a degree course.
It has also been argued by the Department of Health that graduates would “be able to deal more readily with increasingly complex care in an increasingly challenging health and social care system”. It is not at all clear that the difference between a degree course and the existing diploma will necessarily equip nurses to function better. The kind of multitasking I referred to requires quite different qualities. At any rate, I would like to see the evidence that the 75 per cent of nurses who currently lack degrees are less capable than the remainder who have them.
Many nurses have successfully extended their roles — acting as specialists in different contexts — without a degree. They have simply had additional training as required. I have a particular reason for being grateful to specialist epilepsy nurses who vastly improved the care I was able to give to older patients with seizures. Most simply took on the extra training. Requiring all nurses to have a degree seems to be a blunt instrument for enabling some nurses to acquire new skills and take on new roles. There is no reason why some nurses should not choose to proceed to a degree after they have acquired a diploma.
There is, however, a deeper concern about the proposal. It will not address the failures of basic care that all of us have witnessed when visiting the bedsides of friends and relatives in hospital. Indeed, it may exacerbate the problem.
The emphasis on the academic aspects of nursing, rather than practical skills and the deeply humane activity of hands-on care, may constitute a kind of “dumbing up”. Focusing on more abstract and theoretical issues, which a degree course, as opposed to vocational training, would require, might diminish the commitment to basic nursing — a fear captured in the much used phrase: “too posh to wash”. This is dangerous, particularly at a time when such care is undervalued — though not by those who receive it. One could be forgiven for thinking that the rewards and prestige of nursing rise in proportion to the distance from the bedside.
Already, we are seeing core nursing activities handed over to healthcare assistants who require only an NVQ or similar qualification. Such individuals are often deeply caring and highly skilled but it cannot be good for patients to have their nursing care divided between yet more professionals — or an iron wall erected between different aspects of nursing. Experienced nurses know that they are often able to learn much more about the patient’s needs and indeed his or her condition during the course of giving a blanket bath than through a structured interview in which many boxes are ticked.
We are told that there will be “a consultation process”. However, as is customary, the main outcomes have already been decided. Though the consultation will run until the end of April, the standards will be finalised only a few months later and the first new programmes will start in the autumn of 2011.
One can only hope that this latest development in nurse training will not simply place more distance between nurses and the patients who need their care. Ann Keen’s talk of providing “new nurses with the decision-making skills they need to make a high-level judgment in the transformed NHS” doesn’t awaken the expectation that the reforms will do much for the lonely, frightened, thirsty patient sitting in a pool of urine. My concern for such a patient is not exactly disinterested. One day it will be me. Or you.
Australia: Emergency rooms fail to deliver, say Queensland health figures
One of the world's oldest "free" hospital systems (from 1944) shows where such systems end up. They employ more bureaucrats than medical staff so the patients get the short end
EMERGENCY departments are failing to meet national performance targets in every area but non-urgent treatment, according to latest Queensland Health figures. Quarterly public hospital performance reports released yesterday showed emergency departments fell short of recommended treatment time targets for resuscitation, emergency, urgent and semi-urgent patients. The figures also revealed more than a third of Queenslanders waited in excess of eight hours for a bed in a ward after arriving at emergency departments.
Elective surgery figures showed that at October 1, 17.5 per cent (or more than 6000 patients) were still waiting longer than clinically desirable for treatment.
Defending the results Health Minister Paul Lucas said the number of long wait patients in the September quarter had decreased by 15.3 per cent compared with the 2008 September quarter. Mr Lucas said that emergency department admissions were increasing well in excess of population growth and swine flu had placed additional pressure on hospitals. "Surgeons must give priority to emergency cases and both medical and surgical emergencies use beds that would otherwise be used for elective surgery," Mr Lucas said.
Australian Medical Association Queensland president Dr Mason Stevenson said there was little good news in the report, and labelled the average wait of six hours and 20 minutes for a bed in emergency, "unacceptably high". Dr Stevenson said there was a "cascading effect of suffering" from emergency departments to elective surgery lists. "Its very frustrating for clinicians to see that patients are suffering unnecessarily as a result of unavoidable delays due to resource shortages," he said.
High priority patients at Townsville hospital waited an average of 17 days for oncology radiation – falling short of the national benchmarks of 10 working days. Mr Lucas said the three other hospitals performing the treatment, the Mater, Princess Alexandra and Royal Brisbane and Women's hospitals, had improved to easily meet the benchmark. "At Townsville there is still more work to be done . . . This report is a benchmark that identifies where our strategies are working and where we can do better."
LNP Health spokesman Mark McArdle said the figures showed Labor's 12 years of neglect and mismanagement. "Labor's ad hoc approach to health planning is downright dangerous for patient health."
AARP's Tacit Support For Medicare Cuts Shorts Seniors It Supposedly Represents
Clearly something must be up with the AARP. Why else would the nation's largest lobbying organization, sworn to protect the interests of senior citizens, watch silently as Congress plans to cut Medicare spending by $400 billion to pay for its health reform legislation? Could it be that the interests of seniors and the AARP are not exactly aligned?
Let's follow the money. The AARP takes in more than half of its $1.1 billion budget in royalty fees from health insurers and other vendors that market services with the organization's name. Medicare supplementary policies, called "Medigap" plans, make up the biggest share of this royalty revenue.
The AARP has an interest in selling more, not fewer, Medigap plans, of course. But there is a competitor on the block. A growing number of seniors are enrolling in a new form of Medicare coverage ? Medicare Advantage ? where they don't need Medigap.
Medicare Advantage was created in 2003 to give seniors the option of joining private plans that are paid up to 12% more to provide better health benefits than traditional Medicare. These private plans compete with each other by offering seniors such services as lower premiums, better drug coverage, dental care and eyeglasses, and more comprehensive coverage for major medical expenses. Nearly 11 million of Medicare's 45 million beneficiaries are in the program.
Congress' health reform bills would cut spending for Medicare Advantage by at least $150 billion. President Obama has singled out Medicare Advantage, saying it is a giveaway to private insurers. But virtually all of the extra money goes back to seniors in the form of better benefits, so it's seniors who have the most to lose.
A Washington Post front-page story on Oct. 27 questioned whether the AARP has a conflict of interest in appearing to represent seniors while watching Congress cut Medicare. "Democratic proposals to slash reimbursements for ... Medicare Advantage are widely expected to drive up demand for private Medigap policies like the ones offered by AARP, according to health care experts, legislative aides and documents," the Post's Dan Eggen reported.
Medigap plans are a cash cow for the AARP. And if people don't need them because they can enroll in Medicare Advantage plans, that's a revenue loss for the AARP. While the organization has some partnering arrangements with Medicare Advantage plans, they provide a fraction of the revenue to the organization that Medigap does.
Second, if Medicare's benefits are cut by $400 billion or more, seniors will have an ever greater need for Medigap coverage. "There's an inherent conflict of interest," former AARP executive Marilyn Moon says of the AARP's royalty arrangements. "They're ending up becoming very dependent on sources of income."
Tens of thousands of seniors have resigned from the AARP, many of them cutting up their membership cards to protest the organization's promotion of health reform.
The new chief executive of the AARP, Barry Rand, who was a strong supporter of President Obama during last year's presidential campaign, says the AARP is not protesting the Medicare cuts because reducing waste and fraud in Medicare will make the program stronger over the long term.
Medicare is in dire need of modernization to make it more efficient, but savings should go back into making it more solvent. But instead of contributing any savings to the $38 trillion in long-term debt the program is facing, the bills before Congress would use Medicare funds to expand health insurance coverage to working Americans.
While expanding coverage is also a worthy goal, if the AARP were representing its members well, it would argue that the money should come from other sources. It's no wonder seniors are upset. Clearly, the interests of the AARP and the 40 million seniors it purports to represent are not aligned in the health reform debate.
As an American, I am embarrassed that the U.S. House of Representatives has 220 members who actually believe the government can successfully centrally plan the medical and insurance industries. I'm embarrassed that my representatives think that government can subsidize the consumption of medical care without increasing the budget deficit or interfering with free choice. It's a triumph of mindless wishful thinking over logic and experience.
The 1,990-page bill is breathtaking in its bone-headed audacity. The notion that a small group of politicians can know enough to design something so complex and so personal is astounding. That they were advised by "experts" means nothing since no one is expert enough to do that. There are too many tradeoffs faced by unique individuals with infinitely varying needs.
Government cannot do simple things efficiently. The bureaucrats struggle to count votes correctly. They give subsidized loans to "homeowners" who turn out to be 4-year-olds. Yet congressmen want government to manage our medicine and insurance.
Competition is a "discovery procedure," Nobel-prize-winning economist F. A. Hayek taught. Through the competitive market process, we producers and consumers constantly learn things that force us to adjust our behavior if we are to succeed. Central planners fail for two reasons:
First, knowledge about supply, demand, individual preferences and resource availability is scattered -- much of it never articulated -- throughout society. It is not concentrated in a database where a group of planners can access it.
Second, this "data" is dynamic: It changes without notice. No matter how honorable the central planners' intentions, they will fail because they cannot know the needs and wishes of 300 million different people. And if they somehow did know their needs, they wouldn't know them tomorrow.
Proponents of so-called reform -- it's not really reform unless it makes things better -- have shamefully avoided criticism of their proposals. Often they just dismiss their opponents as greedy corporate apologists or paranoid right-wing loonies. That's easier than answering questions like these:
1) How can the government subsidize the purchase of medical services without driving up prices? Econ 101 teaches -- without controversy -- that when demand goes up, if other things remain equal, price goes up. The politicians want to have their cake and eat it, too.
2) How can the government promise lower medical costs without restricting choices? Medicare already does that. Once the planners' mandatory insurance pushes prices to new heights, they must put even tougher limits on what we may buy -- or their budget will be even deeper in the red than it already is. As economist Thomas Sowell points out, government cannot really reduce costs. All it can do is disguise and shift costs (through taxation) and refuse to pay for some services (rationing).
3) How does government "create choice" by imposing uniformity on insurers? Uniformity limits choice. Under House Speaker Nancy Pelosi's bill and the Senate versions, government would dictate to all insurers what their "minimum" coverage policy must include. Truly basic high-deductible, low-cost catastrophic policies tailored to individual needs would be forbidden.
4) How does it "create choice" by making insurance companies compete against a privileged government-sponsored program? The so-called government option, let's call it Fannie Med, would have implicit government backing and therefore little market discipline. The resulting environment of conformity and government power is not what I mean by choice and competition. Rep. Barney Frank is at least honest enough to say that the public option will bring us a government monopoly.
Advocates of government control want you to believe that the serious shortcomings of our medical and insurance system are failures of the free market. But that's impossible because our market is not free. Each state operates a cozy medical and insurance cartel that restricts competition through licensing and keeps prices higher than they would be in a genuine free market. But the planners won't talk about that. After all, if government is the problem in the first place, how can they justify a government takeover?
Many people are priced out of the medical and insurance markets for one reason: the politicians' refusal to give up power. Allowing them to seize another 16 percent of the economy won't solve our problems.
There's been plenty of coverage about the outrage on the left incited by the Stupak amendment. But what lots of the MSM coverage has neglected is what should really be upsetting Americans, pro-choice and pro-life alike -- and that's the one-size-fits-all health care that Pelosi's "reforms" will impose on all of us. From a Jake Tapper report:
The office of House Speaker Nancy Pelosi, D-Calif., says that the Stupak amendment does not prohibit by law private insurance companies from offering plans that include abortion coverage to women not receiving government subsidies.
But many in the abortion-rights community say the amendment will likely have that effect because so many Americans would be receiving a subsidy, insurance companies would drop abortion coverage so as to appeal to the largest number of consumers possible.
Let's all think about what that means. By that logic, the plans open to those receiving government subsidies would effectively determine what health care benefits are available to us all -- if they don't cover it, this argument goes, no one will, for competitiveness reasons.
So just take abortion out of the equation for a minute. In effect, what the liberals and abortion rights activists are telling us is an ugly truth about the House "reform": It will effectively impose one-size-fits-all health care on Americans. The plan(s) open to those receiving government subsidies (and therefore essentially under government control) will indirectly determine what you and I will be able to get from our own private health care plan.
And on the off-chance that there remains a plan that offers more benefits but at higher cost, we'll be taxed for choosing it. Nice.
British veteran dies after NHS doctors fail to spot broken neck and send him home with painkillers
This case should have been highly manageable
A Royal Air Force war veteran was sent home from hospital after doctors failed to diagnose his neck was broken. Hugh Jackson, 87, tripped over while picking up litter in his garden and fell head-first into an apple tree before knocking himself unconscious in May this year.
He died one month later. The great-grandfather, who had been awarded the British Empire Medal for rebuilding Vulcan planes in the RAF, spent two days in agony before deciding to call an ambulance. Mr Jackson was told his injuries were not a "blue light emergency" by a nurse over the telephone, and he instead decided to attend the Boston Pilgrim's Hospital in Lincolnshire in person.
The inquest in Boston, heard how the pensioner was sent home with painkillers after arriving at the hospital on a Bank Holiday Monday. He was told to come back the following day so he could be checked over because doctors had noticed tenderness at the top of his spine.
Mr Jackson, a widower, only discovered his neck was broken when a specialist radiologist from another hospital saw the break on the x-rays the following day. He informed frantic staff at Pilgrims Hospital, who rushed an ambulance to Mr Jackson's home the following day after realising they had missed the potentially life-threatening break. Mr Jackson had also been to see his GP just before the ambulance arrived - and she too had failed to find the broken neck.
He was eventually diagnosed with an odontoid peg fracture, placed in a stable position on his back for five days in the hospital's orthopaedic ward. A catalogue of blunders followed and Mr Jackson died from a lung infections in the hospital's intensive care ward nearly a month later.
His health had gradually deteriorated amid claims from his family that staff at the hospital were not looking after him properly. Speaking after the inquest on Tuesday, Mr Jackson's eldest son, electrician Jim, 67, from Wimblington, Cambridgeshire, said his father 'deserved better.' He claimed nurses had forgotten to replace his father's drip and left him strapped to a spine board for five days staring at the ceiling. He was not taken to the toilet regularly and also fell out of his bed - something that could have proved lethal with his broken neck.
Jim said: 'My father had a terrible accident and from that point onwards the hospital just did not care for him properly. "First they missed his broken neck and when they did finally diagnose it they strapped him to a board and left him on his back for five days so he couldn't eat or drink. 'He was meant to be fed through a drip but when that fell out of his hands the nurses failed to replace it - it was like a third world hospital.'
The inquest heard from Dr Rajeshwar Ranganathan, who was the first doctor to examine Mr Jackson. He said he had not seen the break on Mr Jackson x-rays and had consulted two doctors from the orthopaedic department who had also failed to spot the break.
The consultant in charge of the Pilgrim Hospital's accident and emergency department, Mr Hussain Hassan said all possible steps were taken to treat Mr Jackson correctly. He said: 'In my opinion all possible steps were taken to provide the right course of action. 'Mr Jackson's injuries were insufficient to highlight the problem and his neck had been stable for two days previously otherwise the fracture would have led to immediate death. 'Sixty to seventy per cent of accident and emergency procedures involve an x-ray but that does not mean our doctors are x-ray experts.'
When questioned whether he thought the two orthopaedic doctors had checked Mr Jackson's x-rays properly Mr Hassan said it would be 'grossly negligent' if they had not.
The hospital's risk manager Rick Dickinson said following the death of Mr Jackson they were reviewing some of their procedures. But he added: 'I don't believe anything we have identified as a problem could have changed the outcome of death overall.'
Coroner for Boston and Spalding Paul Cooper said the primary cause of death was a lung infection but said the neck break would have contributed to his death. He said: 'This all started with Mr Jackson hitting his head and breaking his neck. 'While it was not the neck break which actually killed him - the pathologist does admit immobilising a person with a lung disease would have increased the risk of death.'
Four-hour Emergency Room target is putting patients at risk, warn British nurses
Nurses are being 'pressured' into manipulating data and falsifying information to meet Government targets, the Royal College of Nursing has claimed. The four-hour target for staff to get emergency patients treated and admitted, or discharged, means many nurses are 'pushed into practices' that are risky for patients, it warned. It says there are 'negative consequences' for patient care, especially those needing treatment in accident and emergency wards.
A survey of its members found nine out of ten accident and emergency nurses claimed they have been unduly pressured to meet the four-hour targets. Three out of four nurses say patients were regularly admitted to inappropriate wards just to get them out of A&E departments within the time limit set by the targets.
RCN chief executive and general secretary Dr Peter Carter said targets had played a positive role in the NHS, but patients must come first. He added: 'We know of certain instances where nurses have been pressurised to manipulate information and who are pushed into meeting targets ahead of patient care. 'We are worried these cases represent the tip of the iceberg and we want to find out the true extent of pressures to meet targets - we are determined to bring this out into the open.'
British National Health Service Penalizes Woman for Supporting Her Own Cancer Treatment
Colette Mills of North Yorkshire, England was up against a rigid National Health Service policy that at the time would have taken away her taxpayer-provided health care if she purchased a life-extending cancer drug beyond the dosage the government provided for her.
Mills has fought breast cancer for over a quarter century. Though the last roughly 20 years were "blissfully" clear of cancer, she says, it returned in 2003 and spread throughout her body. The 58-year-old former NHS nurse was given Taxol, a chemotherapy drug, as part of her publicly-financed health care. But, following the advice of her hospital specialist, Mills decided to spend her own money to boost her treatment with the so-called wonder drug, Avastin. Drug trials show Taxol is perhaps twice as effective when combined with Avastin, and, when coupled, the drugs could slow advanced breast cancer.
Mills believed that combining the drugs "would probably give me a longer life and a better quality of life." She added, "Avastin may only increase your lifespan by six weeks or six months but, believe me, when it's your life, you're not picky."
The rub at the time was even if Mills paid out-of-pocket to supplement her care, the NHS would begin to bill her for the entire cost of treatment because she would be considered a private patient. "If a patient chooses to go private for certain drugs they elect to become a private patient for the course of their treatment for that condition. That is trust policy," said a statement by South Tees Hospitals NHS Trust, Mills' local health care provider.
Though Avastin was publicly available elsewhere in the UK, South Tees Hospitals NHS Trust would not fund Avastin because of its high cost. In Britain, the wide disparity of drugs and services made available depending on locality is informally termed the NHS 'postcode lottery.'
Mills was willing to pay the estimated £4,000 a month to get the expensive drug and have it administered - but she did not want to be stuck with the tab for her entire treatment. "The costs would increase from £4,000 a month to about £10,000 to £15,000 for all my care. I would need to pay charges for seeing the consultant, for the nurses' time, for blood tests and scans," Mills explained.
Thus, by doing what she thought necessary to improve her chances of survival, Mills would be responsible for paying some £15,000 (~$24,400) to the government. "The policy of my local NHS trust is that I must be an NHS patient or a private patient," said Mills. "If I want to pay for Avastin, I must pay for everything. It's immoral that the drugs are out there and freely available to certain people, yet they say I cannot have it."
The rationale for the bizarre policy that restricted how citizens spent their own money for health care was rooted in the NHS's belief that care should be equal and not based on a patient's ability to pay. "The Government is committed to a publicly funded NHS, free at the point of use and available to all regardless of income," explained a spokesman for Britain's Department of Health. "Co-payments would risk creating a two-tier health service and be in direct contravention with the principles and values of the NHS."
The health care provider, therefore, rejected Mills' request because it considered her buying an extra drug to be an "add on" to her existing NHS treatment. Mills' pleas to the NHS health trust were rejected, and she and husband, Eric, abandoned their challenge. "I can't go private..." said Mills. "This decision is totally unjust... this drug would prolong my life."
Mills recognized there naturally may be cost prohibitions for some care. But, she argued, "The whole concept of the NHS is that it's free at the point of need. Why should that stop because I want to pay for something?" She also pointed out the NHS's apparent double standard. "It is already a two-tier NHS," said Mills. "I'd had a scan privately when there was a two-week wait on the NHS... If I go to the dentist I can mix my NHS and private treatment."
Professor Karol Sikora, a medical expert who advises the World Health Organization, sided with Mills. "For health bosses to say Mrs. Mills cannot top up her NHS treatment is ideology gone mad. It is medical communism and utterly immoral," he charged. "This is unfair to taxpayers who are entitled to NHS care. If this patient wishes to pay for another drug, that should be her choice."
After considerable public disapproval and an official Department of Health Review, the NHS reversed its supplemental treatment policy in November 2008. Alan Johnson, the then-Health Secretary, announced new guidelines that purchasing private treatment will not mean that patients forfeit their entitlement to NHS services.
Reacting to the policy change, Mills said, "This move by the Government is exactly what I've been fighting for - but it has been a long time coming." Although the government's change of policy was welcome news for patients like Mills, it came too late for Mills herself - four months after her unsuccessful effort to purchase Avastin herself, her cancer spread to such an extent that it will no longer respond to the treatment.
Power is draining from Obama. If he can’t get his Bill through he will be at best another Clinton, at worst another Carter
A funny thing happened in Ida Grove, Iowa, last Saturday. Funny and a bit sad. Steve King missed his son’s wedding. The weather was perfect. The traffic was light. Steve really loves his son, Mick, and has no problem with his new wife, Stephanie. He wanted to be there and could have been, but instead he was in Washington voting against a healthcare reform Bill in the House of Representatives. Despite his vote, the Bill passed.
What was Mr King thinking? Did he miss the most important day in his son’s life because he believes the Democrats are wrong to try to extend health insurance cover to the 46 million who lack it, or because he thinks they are going about it the wrong way? He did not. As a fellow Republican with more in the way of name recognition said yesterday: “This is not about healthcare. This is about power and political control.”
That Republican was Dick Armey, an icon of the anti-Clinton movement of the early 1990s and a hate figure for the Left, but also a keen student of US social history. He knows full well that America’s employer-based health insurance system exists largely by accident. It started as a 50 cents-a-month scheme for teachers, offered in the 1920s by a Dallas hospital looking for ways to keep its wards full.
It grew as a result of bureaucratic accident and business opportunism — not legislation, let alone constitutional amendment — and for decades it offered superb care at reasonable prices. It doesn’t any more. It denies cover to many and doles out too much care to many more at prices employers and taxpayers can no longer afford. Few serious politicians in either main party deny that large parts of it are failing.
The central issue for Congress is not whether healthcare needs fixing or even how. It’s by whom.
Deep down, Barack Obama believes it’s his turn. He ran for President promising change, and won. “Change” could mean anything to anyone. That was its chief merit as a slogan. But this Administration believes in its soul that the many meanings of the word should include a willingness to expand the role of the State itself if nothing else works. On economic management that meant taking controlling stakes in banks and car giants to stop them failing. On healthcare, it means proving that the Federal Government can move into running a nationwide low-cost insurance programme, and not screw it up.
My father-in-law believes a screw-up is inevitable. For his generation of Eisenhower Republicans it is axiomatic that anything the private sector can do, the public sector can do only worse. Dick Armey and the army of Tea Party activists that he informally leads go much farther. They call the slightest expansion of the State a step towards Marxism. They say so politely, seriously, despairingly, on battle buses and in town halls across the country, and it is a great mistake to doubt their sincerity.
Never mind that the most progressive healthcare reforms debated on Capitol Hill since Mr Obama entered the White House are still so private sector-dependent that in Britain no right-wing Tory could advocate them without risking his seat. Never mind that the most state-phobic conservatives are also among the most enthusiastic supporters of a gigantic and reasonably effective government-run machine at the heart of American society, foreign policy and economic life — the US military. There is a new insurgency in US politics that believes the Democrats’ pursuit of a public healthcare option is politically, constitutionally, fundamentally unAmerican.
The insurgents also smell blood. As Mr Armey said, this is about power and political control. Mr Obama has staked his presidency on showing that he can win reforms that eluded Mr Clinton in 1994 and generations before that. He has majorities in both houses. Even the legal tussle for a disputed Minnesota Senate seat went the Democrats’ way, adding a self-important comedian to their caucus in the upper house and giving them, in principle, a filibuster-proof majority. Yet the President seems unable to use it.
His first deadline for a healthcare Bill to reach the Oval Office sailed by in August. Christmas is the next, unofficial, deadline. That looks likely to be missed as well. Each day of delay on healthcare is a day of delay on everything else the White House wants Congress to do, starting with once-in-a-century financial regulatory reform and the climate change legislation that has become a test for how the rest of the world judges this Administration’s break with the last one. Even Afghanistan is waiting. One reason for Mr Obama’s interminable delay over requests for more troops is his fear of splitting the liberal base on which robust healthcare reforms depend.
In truth “robust” already sounds ambitious. The Tea Party insurgency has blunted the health crusade from the Right. Democratic infighting over tax-funded abortions may do the same from the Left. Slippage deep into next year is entirely possible. So is complete failure, and if Mr Obama fails on healthcare what remains of the bubble of hope he created in his 2008 campaign will deflate faster than a blood pressure cuff in an overpriced private hospital. He will be, at best, a Clinton facsimile; at worst another Carter, undone by his own naivety and shorn of his unused majorities in next year’s mid-terms.
It is a prospect that sets Steve King’s pulse racing. That is why he came to Washington on Saturday instead of watching Mick wed Stephanie. It is also why Mr Clinton told a Democratic power lunch on Tuesday to stop bickering over details and get healthcare done. A Bill — any Bill — would silence the President’s critics and kick-start the rest of his agenda, he said. “The worst thing is to do nothing.”
Power drains from those too afraid to use it. It is draining now from the White House to a handful of senators who could make or break Mr Obama’s healthcare reforms, and thus his presidency. One is Joseph Lieberman, widely accused of being in hock to the health insurance industry that dominates his home state of Connecticut. I don’t think so. He’s our new neighbour; a modest chap who happens to hold the fate of a nation in his hands.
Pelosi's New Payroll Tax: A Whip for Socialized Medicine
Rep. Joe Barton of Texas, ranking Republican on the Energy and Commerce Committee, set out a startling scenario in floor debate Saturday before the House approved the health care bill pushed by Speaker Nancy Pelosi.
The bill would slap an 8 percent tax on the payrolls of employers who do not provide health insurance to their workers and pay at least 65 percent of the premiums for an employee who has a family insurance plan and 72.5 percent of the premiums for an employee who has an individual insurance plan. Barton spelled out what he believes will happen if this provision becomes law.
Many Americans might be tempted to casually conclude that the purpose of Pelosi's new payroll tax is to force employers to buy health insurance for their workers and that the parties hurt most by the tax would be the employers who pay it.
This is wrong on both counts. The Pelosi tax will not force employers to buy insurance for their workers, it will give them an incentive not buy insurance. The parties most hurt by the Pelosi tax will not be the employers who pay it but the workers dumped into the government-run health care system Pelosi's plan creates.
This will happen when employers discover that paying Pelosi's tax is cheaper than buying health insurance. The Pelosi payroll tax will be a whip wielded by the state to drive Americans into a socialized health care system from which there will be no escape.
In 2016, when the Pelosi plan would be in full force, the average employer-provided health insurance plan will cost $11,000 for a family and $6,000 for an individual, according to the Congressional Budget Office. Barton based his analysis on a family plan that cost only $10,000. "The employee pays $3,500 and the employer pays $6,500," said Barton. "Since there's an 8 percent payroll tax on the (employer's) average (wage) of $40,000, that would be about $3,200. Most employers, when this plan is implemented, can pay the 8 percent tax, which is $3,200, or the $6,500 premium that they pay for their employees. "They're going to stop providing health care ... and they're just going to put them in the public option," said Barton. "The employee is going to take that $3,500 that he or she was paying for their premium for a $10,000 plan and they're going to find out that when they go into the health care exchange, their $3,500 doesn't buy a $10,000 policy. It buys a $3,500 policy. It's a bad deal."
The deal looks even worse when you consider some of its technicalities -- which are also designed to drive Americans into government-run health care.
The bill that passed the House sets up a national "health insurance exchange" run by the government. Families earning up to 400 percent of the poverty level ($88,200 for a family of four) will qualify for a federal insurance subsidy that attenuates as family income rises. But families will not get this subsidy if their employer provides them with insurance, or if they buy their insurance anywhere but in the government exchange. One of the plans in the exchange will be the "public option" run by the government itself.
The Pelosi payroll tax will be phased in for companies with annual payrolls between $500,000 and $750,000. Employers with payrolls less than $500,000 will not pay it at all. Employers with payrolls between $500,000 and $585,000 will pay 2 percent of payroll if they don't provide health insurance. Employers with payrolls between $585,000 and $670,000 will pay 4 percent. Employers with payrolls between $670,000 and $750,000 will pay 6 percent. And employers with payrolls over $750,000 will pay the full 8 percent.
An employer who has 10 employees and an annual payroll of $499,000 (or an average of $49,900 per worker) will not pay a penny of Pelosi tax if he cancels his private health insurance program and dumps his workers into the government health care system. He will also have an incentive not to give his workers a raise or to risk his own money trying to grow his business.
But assume he does give each worker a $1,000 raise at the end of the year, bringing his payroll to $509,000. In that case, he faces a choice: Either pay 65 percent of the $11,000 annual insurance premium for every one of his workers who has a family and 72.5 percent of the $6,000 premium for every worker who does not have a family -- or pay the 2 percent Pelosi tax. The Pelosi tax would only charge him a flat fee of $10,180 (2 percent of his $509,000 payroll) to offload all his workers into the government system.
Because the government-run public option would be able to undersell the government-approved private plans in the government-run insurance exchange, the government-run option would soon be the only option. Government would control our health care from womb to tomb, a time span likely to be shortened by government care.
A Total Unmitigated Disaster for the Economy and for Freedom
In the wake of the euphoria that passed through Great Britain after Prime Minister Neville Chamberlain displayed the Munich Agreement and declared “peace in our time,” Winston Churchill had a different view. The agreement between France, Britain, and Hitler’s Germany, Churchill told Parliament, was a “total and unmitigated disaster.”
I thought about this exchange after seeing the euphoric comments in the media following passage of the House bill late Saturday night. Instead of “peace in our time,” we have something akin to “universal coverage in our time,” which has been the dream of leftists and left-liberals since the Great Depression. Whatever they might call it, I call it an unmitigated disaster.
There is nothing good to say about a new law that is going to raise taxes to confiscatory levels and will place a huge financial burden on people at a time when the government is actively going to war against American businesses. We are looking at totally politicized medical care in which every decision made by doctors and patients potentially can be nationalized and thrown into the maw of “public debate.”
This is a bill that relies on coercion and criminal penalties to force people to do what they never would do on their own. This is a bill that proclaims that bankruptcies due to high medical bills will be a thing of the past, but the financial burden it places on each family will increase bankruptcies as people will find it harder to pay their other bills.
Courtesy of the Washington Post (which supports this legislation) are a few items that are sure to turn into huge costs:
"The complex package would affect virtually every American and fundamentally alter vast swaths of the health insurance industry. Starting next year, private insurers could no longer deny anyone coverage based on preexisting conditions, place lifetime limits on coverage or abandon people when they become ill. Insurers would be required to disclose and justify proposed premium increases to regulators, and could not remove adult children younger than 27 from their parents’ family policies."
Like all socialistic policies, this bill contains “goals and mandates” that will become law in a few years. Like all socialistic policies, this bill is heavily backloaded with costs that will become oppressive not just for the wealthiest among us, but also others who will be inflated into higher tax brackets. (The income thresholds for the new taxes are not indexed for inflation.)
Furthermore, the bill has a stealth goal of driving private insurers out of business by overwhelming them with new costs.” To put it another way, Americans are going to have “single payer” coverage whether they want it or not.
I need to stress the point that I do not approve of our current system, which already is heavily regulated and is costlier and less-efficient than a free market in medical care would be. (Whenever we see true free markets at work, the costs for products always fall in real terms over time. Perversely, so-called economists like Paul Krugman continually claim that medical costs are rising because of the introduction of new medical capital and drugs, which is like claiming that the introduction of the microchip has driven up computer costs. That does not compute.)
For all of the talk of cutting costs and saving money, this bill will do the opposite. It flies in the face of everything we know to be true in economic analysis, and it flies in the face of natural law itself.
No matter how many people are thrown into prison for not obeying the new congressional mandates, this new policy will not have the supposed desired effect of making medical care more affordable and improving -quality. We are about to learn that hard lesson to our sorrow, but we will learn it.
Fourteen Hospitals Turn Away Critically-Injured Elderly Man
Rescue workers in Japan called fourteen hospitals before finding one that would take an elderly bicyclist who collided with a motorcycle. The accident, which occurred at 10:15 pm in the Japanese city of Itami, left the 69-year-old bicyclist, who was not identified, in critical condition with back and head injuries. Paramedics arrived on the scene five minutes after the crash and administered first aid. Yet, for about an hour, they were unsuccessful at locating a hospital to treat the man.
Helpless, the elderly man waited in the ambulance at the accident scene as hospital after hospital rejected treating him, citing unavailable beds, staff shortages and a lack of equipment and specialists. All told, fourteen hospitals in the neighboring prefectures - i.e., governing districts - of Hyogo and Osaka refused his entry.
"There were four other emergency calls in the same time frame of that night," explained Mitsuhisa Ikemoto, the fire department spokesman. "[A]s a result, we were unable to find a hospital."
It took a second round of calls for rescue workers to find a hospital. Finally, at 11:30 that night - 75 minutes after the accident - they took him to a hospital in Itami, which had initially declined to accept him. Unfortunately, it soon became apparent that the hospital's resources that night were unsatisfactory.
At the time of his arrival at the hospital, the elderly man was already in critical condition from the accident and post-accident delay. When his condition suddenly deteriorated, hospital staff scrambled "to transfer him for better treatment," according to the Associated Press.
Two hospitals rejected that transfer request. By the time a third hospital agreed to take the man, his condition was too poor to permit him to be moved. He died of hemorrhagic shock at about 1:15 the next morning.
The Associated Press reported that the man "initially showed stable vital signs," and, attributing the assessment to Ikemoto, reported the man "might have survived if a hospital accepted him more quickly." Ikemoto was quoted saying, "I wish hospitals are more willing to take patients..."
Rescue workers also had trouble finding a hospital to treat a 29-year-old motorcyclist who also had been involved in the crash. Despite the motorcyclists' severe injuries, the first two hospitals contacted refused to admit him. The third try succeeded, and the man was taken to a university hospital in Hyogo. Fortunately, two weeks after the accident, he was recovering.
The frustrating, and in one case, tragic experiences of the two accident victims initially denied medical care are not unique in Japan's universal health insurance system.
According to a government survey conducted by the country's Fire and Disaster Management Agency, Japanese hospitals denied admission to some 14,387 emergency patients in 2007. All 14,000-plus patients identified on paramedics' reports were rejected at least three times. Moreover, at least 3.5 percent of these victims had serious conditions, which the survey defined as requiring more than three weeks of hospitalization.
Zogby: Obama Job Approval on Healthcare Legislation Sits At 39%
President's Approval Still Double That of Both Congressional Democrats and Congressional Republicans
As the United States Senate prepares to vote on its version of the healthcare bill, likely voters show a strong dissatisfaction with both major political parties. President Obama has the highest job performance rating with regard to healthcare reform legislation of the five politicians and parties tested, a paltry 39% approval.
President Obama still holds a healthy positive approval on the issue of healthcare among his base - 74% positive among Liberals and 73% positive among Democrats. The President's performance on healthcare is also rated positively by half of all Moderates (50%), though 47% rate his performance as negative.
Congressional Republicans and Democrats fare much worse, even among their own base of supporters, with each group receiving a positive rating from fewer than one-in-five likely voters. Only one-in-three Conservatives (34%) rate Congressional Republicans performance as "excellent" or "good," while two-in-three Conservatives (65%) rate the performance "fair" or "poor." Congressional Democrats receive similar ratings from Liberals (38% positive, 59% negative).
Narrowly passed House health care bill lacks broad support
The narrow margin that carried the Nancy Pelosi/Barack Obama health care bill to victory in the House late Saturday should inform the Senate as it finalizes its own plan. The bill passed 220-215 with one Republican siding with the majority and 39 mostly moderate and conservative Democrats joining opponents. This is an economy busting bill devised and passed by liberal Democrats who largely ignored appeals for moderation.
A measure that will impact every American and greatly rework the nation's health care system should not be rammed through in such a divisive way. The Senate's task is to scale back the expense and scope of the bill to something more palatable to the broadest number while favoring less disruptive, incremental change at a time when the economy can ill afford higher taxes and deeper deficits.
Concerns and questions about the bill were waved away by the House majority. But they must be forthrightly dealt with by the Senate. Above all else is the cost. Democrats estimate the cost at $1.2 trillion over the next decade, but have worked feverishly to repress credible, contrary estimates that the true expense will be $2 trillion or more. The plan will levy taxes for 10 years to pay for six years of benefits, suggesting that in the second decade the annual costs will explode.
Democrats say the health care package will not increase the deficit because it contains offsetting cost cuts. To believe that, Americans would have to forget everything they know about how the federal government operates and its inability to manage its current health care programs -- Medicare and Medicaid -- with anything resembling fiscal responsibility.
Part of the supposed savings will come by trimming $500 billion from Medicare, a reckless move considering that the program is already hurtling toward insolvency.
The House bill makes a mockery of President Barack Obama's promise that those who currently have health insurance they're satisfied with will not be forced to change. By setting up a government panel to mandate coverage levels, it will strip employees and employers of the right to negotiate their plans that suit their own needs. It also mandates that employers cover 72.5 percent of employee insurance or pay an 8 percent fine. Many employers will find the fine less expensive than the mandated policies and dump their employees into government sponsored plans.
It returns an HMO-style management system for determining what procedures and treatments are covered, what fees are paid and who can provide care. Americans have unpleasant memories of how such a system worked in the 1980s, and have no reason to think government can execute it any better.
The bill reaches well beyond the stated goals of providing everyone access to affordable health care and controlling the soaring costs of insurance. It diverts billions of dollars into ill-defined community health programs that are bound to become a major pay-off to Democratic interests. It also contains a series of gratuitous racial preference requirements.
The House bill has the real potential of raising taxes on businesses and consumers alike, killing jobs in a fragile economy and establishing a massive new bureaucracy with an insatiable appetite for tax dollars.
It's a mess. Surely the Senate can do better. It ought to start by acknowledging the House bill is too expensive, too radically changes health care and promises to bring a deep and bitter divide to the nation.
Article below from the NY Slimes. Interesting that even they acknowledge problems
Mr. Obama has made cost containment a centerpiece of his health reform agenda, and in May he stood up at the White House with industry groups who pledged voluntary efforts to trim the growth of health care spending by 1.5 percent, or $2 trillion, over the next decade. But health economists say it is impossible to know whether the bills, including one passed by the House on Saturday night, would meet that goal, and many are skeptical that they even come close.
Experts — including some who have consulted closely with the White House, like Dr. Denis A. Cortese, chief executive of the Mayo Clinic — say the measures take only baby steps toward revamping the current fee-for-service system, which drives up costs by paying health providers for each visit or procedure performed. Some senators are also dissatisfied. “My assessment at this point,” said Senator Ron Wyden, Democrat of Oregon and a member of the Finance Committee, “is that the legislation is heavy on health and light on reform.”
There are a variety of ideas for attacking cost increases more aggressively, including setting Medicare reimbursement rates for doctors and hospitals more rigorously and discouraging workers and employers from buying expensive health insurance policies that mask the true costs of treatment.
Among other innovations being considered is a cost-cutting method known as bundling, in which health providers receive a lump sum to care for a patient with a particular medical condition, say, diabetes or heart disease. The House bill calls for the administration to develop a plan for bundling, while the Senate Finance Committee version of the bill gives it until 2013 to create a pilot program.
Some experts would like to see such changes adopted more quickly, and senators of both parties say they will press for more aggressive cost-cutting measures when the bill comes up for debate. But drastic changes in the health care reimbursement system could cost the White House the support of doctors and hospital groups, who have signed onto the legislation and are lobbying hard to keep the current fee-for-service system from being phased out too quickly.
The debate underscores a fundamental tension inside the White House between cost-containment idealists and pragmatists.
The first group includes officials like Peter R. Orszag, the budget director, and Dr. Ezekiel J. Emanuel, the medical ethicist whose brother Rahm is the chief of staff. The second includes Rahm Emanuel and Nancy-Ann DeParle, the director of the Office of Health Reform, who must contend with the realities of getting legislation passed. “Let’s be honest,” Rahm Emanuel said in a recent interview. “The goal isn’t to see whether I can pass this through the executive board of the Brookings Institution. I’m passing it through the United States Congress with people who represent constituents.” He went on: “I’m sure there are a lot of people sitting in the shade at the Aspen Institute — my brother being one of them — who will tell you what the ideal plan is. Great, fascinating. You have the art of the possible measured against the ideal.”
Mr. Orszag would not be interviewed. But in an e-mail message sent through a spokesman, he said the current legislation “lays the foundation” for cost-cutting over the long-term, adding: “Will more need to be done in the future? Absolutely.”
Senator Susan Collins, the Maine Republican whose vote the administration is courting, convened a news conference on Monday with Senator Lamar Alexander of Tennessee, a member of the Republican leadership, to spotlight her concerns over cost containment. Ms. Collins said she had been meeting with a group of moderate Democrats who shared her views. “I don’t believe we need more pilot projects to show us that health care delivery reforms are necessary,” she said in an interview. She added, “I think people are much more upset over the cost of care than the administration is acknowledging.”
Both the House and the Senate are proposing cost-saving measures. The House bill projects $440 billion in Medicare savings over 10 years; the Senate Finance Committee bill projects about $420 billion. White House officials say there will be additional, substantial savings in the private sector, as well. But how much is not clear.
Still, it is one thing to wring savings out of a bloated system, quite another to change the way that system does business. Experts agree that the Senate Finance bill does more to put systemic changes in place. That is because the bill includes two measures that health economists favor: a tax on high-value “Cadillac” health plans, and an independent commission that would make binding recommendations on how to cut Medicare costs.
House Democrats strongly oppose the Cadillac tax, which would hurt, among other people, union workers with generous benefit plans. But Ms. DeParle said in an interview that she sensed fresh interest in the House in adopting the Medicare commission idea. “There is a lot of support for cost containment,” she said.
Dr. Cortese, of the Mayo Clinic, said the bills could do more to reward quality care over quantity. He said he had met with Mr. Orszag and others at the White House and had proposed legislative language that would give Medicare three years to begin rewarding hospitals that are delivering better care at lower cost. “Our position has been focusing on paying for value,” he said, adding, “My take is there are people in the White House who understand exactly what I’m saying.”
Yet a deal the White House made with the hospital industry could make it difficult to cut costs too deeply. The White House and the Senate Finance Committee chairman, Max Baucus of Montana, agreed to limit hospitals’ payment reductions to $155 billion over 10 years. Those savings will come almost exclusively from “an agreement to squeeze the prices a little bit across the board, rather than reforming the way payments work,” said Mark McClellan, who ran Medicare under President George W. Bush.
As the Senate prepares to vote on its version of health care legislation, one of the most contentious issues will be a provision requiring employers to provide insurance coverage. With the jobless rate at 10.2 percent and expected to climb, penalties for employers who don't offer insurance benefits will make it difficult for moderate Senate Democrats to support the plan.
While most big companies provide workers with health insurance, many smaller employers do not, and they would end up having to come up with the money to either buy coverage or pay a penalty. "There is no question it will result in job loss and it will encourage employers not to hire employees," said John Goodman, president of the conservative National Center for Policy Analysis.
In the Senate, Democratic leaders are considering a $750-per-worker tax on companies that employ more than 50 people but don't offer benefits.
The House bill passed narrowly on Saturday night requires employers to pay a tax of 8 percent of total payroll if they do not provide health care coverage that meets federal standards. The House bill requires companies to pay 72.5 percent of a single worker's health care premiums and 65 percent of a family's coverage. Goodman called the proposal "a huge tax on labor," especially if it is coupled with the 2.5 percent income tax that would be levied on an individual who went without coverage under the House bill.
The House bill would also assess a graduated payroll tax beginning at 2 percent for companies earning $500,000 annually and rising to 6 percent for those making between $670,000 and $750,000 per year. "There are plenty of employers earning more than $500,000 annually," said Amanda Austin, director of federal public policy for the National Federation of Independent Businesses. "That, in our estimation, is right around a 15- to 17-employee firm."
Companies are so fearful of a looming tax and mandate coupled with the tough economy, Austin said, that many have stopped hiring. If the an employer mandate become law, she said, many companies will shed jobs. "The workers who are going to get cut are the low-wage workers," Austin said. "Or the employer will cut them down to part time, or won't expand the business. Or, he'll keep his full-time workers, and nobody gets raises."
Henry Aaron, a health care expert at the liberal Brookings Institution, said employer mandates play a critical role in reforming health care by providing an incentive for companies to maintain employee health care coverage. Without such penalties and taxes, Aaron said, companies would be tempted to boot workers into the new government plan. "There are going to be gainers and losers, but on balance, there is no reason to expect that these costs over the long haul are going to put a big dent in profits," Aaron said. "They are most likely to put a big dent on future wage increases that workers enjoy."
An insurance plan championed by Sen. Edward M. Kennedy that would help elderly or disabled people avoid nursing homes ironically adds yet another sticking point to the comprehensive health care reform plans for which the Massachusetts Democrat fought through much of his career. The Community Living Services and Support (CLASS) Act is designed to help those who need assistance with basic daily tasks pay for in-home assistance. But moderate Democrats and Republicans worry about the plan's impact on the deficit and the potential for saddling the federal government with the responsibility of another insurance program.
Sen. Kent Conrad, North Dakota Democrat and chairman of the Budget Committee, has called the act a Ponzi scheme.
Under the proposal in the House-passed version of the overhaul, the CLASS Act fund would collect monthly premiums, estimated to be $65 in 2011, from the wages of all working Americans, unless they elect to opt out - a technique used to help drive participation. Once they pay premiums for five years, participants would be eligible for cash benefits to help them buy in-home care, if they can no longer care for themselves. Participants would qualify if they could no longer do two of life's basic tasks on their own, such as eating, showering and dressing.
Mr. Kennedy first proposed the act years ago and later included it in the comprehensive reform bill that his Senate health committee passed a month before he died in August. "We must pass the CLASS Act and create a long-term care infrastructure in this country that will support every American's choice to live at home and be part of their community," he said in November 2006. "Every older or disabled American has this right, and it's our job in Congress to provide them with the support they need to make this a reality."
But budget hawks warn that cost estimates for the program by the Congressional Budget Office (CBO), Congress' nonpartisan budget-keeper, don't look far enough into the future, when they expect benefit requests will far outweigh revenue. "While the goals of the CLASS Act are laudable - finding a way to provide long-term care insurance to individuals - the effects of including this legislation in the merged Senate bill would not be fiscally responsible for several reasons," several senators wrote late last month in a letter to Senate Majority Leader Harry Reid, Nevada Democrat, asking him to keep the act out of the bill he sends to the Senate floor.
"Nearly all the savings result from the fact that the initial payout of benefits wouldn't begin until 2016, even though the program begins collecting premiums in 2011," wrote the group, which includes Mr. Conrad and Democratic Sens. Mary L. Landrieu of Louisiana, Evan Bayh of Indiana, Blanche Lincoln of Arkansas, Ben Nelson of Nebraska and Mark Warner of Virginia, as well as Connecticut independent Joe Lieberman.
Health care reform bill 'dead on arrival' at US Senate
President Barack Obama is facing a tough battle to steer health care reform through the US Senate after his bill was declared 'dead on arrival' at the upper house.
Having proclaimed s "historic" approval by the House of Representatives at the weekend of a bill that will extend medical insurance to almost every American, the president consulted his senior advisers on Monday about how to negotiate the next hurdle in a prolonged effort to overhaul the health system.
While the bill passed the House of Representatives by a mere five votes, margins are also extremely tight in the senate, where Democrats will need all their 60 senators to have a hope of passing the legislation through the 100-seat chamber. Just one defecting senator, acting with Republicans, could subject the bill to filibuster - the archaic practice of talking an item off the agenda.
Sen Joe Lieberman, an Independent Democrat from Connecticut, has vowed to filibuster the bill "as a matter of conscience" if it includes a measure to create a government-run insurance company. "I believe the debt can break America and send us into a recession that's worse than the one we're fighting our way out of today," said Sen Lieberman, who supported Senator John McCain in the 2008 presidential election.
Signalling the tough fight ahead, Senator Lindsey Graham of South Carolina, a friend of Mr Lieberman, said dismissively: "The House bill is dead on arrival in the Senate. Just look at how it passed." Thirty-nine Democrats joined Republicans in opposing the bill, which included the so-called public option and made health insurance mandatory.
Though the president has urged the Senate to hold its health vote this year, Sen Harry Reid of Nevada, the Democratic Senate Majority Leader, has signalled that liberal-moderate party divisions in the Senate could well see the timetable slip to 2010. "We're not going to be bound by any timelines. We need to do the best job we can for the American people," said Mr Reid.
Nicholas Kristof of the New York Times has a column purporting to debunk the claim that America's health-care system is the best in the world. But if you scratch the surface, you find that he is misleading his readers. Here's Kristof's claim:
Yet another study, cited in a recent report by the Robert Wood Johnson Foundation and the Urban Institute, looked at how well 19 developed countries succeeded in avoiding "preventable deaths," such as those where a disease could be cured or forestalled. What Senator [Richard] Shelby called "the best health care system" ranked in last place.
But if you look at the report, on pages 3-4, you find this:
Among 19 countries included in a recent study of amenable mortality, the United States had the highest rate of deaths from conditions that could have been prevented or treated successfully. The extent to which differences across countries in the prevalence of particular conditions may explain the poor U.S. showing in the recent study is unknown, although studies in which it was possible to adjust for such differences found that the greatest part of regional differences in mortality for certain conditions were explained by differences in disease prevalence.
A recent study comparing the United States and 10 European countries found that the United States had a much higher prevalence of nine of 10 conditions, including cancer, heart disease, and stroke, in its population over age 50.
In other words, Americans are more likely to die of these diseases because they're more likely to get them, not because they are likely to get inferior treatment.
Longtime readers will recall that we caught Kristof playing similar games with statistics back in January 2005, when he claimed that the U.S. infant-mortality rate was worse than communist Cuba's and much worse than European rates. We pointed out that a central reason U.S. rates are high is that American physicians make heroic efforts to save extremely premature infants, who nonetheless have a mortality rate in excess of 50%. In other countries, these babies are simply discarded and not even counted in the statistics.
Almost five years later, Kristof acknowledges his error--sort of: "We rank 37th in infant mortality (partly because of many premature births)," he writes. He still presents the infant-mortality rate as if it were evidence that America's medical care is inferior, when in fact it is evidence that it is superior. This time there is no question that he knows better.
Back in 2005, we observed that Kristof "seems to think it's cute to cast America in a negative light." That hasn't changed. Here are the two closing paragraphs of yesterday's column:
In several columns, I've noted indignantly that we have worse health statistics than Slovenia. For example, I noted that an American child is twice as likely to die in its first year as a Slovenian child. The tone--worse than Slovenia!--gravely offended Slovenians. They resent having their fine universal health coverage compared with the notoriously dysfunctional American system.
As far as I can tell, every Slovenian has written to me. Twice. So, to all you Slovenians, I apologize profusely for the invidious comparison of our health systems. Yet I still don't see anything wrong with us Americans aspiring for health care every bit as good as yours.
The narrow 220-215 victory in the House on Saturday night was a step forward on the road to a government takeover of the health care system. But as close and dramatic as that vote was, that was the easy part. The Senate must still pass its version of reform--which will not be the bill that just passed the House. Nancy Pelosi was, after all, able to lose the votes of 39 moderate Democrats. Harry Reid cannot afford to lose even one. A conference committee must reconcile the two vastly different versions. And then, Pelosi must hold together her 3 vote margin of victory (if it gets that far). Yet several House Democrats who voted for the bill on Saturday said they did so only to “advance the process.” Their vote is far from guaranteed on final passage. And, House liberals are almost certain to be disappointed by the more moderate bill that may emerge from the conference.
Among the more contentious issues:
Individual Mandate: This should’ve been low-hanging fruit. Democrats agreed on a mandate early in the process. But it became increasingly plain that a mandate would hit those with insurance as well as the uninsured — forcing people who are happy with their plan to switch to a different, possibly more expensive plan. With this mandate now being seen as a middle-class tax hike, qualms have developed. The House bill contains a strict mandate, with penalties of 2.5 percent of income backed up by up to five years in jail. The Senate Finance Committee, on the other hand, watered down the mandate’s penalties and delayed the mandates implementation.
Employer Mandate: The House bill also contains an employer mandate, a requirement that all but the smallest employers provide insurance to their workers or pay a penalty tax of up to 8 percent of payroll. The Senate, looking at unemployment rates over 10 percent, seems unlikely to include an employer mandate.
The Public Option: The House included, if not a “robust” public option, at least a semi-robust one. But moderate Democrats in the Senate are clearly not on board. Joe Lieberman (I-CT) says that he will join a Republican filibuster if the public option is included. Harry Reid is trying various permutations: a trigger, an opt-in, an opt-out. But as of now there is not 60 votes for any variation.
The Sheer Cost: Fiscal hawks like Sen. Evan Bayh (D-IN) say they will not support a bill that adds to the deficit or spends too much. But the house bill cost a minimum of $1.2 trillion.
Taxes: The House plan to add a surtax on incomes of $500,000 or more a year has no support in the Senate. At the same time, the Senate plan to slap a 40 percent excise tax on “Cadillac” insurance plans is unacceptable to key Democratic constituencies like labor unions.
Abortion: Conservative Democrats insisted on a strict prohibition on the use of government funds for abortion. The bill could not have passed without the inclusion of that provision. House liberal swallowed hard and voted for the bill, despite what they called “a poison pill” anyway with the expectation that it will be removed later. If the final bill includes the prohibition at least a couple liberals could defect. If it doesn’t, conservative Democrats won’t be on board.
Immigration: The Senate Finance Committee included a provision barring illegal immigrants from purchasing insurance through the government-run Exchange. The House Hispanic Caucus says that if that provision is in the final bill, they will vote against it.
As if these disagreements among Democrats wasn’t bad enough, public opinion is now turning against the bill.
President Obama has called for a bill to be on his desk before Christmas—the latest in a series of deadline that are so far unmet. It is hard to see how Congress can meet this one either. The Senate has not yet received CBO scoring of its bill and is not prepared to even begin debate until next week at the earliest. That debate will last 3-4 weeks minimum, assuming there are 60 votes for cloture. That means, the bill cant’ go to conference committee until mid-December, even if everything breaks the way Harry Reid wants. Privately, Democrats are now suggesting late January, before the State of the Union address, is the best they can do.
The fat lady can go back to sleep—this isn’t over yet.
Now that the House has passed the $2.1 trillion ObamaCare abomination by the slimmest of margins, the scene shifts to the Senate. There, members will be put to the test as to whether to pass the single largest redistribution of the wealth in U.S. history.
Or whether to torpedo it to the icy depths of the Abyss--never to reawaken.
Only 50.5 percent of Representatives voted in favor of the government takeover of health care on Saturday. The final vote was 220 to 215. If the same pattern holds in the Senate where 60 votes are needed, the road left-alone to socialized medicine could run awry in 2010.
Especially since a full 54 percent of voters oppose it and only 42 percent support a bill that will ration care away from seniors, reduce quality, increase taxes by more than $780 billion, and increase the unsustainable burden of the national debt by substantially exploding entitlement spending—adding more than 36 million to the taxpayer-subsidized health system.
Unlike the House, however, the Senate now needs 60 votes, and it is going to be harder to get. Then, even if they do pass their own version of the bill, it would still have to go to conference. Pressure on House and Senate targets to vote “No” on the conference report and to mount a filibuster on the conference report will be the game. So, there is still a long way to go before the left is allowed to turn the world’s leading health care system into yet another entitlement program.
The House version of ObamaCare was pushed to give the embattled Administration a "win." The elections were harsh and the mood of the public is not good. Everything was turning against them. This was meant as a way to stop the bleeding and give some guys a "pass" vote.
But at the end of the day, the House action may only make matters worse for them. U-6 unemployment has steadily climbed past 17.5 percent. The past two most recent major votes in the House have been on two key jobs-killing measures: the national energy cap and tax, and now the push for a government “public option”.
In short, the health care and energy tax bills will weaken and destroy the American economy, increase premiums and prices across the board, and put further stress on the American people, many of whom are barely staying afloat financially. Foreclosures continue to mount, and inflation is looming.
The Senate has yet to vote on either measure. Nor will they vote this year, indicates Harry Reid—himself in deepening election troubles in Nevada. The political tide for the majority is still running out while the Hard Left fringe in its party pushes an agenda of ever-expansive entitlements, bailouts, favors, kickbacks, and handouts.
Last Tuesday’s results clearly gave 39 members of the House Democrat caucus pause when they voted against the health bill. It followed a similar pattern wherein 44 Democrats voted against the Waxman-Markey bill capping carbon emissions—these vulnerable members of the House majority are under considerable pressure from their constituents.
The public’s outrage at incumbents has been—and will continue to be seen—throughout the year at tea parties and town halls. It’s alive in communities where individuals who never have before been involved with the political process are standing up and speaking out against members of Congress. These national issues have awakened a national anger that will not quickly or easily subside.
What’s worse for House members is that the Senate may never vote for these controversial measures as the election year politics change the landscape. Suddenly, polling in particular states and districts will become key decision-makers.
The influence of party leadership on member votes will continue to wane as the public becomes the greater arbiter.
For the Democrats in 2010, the only way to assuage the public’s anger and save their seats may be to deep-six the Obama agenda for contracting wealth and expanding welfare. As the results in the House clearly indicated, it may be an alternative increasing numbers of Democrat office-holders are eager to embrace.
It certainly is a surreal day in the neighborhood and I don't think it has got anything to do with Rush Limbaugh criticizing the President, as David Axlerod, one of the President's advisor's would like you to believe. What I find surreal is all the attention being paid to the Public Option as well as Al Sharpton's assertion on This Week with George Stephanopoulos that Liberals are the real conservatives. Yes, he actually said that with a straight face. That line was about as surreal as it gets, boys and girls.
Back to the Public Option. The public option argument is no different and just as silly as me arguing with my wife that the pin-stripping should be gold and double lined on our Ferrari Enzo. What makes these arguments different is my wife and I both know we joking, whereas Al Sharpton's conservative wing of the Democratic Party is deadly serious. What makes the argument surreal is that we know we can't afford what we want and so do they, but that is not stopping Al's pals.
It gets even funnier when they begin to explain how they will afford the unaffordable. They want you to believe that they are going to cut Medicare. Let me say that one more time, only slower.
The Democrats in Congress lead by the President are going to cut Medicare.
The idea that this Administration is going to cut spending is laughable. The notion that they will take a meat cleaver to Medicare and hack 50 billion dollars from it's budget each and every year for the next ten years is a side splitter. A solemn pledge of fiscal prudence from the leader of the gang that is projecting Trillion Dollar Deficits for as far as the eye can see isn't all that reassuring. But it's comforting to know that their lack of fiscal discipline has some limits, or does it?
Their spin on the deficit is every bit as surreal as their foolish public option debate. The President says he won't sign a bill that will increase the deficit. That's pretty rich, don't you think? What he means to say is get ready for big tax increases, both the direct and indirect kind.
Forcing, excuse me, mandating (that's more PC) that everyone must purchase health insurance while at the same time imposing a tax on medical device manufacturers is merely a stepped transaction. It is a tax increase disguised as a fee extracted from the medical device manufacturers, which they pass on to the insurance company in the form of higher prices, who then passes it on to you through higher insurance premiums. Raising the top marginal rate by 5% is well, it's just a tax increase. Hey good thing that recession is over and the economy is surging ahead, cause we all know that raising taxes in a recession is a recipe for disaster!
What they want you to believe and what is reality in this debate occupy positions that are polar opposites on the reality continuum!
Reality: government programs always cost more than originally projected. Congress has an abysmal record when it comes to cutting spending and raising tax rates, never produces anywhere near the amount of tax revenue that Congress believes it will.
Surreality: Congress can provide quality health care for everyone without bankrupting us all along the way.
Congress should do what I did when I realized that I couldn't afford the $1,000,000 Ferrari. I settled for just the pinstripes instead. Now I'll be the first to admit they don't look as good on me as they would on that Ferrari, but they don't look that bad, and on the plus side I won't need to hire a bankruptcy attorney.
Fears over child protection at one third of NHS trusts
More than 140 NHS trusts have been challenged over the adequacy of their child protection procedures by the Care Quality Commission in the wake of the Baby Peter scandal. Trusts are responsible for declaring whether they meet basic standards for child protection as part of the health service's annual inspection process. This year, 363 of England's 392 trusts - over 90 per cent - declared that they met the standard.
But in a special review commissioned after Baby Peter's murder, the watchdog, the Care Quality Commission (CQC), has challenged the claims made by 112 trusts. Eighteen of them - including the main GP service in Manchester - have already been marked down by the watchdog, with other investigations "ongoing."
Internal NHS documents seen by The Sunday Telegraph show the CQC review uncovered "significant lapses" in child protection that "trust boards should have been aware of, but did not take into consideration when making [their] declarations." The documents say that the CQC review has uncovered "clear evidence" which "conflicts with the 2008/9 declarations made by trusts."
In addition to the 112 trusts whose claims have been questioned, a further 29 trusts admitted that they fell below the standard. They include hospitals, mental health trusts and primary care trusts, which run GP services and health centres.
Cynthia Bower, chief executive of the Care Quality Commission, said: "We make no apologies for coming down hard on trusts not meeting the standard on safeguarding children. Baby Peter was a wake-up call for the NHS. Some trusts have realised they've got more to do than they previously thought. In other cases we needed to bring shortfalls to their attention."
Baby Peter, now named as Peter Connolly, died of multiple injuries in August 2007. He was a patient at a child abuse clinic at St Ann's Hospital, Haringey, north London, and had been seen eight times by NHS staff in the month before his death. At his last visit to the clinic, two days before he died, the paediatrician examining him sent him home after failing to notice that he had a broken back. The 17-month-old was found dead in his blood-stained cot with eight broken ribs, severe lacerations to his head, a tip of a finger missing, broken teeth, missing nails, and scores of bruises, cuts and abrasions, including a deep tear to his left earlobe, which had been pulled away from his head.
Lynne Featherstone, Liberal Democrat MP for Hornsey and Wood Green, which covers Haringey, said: "Haringey social services rightly got a lot of attention for their failings in the Baby Peter case. But for the last several months I have been convinced that the failings of the NHS were just as bad."
In May, the CQC issued a scathing report blaming "systemic failings" in the NHS as a whole, not simply in Haringey, for Peter's death. In July, it said there were "worrying shortfalls" in adequately-trained staff dealing with child protection in the Health Service and called for "major improvements."
After the July report, the CQC issued a series of detailed questionnaires to NHS trusts in order to obtain specific data about each trust's child protection plans. It is the responses to these questionnaires which informed the watchdog's recent actions.
A report presented to last month's board meeting of NHS London, the strategic health authority for the capital, says that in London alone 14 trusts - including seven acute hospitals - were "deemed by the CQC to show evidence of a significant lapse against C2 [the basic child protection standard] that Trust boards should have been aware of but did not take into consideration when making [their] declarations".
Most of the "lapsing" trusts in London have presented "mitigation" to the CQC. The report says they will publish their revised declarations "in the next couple of months."
A spokeswoman for the CQC said that in England as a whole, 112 trusts which declared they were "compliant" with the basic standard had not satisfied the commission and had been challenged to produce more evidence for their claim. Not all will be found to be failing in the area, but 15 trusts which claimed to be "compliant" have been marked down and seven have been inspected, of whom a further three were also marked down. Twenty-nine more trusts were entered as non-compliant.
The basic NHS standard for child protection says that hospitals must show that they "follow national child protection guidelines" on matters such as training, staffing and liaising with other agencies, such as police and social services.
Baby Peter's is far from the only recent case where NHS staff have failed to act on clear signs of abuse. An official investigation earlier this year found that "faulty" NHS procedures had allowed seven-week-old Jessica Randall to be sexually abused, tortured and killed by her father. Staff at Kettering General Hospital failed to spot tell-tale signals of abuse and a GP who saw Jessica did not record his suspicions clearly in his notes, the investigation found.
Also this year, Claire Biggs, 27, was jailed after her two-month-old son, Rhys, was found dead with 13 broken ribs and a broken shoulder. Biggs, a crack addict, was known to health workers, one of whom may have missed crucial signs of the child's broken ribs.
In 2007 James Craig, 26, and Sharma Dookhooah, 25, of Romford, Essex, were jailed after admitting causing or allowing the death of their 10-month-old son Neo. Their Old Bailey trial heard of a series of failings by police, doctors and social workers who knew about the boy's "derelict" home life but did not intervene, despite a number of warnings.
Earlier this year it emerged that NHS managers at Great Ormond Street Hospital, whose doctors staffed the child abuse clinic in Haringey, had failed to act on clear written warnings from the consultant team at the clinic the year before Baby Peter's death. In a joint letter to their bosses, the four consultant community paediatricians at St Ann's Hospital warned that the clinic was understaffed and records were inadequate. They said this posed a "very high risk" to the safety of their child patients.
One of the four consultants, Dr Sethu Wariyar, said that instead of acting on the letter, Great Ormond Street management "ignored" it. He described the clinic as a "disaster waiting to happen". After writing their letter, two of the four consultants were driven to resign, a third went on long-term sick leave and the fourth was removed from work and remains on leave on full pay.
By the time Baby Peter came to the clinic, none of the experienced permanent consultants remained in place. He was instead seen by a temporary locum doctor, who now faces a General Medical Council hearing for failing to spot his injuries.
I don’t want to sound like an ingrate here, but the Veterans Administration is not the healthcare provider of choice for anybody who actually has a choice.
I know, I know. As a libertarian, I’m not supposed to be sucking on the government’s tit. But a few years ago Blue Cross raised my premiums a hundred dollars a month to cover the cost of the “legislatively mandated benefits” that the state of Oregon had forced health insurance companies to provide as part of someone’s scheme to get re-elected. The benefits in question turned out to be an extra day, all expenses paid, in the maternity ward for anybody who has just given birth. This was not a benefit I was ever likely to benefit from, but there it was. Provided to me by law. Paid for by me, also by law, and pricing me right out of the private insurance market.
As long as I was rationalizing sucking government tit, it occurred to me that I hadn’t had all that much choice about being a veteran, either; and the more I thought about it, the more it seemed meet and right for Uncle to front me a little healthcare in return. Yea, very meet and right. And Uncle’s bounden duty, once my thoughts got rolling in that direction. Verily, healthcare is the least he can do for me. Unfortunately, healthcare through the Veterans Administration is the least he can do.
I don’t know what stories you have heard about VA hospitals, but I can tell you this: they are all true. VA hospitals are worse for you than Nazis. At least they were for my brother-in-law’s dad. He was a genuine World War II hero, a paratrooper who solo-jumped behind German lines to spy out troop dispositions and, somehow, made it home alive. He didn’t make it home alive from the VA, though.
Luther was a bricklayer who had just finished a job that required him to haul hundreds of concrete blocks high onto a scaffold, then spend ten hours a day placing the blocks into a wall, so he was in plenty good health. But he did have that irregular heartbeat his doctor told him he should get looked into sometime, and he decided Wednesday would be as good a day as any to drop by the VA and have it checked out. Being a member of the FDR generation, he actually trusted the government to do something like that.
The VA stuck him with a needle which gave him an infection. By Friday, the infection was so bad that they sent a blood sample down to the lab to find out what was infecting him. It was a ten-minute test, and any other lab in the world would have shot back the results half an hour later, but a three-day weekend was coming up, this was a VA lab, and the results didn’t arrive until the following Tuesday. Luther turned out to have an easy sort of infection to treat, but, without the test results, nobody treated it. By Tuesday, the old paratrooper was dead.
What triggered this rant was an article in the New Yorker in which some overly important twit named Hendrik Hertzberg tried to persuade the rest of us that the healthcare plan Hillary Clinton schemed up back when she wanted to get herself elected wasn’t nearly as scary as the one she tried to ram down our throats in 1993. Because Hillary’s later plan would have been modeled on the VA system, Hertzberg assured us, nobody should have been spooked by the prospect of actually having to receive healthcare under the thing. He wound up with the soothing conceit that VA healthcare is one of the “most efficient, merciful . . . components of the American health-care system.”
This kind of crap is the Left’s Fantasyland way of dealing with the fact that no society on earth can afford top-of-the-line healthcare for all its citizens. Modern medicine is too complex and way too expensive for everybody to have as much of it as he needs. Every country has to cut corners, and every corner cut hurts lots of people. Different countries just cut different corners.
When you ask people on the Left whose system works better than ours, whose model should we scrap ours in favor of — Canada’s? Britain’s? Cuba’s? Red China’s? — they never point to these foreign debacles, at least if they know anything about what goes on in those countries. Instead, they point to the VA.
The VA is the model we want, the American Lefty says. The VA is one of the most efficient and merciful components of our healthcare system. All we have to do is open the VA to all Americans and presto chango, health problems are solved.
This kind of blather just reinforces my impression that no member of the American Left has ever actually served in the military. In fact, it leaves me thinking that members of the Left are so cut off from the rest of society that they don’t even know any veterans. If they did, they might have heard some basic facts about VA healthcare, such as what happens when you try to fill a prescription.
VA prescriptions are fillable at VA pharmacies, so that’s where you take them. When you get to the pharmacy, something like 20 or 30 old farts — unless this is the day the bus comes in from the Old-Vet’s Home, in which case many, many more old farts — will be waiting in leatherette-covered government chairs ahead of you. At the end of the room will be four or five pharmacy windows where, when your turn comes, you hand in your prescription. Some windows will be empty, some will have a pharmacist inside. But just because there’s a pharmacist in a window doesn’t increase your odds of being called to that window, at least not any time soon, because, mainly, the pharmacists aren’t accepting prescriptions. Instead, they are involved with important paperwork tasks, and only deal with veterans when they need to clear their heads and take a momentary break from their real work. On average, a vet gets called to a window about every 20 minutes. With one or two dozen guys ahead of you, you can spend the better part of a day waiting to hand in your prescription.
This isn’t to get pills, mind you. Pills come hours later — at the end of another line, stalled in front of another window. That is, assuming the pharmacist jotted down the right notes when he read your prescription, the person filling the prescription went to the right shelf, and the person who handed you your pills grabbed the right bottle. You’d better check, because lots of times one of them didn’t. But if you discover something amiss, you have to start over. I have made as many as five trips to the VA to have a single prescription filled.
If you are of a reflective turn of mind, it will occur to you that you shouldn’t ever have to wait to hand in a prescription, that it would be a small matter for your doctor to phone the prescription directly to the pharmacy and an even smaller matter for the physician’s assistant to post it on the pharmacy’s computer. An almost trivial matter for someone at the pharmacy to set out a pasteboard box and let everybody drop prescriptions in. But none of this would be the Government Way. Being ignored by a bureaucrat is the Government Way and, by golly, ignored by a bureaucrat you will be. Unless you can’t stand it anymore and call attention to yourself. Which happened once while I was there.
The pharmacists had been not calling vets to the window for so long that one old fart lost his cool and pointed out that he had been sitting in a leatherette-covered chair all morning, and couldn’t one or two of you gentlemen please see your way clear to actually dealing with the folks you are here to deal with? Hearing this, a fellow who looked old enough to be the last surviving soldier from the Spanish American War ventured in a quavery voice something along the lines of, Yeah, I’ve been here a long time, too. Which led a couple of Civil War vets, and one or two from the War of 1812 and, I’m pretty sure, a guy left over from the Continental Army, to pipe up in agreement. A general murmur began to rise from walkers and wheelchairs and gurneys around the room, and all three pharmacists stopped what they were doing and looked up, one for the first time that morning. Veterans out of control, you could almost see them thinking.
We have a situation here, the pharmacists told themselves, then did what they had undoubtedly taken seminars to learn to do when a situation arises. They slammed steel shutters over all five windows, going into lockdown mode as smoothly and thoroughly as a Federal Reserve bank threatened by terrorists.
As bad as left-wing Americans imagine our private healthcare system to be, I challenge anyone to name another pharmacy in the country that has to keep physical barriers and formal procedures at the ready just to protect its employees from outraged customers.
This didn’t happen at some run-of-the-mill backwoods outpost of the VA, either. This happened at the Portland, Oregon, Veterans Administration Medical Center, probably the finest, most cutting-edge, most award-winning hospital in all VAdom. Because it is so well run, because its standards are so high and it is so generally well thought of, the Portland VAMC attracts healthcare workers from all over the country to hone their skills working with the finest of their profession.
This brings up an odd point. These pharmacists may actually be good at being pharmacists. It’s just that having to spend most of their professional lives doing government paperwork makes them look bad. On the other hand, they may have started out good at being pharmacists but were dulled into their present level of ability through a kind of reverse Peter Principle from years of mind-numbing routine and unrelenting boredom. On the third hand, they may be sitting at that pharmacy window because every private hospital, drugstore, and HMO they applied to out of pharmacy school checked their transcripts, looked over their letters of reference, and then sent them a polite note thanking them for their interest and promising to keep their application on file in case a suitable vacancy comes up.
Like every other employer, the VA hires what it can get, and (there is no courteous way of putting this) the VA is not Johns Hopkins. Not every best-and-brightest, most energetic and intellectually active up-and-coming young medical professional looks to a lifetime of federal wages, federal job security and federal paperwork as the crème-de-la-crème of career opportunities.
Johns Hopkins or not, the VA still has a lot of hospitals and a lot of clinics to staff and, because their reputation precedes them, they may have to dip deeper into the applicant pool than most storefront clinics in America would consider best practice. Add to this the general inability of any government agency to deal forthrightly with poor employees through demotions, firings, or even promotion of everybody else for any reason besides longevity, and the VA has no management tools left, other than overmanagement through rules and paperwork that are guaranteed to squeeze the competence out of the people who don’t need so many rules and so much paperwork to make them do their jobs.
With these factors at work, you can find professionals at the VA with a level of remove from modern theories of medicine that should have been hard to come up with in any Western community since the close of the Middle Ages. If Hertzberg had ever talked to a vet, he might know some of this. He might even have heard stories about the kind of people you can run into down there....
D.C.'s 'Failure To Launch' National Health Care Policy
The Senate Health, Education, Labor and Pensions Committee health care bill includes a provision that would allow parents to keep their children as dependents on their health care policies until age 26. Not to be outdone, House Speaker Nancy Pelosi announced last month that, as Congressional Quarterly reported, the House bill "will allow young people to stay on their parents' policies until age 27."
Do I hear age 28? Why not 30? As long as Washington is giving away private health care coverage, why not eliminate the age cap entirely? The House plan enjoys the support of a new group, "the Young Invincibles," an organization, Pelosi explained "formed to get young adults behind the campaign for health insurance reform."
Eureka. Pelosi has found the way to get young adults behind health care reform -- have mom and dad (or their employers) pay for it. Of course young adults are jumping on the bandwagon. A few years ago, Matthew McConaughey starred in the movie "Failure to Launch" about a thirty-something adult who did not want to fly the familial coop. Now the Beltway wants to enable adults to live as their parents' health care wards for years after they've been emancipated.
Forget the old system that allowed adult children to remain on their parents' policies until age 19, or up to age 23 if they were in college, and hence financially dependent. The Washington measures would apply to adults up to age 26 or 27, whether they live at home or not -- as long as they are not married or parents. (And how long do you think it will take for politicians to eliminate those exclusions?)
To my surprise, the insurance industry believes that, if enacted, the failure-to-launch provisions "will have a minimal impact," according to Robert Zirkelbach, press secretary for America's Health Insurance Plans. In part, the industry accepts this new definition of "dependent" because states have been passing laws extending the wonder years. According to Zirkelbach, Delaware and Oklahoma draw the line at age 18, but it's 22 for North Dakota; 24 in Indiana, South Dakota and Tennessee; 25 in 13 states; and, age 30 in four states, including New Jersey. Also, states have different criteria dealing with residency. The toothpaste is out of the tube; at least a federal measure would provide uniform standards.
As health care expert Steve Zuckerman of the Urban Institute noted, putting young adults on their parents' policies mean more premiums for insurers to cover a group that has pretty low claims. Besides, a law that would make insurers cover healthy young adults is far less onerous than other congressional provisions, such as the requirement that health care providers cover cancer patients at no extra cost. Ditto restrictions on what they can charge older Americans.
Joshua B. Gordon of the fiscal watchdog group The Concord Coalition, sees "very minimal federal budget implications" -- as there are advantages to adding "young and healthy people" to the ranks of the insured. "It actually saves costs in a way," he added -- a point that has been made by elected failure-to-launch boosters.
It's true that 1 in 3 young American adults lacks health care coverage -- and Washington should try to pass laws to correct the situation. But don't tell me it's practically free. As Geoffrey Sandler testified for the American Academy of Actuaries last year, "Although young people age 19 to 25 generally have lower claims costs than other age groups, increasing coverage to this group will increase claims."
And don't act as if there is something noble about failure-to-launch provisions -- when they do nothing for young adults who have no parents or whose parents don't have health insurance. "It's a way to get people to have coverage, but without the federal government picking up the tab," noted Zuckerman. But that does not mean there is no cost -- only that employers or employees will have to pay the added cost.
This is where a proposal by the Senate Finance Committee, chaired by Sen. Max Baucus, D-Mont., to sell low-premium, high-deductible "young invincibles" policies to young adults comes in handy. As Time Magazine reported, such policies "do not constitute full coverage." But if crafted correctly, Zuckerman told me, "the young-invincibles plans could be a good option."
And not just for the sons and daughters of the middle class. It makes no sense, but the so-called caring members of Congress want to avoid the path that paves strong incentives for young-invincibles to take charge of their health care. Instead, they're pushing the "failure to launch" model.
The health care reform bill unveiled by House Democrats last week looks increasingly like one of the most expensive pieces of legislation in history.
When Democrats announced the bill, House Speaker Nancy Pelosi claimed the bill cost only-only!-$894 billion over the next ten years. But outside analysts, including the Congressional Budget Office, suggest that the real cost will be far, far higher.
The CBO, for example, points out that the bill would actually increase government spending by slightly more than $1 trillion. Democrats reported a lower "net" number by subtracting revenues from penalties paid by individuals and businesses that fail to comply with the bill's insurance mandate. But even that does not reflect the bill's true cost.
The Democratic leadership simply shifted some of the bill's cost to other bills. For example, for purposes of the health care bill, the Democrats assume that a currently scheduled 21 percent cut in Medicare reimbursements will take affect next year. However, at the same time, they have introduced a separate bill repealing those cuts at a cost of $250 billion, so that cost isn't technically part of health care reform. And your household budget would look so much better if you didn't have to pay your mortgage and car payment. (The Senate just tried to do something similar, only to have the cynical ploy rejected 53-47, with 13 Democrats refusing to play along.)
If you count that cost honestly, the bill's cost rises to nearly $1.3 trillion. And that still understates the bill's cost.
The CBO provides ten year projections of a bill's cost, between 2010 and 2019 in this case. But most provisions of the health bill don't take effect until 2014. So the "10-year" cost projection only includes six years of the bill. Again, consider your household budget. Wouldn't it be great if you could count a whole month's income, but only two weeks expenditures? If we look at the bill more honestly over the first 10 years that the programs are actually in existence, say from 2014 to 2024, it would actually cost more than $2.3 trillion. And, this doesn't include approximately $200 billion in additional spending for public health programs, a reinsurance program for retiree health care, and new preventive care programs that was added to the bill after it was submitted for official "scoring." So call the total cost somewhere in excess of $2.5 trillion.
There has been a lot of talk recently about "bending the curve" of health care spending, but as the actuaries at the Centers for Medicare and Medicaid Services (CMS) recently noted, the House bill bends the curve in the wrong direction - increasing government health care costs.
All this new spending will be accompanied by equally massive federal tax hikes, roughly $500 billion over the first 10 years, $700 billion if the penalties for failing to comply with the mandate are included.
Furthermore, much of the bill's cost is shifted off the federal books onto businesses, individuals, and state governments. These business and individual mandates are the equivalent of tax increases, but those costs aren't included in the bill's cost estimates. Nor is the cost of increased insurance premiums, though nearly everyone agrees that insurance premiums will go up under reform, especially for younger and healthier people. And state governments will have to pick up at least part of the cost for the bill's Medicaid expansion. In fact, already strapped states could have to come up with as much as $34 billion.
And, it could get worse. The bill promises to pay for part of the cost with $500 billion in cuts to Medicare over the next 10 years. But how likely is it that those cuts take place? After all, this is an administration that is paying seniors $250 to make up for the fact that they didn't get a Social Security cost of living increase this year (because the cost of living didn't increase). And, Congress is in the process of repealing a scheduled increase in Medicare premiums.
If those cuts don't happen, that just means more taxes or more debt passed on to our children and grandchildren.
So far much of the debate over health care reform has been focused on the details of the bill. But, eventually the public is going to notice the price tag. When they do, House Democrats, especially those who claim to be fiscally responsible Blue Dogs, may have a lot of explaining to do. A billion dollars here, a trillion there, and pretty soon it adds up to real money.
A letter from the non-partisan Joint Committee on Taxation (JCT) sheds some light on the consequences outlined in Pelosi's new health care proposal for those who choose NOT to comply with its new individual mandate--including up to a $250,000 fine and 5 years in jail: Key excerpts from the JCT letter appear below (courtesy Ways & Means Ranking Member Dave Camp, R-MI):
"H.R. 3962 provides that an individual (or a husband and wife in the case of a joint return) who does not, at any time during the taxable year, maintain acceptable health insurance coverage for himself or herself and each of his or her qualifying children is subject to an additional tax." [page 1]
"If the government determines that the taxpayer's unpaid tax liability results from willful behavior, the following penalties could apply." [page 2]
Criminal penalties. Prosecution is authorized under the Code for a variety of offenses. Depending on the level of the noncompliance, the following penalties could apply to an individual:
Section 7203 - misdemeanor willful failure to pay is punishable by a fine of up to $25,000 and/or imprisonment of up to one year.
Section 7201 - felony willful evasion is punishable by a fine of up to $250,000 and/or imprisonment of up to five years." [page 3]
Rep. Camp reports that according to the CBO, the "lowest cost family non-group plan under the Speaker's bill would cost $15,000 in 2016.
British Government targets increase superbug risks, say NHS infection chiefs
Deadly superbugs have increased despite a crackdown on the best-known infections such as MRSA, a parliamentary report will warn this week. While rates of MRSA and Clostridium difficile are falling, after scandals over major outbreaks, other potentially fatal infections which receive less attention appear to be soaring, the Commons public accounts committee will say.
Around 300,000 infections are diagnosed in English hospitals every year – but many more potentially fatal bugs may be going undetected, because of a lack of surveillance, research has found. A voluntary scheme charting all bloodstream infections found numbers increased by 30 per cent between 2003 and 2007, in what the committee's chairman Edward Leigh described as a "rising tide" of infections threatening all hospital patients. The report is expected to show increasing numbers of cases of E-coli, linked to surgical site infections and urinary tract problems, and in cases of the bacterial infection Klebsiella.
The Sunday Telegraph has established that the NHS' most senior doctors and scientists responsible for infection control believe their efforts are being hindered by Government waiting targets. An anonymous survey of 170 NHS directors of infection control found that 59 per cent had experienced a clash between their efforts to block the spread of disease and rules which say new patients must be found a bed within four hours.
Infection experts say NHS managers are so fearful of missing the four hour target for Accident and Emergency patients to be admitted to a ward, that infected patients are being shunted around overcrowded hospitals, hastening the spread of disease, in a rush to clear space for new arrivals.
The four hour target has already been implicated in a series of NHS hospital scandals, in which hundreds died, but, on each occasion, ministers have insisted that poor management, rather than the target, was to blame. In total, 100 of 170 directors at England's hospital trusts reported difficulties as a result of the four hour target, in research carried out for the National Audit Office.
A Department of Health spokesman said MRSA bloodstream infections had fallen by 74 per cent since 2003/04 and C. difficile infections by 35 per cent between 2007/08 and 2008/009.
Barack Obama's healthcare reform bill passes first hurdle
The US House of Representatives approved the broadest overhaul of US health care in four decades overnight, handing President Barack Obama a hard-fought victory that energised his top domestic priority. Heeding Mr Obama's appeal to "answer the call of history," lawmakers capped 12 hours of bitter debate with a 220-215 vote for a 10-year, $US1 trillion-dollar plan to extend health coverage to some 36 million Americans who lack it now. "Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable health care for the American people," Mr Obama said in a statement shortly after the vote.
One Republican supported the measure, but most criticized its $US1 trillion price tag, new taxes on the wealthy and what they said was excessive government interference in the private health sector.
The battle over Mr Obama's top domestic priority now moves to the US Senate, where work on its own version has stalled for weeks as Senate Democratic leader Harry Reid searches for an approach that can win the 60 votes he needs. Any differences between the Senate and House bills ultimately will have to be reconciled, and a final bill passed again by both before going to Mr Obama for his signature.
The overhaul would spark the biggest changes in the $2.5 trillion US healthcare system, which accounts for one sixth of the US economy, since the creation of the Medicare government health program for the elderly in 1965.
The vote followed days of heavy lobbying of undecided Democrats by Mr Obama, his top aides and House leaders, and a deal designed to mollify about 40 moderate Democrats who are foes of abortion rights. Democrats could afford to lose 40 of their 258 House members and still pass the bill. In the end, 39 Democrats sided with Republicans against the bill.
The landmark vote was a huge step for Mr Obama, who has staked much of his political capital on the healthcare battle. A loss in the House would have ended the fight, impaired the rest of his legislative agenda and left Democrats vulnerable to big losses in next year's congressional elections. Mr Obama said he was "absolutely confident" that the Senate would pass its own bill, stressing: "I look forward to signing comprehensive health insurance reform into law by the end of the year."
As the suicidal Democratic congressmen proceed to rubber-stamp the Obama healthcare reform despite the drubbing their party took in the '09 elections, the president trotted out the endorsements of the AMA and the AARP to stimulate support. But these -- and the other endorsements -- his package has received are all bought and paid for. Here are the deals:
* The American Medical Association (AMA) was facing a 21 percent cut in physicians' reimbursements under the current law. Obama promised to kill the cut if they backed his bill. The cuts are the fruit of a law requiring annual 5-6 percent reductions in doctor reimbursements for treating Medicare patients. Bravely, each year Congress has rolled the cuts over, suspending them but not repealing them. So each year, the accumulated cuts threaten doctors. By now, they have risen to 21 percent. With this blackmail leverage, Obama compelled t
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