The downward spiral observed...  

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24 March, 2010

Blog suspended

Now that the battle against socialized medicine in America is largely over, I have decided to suspend publication of this blog. I will of course still be posting on the issue when matters of particular interest arise but I will do so on DISSECTING LEFTISM from now on -- as you will see currently. My AUSTRALIAN POLITICS blog will also continue to cover the disasters of socialized medicine in Australia.

23 March, 2010

Landmark health care plan passes

House Democrats rallied late Sunday night to pass President Obama's landmark health care overhaul plan and send to the president's desk the politically risky initiative, which Republicans vow to wield against the Democrats in November's mid-term elections. A companion package of repairs to the bill now heads to a Senate fight. But regardless of the outcome there, Mr. Obama's yearlong struggle for his signature initiative is just a stroke of his pen away from becoming law.

The Senate's health care bill squeaked through the House in a 219-212 vote, with 34 Democrats joining all 178 Republicans in opposition after a last-minute White House executive order convinced a small group of pro-life Democrats that the bill wouldn't fund abortions. The companion "fixes" bill passed 220 to 211, with 33 Democrats joining all 178 Republicans in opposition.

Democrats hailed the vote as one of the most significant change in American social policy since the creation of Medicare in 1965 or Social Security in 1935. "This is an American proposal that honors the traditions of our country," House Speaker Nancy Pelosi said, adding that access to health care is in the same league as the Declaration of Independence's claims about the inalienable rights to "life, liberty and the pursuit of happiness."

The 10-year, $940 billion overhaul plan aims to reshape the nation's health system by imposing new reforms on the insurance industry and guaranteeing insurance coverage to nearly all Americans with hopes of reducing health care costs and the federal deficit. "This is what change looks like," Mr. Obama said at the White House shortly after the vote, which he watched in the Roosevelt Room with Vice President Joseph R. Biden Jr.

Outside the Capitol, a few hundred protesters shouted "Kill the bill." Walking from a House office building to the Capitol on Sunday afternoon, Mrs. Pelosi linked arms with Rep. John Lewis, a Georgia Democrat who walked in the civil rights marches in Selma, Ala., in the 1960s and who said he was called a racial epithet by health care protesters on Saturday. Republicans called it an isolated incident and maintained their opposition to the health reform plan.

They argue that cuts to Medicare would undoubtedly hurt seniors' coverage, that insurance premiums for all Americans would spike, and that Democrats won't be able to make good on Mr. Obama's often-repeated promise that "if you like your plan, you can keep it." "The decisions we make will affect every man, woman and child in this nation for generations to come," Minority Leader John A. Boehner said. "This bill is not what the American people need." Mr. Boehner and Sen. Jim DeMint, South Carolina Republican, separately promised to introduce legislation to try to repeal the plan.

Mr. Obama, in his pitch to Democrats on Capitol Hill in recent weeks, said that much of his presidency is on the line with passage of his overhaul plan. It marks the most significant legislative accomplish of his presidency. But it would be a victory with a large asterisk. The Senate promised House members that it will be able to pass a companion bill to "repair" controversial provisions in the bill, such as a tax on high-cost insurance plans and state-specific deals that critics say were meant to buy votes. Mr. Obama could sign the Senate bill into law immediately. But doing so without the Senate repair bill would likely anger House members.

The debate over how to reform the $2.5 trillion health care industry has taken on a deeply partisan tone for more than a year. Many of the moderate Democrats who won Republican-leaning districts on Mr. Obama's coattails in 2008 acknowledged that their support may cost them their jobs this November as the overhaul hasn't polled well.

Democrats say that support will shift once Americans see the plan's benefits -- the poor will get tax credits to help them meet the requirement to buy insurance coverage; their insurance company won't be able to impose lifetime or annual caps on coverage or deny coverage because of pre-existing conditions; young adults can stay on their parents' plan until age 26; and Medicare's gap in drug coverage will be filled. It's paid for through cuts to Medicare funding, which Democrats say will only cut waste and fraud, and a new Medicare tax on unearned income, such as investment profits, of couples making over $250,000 and individuals making over $200,000.

Abortion threatened to hold up the vote until almost the last minute. A group of about 10 pro-life Democrats said they wouldn't vote for the Senate plan unless they had a guarantee that it wouldn't allow for federal funding of abortions. They were concerned the bill would allow federal tax subsidies to fund insurance policies that cover the procedure and that funding for community health centers would not come with a prohibition on covering abortions. But their objections were met with an executive order Mr. Obama issued on Sunday affirming that the bill wouldn't do so.

Catholic groups have been divided over whether the Senate bill would authorize the federal funding of abortions, with the U.S. Conference of Catholic Bishops staunchly opposed to the Senate plan; but others, such as a group of hundreds of nuns, endorsed the plan last week. Catholic Advocate, a 501(c)(3) lobbying group, said Sunday that passing the Senate bill would account for one of the greatest expansions of abortion since the landmark Roe v. Wade Supreme Court ruling and promised to contest House members who supported it.

But the executive order was thought to be enough to push Democrats over the 216 mark required for passage. The companion reconciliation bill would remove the Senate's tax on high-cost insurance plans, federal funding for Nebraska's Medicaid costs and other problems House members had with the Senate plan. The Senate is expected to start work on the bill on Tuesday.

Over the weekend, Democrats decided against using a controversial procedure, called "deem and pass," that would have allowed both bills to pass with one vote. Republicans had called it a parliamentary trick. The vote required House members to take a bit of a leap of faith that the Senate was going to be able to deliver on the companion bill. They now have no leverage left since the Senate bill can go to Mr. Obama's desk and become law despite their grave misgivings about it. Senate Democratic leaders are expected to easily come up with the 51 votes they need. "There's a strong desire to do what's in that bill," Sen. Debbie Stabenow, Michigan Democrat, told reporters last week.

But it's a potentially difficult climb for the Senate as reconciliation rules allow Republicans to introduce an unlimited number of amendments and require each provision of the bill to affect the budget or be struck by the Senate's nonpartisan parliamentarian. If the bill is changed at all, in the form of amendments or budget strikes, it will have to go back to the House for another vote, throwing another wrench into the process.

Republicans have promised a fight, warning they plan to put up every procedural obstacle they can. They've already eyed parts of the bill that they contend are not related to the budget and can be brought up as a violation of the so-called "Byrd" rule.

Mrs. Pelosi said Friday that she doesn't foresee any Byrd-rule violations surviving. "We tried to have a 'Byrd' scrub," she said, but "the parliamentarian would not necessarily give us definitive answers on anything."

Republicans said Sunday they like their chances on an objection that the bill affects Social Security, which would be a violation of budget rules. If the parliamentarian agrees and the presiding officer of the Senate upholds the decision, Democrats would need 60 votes to override the decision. All 41 Republicans recently signed a letter saying they will object to overriding the parliamentarian. "We've informed our colleagues in the House that we believe the bill they're now considering violates the clear language of Section 310g of the Congressional Budget Act, and the entire reconciliation bill is subject to a point of order and rejection in the Senate should it pass the House," said Don Stewart, spokesman for Senate Republican leader Mitch McConnell of Kentucky.


Democrats' death by suicide

The government takeover of health care will go down in history as the worst piece of legislation to emerge from a Congress held in general disdain by the American people. The only bipartisanship on the health bill was in the opposition.

Usually autopsies are reserved for after the patient has died, but in this case it is useful to get ahead of the matter. The malformed health legislation is not the only reason Democrats are facing political extinction in November, but it is one of the most dramatic. The legislative process in this country has never been so unseemly. Arm twisting, backroom deals, special privileges and potentially criminal "government jobs for votes" agreements became a normal way of doing business. House Speaker Nancy Pelosi fixated on the mantra that the Democrats' health plan is "historic," but so was the Black Plague.

President Obama went to Capitol Hill on Saturday to give a final pep talk to Democrats, where he absurdly called his socialist health care measure "one of the biggest deficit reduction measures in history." This contradicts the chief actuary at the Centers for Medicare and Medicaid Services, who says his staff currently has no idea what the impact of the plan is "due to the complexity of the legislation." Democrats have been hoodwinked into believing they won't pay a political price for their actions, but they will soon discover they miscalculated.

The new system will suffer a tsunami of bad publicity when states sue the federal government over unfunded mandates, when the IRS begins enforcing the aspects of the bill that voters never knew existed, when small businesses start firing employees because they cannot afford the higher costs of the new system, when new and unforeseen costs blow out the already record federal budget deficit, and when seniors begin to feel the impact of Medicare cuts. All of this is what Mr. Obama euphemistically calls "bending the curve" but which seniors will find out is better termed "denial of care." Whether the formal "death panels" will convene before the November elections is still to be determined.

Many members of Congress probably don't know exactly what is in the bill. The 2,300 pages of "fixes" to the Senate bill presented last week were only a draft, and no member can be certain what has been slipped in. A frantic Democratic Party memo sent out Thursday instructed members -- twice, in italics -- not to "get into a discussion of details of the [Congressional Budget Office] scores and the textual narrative" with the bill's opponents. But the devil was in those details. Mrs. Pelosi's offhand statement that members would learn what was in the bill after it was passed should have been a warning.

The majority party was even having problems over the weekend determining if they could vote to amend a law before it was signed by the president. It is a sad day for America when senior members of Congress either dont understand the Constitution or no longer think it applies.

Democrats in Congress refuse to believe the contempt with which the American people hold them. Gallup shows congressional approval ratings in the teens and headed downward. Gallup also found that "more Americans believe the new legislation will make things worse rather than better for the U.S. as a whole, as well as for them personally."

Democrats are in much worse shape than in 1994 when they lost power, and the opposition is far more energized. Once voters have a chance to tell the most irresponsible government in American history that enough is enough, the Democrats' brief reign will expire, and be deemed death by suicide.


Burned girl 'turned away' from British hospital

A five-year-old girl with severe burns was turned away from hospital and her parents forced to drive 25 miles before doctors would treat her. Madison Healy was turned away from Coventry's University Hospital after her clothes caught fire in a freak accident at home. Her mother Alana Regan, 27, took her to A&E, expecting her daughter's injuries to be treated swiftly.

Instead, she says a doctor merely "poked at her leg" before telling her and her partner John Austin, 33, they would have to drive Madison to a specialist burns unit 25 miles away themselves. The Coventry couple, who had no money for petrol and did not know the way drove for an hour before doctors at Birmingham Children's Hospital were able to treat her. There it was discovered Madison had third degree burns requiring a skin graft plus years of treatment and physiotherapy in the future.

Now, Ms Regan has filed an official complaint against University Hospital, saying they let down her seriously injured child. Ms Regan said: "She is only a five-year-old girl and she should have been treated with more priority. "She suffered long term, life-changing injuries and they should have treated her with more compassion and urgency."

A spokesman for University Hospital said Madison had been seen by triage staff within four minutes of arriving at A&E and given painkillers. He added within 50 minutes she went on to be reviewed again by a doctor. "In line with our pediatric pathway relating to burns and scalds Madison was referred to Birmingham Children's Hospital who were advised to expect her arrival and provide ongoing specialist service.

"As the burn was categorised as a small burn covering less than one per cent of the total body surface it is considered safe and within guidelines to transfer by car with a written referral and full directions. "The Trust do apologise if the family felt distressed, however Madison did not require resuscitation or treatment during her transfer."


22 March, 2010


Four articles below from ONE DAY show what Americans can expect under Obamacare

The NHS bungles never stop

Man left infertile after wrong testicle disabled

A man was left infertile when he had part of the wrong testicle removed by surgeons. Doctors were supposed to cut away the patient's right epididymis - one of two narrow tubes connected to the testes which is used to store mature sperm. But the patient's left epididymis was removed by mistake at the West Suffolk Hospital in Bury St Edmunds. Surgeons had to operate on his again to take out his other epididymis after the blunder was discovered and the man was left infertile.

Officials at the NHS hospital have refused to identify the man or confirm if he was paid compensation.

A major investigation was launched into the error and the hospital has now introduced more stringent procedures to stop it happening again. Nigel Kee, the hospital's interim chief operating officer, said: "The safety of our patients is our number one priority. "As such, we take any incidents which compromise safety extremely seriously.

"A thorough investigation into this case was carried out by an independent consultant, who advised us to introduce an additional hospital-wide policy giving clearer instructions on marking and verifying sites prior to surgery. "We implemented this recommendation immediately."


British TV star's death was 'unnecessary and preventable': Her doctor launches attack on NHS

Jade Goody's death was preventable and a result of 'incompetence and neglect' by the NHS, a leading doctor and Harley Street consultant claimed today. One year after the 27-year-old died on March 22, Dr Ann Coxon said Goody's symptoms - which included heavy and irregular bleeding, pain and abnormal smear tests - were 'glaringly obvious'.

The former NHS doctor claimed the reality television star had a tangerine-sized tumour which medical experts failed to spot. 'There should have been alarm bells ringing,' she told The Sun. 'Jade's death was completely unnecessary and preventable. She died of neglect and incompetence.'

Despite strong evidence of cervical cancer, Jade did not suspect anything serious was wrong due to her medical history. 'She'd had abnormal smear tests since she was 16 so by the time she was 27 it didn't worry her much, because she didn't really know what it meant,' Coxon said. 'It had never been properly explained to her.

'After she was diagnosed she said to me, in that typically Jade way, "I'm not daft. If I'd known it was to do with cancer, I'd have been checked out every three months". She added: 'Jade realised she had been let down. She simply said, "Sometimes people make mistakes".'

The mother-of-two, who became a star as a contestant on Big Brother, refused to attend scheduled smear tests after being told she could not have any more children, Coxon alleged. This was nine months prior to her diagnosis.

Jade was given an ultrasound at the Princess Alexandra Hospital in Harlow, Essex, in August 2008. She then flew to India to appear in a reality television show after doctors had confirmed she could travel. However, results of a smear test - only performed because a nurse noticed she had skipped appointments - revealed cancerous cells. Goody received the news she had cervical cancer on camera and flew back to the UK where she was treated by Coxon.

The doctor said: 'An ultrasound should be able to pick up lesions just 1.2mm wide, and Jade had a tumour the size of a tangerine. It should have been blindingly obvious.'

Jade underwent an emergency hysterectomy, chemotherapy and radiation therapy - but it was too late to save the star. 'She probably had cancer for at least a year before her diagnosis. The abnormal smear tests were signs that she was high-risk,' said Coxon. 'She was only diagnosed because of one nurse bothering to do her job.'


Girl, 9, saved by optician after NHS doctors fail to spot plum-sized brain tumour SIX times

For money reasons, diagnostic scans are avoided

A nine-year-old girl whose brain tumour was missed by doctors six times was saved by opticians after her worried mother took her for an eye test. Shanice Bailey could have been left paralysed by a rare plum-sized 'schwannoma' tumour growing out of a nerve and pressing on her brain stem. She visited GPs six times between September 2009 and January this year complaining of headaches and sickness but was repeatedly diagnosed with asthma and sent away.

Only when Shanice developed a squint in her left eye did her mother Laura, 27, decide to take her for an eye test - where Specsavers optician Nadia Ahmed immediately spotted the growth. Ms Ahmen told Ms Bailey to take her daughter straight to Queen Elizabeth Hospital in King's Lynn, Norfolk, where a scan revealed the two inch tumour. Eleven days later surgeons removed the tumour in a nine-hour operation.

Despite spending a month in hospital with side-effects Shanice is now at home recovering with her family. Ms Bailey, from Wisbech, Cambs., said she would be forever grateful to the optician. 選t's so lucky we went to Specsavers when we did, otherwise the effects could have been devastating. 選 kept taking Shanice back to the doctor as her symptoms got worse and more frequent. 前riginally they said her symptoms could mean anything but then they thought it was asthma because she was coughing when she was sick. 全he has been so brave it was unbelievable - she hasn't cried once.

選f they hadn't have found the tumour she could have died because it was blocking fluid at the top of her spine. 選 don't necessarily blame the doctors but they should be given more training to check for problems in these areas. Just because it's rare doesn't mean they should ignore it.

Laura took Shanice to the Clarkson Surgery in Wisbech over five months where she was seen three times by one GP and by a different doctor on every other occasion. On their last visit, the doctor referred Shanice for an appointment with a paediatrician on January 20 to work out why her mystery symptoms were persisting.

But she had the eye appointment on January 3 where optician Ms Ahmen used a magnifying light that picked up swelling on the optic nerves.

The schwannoma tumour is usually only found in elderly women but the benign growth was coming out of Shanice's hyoglossal nerve and blocking fluid at the top of her spine. A week after her surgery the youngster also suffered from a vasospasm, where blood gets into the brain, and needed a second operation to drain cerebrospinal fluid.

Shanice said she felt great after her ordeal. 選 feel so much better now. I can do things I couldn't do before like my favourite street dancing classes, she said.

Trevor Lawson, a spokesman for Brain Tumour UK, said Shanice's type of tumour was extremely rare in such a young child. 禅o my knowledge in the last five years no children were reported to have suffered that from type of tumour, which was responsible for only six per cent of all adult cases, he said. 禅he challenge for doctors is that brain tumours can present with common symptoms and we regularly support people who were diagnosed after an eye test.

Paul Eagling, manager of Specsavers in Wisbech, said he was 粗xtremely pleased they had been able to spot the growth. 腺enign tumours can leave people with long term problems and we believe every brain tumour case should be given the same level of attention as cancer. 善eople tend to only go to the opticians when they have problems with their eyesight but regular visits to the optician are vital for checking general eye health.


Hundreds may have died in British ambulance blunder

An inquiry is being demanded into ambulance services after a Sunday Telegraph investigation uncovered a major flaw in the 999 [emergency number] system that may have left hundreds dead. Doctors, politicians and charities have called for the inquiry to examine how a mistake by ambulance chiefs led to delays in despatching paramedics.

The scandal is exposed by the death of a woman who was left for 38 minutes after an emergency call was received despite the fact that she was unconscious and breathing abnormally, having fallen 12ft. Call handlers following automated advice provided by a computer program categorised the case of Bonnie Mason, who died last May, as a lower priority than that of a drunk woman who had fallen on the pavement. By the time paramedics reached Mrs Mason, 58, she could not be saved.

An investigation by The Sunday Telegraph has uncovered a critical danger placed in the software used by most ambulance services. It meant that for a decade, 999 calls in which a patient lay unconscious and struggled to breathe after a fall of 6ft or more were 電owngraded, with call handlers told not to send the most urgent response. Some services told operatives to 登verride the flaw, but The Sunday Telegraph has established that five out of 12 of England痴 ambulance trusts told call handlers not to diverge from the automated advice.

Last night experts demanded an inquiry to establish how many patients had suffered because of the blunders. John Heyworth, of the College of Emergency Medicine, said the potential risks were devastating. He said: 鄭ny system which isn稚 prioritising accurately needs review because the consequences are so catastrophic.

Peter Walsh, of the charity Action Against Medical Accidents last night expressed horror at the dangers. He said: 展ho knows how many people this could have harmed and how many may have died? Given the volumes of 999 calls involving people who have fallen and are unconscious, there is a risk that thousands were affected. Who knows how many might have died it could be hundreds, but even if it痴 just one needless death, we need a full review.

The problem occurred when a government committee which governs the use of computerised 999 software allocated a lower priority to falls of 6ft or more than had been recommended by the system痴 makers. As a result, the automated system instructed call handlers to class such calls as category B even if the person was also unconscious or breathing abnormally life-threatening conditions which should have had the most urgent response. The Department of Health said the risk had been eliminated from the latest version of the software, introduced last year.


21 March, 2010

Paging Doctor Kildare

If Obamacare becomes law, about 30 percent of the primary care doctors in America will consider leaving the medical profession. That bit of brightness comes from a survey by The Medicus Firm, the results of which were posted by The New England Journal of Medicine. Medicus interviewed more than a thousand American physicians, and 55 percent of them believe the quality of medical care in America will decline if the Democrats pass the current health care reform proposals. Apparently, many of them want no part of it.

Although the media largely ignored the Medicus study, the story is huge. Perhaps as many as 30 million more Americans may have access to health insurance. The question is: Who will treat them? The Bureau of Labor Statistics projects a 22 percent increase in practicing physicians over the next decade. But that will not be enough to treat the universal health care crush, especially if a bunch of doctors now on the job pack it in.

There are essentially two reasons why Obamacare nauseates some doctors. First, control. Medical people simply do not want federal pinheads telling them how to treat their patients. The medical profession attracts intelligent, assertive people who are motivated to help others. This is not a docile crowd.

Second, money. Right now, many doctors are already seeing too many patients in order to pay the bills and provide a decent living for their families. Obamacare does nothing to bring down the outrageous expense of medical malpractice insurance, and it is likely to cut Medicaid and Medicare reimbursements. Doctors can do the math. Their expenses remain high; their incomes decline. Again, these are smart people who could make good money doing something else.

In Canada and Great Britain, where socialized medicine is practiced, it is difficult to actually see a doctor in some places. Instead, nurses, physician assistants and other medical personnel fill the need. That is what could happen in the United States if the feds begin calling the health care shots.

Not since the Iraq war has America been so divided on an issue. Yes, ideology is playing a part. Conservatives despise government intrusion in the marketplace, but liberals love it. Right now, however, most polls show that the majority has turned on Obamacare. The latest Wall Street Journal poll, for example, found 48 percent opposing and just 36 percent supporting.

Here's my question: What would Marcus Welby, M.D., and Dr. Kildare say? These guys usually had the answers, back when wise doctors were the subjects of TV programs and health care seemed to be a glamorous profession. Would Ben Casey support Obamacare? We know the "M*A*S*H" guys would. Dr. Jekyll might like it, but Mr. Hyde? I don't know. What I do know is that many Americans are sick of the whole health care thing. And no prescription on earth will change that.


16,500 more IRS agents needed to enforce Obamacare

New tax mandates and penalties included in Obamacare will cause the greatest expansion of the Internal Revenue Service since World War II, according to a release from Rep. Kevin Brady, R-Texas.

A new analysis by the Joint Economic Committee and the House Ways & Means Committee minority staff estimates up to 16,500 new IRS personnel will be needed to collect, examine and audit new tax information mandated on families and small businesses in the 喪econciliation bill being taken up by the U.S. House of Representatives this weekend. ...

Scores of new federal mandates and fifteen different tax increases totaling $400 billion are imposed under the Democratic House bill. In addition to more complicated tax returns, families and small businesses will be forced to reveal further tax information to the IRS, provide proof of 組overnment approved health care and submit detailed sales information to comply with new excise taxes.

Americans for Tax Reform has a good breakdown of the bill by the numbers. Isn't it reassuring that at a time of recession, government will do what's necessary to ensure its growth?


The corruption never stops

Health-vote ally Nelson to get new VA hospital for Nebraska

The Obama administration has delivered another budget plum to Democratic Sen. Ben Nelson and the state of Nebraska, adding more than a half-billion dollars for a new veterans hospital in Omaha.

The move reverses a decision by Mr. Obama's own Veterans Administration of a year ago, which called for repairing an existing hospital.

The Veterans Administration made the budget switch during internal deliberations in 2009 at a time when the White House was wooing the moderate Democrat to vote for President Obama's health care overhaul bill.

Mr. Nelson was among the last of the Senate Democrats to sign on to the health bill, deciding to vote "yes" after securing special Medicaid payments for Nebraska in a deal known as the "Cornhusker Kickback." Health care reform opponents have widely panned that deal.

At the time that deal was being made, Mr. Nelson was getting another boost from the VA as it formulated its next budget.

Jake Thompson, a spokesman for Mr. Nelson, rejected the idea the new hospital was awarded in exchange for the senator's health care vote.

"It was never discussed," Mr. Thompson said. "He wasn't discussing the Omaha VA hospital in any relation to health care. The answer is no."

The spokesman added that Mr. Nelson "has been advocating [a new hospital] with this administration, with the previous secretary of the VA and the current secretary of the VA. But in relation to health care, it wasn't discussed at all. I think the VA's own study was the principal reason it was moved up" on the construction priority list.

But Rep. Steve Buyer of Indiana, ranking Republican on the Veterans' Affairs Committee, said, "This one doesn't smell right or feel right."

Mr. Buyer said testimony by VA officials to the Senate last August showed managers recommended renovation and some expansion of the existing Omaha site -- not an entirely new hospital at a much higher cost.

More here

Study Shows 前bamaCare Could Cost 700K Jobs

As many as 698,000 jobs could be lost if the health care reform plan (a.k.a., 徹bamaCare) being pushed hard by liberal Democrats is passed by Congress and signed into law by President Barack Obama, according to a study released today that was the subject of a blogger conference call this morning.

The executive summary for the study, conducted by the Beacon Hill Institute in conjunction with Americans for Tax Reform, boils down the findings in a nutshell:

Nancy Pelosi, the Speaker of the House of Representatives, has urged passage of the massive health reform plan moving through Congress as a way to create up to 400,000 jobs. Speaker Pelosi bases her claim on a report by the Center for American Progress (CAP) in which the Center estimates that the Patient Protection and Affordable Care Act (PPACA) would create 250,000 to 400,000 jobs per year over 10 years.

This estimate by CAP amounts to a hurried effort to add academic heft to the claim that national health care reform offers a collateral benefit in the form of an economic 都timulus. It turns out, however, that its methodology, stripped of unsupportable claims about savings in health care costs, shows just the opposite of what CAP intended. PPACA is a job killer, not a job creator.



Three new reports from just ONE DAY about Britain's NHS below

Life-saving cancer scans delayed in NHS funding crisis

Vital scans for patients who may have cancer are being postponed by up to six weeks as the NHS grapples with a major funding crisis. GPs have also been ordered not send elderly people for osteoporosis scans, to refer children with tonsillitis to specialists - or even allow men to have vasectomies. In addition, wards are threatened with closure and thousands of key staff have been told to work shorter hours or take unpaid 'career breaks'.

Charities and patient groups said the delays could have disastrous consequences if early signs for potentially fatal conditions go undetected.

The drastic cutbacks illustrate a funding nightmare threatening to overwhelm the NHS within months, as trusts battle to save millions of pounds in the wake of the credit crunch.

Last night the Royal College of Physicians warned ministers and NHS managers against 'slash and burn' cuts. In a strongly-worded pre-budget briefing to MPs, they said: 'Following a decade of growth, the NHS is being asked to deliver considerable efficiencies. 'There is a risk that without careful management, a supportive rather than confrontational culture and a high degree of medical engagement, any effort to reduce productivity could easily subside into a process where services and posts are indiscriminately slashed and burnt. 'Over-hasty decisions now to cut back on the medical workforce, biomedical research, and audit programmes could have implications for generations.'

Ministers say the NHS needs to save 20billion pounds over the next five years. Although both Labour and the Tories have pledged not to cut NHS funding, rising demand and an ageing population means the money will not go as far as in the past, necessitating cuts.

Dozens of hospitals are already considering closures of A&E departments and maternity wards, while others are asking staff to consider voluntary redundancy and early retirement. The respected King's Fund think tank says it may be necessary to freeze NHS pay until 2014.

One NHS trust under pressure is North East Essex primary care trust, which last month asked its GPs not to refer patients for MRI scans - used to diagnose possible tumours and kidney disease - and other tests until April 1.

Sarah Woolnough of Cancer Research UK said delays in MRI scans could run the risk of early signs of cancer being missed. She said: 'Speedy access to diagnostic tests and quick referral can help to diagnose cancer as early as possible which can ultimately lead to better treatment for patients and improved survival.'

Matt Bushell, director of commissioning at the trust, said: 'As part of the procedures to ensure budgets are balanced at the end of the current financial year, we have, just for the month of March, asked GPs to defer referrals for a very small number of non-urgent, therapeutic services: heel scans, vasectomies, ENT and nonurgent MRI scans. 'We have maintained priority for urgent MRI scans. These arrangements will remain in place only until April 1 2010.'

Other examples of cuts across the NHS include:

* GPs in Hertfordshire being told to get 'approval' before referring patients for hysterectomies, tooth extraction and removal of skin 'lumps and bumps';

* Planned closures of A&E wards at Whittington Hospital in North London, Queen Mary's in Sidcup, Chase Farm in Enfield and others;

* Almost 4,000 workers at Stepping Hill hospital in Stockport, and 2,000 at Scunthorpe general hospital, being asked to consider early retirement, voluntary job cuts or shorter hours.

Tory health spokesman Andrew Lansley said: 'This will be very worrying for patients. The NHS has had increased funding this year, so just where has the money gone?'

Matthew Elliott of the TaxPayers' Alliance said: 'It's infuriating that despite billions of pounds being poured into the NHS, patients are having treatment delayed thanks to a failure to plan properly.'


Blundering NHS surgeon in 」10m lawsuit after 100 women patients take him to court

Bungling surgeon George Rowland was allowed to operate for almost FOUR YEARS after the first alarm was raised

More than 100 women suffered botched bladder surgery at the hands of a gynaecologist who continued to work for four years after the alarm was raised. Patients of George Rowland suffered chronic pain or worsening bladder symptoms after he operated on them. But it was only after doctors expressed concern about his behaviour that the scale of his mistakes was realised and he was told to stop carrying out procedures.

Yesterday, as a report criticised managers for not picking up on the problem sooner, it emerged that more than 100 of his patients are taking legal action - leaving the NHS facing a compensation payout of as much as 」10million.

Ian Cohen, of Goodmans solicitors which is representing most of the women, said: 'There have been devastating, life-changing outcomes for many patients. We have a substantial number of women who should never have had that surgery, who have been left worse following the surgery. Some have been left in a bad state, with chronic pain. 'Some women have complete difficulty passing urine. 'The trust's board appears to have allowed an obsession with targets and anxiety about potential damage to its reputation - and that of the consultant - to bar earlier action to prevent patient harm.'

Mr Rowland, aged in his 50s, was a respected urogynaecologist performing hundreds of operations a year at Aintree Centre for Women's Health in Liverpool.

In 2004 concerns were raised that he was carrying out more surgery than colleagues, often 'bundling' different procedures into single operations, such as hysterectomies with surgery for incontinence. But it was not until colleagues began expressing concern in 2007 that an investigation was launched. Mr Rowland was not suspended until the following year.

Last year the General Medical Council barred him from performing urogynaecological procedures until further notice, and hundreds of his patients were recalled to the hospital for a further consultation. Some complained they had been left in chronic pain and that their incontinence had not improved. Lawyers representing others say the surgery was simply inappropriate for their conditions.

The highly regarded Liverpool Women's Hospital, which runs the Aintree centre, commissioned an independent report into the affair, and yesterday criticised bosses for not noticing the mistakes earlier. It pointed out that Mr Rowland was responsible for picking up such problems as the clinical governance lead - a clear conflict of interest, the women's lawyers say.

Its report found warning signs dating back to 2004 were not acted upon, criticised the 'cultural divide' between staff at the Aintree centre and the main hospital, and said more needed to be done to stop doctors from working in isolation from their departments. Jonathan Herod, clinical director of gynaecology, admitted Mr Rowland often worked alone. If the case was repeated, 'it would be picked up on straightaway', he added.

Trust chief executive Kathryn Thomson said: 'We decided it was important to look at governance practices more widely to ensure we learnt as much as possible.'


」250,000 victory for war vet who sold home to pay care bill that NHS should never have charged him

NHS bureaucrats don't care about people at all. Saving money is their no.1 priority

The family of a war veteran suffering from Alzheimer's has won more than 」250,000 from the NHS for nursing home fees he should never have been charged. The payout, which is believed to be the biggest of its kind, was awarded to relatives of Leslie Terry, 86, whose home was sold to pay for his 」3,500-a-month care. Despite being totally immobile - he has not been out of bed for four years - and in need of constant nursing, Mr Terry was denied funding under the NHS's ' Continuing Care' scheme.

The scheme is meant to fully fund patients with health needs resulting from conditions such as Alzheimer's and Parkinson's disease. It applies mainly to those who are in nursing homes, or long-term hospital or home care.

Mr Terry's nephew, Bryan Talbot, 71, from Banbury, Oxfordshire, who mounted a legal challenge to recover the backdated fees covering eight years, said: 'My uncle has been unable to get out of bed for four years, he is at risk of choking, has to be fed, and is unable to communicate verbally. 'I felt it was clear that his health needs meant he should be the responsibility of the Health Service. I am amazed that, despite him having annual assessments, the NHS did not inform me about possible available funding. It's important people take advice. 'We've had a rough ride to get to this point but I want other people to know you don't have to sell your home to get the care you need. He has received first class care from very professional staff at Gloucester House Nursing Home.'

The payout comes after three families last year won a total of 」350,000 - with the family home sold in two cases - after being wrongly denied Continuing Care. So far, more than 」9million has been recovered by solicitors representing 2,000 families who claim they have been wrongly charged nursing home fees. Under English law, the elderly must pay for residential care unless their needs are health-related, when the whole cost is met.

However, Department of Health criteria on who qualifies for health needs are subject to interpretation by individual NHS trusts. The Daily Mail's Dignity for the Elderly campaign has repeatedly highlighted the unfairness of the system, which means many families of Alzheimer's sufferers are being charged for long-term nursing care. Many are denied funding by Primary Care Trusts, which have to foot the bill, because the disease does not automatically make the patient eligible for NHS 'continuing care'.

Mr Terry, who joined the Army in 1942 and fought in India and Burma, retired from his job as a porter at Sevenoaks Hospital in Kent, in 1983 before succumbing to dementia in his 70s. He never married. Mr Terry also suffers from a severe skin disease, which needs monitoring.

Solicitor Lisa Morgan, of Welsh law firm Hugh James, who acted for him, said: 'Under current government policy, there should be a full assessment on health needs, which determines whether patients pay for their nursing care fees. 'That is not happening in many cases. With the cost of nursing homes averaging 」675 per week, families are still being left with huge fees to pay. There is a clear disparity across the country and, despite national guidance, Primary Care Trusts still apply their own judgment.'

Michelle Mitchell, charity director for Age Concern and Help The Aged, said: 'The system for deciding where the line is drawn between free NHS Continuing Care, and paid for social care has been a mess for years. 'We are still very concerned older people may wrongly be forced to pay for their care when it should be free. We strongly encourage anyone who believes they are unfairly missing out to fight for their rights.'


20 March, 2010

Democrats offer a new budget of lies

In the final push to pass a health care overhaul, Democratic leaders on Thursday sought to sway anxious party members with a new $940 billion plan that cuts the deficit, raises Medicare revenue with a new tax on the investment income on wealthier Americans and placates unions by slashing the tax on high-end insurance plans.

The concept, backed by President Obama, is designed to build positive momentum ahead of a Sunday vote on the landmark health care overhaul, which would extend insurance coverage to more than 30 million Americans, fill the Medicare prescription drug "doughnut" hole of limited coverage and curb insurance industry abuses. It swung two former "no" votes to the "yes" column.

Majority Leader Steny H. Hoyer called the plan "the biggest deficit reduction bill that any member of Congress is going to have an opportunity to vote on" with hopes of swaying fiscally minded Democrats to support it.

Republicans remain steadfastly opposed to the plan, leaving Democrats to come up with all of the support themselves. "The reason House Democrats don't have the votes is because the American people know this is a government takeover of health care," said Rep. Mike Pence of Indiana.

The 153-page bill released Thursday represents repairs that Mr. Obama and House leaders requested in exchange for voting for the Senate's health care plan. If passed, the "repair" bill would also have to pass the Senate through complicated reconciliation procedures that can circumvent a Republican filibuster.

Critics of the plan already spotted two provisions that they say are tightly focused on specific states, possibly in exchange for support of the legislation similar to the now infamous "Cornhusker Kickback." They plan to rally against the bill as the final vote nears.

White House spokesman Robert Gibbs said Thursday that Mr. Obama would postpone his Asia trip, originally scheduled to start Sunday, to help corral votes for his chief domestic agenda item.

The Congressional Budget Office analysis found that the plan would reduce the deficit by $138 billion over the next 10 years - $20 billion more than the House's original plan - and continue to drive down the deficit in later years.

More here

Slaughter House Rules

How Democrats may 'deem' ObamaCare into law, without voting

We're not sure American schools teach civics any more, but once upon a time they taught that under the U.S. Constitution a bill had to pass both the House and Senate to become law. Until this week, that is, when Speaker Nancy Pelosi is moving to merely "deem" that the House has passed the Senate health-care bill and then send it to President Obama to sign anyway.

Under the "reconciliation" process that began yesterday afternoon, the House is supposed to approve the Senate's Christmas Eve bill and then use "sidecar" amendments to fix the things it doesn't like. Those amendments would then go to the Senate under rules that would let Democrats pass them while avoiding the ordinary 60-vote threshold for passing major legislation. This alone is an abuse of traditional Senate process.

But Mrs. Pelosi & Co. fear they lack the votes in the House to pass an identical Senate bill, even with the promise of these reconciliation fixes. House Members hate the thought of going on record voting for the Cornhusker kickback and other special-interest bribes that were added to get this mess through the Senate, as well as the new tax on high-cost insurance plans that Big Labor hates.

So at the Speaker's command, New York Democrat Louise Slaughter, who chairs the House Rules Committee, may insert what's known as a "self-executing rule," also known as a "hereby rule." Under this amazing procedural ruse, the House would then vote only once on the reconciliation corrections, but not on the underlying Senate bill. If those reconciliation corrections pass, the self-executing rule would say that the Senate bill is presumptively approved by the House容ven without a formal up-or-down vote on the actual words of the Senate bill.

Democrats would thus send the Senate bill to President Obama for his signature even as they claimed to oppose the same Senate bill. They would be declaring themselves to be for and against the Senate bill in the same vote. Even John Kerry never went that far with his Iraq war machinations. As we went to press, the precise mechanics that Democrats will use remained unclear, though yesterday Mrs. Pelosi endorsed this "deem and pass" strategy in a meeting with left-wing bloggers.

This two-votes-in-one gambit is a brazen affront to the plain language of the Constitution, which is intended to require democratic accountability. Article 1, Section 7 of the Constitution says that in order for a "Bill" to "become a Law," it "shall have passed the House of Representatives and the Senate." This is why the House and Senate typically have a conference committee to work out differences in what each body passes. While sometimes one house cedes entirely to another, the expectation is that its Members must re-vote on the exact language of the other body's bill.

As Stanford law professor Michael McConnell pointed out in these pages yesterday, "The Slaughter solution attempts to allow the House to pass the Senate bill, plus a bill amending it, with a single vote. The senators would then vote only on the amendatory bill. But this means that no single bill will have passed both houses in the same form." If Congress can now decide that the House can vote for one bill and the Senate can vote for another, and the final result can be some arbitrary hybrid, then we have abandoned one of Madison's core checks and balances.

Yes, self-executing rules have been used in the past, but as the Congressional Research Service put it in a 2006 paper, "Originally, this type of rule was used to expedite House action in disposing of Senate amendments to House-passed bills." They've also been used for amendments such as to a 1998 bill that "would have permitted the CIA to offer employees an early-out retirement program"傭ut never before to elide a vote on the entire fundamental legislation.

We have entered a political wonderland, where the rules are whatever Democrats say they are. Mrs. Pelosi and the White House are resorting to these abuses because their bill is so unpopular that a majority even of their own party doesn't want to vote for it. Fence-sitting Members are being threatened with primary challengers, a withdrawal of union support and of course ostracism. Michigan's Bart Stupak is being pounded nightly by MSNBC for the high crime of refusing to vote for a bill that he believes will subsidize insurance for abortions.

Democrats are, literally, consuming their own majority for the sake of imposing new taxes, regulations and entitlements that the public has roundly rejected but that they believe will be the crowning achievement of the welfare state. They are also leaving behind a procedural bloody trail that will fuel public fury and make such a vast change of law seem illegitimate to millions of Americans.

The concoction has become so toxic that even Mrs. Pelosi isn't bothering to defend the merits anymore, saying instead last week that "we have to pass the bill so that you can find out what is in it." Or rather, "deeming" to have passed it.


Landmark Legal Foundation readies constitutional suit if Obamacare passes with Slaughter Solution

Landmark Legal Foundation president and Talk Radio powerhouse Mark Levin promised today that his foundation will file suit in federal court challenging the constitutionality of Obamacare if it is approved in the House using the Slaughter Solution.

鏑andmark has already prepared a lawsuit that will be filed in federal court the moment the House acts. Such a brazen violation of the core functions of Congress simply cannot be ignored. Article I, Section 7 of the Constitution is clear respecting the manner in which a bill becomes law. Members are required to vote on this bill, not claim they did when they didn稚. The Speaker of the House and her lieutenants are temporary custodians of congressional authority. They are not empowered to do permanent violence to our Constitution," Levin said.

Even if Landmark never does another good thing for the Republic, what it has been doing for more than a decade to expose the facts about the partisan political partnership between the National Education Association and the Democratic Party makes it an invaluable asset. You can check that out here.

Landmark also has done superb work in exposing how federal bureaucrats at the EPA have funneled billions of tax dollars to radical environmental groups that lobby on behalf of more regulatory power, bigger budgets and expanded staffing for ... EPA. Check that out here.

Levin may be best known for his New York Times best-seller, "Liberty and Tyranny: A conservative manifesto." I knew something remarkable was bubbling "out there" among the American people last year when Levin's book zoomed to the top of the best-seller's list and people lined up for blocks in places like Fairfax County, Va., to buy signed copies of the book and to meet him.


Into the twilight zone

Nancy Pelosi has scheduled a vote for Sunday, maybe to vote by not voting. The president has canceled his trip to Asia and the atmosphere in Washington grows surreal and surrealer. The speaker yearns to be a suicide bomber, blowing up her party's November prospects, or at least the leader of the Democratic squadron of kamikaze pilots.

No one can quite remember when a party in power has been so determined to self-destruct, with the speaker as provocateur, egging everyone on. Rep. Mike Honda, a Californian of Japanese descent, objects to some of the metaphors applied to Mzz Pelosi's mission of death by obsession, but to neutral observers - assuming any are left - her execution of the president's obsession looks like the Bataan death march, or at least a ride to the gallows in a Toyota.

Everything the Democrats are doing is turning to mud, or maybe even the smelly stuff wives accuse husbands of tracking into the house. Barack Obama even chose this week to pick an unnecessary fight with Israel, our only true friend in the Middle East. When Joe Biden quickly wore out his welcome in Jerusalem, he was brought back to Washington to employ his considerable Irish charm to entertain the Irish prime minister, Brian Cowen, who dropped in for a St. Patrick's Day visit to the White House. Nobody could mess up such a jovial occasion, even with beer dyed green for the occasion.

Good old Joe, ever the bumbling uncle we've come to love (so far the president hasn't consigned him to the attic where crazy aunts and uncles usually live), nevertheless pronounced obsequies on the prime minister's ailing mother: "God rest her soul." Good old Joe quickly learned that the elderly Mrs. Cowen's soul is still among us. Never mind. He rewrote his benediction to "God bless her soul," and recalled the Irish proverb that "a silent mouth is sweet to hear." To the relief of all he turned the podium over to the president's teleprompter, and no further harm was done. No need for the media's Gaffe Patrol even to fire up the engines on their ancient Jennies.

But what other explanation for Mr. Obama's damn-the-torpedoes strategy could there be other than a suicide wish? The only outcome worse for him than losing the health care vote would be winning the health care vote. The debacle in Massachusetts has taught him nothing, but it has surely taught the public a lot. Gallup now puts the president's approval rating at 46 percent, the lowest yet, and his disapproval at 47 percent. These are dreadful numbers for any president, and particularly for a messiah who arrived at the White House little more than a year ago with approval ratings in the high 70s.

The debacle in Massachusetts will be small stuff if Mzz Pelosi proceeds with the aptly named "Slaughter solution," the bright idea of Rep. Louise M. Slaughter of New York, to dispense with actually voting for the Senate bill and declaring that the House "deems" the Senate measure enacted. This would avoid a voice vote and guilty congressmen could go home to tell credulous constituents that they should deem them as having voted against the monstrosity that almost nobody wants. Such a solution is so nutty that only Nancy Pelosi and Harry Reid would have imagined using it. But if they succeed Congress will have opened up vast new avenues of chicanery, deceit and dishonesty. A husband caught staying out all night can tell his angry wife that she should "deem" him to have slept on the sofa discarded in the garage; a schoolboy who wouldn't dare claim the dog ate his homework can now tell a teacher that she should "deem" the homework done.

Mr. Obama, who long ago perfected the verbal sleight of hand that has served him well until now, got particularly flustered and visibly irritated when he sat down for an interview with Fox News and learned for the first time how uncomfortable a real interview can be. The more interviewer Bret Baier pressed the more the president wiggled and the more the interviewer persisted. Soon it descended into presidential argle-bargle. The president doesn't have an opinion on "deeming" because "I don't spend a lot of time worrying about what the procedural rules are." He's not concerned about "the Louisiana Purchase" or the "Cornhusker Kickback" - special deals for Louisiana and Nebraska to buy Senate votes - because special deals "also affect Hawaii, which just went through an earthquake." It did?

But maybe it was a slip of the tongue and he meant Haiti. But surely he doesn't think Haiti is one of the 57 states. We can't be sure.


Hiding the true cost of Obamacare

President Obama keeps saying America needs the Democrats' health care bill to reduce costs. In reality, the government takeover of health care will raise costs and cause a large number of people to lose their health insurance.

"Well, if [the health care bill] doesn't pass, I'm more concerned about what it does to families out there who right now are getting crushed by rising health care costs and small businesses who were having to make a decision, 'Do I hire or do I fix health care?' " Mr. Obama claimed to Fox News on Wednesday.

Saying his bill will reduce costs doesn't make it true. Take the legislation's huge $500 billion cuts in Medicare. The government already reimburses hospitals and doctors less than their costs. Further cuts mean even more cost shifting to privately insured patients to cover deeper Medicare losses. Private insurance won't cover all of these exorbitant losses, which will force many doctors and hospitals out of business.

This week, the New England Journal of Medicine released a survey of doctors showing that 46.3 percent of "primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine." Not only will doctors leave medicine, but "27 percent [of physicians] would recommend medicine as a career but not if health reform passes." The survey is merely suggestive, but if the real reduction in the number of doctors is even 5 percent or 10 percent, medical costs will rise significantly. A lower supply of doctors amid rising demand for care means higher medical prices.

Another example is the ban on insurance companies charging different premiums based on pre-existing health conditions. Imagine what would happen if motorists could buy auto insurance after an accident and were allowed to drop it once a car was fixed. People would wait until they were in an accident to buy insurance, and insurance premiums would skyrocket. The same will happen if insurance companies can't charge higher premiums for sick people.

Even the few purported cost-reducing measures in the Senate bill are being gutted by the president's proposal. The reconciliation bill delays a tax on high-quality insurance, dubbed Cadillac plans. The idea was if the cost of insurance was raised, fewer people would want such extensive medical coverage and thus would not seek medical care as often. Reduced demand therefore would reduce the price of medical care. But after striking a deal with unions, Mr. Obama decided to delay the tax for eight years, until he's out of office.

The Democrats' plan will destroy American health care. Obamacare will dramatically raise the cost of medical care, forcing many Americans to drop their insurance. Responsible members of Congress have to vote this down.


The unbelievable NHS again

Bungling foreign nurse can KEEP his job... despite barely speaking English and 'worrying' lack of competence

An Indian nurse who could barely understand English and refused to learn the language was told yesterday he could return to his hospital and carry on working. The decision by the Nursing and Midwifery Council came despite despite the watchdog commenting on his 層orrying lack of competence.

Biju John, 38, had insisted he was able to understand instructions and wrote to the council stating: 選 never be confused at all. But staff felt they were 祖arrying him and did not feel safe leaving patients in his care, an NMC hearing was told.

Mr John also had a limited knowledge of basic nursing skills and did nothing when a patient was struggling to breathe, it was claimed. The NMC heard Mr John should have started basic airway management as the man gasped for breath after coming round from an operation. But instead he had to be helped by a colleague who rushed over when she heard the man痴 wheezing from the other side of the anaesthetic unit at Leicester Royal Infirmary.

On another occasion Mr John almost caused a patient to go into shock when he wore latex gloves to treat him despite being told he was allergic to the material. The hospital then devised a set of objectives for the nurse, including meeting the required standard of English so he could effectively communicate with staff and colleagues. But he failed to reach the targets and was kept on supervised practice.

A further incident on October 20, 2004 led to Mr John being suspended and a disciplinary meeting was scheduled for January 20, 2005, but he quit seven days before. He was later reported to his regulating body. Mr John, from Cambridge, was found guilty of seven charges relating to his lack of competency when he worked at the hospital between July 2003 and December 2004. These include failing to complete basic skills required of a nurse, not demonstrating his English was sufficient to communicate with colleagues effectively which gave rise to the incident with the latex gloves and failing to take appropriate action when a patient痴 oxygen levels dropped. He was cleared of mistaking the Surgical Assessment Unit for the Surgical Acute Care Unit.

NMC chairman David Kyle said his lack of competence was 層orrying but 創ot irremediable. He added: 羨lthough the registrant was a caring nurse, he lacked confidence, was reluctant to act on his own initiative and could not be trusted to work unsupervised. 前ther nurses felt they were carrying him. 羨naesthetists were nervous about leaving their patients in his care and adopted a practice of returning to check on their patients because they were concerned about them.

禅he panel has heard evidence of a worrying lack of competence demonstrated over a considerable period of time and that lack of competence, in some basic areas of practice for any registered nurse, particularly in communication, is still present.

But the panel ruled Mr John could return to work subject to conditions. Mr John must tell the NMC where he is working, remain supervised, complete a personal development plan and an English language test he complies with the conditions he will be allowed to return to normal practice after 18 months.


19 March, 2010


Below are five reports from just ONE DAY in Britain

Terrifyingly inept foreign doctors are a symptom of a sickness in the NHS - not the cause

By Professor Karol Sikora

When a supposed cure has instead become a new kind of sickness, then surely something is badly wrong. Yet that is what has happened in the modern NHS. The target culture brought in to benefit patients is having fatal consequences. A system that originally aimed to improve performance and efficiency is now threatening patients' lives, distorting clinical priorities and encouraging the use of foreign doctors, who may be too inexperienced or unqualified for the jobs they have been given.

The tragic case of 94-year-old Ena Dickinson is a heart-rending example of what can go wrong in a health service that puts compliance with political requirements above the real needs of patients. Mrs Dickinson, a Lincolnshire grandmother, died in 2008, soon after she underwent a hip replacement operation which was carried out at Grantham Hospital by a German locum surgeon, Dr Werner Kolb. In an appalling series of errors, Dr Kolb cut through the wrong muscle, severed an artery and used the wrong cutting tool, with the result that Mrs Dickinson lost almost half her blood in an operation that should have been routine. One witness, another doctor from the hospital, said he was 'horrified by what I saw', while an expert surgical witness, Professor Angus Wallace, told the inquest on Tuesday that he 'could not believe the level of neglect in the operation'.

The episode raises troubling questions about the NHS's increasing reliance on foreign doctors, both from the European Union and from further overseas, a practice that has been driven partly by the Government's fixation with meeting targets and partly by an inadequate supply in the number of domestic trained doctors.

We do not, of course, live in an insular world and overseas doctors have long been an integral part of the NHS. Indeed, when I first worked in the NHS in the early Seventies, I saw that the service would not have been able to function without the support of doctors from Asia. And, whether we like it or not, Britain is part of the European Union, one of whose guiding principles is the free movement of labour throughout the member states. So, without drastic political changes to the very nature of our society, we would not be able to adopt a siege mentality when it comes to employment in the NHS.

Nevertheless, the disastrously botched operation that Mrs Dickinson suffered highlights a worrying trend, where too often foreign doctors have been imported to provide cover in the NHS, without any proper checks on their background, their ability to speak English, their experience or their competence.

According to reports about Dr Werner Kolb, he had actually performed few hip operations during his career and had spent most of his recent years giving lectures, hardly a record to inspire confidence in the operating theatre. Dr Kolb's negligence may be particularly graphic, because of the way he sawed through the wrong muscle, like some grotesquely inept carpenter.

Some might argue, therefore, that it is particularly dangerous to let foreign doctors carry out surgery without rigorous monitoring. But this would be a fallacy. Every branch of medicine, from general practice to pathology, has the potential to do mortal harm because of its intimate connection with the delicate structure of the human body. In my own field of cancer care, disasters can occur because of a misdiagnosis or the administration of the wrong dosage of drug.

The calamitous risks of incompetence by GP locums were illustrated in early 2008 by Dr Daniel Ubani, who flew in from Germany to Cambridgeshire to provide weekend cover for a local practice, only to end up killing one pensioner, David Gray, by accidentally giving him ten times the maximum dosage of diamorphine. The coroner then said Mr Gray's death had been caused by 'gross negligence', words that carry a chilling echo in the Dickinson case.

One of the key problems is that, under an EU directive of 2004, doctors who qualify in any EU country can move to work in any other EU state without even the most limited examination of their skills, aptitude or language. In contrast, foreign doctors (ie from outside the EU) must pass a skills and English language test - yes, even the Australians and Americans.

EU countries are also not forced to provide information on their doctors' professional histories - for example, whether they have been struck off for committing a criminal offence or killing a patient through negligence.

There are estimated to be around 20,000 EU doctors registered to work in the NHS, a quarter of them from the former Eastern Bloc countries.

Now the vast majority of them are certainly perfectly competent, but, even so, difficulties will inevitably arise over language and culture. Every nation, for instance, has its own medical hierarchies, differing relationships between doctors and nurses, or unique approaches to patient care.

Moreover, foreign doctors without a sound grasp of English will not understand what their patients are telling them, something that is a particular concern in GP services.

It is telling that EU doctors are twice as likely to face disciplinary hearings before the General Medical Council as their British counterparts, in which foreign doctors from outside the EU are three times as likely to be struck off the medical register - statistics that point to the laxity of checks.

We cannot blame foreign doctors for wanting to work in the NHS. Britain has one of the best-rewarded medical professions in the world, with GPs earning on average over 」100,000-a-year and leading consultants far more. These are incredible riches for doctors from the old Soviet sphere of influence. In Poland, where my family has some of its roots, a doctor is likely to earn around 」500 a month or 」6,000-a-year, a sum that can be made with a few weekend or holiday stints in Britain. As a consequence, one in six of Poland's doctors now works abroad.

Nor is the NHS management entirely to blame for the catalogue of controversies that has arisen from the employment of foreign staff. NHS bosses are under tremendous pressure to meet waiting lists targets set by the Government, so they will take any action, bear almost any cost, to achieve this. So rather than postpone operations during periods when staff are on leave, they bring in foreign doctors to keep the conveyor belt moving.

In Ena Dickinson's case, it would not have mattered if her hip replacement operation had been delayed by a week or two, but no doubt the management of Grantham Hospital was appalled at the idea of slipping behind the Government's arbitrary 18-week deadline for such routine surgery. So, in a disastrous misjudgment, Dr Kolb was brought in so the needs of bureaucracy, if not the patient, could be met.

The problem has been compounded by the Government's failure to assess correctly the needs of the NHS for doctors, with the result that foreign doctors have been brought in to cover gaps in supply. It must be admitted that the demands on the NHS have grown enormously in recent years as a consequence of increasing numbers of elderly patients, a growth in the British population and advances in medical care. Twenty years ago, the idea of carrying out a hip replacement operation on a 94-year-old grandmother would have been unthinkable.

Moreover, the EU working time directive drastically reduced the number of hours that any doctor could be on duty, which meant that more staff had to be made available. But the need to increase the supply of doctors only emphasises the need to scrutinise their competence more vigorously. What we need, therefore, is an assessment of their skills by practical and verbal demonstration, accompanied by checks on their background and a basic language test. We're doing it for our own graduates, after all. That is what our NHS patients deserve. We cannot allow any more tragedies like that of Ena Dickinson.


Killer Muslim doctor with repeated disregard for patients is suspended for just FOUR MONTHS by British regulators

A doctor with a 'disregard' for patient safety was suspended for just four months today for sending home a baby girl who died the next day from blood poisoning. Dr Salawati Abdul-Salam failed to spot little Aleesha Evans' deadly condition and sent her home saying she had a viral infection that needed only Calpol and Nurofen. She died the next day.

A year before the baby's death, another of Abdul-Salam's patients died after a wrong diagnosis, while a pensioner suffered a collapsed lung under the trainee's care. GMC panel chairman Professor Denis McDevitt said the doctor's actions demonstrated a 'total lack of attention to detail' and a 'serious degree of carelessness.'

Colin Perriam, 66, had died after Abdul-Salam analysed six-month old blood samples, then wrongly diagnosed a ruptured ulcer as constipation. Mr Perriam was discharged from Cardiff's University Hospital of Wales on December 15, 2004 with a prescription of laxatives.

Widow Pamela Perriam had told the hearing: 'She said that he was suffering from constipation. 'We were given some powders that you mix with water for mild constipation and we were not given any other instructions. 'We were not given anything else except to say that it was mild constipation and mild laxatives should deal with the problem.'

But the next day Mr Parriam could not get out of bed and when his stomach appeared swollen and blotchy the following evening, his wife called an ambulance. By the time it arrived her husband was unconscious. Mr Parriam underwent emergency surgery but never recovered and died the next day on February 5, 2005.

A month earlier, Abdul-Salam gave a 79-year-old woman an unnecessary chest drain after reading the wrong x-ray. She had to apologise after the elderly woman's lung collapsed.

On August 9, 2006, Aleesha Evans was rushed to the Royal Gwent Hospital in Newport, Wales, vomiting with a rash and a temperature of 37 degrees. But the trainee specialist registrar did not even examine the baby and discharged her two hours later after noting her condition was 'unremarkable.' The doctor had seen the patient by this stage and noted she appeared to be better than she had been and that she was playing. But her heart rate was still high and her temperature had risen to 39 degrees, the hearing was told. The baby was discharged at 11pm with a diagnosis of viral illness.

But she was suffering from meningococcal septicaemia - blood poisoning - and died the following day. Abdul-Salam was placed under supervision at the Princess of Wales Hospital in Bridgend after Aleesha's death. She was only allowed to perform three hours of clinical work a day and had to sign every patient off with a supervisor. But within three weeks Abdul-Salam had broken the terms of her training and more than a third of her patients had been discharged without her superior's consent.

One of these patients was a 10-year-old girl with a broken wrist who attended A&E on 22 September 2008. The child required treatment under anaesthetic but Abdul-Salam discharged her to the outpatient fracture clinic.

Prof McDevitt told Abdul-Salam: 'The panel has concluded that you have not yet fully appreciated the magnitude of your deficient performance and misconduct. 'You demonstrated poor judgment when under pressure. Your lack of careful clinical method resulted in the inadequate assessment and management of patients and you failed to appreciate fully the discordance between the patients' clinical condition and the results of investigations. 'The panel considers there remains of risk of you repeating errors and exercising poor judgment, particularly if you were to return to work in a more pressures environment than you are currently exposed to.'

Prof McDevitt said the panel had considered imposing conditions on Abdul-Salam's practice but concluded her actions involving baby Aleesha Evans were too serious: 'Taking all the factors into account, the panel concluded that your registration should be suspended for a period of four months. 'Your misconduct was sufficiently serious to undermine public confidence in the profession. It is also important that you, and the medical profession, are left in no doubt that such behaviour, which clearly had consequences for patient safety, is unacceptable.'

The doctor had been working as a locum at the Kent and Sussex Hospital in Tunbridge Wells, Kent for the last five months, but she will now be unable to keep her job.


British doctors who wouldn't listen allow little girl to die

An eight-year-old girl with an acute fear of dentists who starved to death after her milk teeth were taken out under anaesthetic died because of a 斗ack of communication between health agencies, an investigation has concluded.

Sophie Waller refused to open her mouth even to eat after the operation. She had developed her phobia at the age of four when her tongue was scratched during a routine check-up. When she refused treatment after cracking a tooth on a boiled sweet her parents became so concerned they took her to their GP who referred her to the Royal Cornwall Hospital in Truro.

Surgeons decided to remove eight remaining milk teeth under anaesthetic to avoid problems in future. But she was left so traumatised by it she refused to open her mouth to eat or drink.

A report by the Local Safeguarding Children Board has now found there was a 斗ack of clarity from the agencies responsible for Sophie痴 care after her discharge from hospital. She was sent home despite her condition and her parents did not know who to turn to when her health deteriorated.

By the time of her death in December 2005 Sophie, from St Dennis in Cornwall, was severely malnourished and weighed just 22kg. Her parents had been feeding her a diet of yoghurt and mashed fruit and tried to get help from their GP and the hospital but were instead referred to a child psychologist.

She was found dead in bed by her mother four weeks after her discharge and the cause of death was given as kidney failure as a result of starvation and dehydration. An inquest in February 2009 found there was no blame attached to her parents who had tried to get help for their daughter.

The serious case review found of a lack of communication between all the health agencies involved in her care. The report says: 哲o clear written plan was made on discharge and there was lack of clarity about responsibility for medical review following discharge.

典he clinical psychologist made telephone contact with the child痴 parents in the week after discharge but did not see her again. 典here was a lack of clarity over the open door arrangement which was intended to allow the child痴 parents to bring her back in the week following discharge. When they phoned for advice on the seventh day, they were referred back to the psychologist for support.

Her mother Janet Waller, a nursery school teacher who has two other children, said the report highlighted how their pleas should have been heard. She said: 鄭ll we致e wanted all along is for people to listen to us. People ask me how many children I have, I say three, but technically I haven稚 any more. I致e got to live with this for the rest of my life.

At Sophie痴 inquest in February last year the Cornwall coroner, Dr Emma Carlyon, said that the Royal Cornwall Hospital was guilty of a number of failings which led to Sophie痴 death. She said: 典he severity of her malnutrition and dehydration was not recognised. This prevented her from receiving the medical support that could have prevented her death.

Dr Ellen Wilkinson, Medical Director of Royal Cornwall Hospital Trust, said: 展e would like to apologise to the family of Sophie Waller. Everyone involved in her care was saddened by her tragic death. This was a very unusual case. 典here were shortcomings in the communication between the health organisation and Sophie痴 parents.


'Blood-spattered walls and mouldy equipment': How a quarter of British government hospitals fail to meet basic hygiene tests

A quarter of NHS hospital trusts are failing to meet basic hygiene standards, with some treating patients on blood-spattered wards or with dirty equipment, a damning report has found. A third of ambulance trusts have also missed the targets set, according to the Care Quality Commission. The watchdog's report follows the introduction of tough new hygiene standards after a series of scandals at hospitals in Maidstone, Basildon and Stafford.

It also came as a survey of NHS employees found many are too overstretched to do their jobs properly because of staff shortages.

On hygiene, the CQC found 42 out of the 167 NHS trusts inspected were in 'breach' of registration requirements by failing to meet standards, with some hospitals being warned over blood-spattered wards and dirty equipment. In Basildon, where at least 70 patients died as a result of poor hygiene last year, investigators found a commode soiled under the seat and 'procedure trays, used by staff to carry equipment when they take blood samples or give injections, had blood spattered on them'.

At children's hospital Alder Hey, in Liverpool, the inspection revealed dirty toys, hair stuck to medical equipment and 'nappy changing mats stored on the floor next to a toilet'. Water 'ran brown' from taps in patient areas.

A total of 36 trusts did not provide areas to decontaminate instruments, three trusts failed to flush unused water regularly to control legionella outbreaks, and a dozen failed to keep clinical areas clean. The situation was so bad at four ambulance trusts that they were given written warnings about the state of their vehicles and stations.

Nigel Ellis, the CQC's head of inspection, said: 'We have on rare occasions found evidence of a direct risk to patients and have intervened using our enforcement powers to ensure swift improvements were made. 'In over half of trusts we have made some suggestions or requirements for improvements to ensure their practices are the best they can be.'

A spokesman for the Department of Health said: 'There's no doubt that the trusts rose to the challenge --we've seen swift and tangible improvements in their performance, and on follow-up meetings all met the required standards.'

Meanwhile, half of NHS workers claim that staff shortages are stopping them doing their jobs properly. Of the 160,000 workers questioned by the CQC, 46 per cent said they were unable to do a proper job.


One in ten doctors in Britain is foreign and untested

Almost one in ten doctors on the medical register comes from the EU and has not had to take any language or competence tests before working in Britain. The shocking figure exposes the lax controls over European locums taking up hospital posts in the NHS and providing out-of-hours GP cover. Unlike doctors from elsewhere in the world - who are forced to prove language skills and medical knowledge before being registered - such testing is forbidden for doctors qualified in Europe and Switzerland.

Campaigners want a complete overhaul of the system after the death of a grandmother following appalling blunders by a German surgeon flown in by the NHS. Ena Dickinson, 94, lost nearly half the blood in her body during what was meant to be a routine hip operation at Grantham Hospital in Lincolnshire. Werner Kolb, who had been working in the NHS for three weeks, severed an artery and became so flustered he started speaking German in the operating theatre.

An expert witness described it as the worst case of negligence he had come across - yet Dr Kolb, pictured today for the first time, was left free to work in the UK for a further eight months before being suspended by the General Medical Council.

Dr Kolb, who had been mainly lecturing for four years before the tragedy, refused to attend the inquest and denied his conduct had anything to do with Mrs Dickinson's death eight weeks later from pneumonia. Last night a colleague at Bethesda Hospital in Stuttgart insisted: 'I find it hard to reconcile the words said against him in Britain with the precise surgeon I know.'

But Mrs Dickinson's daughter Kathy Ingram, 57, said: 'The system is disgraceful and clearly isn't working. NHS trusts have to assume that locum doctors' qualifications from Europe are reliable without doing their own checks. 'You trust your doctor because he's in authority but if he hasn't been verified and isn't monitored, you never know what standard of treatment you'll get. The law has to be changed so that there is closer monitoring.'

Figures show there are more than 230,000 doctors on the GMC register of which 21,451 - almost 10 per cent - gained their qualifications in other EU countries. The ban on checks comes from a European directive ordering member states to allow workers free movement. This means the GMC is forced to accept qualifications at 'face value', according to its chief executive Niall Dickson.

The GMC has protested about the rights of doctors to work freely across Europe being put ahead of a patient's right to safe treatment. In a presentation to the EU's Green Paper on the European Workforce for Health, it said: 'Legislation must be amended to allow healthcare regulators across Europe to establish that a doctor has the level of language proficiency necessary to practise safely. 'We are also prevented from adopting a general requirement to prove competence and cannot specify the standard of acceptable competence. 'The current situation is profoundly at odds with the pursuit of safe and high quality health care.'

Dr Vivienne Nathanson, head of science and ethics at the British Medical Association, said: 'Whilst it is essential doctors are able to communicate with their patients and the regulatory authorities are able to assess fitness to practise, it is also important we don't make it impossible for those that do have the appropriate skills to work in the UK.'


18 March, 2010

Health care bill can be beaten

House passage of the Democrats' health care bill is not a foregone conclusion despite their 75-seat majority in the chamber. While party leaders such as Speaker Nancy Pelosi and White House spinmeister David Axelrod bravely express confidence, Rep. James E. Clyburn of South Carolina, the House majority whip, conceded on NBC's "Meet the Press" that Democrats don't have enough votes yet.

The all-out effort to ram through the legislation before Easter recess is telling. If members of Congress merely risked being confronted by Potemkin crowds that don't represent the majority of voters, there would be nothing to fear. However, Democratic strategists know these crowds are very real and very mad, and the mobs will rattle wavering congressional votes, especially in vulnerable districts. The latest Rasmussen poll shows that independents oppose the mass of new regulations and taxes by a wide margin of 64 percent to 32 percent.

Despite the barrage of political attacks on insurance companies over the past year, 76 percent of Americans with insurance still rate their coverage as "excellent" or "good." Rasmussen Reports notes that this group has "proven to be a major obstacle for advocates of reform." Last year, Mr. Obama repeatedly promised he wouldn't interfere with the insurance of those who liked their current policies, but that vow has been broken. It's no wonder a constant trickle of Democrats is expressing concern about the party's policy agenda.

According to the latest vote count, released early Tuesday morning by the Hill newspaper, 37 Democrats are either firm "no" votes or "leaning no." Add a wavering Rep. Timothy H. Bishop, New York Democrat, and the number is 38. That is the exact number needed to defeat the bill, and it is up from the 25 firm "no" or "leaning no" votes on Thursday. Of the 38, 28 voted against the bill in November. In total, 55 Democrats reportedly are undecided. If the nays hold and just two of those undecided votes switch, the bill will be defeated.

According to Rep. Bart Stupak, Michigan Democrat, special deals were offered recently to peel off one or two of the 11 Democrats who stood with him against government-funded abortions. He accused his party's leadership of never having had any intention of fixing the abortion language, a posture he attributed to the leaders' belief that the votes of the 12 pro-life Democrats wouldn't be needed. "We'll probably have to wait until the Republicans take back the majority to fix this," Mr. Stupak told National Review, almost sounding wistful for that day.

Democrats are full of a lot of false bravado. Through July, August and October, they kept claiming the votes to pass the health care takeover were imminent. They were wrong.

Democrats still may be able to cobble together enough backroom payoffs or use various tricks and pressure for passage. On Intrade, the largest prediction market, the betting is swinging in favor of the health care takeover, with the latest odds giving Democrats a 70 percent chance of passing it. Stopping this travesty depends on voters expressing their outrage to Democrats on Capitol Hill.


With Medicaid Cuts, Doctors and Patients Drop Out

If America can't afford to pay for Medicare, how can it afford Obamacare?

Carol Y. Vliet began chemotherapy to treat her cancer, but lost her doctor because he stopped seeing Medicaid patients. As she began a punishing regimen of chemotherapy and radiation, Mrs. Vliet found a measure of comfort in her monthly appointments with her primary care physician, Dr. Saed J. Sahouri, who had been monitoring her health for nearly two years. She was devastated, therefore, when Dr. Sahouri informed her a few months later that he could no longer see her because, like a growing number of doctors, he had stopped taking patients with Medicaid.

Dr. Sahouri said that his reimbursements from Medicaid were so low often no more than $25 per office visit that he was losing money every time a patient walked in his exam room. The final insult, he said, came when Michigan cut those payments by 8 percent last year to help close a gaping budget shortfall. 溺y office manager was telling me to do this for a long time, and I resisted, Dr. Sahouri said. 釘ut after a while you realize that we池e really losing money on seeing those patients, not even breaking even. We were starting to lose more and more money, month after month.

It has not taken long for communities like Flint to feel the downstream effects of a nationwide torrent of state cuts to Medicaid, the government insurance program for the poor and disabled. With states squeezing payments to providers even as the economy fuels explosive growth in enrollment, patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage. Inevitably, many defer care or wind up in hospital emergency rooms, which are required to take anyone in an urgent condition.

Mrs. Vliet, 53, who lives just outside Flint, has yet to find a replacement for Dr. Sahouri. 展hen you build a relationship, you want to stay with that doctor, she said recently, her face gaunt from disease, and her head wrapped in a floral bandanna. 添ou don稚 want to go from doctor to doctor to doctor and have strangers looking at you that don稚 have a clue who you are.

The inadequacy of Medicaid payments is severe enough that it has become a rare point of agreement in the health care debate between President Obama and Congressional Republicans. In a letter to Congress after their February health care meeting, Mr. Obama wrote that rates might need to rise if Democrats achieved their goal of extending Medicaid eligibility to 15 million uninsured Americans.

In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare, which are themselves typically well below those of commercial insurers, according to the Urban Institute, a research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts.

In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross.

If she takes too many Medicaid patients, she said, she cannot afford overhead expenses like staff salaries, the office mortgage and malpractice insurance that will run $42,800 this year. She also said she feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies, because of underlying health problems.

As a result, she takes new Medicaid patients only if they are relatives or friends of existing patients. But her guilt is assuaged somewhat, she said, because her husband, who is also her office mate, Dr. Bobby B. Mukkamala, an ear, nose and throat specialist, is able to take Medicaid. She said he is able to do so because only a modest share of his patients have it.

The states and the federal government share the cost of Medicaid, which saw a record enrollment increase of 3.3 million people last year. The program now benefits 47 million people, primarily children, pregnant women, disabled adults and nursing home residents. It falls to the states to control spending by setting limits on eligibility, benefits and provider payments within broad federal guidelines.

Michigan, like many other states, did just that last year, packaging the 8 percent reimbursement cut with the elimination of dental, vision, podiatry, hearing and chiropractic services for adults.

When Randy C. Smith showed up recently at a Hamilton Community Health Network clinic near Flint, complaining of a throbbing molar, Dr. Miriam L. Parker had to inform him that Medicaid no longer covered the root canal and crown he needed.

A landscaper who has been without work for 15 months, Mr. Smith, 46, said he could not afford the $2,000 cost. 的 guess I値l just take Tylenol or Motrin, he said before leaving.

This year, Gov. Jennifer M. Granholm, a Democrat, has revived a proposal to impose a 3 percent tax on physician revenues. Without the tax, she has warned, the state may have to reduce payments to health care providers by 11 percent.

In Flint, the birthplace of General Motors, the collapse of automobile manufacturing has melded with the recession to drive unemployment to a staggering 27 percent. About one in four non-elderly residents of Genesee County are uninsured, and one in five depends on Medicaid. The county痴 Medicaid rolls have grown by 37 percent since 2001, and the program now pays for half of all childbirths.

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Not So Fast! Will Medical 迭eform Cut Real Costs?

by William L. Anderson

It seems that the so-called health care 途eform bill will become law soon enough. (President Barack Obama has told recalcitrant Democrats in the House of Representatives that he won稚 campaign for them if they vote no. Most will give into the President.)

Therefore, I am more interested in what will occur after the bill is passed, not the sordid politics behind it. Specifically, I want to take a hard look at the president痴 claim (echoed by economists like Paul Krugman) that the new law will reduce costs.

According to the Congressional Budget Office, Obama痴 plan will produce 都avings in medical procedures. Not surprisingly, much of the media (and especially the New York Times), has been echoing the same chorus.

However, I think this claim truly falls into the 哲ot So Fast category. In my view there is no possibility that the President痴 plan will even remotely cut real costs. The true legacy of this bill will be to add costs in ways we hardly can imagine.

Given that the bill imposes new mandates, further subsidizes the consumption of medical services, and orders insurance companies to cover applicants no matter their health status, one is hard-pressed to find the 田ost savings. Medicare will supposedly cost half a trillion dollars less because the government will order such a state of being into existence. The 努aste, fraud, and abuse that every preceding administration promised to root out will finally meet their match with the Obama administration.

Since the plan won稚 really cut costs, medical price controls could be in our future. Without going into the various economic dislocations created by price controls, let me deal with an even more fundamental issue: the nature of costs. It is telling that economists who support the bill because of its alleged 田osts savings are exposing their own ignorance about costs. To them, a 田ost is nothing more than a monetary outlay that is paid for a certain good or service. If government orders the prices paid in those transactions to be lower, then voila! costs are lower.

Opportunity Costs

At best, this is a childish view of costs and certainly not a view that any serious economist would hold. Costs, according to basic economic theory, are opportunity costs, or the value to an individual of the closest forgone activity. By imposing lower prices, the government would be raising the opportunity costs to individuals taking part in the exchange. Far from lowering costs, the proposed measures ultimately would result in higher real costs.

For example, if the government forces down the price of a medical procedure below the level at which all service providers can be adequately compensated, then the procedure won稚 be done at all. While that would mean no money outlays, 登fficially lowering costs, the person for whom the procedure is denied would bear a real cost by having to suffer the malady that drove him or her to the doctor in the first place.

Supporters of ObamaCare claim that Canada and Great Britain have lower medical costs with their government-run systems than America does. However, many of those 都avings come about because people are denied care, or must make do with cheaper but inferior alternatives.

In other words, the 都avings come at the expense of individuals who wish to receive care. It might be possible, through accounting trickery, to show that the new medical 都ystem has lowered the federal deficit, but it cannot and will not lower the real costs we will pay.


The truth about health insurance premiums and profits

In a recent Fox News debate about health insurance, Democratic political strategist Bob Beckel explained that, "The president needed an enemy, and the insurance companies are it." Proving that point in a Pennsylvania stump speech, President Obama asked, "How much higher do premiums have to go before we do something about it? We can't have a system that works better for the insurance companies than it does for the American people."

On February 20, President Obama used his weekly radio show to express outrage that a fraction of Californians buying individual Anthem Blue Cross Blue Shield (BCBS) plans "are likely (sic) to see their rates go up anywhere from 35 to 39 percent." He used those figures to justify preempting state regulation "by ensuring that, if a rate increase is unreasonable and unjustified, health insurers must lower premiums, provide rebates, or take other actions to make premiums affordable."

There was always something peculiar about this desperate effort to demonize certain health insurers. Individual plans account for only 4 percent of the insurance market. So why do they account for 100 percent of the president's fulminations about insurance premiums? Could it be because insurance premiums for the other 96percent have not been rising much?

Nonprofit BCBS plans account for a third of the private health insurance market. Michigan's nonprofit asked for 56 percent premium hike without the national media taking that Hail Mary pass too seriously. But even Obama finds it difficult to accuse nonprofits of being too profitable, so he needed to pin his enemy badge on a for-profit firm one of Wellpoint's "Anthem" BCBS plans.

Anthem of California's requested rate increase on individual policies was actually 20-35 percent. The only way it could get to 39percent would be if a policyholder insisted on a gold-plated Cadillac plan and also happened to move up into a higher age group. Besides, requesting a rate hike means nothing. Even Obama's radio address mentioned two requests that had been cut in half. Many are denied.

So, how many Californians have actually been faced with a 39 percent increase in their premiums? Exactly zero.

How many are really "likely" to be faced with even a 35 percent increase after state insurance regulators have their say? My forecast: Zero.

The president highlighted the "likely" increases of "35 to 39 percent" to suggest insurance companies in general were asking for huge premium increases just to boost their lavish profits. He complained that in the $1.2 trillion health insurance industry, "the five largest insurers made record profits of over $12 billion." But that puny sum includes WellPoint's sale of its pharmacy benefits management company NextRX to Express Scripts for $4.7 billion last April. Adding that $4.7 billion to WellPoint profits is like saying a family's income rose by $1 million because they sold a million-dollar home.

University of Michigan economist Mark Perry calculated that without the sale of NextRX, "WellPoint's profit margin would have been only 3.9 percent, the industry average profit margin would have been closer to 3percent" $100 per policy. Yet Obama concluded that, "The bottom line is that the status quo is good for the insurance industry and bad for America."

The media echoed the president words endlessly, and wrote as though one company's hypothetical request for increases of 35 percent-39 percent were a nationwide threat容ven to those with group insurance羊ather than an unique and highly unlikely request that might (if magically approved) touch a miniscule number in a hostile state for health insurers.

"It doesn't take too many 39 percent increases, like the recent one proposed in California that has garnished so much attention, to put insurance out of reach," exclaimed a New York Times report. That same paper's editorial added, "The recently announced plan by Anthem Blue Cross in California to raise annual premiums by 35 to 39 percent for nearly a quarter of its individual subscribers is a chilling harbinger of what is to come if reform fails." Really?

Grasping for confirmation of the 39 percent figure, some reporters cited a Feb. 24 memo about Wellpoint written by journalist Scott Paltrow for The Center for American Progress Action Fund. Paltrow gathered news clippings suggesting premiums are "expected to" increase by "up to" some scary number in various states. For California, however, Paltrow's source was the president's speech. This Action Fund is a is no "liberal think tank," as the Wall Street Journal put it, but a 501(c)4 lobby which can participate in campaigns and elections. Founded by Bill Clinton's former chief of staff John Podesta, it's a propaganda arm of the Democratic Party.

A Wall Street Journal story about Wellpoint's wish list for higher premiums cites the Department of Health and Human Services as its source. That means a shoddy four-page polemic at, "Insurance Companies Prosper, Families Suffer." That pamphlet, like another from the Commonwealth Fund, cites Duke Helfand, an L.A. Times reporter who wrote on Feb. 4 that, "brokers who sell these policies say they are fielding numerous calls from customers incensed over premium increases of 30percent to 39 percent."

So, the president's 39 percent figure came from Duke Helfand, who heard it from insurance brokers who, in turn, said they heard it from customers. The 39 percent figure referred to one person named Mary. After rounding Helfand's 30 percent up to 35 percent, however, that was good enough for the president's purposes.

Like Obama, the "Insurance Companies Prosper" pamphlet repeatedly confuses asking with getting. "Anthem Blue Cross isn't alone in insisting on premium hikes," it says; "Anthem of Connecticut requested an increase of 24 percent last year, which was rejected by the state." So what? If you went to your boss and insisted on a 24 percent raise, would that constitute proof that wages are rising too fast?

If Obama has been reduced to basing the redistribution of health care on the cost of health insurance premiums, he will need much better facts. Fortunately, credible statistics on health insurance premiums are readily available from the Centers for Medicare and Medicaid Services (CMS) and Bureau of Labor Statistics.

CMS statistics (Table 12) reveal that the net cost of private health insurance premiums minus benefits fell by 2.8percent in 2008. Furthermore, CMS Health Spending Projections predict that spending on private health insurance will rise 2.5percent in 2010, while prices of medical goods and services rise by 2.8percent.

Consumers' cost of health premiums is also part of the detailed consumer price index. After all the overheated rhetoric about "requested" or "expected" increases of "up to" 39 percent, who would have imagined that the average consumer cost of health insurance premiums fell by 3.5 percent in 2008 and fell by another 3.2 percent in 2009?

The president's health insurance proposals hoped to use stern command-and-control techniques to run the health insurance system. It was all about minimizing free choice and maximizing brute force庸orcing people to buy certain kinds of politically-designed insurance, forcing insurers to cover services many consumers do not want to pay for, and forcing insurers to curb or roll back premiums even as medical costs go up. The whole shaky apparatus was built upon even shakier statistics擁ncluding the purely hypothetical 39 percent increase in premiums that Mary's insurance agent reported to Duke Helfand.


British hospital trusts warned over poor infection control

Five health trusts were issued with warnings about serious breaches in hospital infection control by the health regulator last year.

An assessment of hospital infection standards resulted in the five warnings from the Care Quality Commission but the trusts responded quickly to all five warnings, which are no longer in a 途ed flag category on the issue, the regulator said.

In last year's infection assessment 42 of 167 trusts were found by the CQC to be in "breach" of NHS registration requirements, although the regulator said all but five were minor breaches.

Ambulance services in the north-west, east of England and east Midlands were the worst offenders, and received formal warnings for the state of vehicles and stations. The regulator said all had responded and now met the requirements in follow-up assessments.

The CQC carried out the assessment as part of preparations for a new licensing regime beginning on April 1. Several trusts are expected to receive conditions in the registration process because of concerns about some core care standards.


Incompetent butcher doctors free to work in the NHS

An elderly woman died after a German locum doctor carried out one of the 努orst botched operations seen in a British hospital, an inquest heard yesterday. Ena Dickinson, a former NHS volunteer, was left unable to walk after the locum made a series of errors during a routine hip operation at Grantham & District Hospital. Werner Kolb removed bone that should have remained intact and severed a major artery during the operation.

Mrs Dickinson, a 94-year-old former nurse and Red Cross volunteer from Barrowby, Lincolnshire, was left bleeding to death on the operating table. It was only when a consultant at the hospital stepped in that her life was saved. However, two months after the August 2008 operation Mrs Dickinson died. Kathy Ingram, her daughter, said that after dedicating her life to the NHS it had 斗et her down when she needed it most.

Orthopaedic specialist Professor Angus Wallace told the inquest it was 鍍he worst botched operation he had seen. The professor, who is based at Nottingham痴 Queen痴 Medical Centre, was so concerned about the case that he reported the doctor to the General Medical Council.

Last week MPs heard how a 堵aping hole in the rules on foreign doctors working in Britain is putting patients at risk. The Health Select Committee is currently investigating out-of-hours-care following the death of David Gray in Cambridgeshire in 2008. He was killed by another German doctor, Daniel Ubani, who administered 10 times the normal dose of diamorphine. Dr Ubani had flown to Britain to provide out of hours care under a contract from the local health authority.

In 2004, ministers gave GPs a controversial new contract that allowed them to give up responsibility for out-of-hours care. The General Medical Council said it is prevented from testing the qualifications of European locums who are brought in as cover.

Dr Kolb, 51, who is based in Stuttgart, was given an interim suspension by the GMC for 18 months last year. Giving a narrative verdict, coroner Stuart Fisher described it as a 杜ost disturbing case.

Mrs Ingram said: 展e feel let down. We don稚 quite understand how he got to operate on my mother. 溺y mother was somebody who was involved in the NHS and supported it even into her retirement working on the tea bar at her local hospital. After all those years the NHS let her down.

A spokesman for United Lincolnshire Hospitals Trust said: 典he Trust has apologised to Mrs Dickinson痴 family for mistakes made during her operation. 摘rrors were made by the surgeon concerned which were rectified immediately by a senior member of staff. After the operation Mrs Dickinson was recovering well and assessed to be medically fit for discharge by 25 September 2008.

典he Trust has done everything possible to learn from this incident and to prevent it happening to another patient. Changes have been made to the recruitment of medical staff, including the appointment of locums, and a new surgical safety checklist produced by the World Health Organisation has now been implemented throughout the Trust.


17 March, 2010

Obama hones final health care pitch

Fighting to overcome the impression of high spending and backroom deals, President Obama has honed his health care message to highlight his bill's benefits to consumers from better Medicare prescription-drug coverage for seniors to guaranteeing insurance regardless of pre-existing conditions.

Supporters say the White House's public relations offensive has breathed new life into Democrats' last-ditch effort to pass the legislation by next week. "So much of his activity in the last few weeks has been around health care," said Karen Davenport, director of health policy at the liberal Center for American Progress. "And I think the power of the presidency drives the stories and makes a huge difference."

After months of drift, with the House and Senate arguing over competing bills, Mr. Obama has taken control of the debate, combining the two bills into a grand compromise, adding Republican ideas and dubbing it bipartisan. On Monday, both he and Democratic leaders said they were very optimistic it would become law.

Mr. Obama took his health care pitch on the road Monday for the third time in one week, traveling to Ohio to again make his case that Congress should ignore the political implications of supporting his bill and vote for it because it's the right thing to do. "The American people want to know if it's still possible for Washington to look out for these interests, for their future," Mr. Obama told a crowd in Strongsville. "So what they're looking for is some courage. They're waiting for us to act. They're waiting for us to lead. They don't want us putting our finger out to the wind. They don't want us reading polls."

Democrats don't yet have the 216 votes required to pass the bills, but House Speaker Nancy Pelosi reaffirmed Monday that they will collect them, dismissing the concerns of some House Democrats about federal funding of abortion, Medicaid funding, Medicare reimbursement rates and the exclusion of protections for illegal immigrants. She called them unfounded. "When we bring a bill to the floor, we will have the votes," she said at a press conference while surrounded by more than a dozen babies and representatives of children's groups that support the health care reform plan.

The yearlong push for health care has seen a series of starts and missteps, culminating with Republican Sen. Scott Brown's surprise victory in a special election to fill the seat of the late Sen. Edward M. Kennedy, Massachusetts Democrat. That victory denied Democrats their filibuster-proof majority in the Senate, and gave backers in both chambers pause.

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Talking Points vs. Realty

by Thomas Sowell

In a swindle that would make Bernie Madoff look like an amateur, Barack Obama has gotten a substantial segment of the population to believe that he can add millions of people to the government-insured rolls without increasing the already record-breaking federal deficit.

Those who think in terms of talking points, instead of realities, can point to the fact that the Congressional Budget Office has concurred with budget numbers that the Obama administration has presented. Anyone who is so old-fashioned as to stop and think, instead of being swept along by rhetoric, can understand that a budget-- any budget-- is not a record of hard facts but a projection of future financial plans. A budget tells us what will happen if everything works out according to plan.

The Congressional Budget Office can only deal with the numbers that Congress supplies. Those numbers may well be consistent with each other, even if they are wholly inconsistent with anything that is likely to happen in the real world.

The Obama health care plan can be financed without increasing the federal deficit-- if the administration takes hundreds of billions of dollars from Medicare. But Medicare itself does not have enough money to pay its own way over time.

However money is juggled in the short run, the government's financial liabilities are increased by adding this huge new entitlement of government-provided insurance. The fact that these new financial liabilities can be kept out of the official federal deficit projection, by claiming that they will be paid for with money taken from Medicare, changes nothing in the real world.

I can say that I can afford to buy a Rolls Royce, without going into debt, by using my inheritance from a rich uncle. But, in the real world, the question would arise immediately whether I in fact have a rich uncle, not to mention whether this hypothetical rich uncle would be likely to leave me enough money to buy a Rolls Royce.

In politics, however, you can say all sorts of things that have no relationship with reality. If you have a mainstream media that sees no evil, hears no evil and speaks no evil-- when it comes to Barack Obama-- you can say that you will pay for a vast expansion of government-provided insurance by taking money from the Medicare budget and using other gimmicks.

Whether this administration, or any future administration, will in fact take enough money from Medicare to pay for this new massive entitlement is a question that only the future can answer, regardless of what today's budget projection says. On paper, you can treat Medicare like the hypothetical rich uncle who is going to leave me enough money to buy a Rolls Royce. But only on paper. In real life, you can't get blood from a turnip, and you can't keep on getting money from a Medicare program that is itself running out of money.

An even more transparent gimmick is collecting money for the new Obama health care program for the first ten years but delaying the payments of its benefits for four years. By collecting money for 10 years and spending it for only 6 years, you can make the program look self-supporting, but only on paper and only in the short run. This is a game you can play just once, during the first decade. After that, you are going to be collecting money for 10 years and paying out money for 10 years. That is when you discover that your uncle doesn't have enough money to support himself, much less leave you an inheritance to pay for a Rolls Royce.

But a postponed revelation is not part of the official federal deficit today. And that provides a talking point, in order to soothe people who take talking points seriously.

Fraud has been at the heart of this medical care takeover plan from day one. The succession of wholly arbitrary deadlines for rushing this massive legislation through, before anyone has time to read it all, serves no other purpose than to keep its specifics from being scrutinized-- or even recognized-- before it becomes a fait accompli and "the law of the land." Would you buy a used car under these conditions, even if it was a Rolls Royce?


The Slaughter Rule: Yet Another Reason Obamacare Would Be Unconstitutional

As written, the current health care bill before Congress already is guaranteed to face serious constitutional challenges on enumerated powers, 5th Amendment, racial discrimination, and unequal state treatment. Now the White House seems determined to add a whole new reason courts will throw out Obamacare on sight. Director of the Stanford Constitutional Law Center at Stanford Law School and former-federal judge Michael McConnell explains:
To become law揺ence eligible for amendment via reconciliation葉he Senate health-care bill must actually be signed into law. The Constitution speaks directly to how that is done. According to Article I, Section 7, in order for a 釘ill to 澱ecome a Law, it 都hall have passed the House of Representatives and the Senate and be 菟resented to the President of the United States for signature or veto. Unless a bill actually has 菟assed both Houses, it cannot be presented to the president and cannot become a law.

To be sure, each House of Congress has power to 電etermine the Rules of its Proceedings. Each house can thus determine how much debate to permit, whether to allow amendments from the floor, and even to require supermajority votes for some types of proceeding. But House and Senate rules cannot dispense with the bare-bones requirements of the Constitution. Under Article I, Section 7, passage of one bill cannot be deemed to be enactment of another.

The Slaughter solution attempts to allow the House to pass the Senate bill, plus a bill amending it, with a single vote. The senators would then vote only on the amendatory bill. But this means that no single bill will have passed both houses in the same form. As the Supreme Court wrote in Clinton v. City of New York (1998), a bill containing the 兎xact text must be approved by one house; the other house must approve 菟recisely the same text.

These constitutional rules set forth in Article I are not mere exercises in formalism. They ensure the democratic accountability of our representatives. Under Section 7, no bill can become law unless it is put up for public vote by both houses of Congress, and under Section 5 鍍he Yeas and Nays of the Members of either House on any question . . . shall be entered on the Journal. These requirements enable the people to evaluate whether their representatives are promoting their interests and the public good. Democratic leaders have not announced whether they will pursue the Slaughter solution. But the very purpose of it is to enable members of the House to vote for something without appearing to do so. The Constitution was drafted to prevent that.

Obama's Health Care 'Victim' Exposed

At his health care pep rally today, President Obama was introduced by Connie Anderson, sister of Natoma Canfield. The president said it was a touching letter written to him from Canfield that brought him to Ohio. (I'm sure the decision had nothing to do with rustbelt America being the source of Democrats' vote deficit at this point...)

In her letter, Canfield described her battle with cancer how she was forced to give up her health insurance after it became too costly--a sad story, to be sure. But, as Gateway Pundit reports, not likely an entirely true story:
Natoma Canfield is 50 years old. She was diagnosed with cancer 16 years ago. She quit her job or was laid off 12 years ago. She has reportedly held odd jobs cleaning homes the last few years. Natoma was paying $5,000 a year for her insurance but dropped it after it went up to $8,000. She wrote president Obama in December to tell him about it. She was worried she might lose her home. Some people might say she痴 lucky to still have a home after losing her job 12 years ago.

Barack Obama came to Ohio today to prop Natoma up on stage with him. But, Natoma Canfield couldn稚 make it. She is back in the hospital. (Our prayers for a quick recovery) She is getting cared for despite the fact that she has no insurance. She痴 not out on the street. She痴 not a statistic like Rep Alan Grayson would have you believe. Natoma is getting the care she needs.
And if Canfield were in favor of real reform, she should encourage President Obama to change the tax code to help insurers properly pool risks instead of additional taxation and government subsidies.

In addition, if the president really wanted to help people like Ms. Canfield, he would encourage the individual ownership rights over health care plans so the American people can maintain control over their health insurance, not employers or the government.


The Health Care Plan You are Going to Get

The itsy-bitsy spider climbed up the water spout and apparently bit the Speaker of the House. Ms. Pelosi had a delusional moment the other day, but she was clear on one thing. She never intended to listen to any Republican suggestions regarding the health care bill.

Close observation of the Bipartisan Health Care Summit provided clarity within the first half hour that there was not much bipartisan here. After listening to President Obama, Harry Reid, and Nancy Pelosi, it was obvious that there was no way that they were going to overhaul their 2,400 page (or is it 2,600) health care bill.

I recently enlisted expert advice on the issue. My source was Dr. Bill Cassidy, who doubles as the Congressman from the sixth district of Louisiana and is part of the growing breed of medical professionals that refuse to leave the administration of our country to interests hostile to a cost-effective, patient-oriented, health care system. Dr. Cassidy was elected to Congress in 2008 after spending 20 years serving the uninsured in Louisiana痴 public hospital system and teaching at LSU痴 outstanding medical school. His specialty is gastroenterology and like many other elected physicians, he still sees patients when he痴 back in his district. He is one of the very few people in Congress who truly has first-hand knowledge of those that the omnibus health care bill supposedly seeks to help.

Dr. Cassidy reminded me of an interesting exchange that confirmed President Obama痴 utter ignorance of how markets function. Republicans pointed out that the Congressional Budget Office (CBO) analysis stated that premiums would rise under the existing proposals. The President initially insisted that this was not true, but then backtracked, arguing that premiums would go up because the new policies would have additional benefits. What the President doesn稚 understand is that for each additional mandate every one of which increases premiums more and more consumers would no longer be able to afford the policy. Dr. Cassidy pointed out that the price of health care insurance is not inelastic.

Dr. Cassidy cited Senator Max Baucus as a prime example of the problem with the proposals. Other than the fact that Senator Baucus had to be tone deaf when he stated that the two sides were not really that far apart a stunning statement unto itself he shockingly misstated the reality of Health Savings Accounts (HSAs). Dr. Cassidy knew that a Kaiser Family Foundation study showed that because the HSA program provides an affordable health insurance alternative, 27% of new HSA participants were previously uninsured. Just think what might happen if HSAs were widely known and encouraged by the government.

But what seems to upset Dr. Cassidy the most is that the legislation does not address the largest problem with the health care system. He believes the system needs to be changed from a volume-based to a value-based system. The system has come to this gradually over the last 45 years as government has become more in involved in health care decisions. Doctors today need to treat huge numbers of patients to generate enough revenue to cover their costs. They often don稚 have the ability to properly focus on their patients needs and may prematurely kick their patient to a specialist or order costly tests. The value-based system that Dr. Cassidy envisions would create greater synergy between doctor and patient, reduce malpractice costs, and provide higher quality service. Unfortunately, Obamacare will force doctors to see even more patients thereby reducing individual attention even further because it cuts physician reimbursements to the bone.

The largest single challenge centers on how to pay for the plan. The Democrats propose that everyone be required to carry insurance. They blithely assume that everyone will happily buy expensive insurance to subsidize those who have pre-existing conditions. Welcome to Dreamland; there痴 no way that healthy young Americans will incur these huge costs, even with the threat of harsh (but obviously unenforceable) penalties.

Republicans have offered a far more palatable solution. Instead of arm-twisting middle-class Americans, Republicans propose to focus subsidizes on the limited market of individuals with medical challenges, and allow everyone else to buy competitively-priced products.

Dr. Cassidy is one of less than 20 health professionals in Congress able to offer realistic solutions based on their first-hand experience within the health system, but unfortunately, their sensible solutions have fallen on deaf ears. Perhaps the spider that Ms. Pelosi was speaking about had a venomous bite that has driven her to push these disastrous policies. God willing, her colleagues will listen to Dr. Cassidy and the American people.


Big rise in complaints about NHS nursing care

But complaints are usually responded to by bureaucratic coverups and there are no apparent changes

For 12 months, while her son Kane underwent treatment for cancer, Rita Cronin sat by her youngest child's bedside. She fed him, gave him drinks, washed him and ensured he had a bedpan. And if Rita was unable to be there, husband Peter, daughter Emma or other son Matthew would take over the nursing duties.

'We'd learnt, quickly, that if we didn't carry out his basic care then we couldn't rely on the nurses to do so,' says Rita, 50, a civil servant from Balham, South-West London. 'It wasn't just Kane who was affected. We saw buzzers being left out of reach and patients missing meals, as no one had the time to feed them. 'The attitude was that patients had to wait. That nurses had other, more important, things to do. The more you asked for things, the more irritated they seemed to become. The night nurses were the worst - they were always "too busy" even to bring a bedpan. But the day ones were often unhelpful, too.'

St George's hospital, in Tooting, where Kane was a patient, 'is an award-winning hospital, yet we may as well have been in a third-world country for the nursing care my son got,' says Rita.

Strong words, but Rita is, tragically, qualified to say them. For three days after being admitted to the hospital for a hip replacement, her 22-year-old son was dead from dehydration. Kane had suffered brain cancer - while treatment was successful, the chemotherapy and radiotherapy had weakened his bones, causing him to the need the surgery. The cancer had affected his pituitary gland, which regulates the body's mechanisms, such as hydration. So, Kane was on desmopressin, medication to control the flow of fluid in his body. We later discovered that the day Kane was admitted in to hospital was the last time he took desmopressin,' says Rita.

Following his hip operation, a routine test showed Kane's sodium levels were high; his fluid levels were out of balance. A ward nurse was told this by the hospital lab, but she went off duty without sorting out treatment. He began begging for water. When his requests were turned down he became - understandably - aggressive. Inexplicably, instead of reading his notes which would have indicated the problem, nurses called security staff who restrained him.

An increasingly desperate Kane then rang the police and begged for help to get a drink. The police turned up, but were sent away by nurses who reassured them Kane was confused.

By the time Rita went to see him before work the next day, it was clear her son was very ill. 'The night nurse was standing outside the room handing over to the day nurse and I said I thought Kane was really ill,' she says. 'It was clear she thought I was being neurotic and said he was fine.'

It wasn't until the ward doctor appeared on his rounds, nearly 15 minutes later, that suddenly everything changed. He took one look at Kane and quickly called for help.'

The post mortem revealed Kane had died from dehydration. Rita has other ideas, and so, it seems, does the coroner who adjourned the inquest, calling the police in to investigate.

'Kane died because of sheer incompetence of the nurses who failed to do their job,' says Rita. 'I found out later that the nurses were offered counselling. They should have been in another job.'

Over the past few years there have been far too many similar accounts. Despite all the money poured into the NHS, and the proliferation of training, job titles and initiatives, it seems patient experience is not improving. Poor nursing care was a key factor in the 400 deaths at Mid Staffordshire NHS Foundation Trust, according to the recent official investigation. Staff numbers were allowed to fall 'dangerously low', causing nurses to neglect the most basic care. While many staff did their best, others showed a disturbing lack of compassion to patients, said Robert Francis QC, heading the inquiry.

Basic nursing care and lack of hygiene have also been blamed for 70 deaths at Basildon University Hospital, where the Care Quality Commission, the health service regulator, found, among other basic failings, blood-splattered equipment and patients lying on stained and soiled mattresses.

And statistics would suggest they are not one-offs. Complaints about nurses have risen by 18.9per cent in the past year, according to the Nursing and Midwifery Council (NMC) , the profession's regulatory body. Although the organisation points out that this figure represents just 0.2 per cent of their total membership, the fact is complaints investigated by them have risen by 30 per cent since 2005.

Experts think the problem is actually far more endemic than even these figures suggest, as many people don't know about the NMC - and instead complain through the hospital system. 'Even then, many incidents are not investigated properly,' says Vanessa Bourne, of the Patients' Association. 'Answers to complaints generally fall into one of two categories; either the letter will say: "You haven't been able to name the nurses responsible so we can't investigate". Or, "you have named the nurses responsible, but they deny any wrong-doing, so we can't take the investigation further".

'The NHS managers and nursing bodies like to say this poor treatment is from a minority of nurses, but it is more about a fundamental lack of decent nursing leadership and a refusal to admit that mistakes are being made. 'When the Staffordshire scandal broke last year, we were inundated with a deluge of heartbreaking cases where people had received careless, sloppy or even rude and cruel treatment at hospitals up and down the country, and where no investigation had ever been carried out. 'The Department of Health bring out endless guidelines and initiatives on patient satisfaction and safety, but our complaint rate doesn't drop.'

Nurses themselves are also concerned about levels of care. A recent survey for the Nursing Times found that only a third of nurses were confident the poor standards at Mid Staffordshire weren't being repeated to some degree in their own hospitals.

Last week, the government published the first comprehensive report on the profession in 40 years. The Commission into the future of nursing and midwifery made some recommendations on how nursing could be improved for the 'new challenges ahead'.

While it was initiated before the recent scandals broke, there's no doubt those events were key to its proposals. 'Events like Mid Staffs do tend to focus the mind,' says Heather Lawrence, a former nurse, now chief executive of Chelsea and Westminster Hospital and a member of the commission. 'And I would agree that in some areas of the country - not all - patient trust has been eroded. As a result there has now been an acceptance within the NHS that the way some wards have been managed has not always been in the patients' best interests.'

In order to help restore patient trust, the Commission wants all nurses to pledge their "commitment to society and service users... to give high-quality care to all and tackle unacceptable variations in standards". 'The Commission is clear that high-quality, safe and compassionate care must rise to the top of the agenda for a 21st-century worldclass NHS,' said health minister and commission chair Ann Keen.

It begs the question: if high-quality, safe and compassionate care is not a priority for some nurses, why are they nursing at all? 'We welcome the pledge, but it is a sad indictment that there is a need for one in the first place,' says Vanessa Bourne. 'Patients should expect compassion.'

'The bottom line is that in Mid Staffs - - and we believe in many other hospitals, still - - there was a culture of nurses saying "its not my job". But if everyone says that, then the job - whether it's feeding a patient, or getting them a bed pan simply doesn't get done. 'Nursing is about rolling up your sleeves and caring and too many nurses seem to forget that. 'Our response would be that if you don't want to do the nitty-gritty of spoon-feeding an elderly patient or changing soiled sheets, then don't go into nursing.

'Employers also have to accept that not everyone who comes into nursing will be cut out for the job. I was told by a university nursing tutor that some trainees on her course who were clearly not suited to nursing and not interested in caring, but it was impossible to remove them because of funding complications.

So what is the solution? The official response is that we need better leadership - giving ward sisters more authority. 'One of the things we found was that on many wards there was no one figure who had the authority to properly lead the ward,' says Heather Lawrence. 'In the Mid Staffs inquiry it was discovered that one nursing sister was in charge for three wards - an impossible task.'

Nurses acknowledge leadership is part of the problem; and the solution. The Nursing Standard magazine (the nurse's own trade magazine) is campaigning to boost the authority and status of ward sisters. 'All these NHS scandals have a common theme,' says editor Graham Scott. 'There was not a clear, identifiable person in charge of the ward. 'We have ward sisters, specialist nurses and nurse specialists, nurse consultants and modern-day matrons. No wonder people get confused about who is in charge.'

But will such a simple solution make the wards a better and safer place for patients? According to Graham Scott, it will. 'Research shows that on a ward where there is an identifiable - and, most importantly, accountable - person in charge, patients have a much better experience,' he says.

The finger of blame is also being pointed at healthcare assistants, who do the basic caring jobs, such as washing, feeding and changing bedpans. 'Some NHS Trusts do train nursing assistants properly,' explains Graham Scott. Others don't. Cleaning, washing and feeding a patient are actually quite complex tasks.'

The Commission recommended these staff need some form of regulation to ensure high-quality care. 'We have to be careful about blaming the healthcare assistants,' says Bourne. 'After all, they are supposed to be supervised by the nurses.'

But will any of this make a real --difference? It seems there will be no legal recommendations to abide by the regulations. 'We do tend to raise our eyebrows at these recommendations,' notes Bourne. 'There is a big noise about them, and then everything goes back to how it was. We still get horror stories like poor Kane's. We are told things will change and they don't.'

Indeed St George's has told Rita Cronin they've made changes to ensure what happened to her son can never happen again. 'But what exactly are these changes?' she asks. 'My son suffered a needless death. How I do know that the same thing isn't happening to someone else?'

A spokesman for the hospital said: "We are extremely sorry about the death of Kane Gorny. 'From the investigation it was clear that there had been failures in communication between clinical staff. Disciplinary action did result from our findings and a number of important changes have been introduced to help prevent such a tragic incident from happening again.'


16 March, 2010

Democratic leaders say health bill will pass

Democratic leaders scrambled Sunday to pull together enough support in the House for a make-or-break decision on health-care reform later this week, expressing optimism that a package will soon be signed into law by President Obama despite a lack of firm votes for passage.

The rosy predictions of success, combined with the difficult realities of mustering votes, underscore the gamble that the White House and congressional Democrats are poised to make in an attempt to push Obama's health-care plans across the finish line. The urgency of the effort illustrates growing agreement among Democratic leaders that passing the legislation is key to limiting damage to the party during this year's perilous midterm elections.

But House Minority Leader John A. Boehner (R-Ohio) pledged to do "everything we can to make it difficult for them, if not impossible, to pass the bill." He also joined other Republicans Sunday in warning that Democrats would pay for the legislation by losing even more seats than expected in November.

The most optimistic talk on Sunday came from the White House. Obama senior adviser David Axelrod predicted that Democrats "will have the votes to pass this," and press secretary Robert Gibbs declared that "this is the climactic week for health-care reform."

But Rep. James E. Clyburn (S.C.), the Democrats' chief head-counter in the House, cautioned that the party has not yet found the 216 votes needed to win approval of the health-care bill passed by the Senate in December. "We don't have them as of this morning, but we've been working this thing all weekend," Clyburn said on NBC's "Meet the Press." "I'm also very confident that we'll get this done."

Democratic leaders are struggling to assemble support amid opposition to the Senate legislation from conservative Democrats, who object to abortion-related language in the bill, and from liberals, who are disappointed about the lack of a public insurance option and other measures. Obama has postponed a trip to Indonesia and Australia to help whip up support for the package.

Republicans pressed ahead Sunday with a battery of arguments against the Democratic plans, saying that polls show firm public opposition to the legislation and that Senate leaders are using parliamentary gimmicks in an attempt to win final passage. Sen. Lindsey O. Graham (R-S.C.), who has signaled a willingness to work with the administration on immigration and detention issues, said Obama's "arrogant" push for health-care reform has divided the country and threatens bipartisan cooperation.

"When it comes to health care, he's been tone-deaf, he's been arrogant and they're pushing a legislative proposal and a way to that legislative proposal that's going to destroy the ability of this country to work together for a very long time," Graham said on ABC's "This Week."

The Democrats' strategy calls for the House to pass the Senate version of reform, followed by consideration of a package of fixes to that legislation known as a reconciliation bill. The fixes must meet specific budget requirements allowing it to be approved in the Senate with a simple majority vote. The approach avoids having to muster 60 votes to overcome a threatened GOP filibuster; Democrats control 59 seats.

House Democrats expect to receive a final cost estimate by Monday afternoon, when the House Budget Committee is scheduled to vote on the reconciliation package. It would then go to the House Rules Committee, where Chairman Louise M. Slaughter (D-N.Y.) could package it with the $875 billion measure the Senate passed on Christmas Eve. The package is also expected to include Obama's proposed overhaul of the student-loan system.

The full House is expected to vote on both measures by week's end, with the climactic moment coming as soon as Thursday but, more likely, Friday or Saturday, aides said.


An undead corpse

Almost nobody is happy with what Sarah Palin dismisses as President Obama's "hopey-changy stuff," but the worst outbreak of hopey-changy just won't stay dead. The president's health care "reform," regarded as road kill only a month ago, is headed for a close vote in the House that he might still win.

There's abundant evidence that Mr. Obama's toxic agenda seems to be disintegrating before our very eyes. Democrats with a bad case of nerves (this includes most of them) finally admit that Obamacare has "problems," and several Democratic office-holders in Missouri suddenly had business elsewhere when the president showed up for a rally in St. Louis this week. Robin Carnahan, the Missouri secretary of state who is the leading Democratic candidate in pursuit of the Senate seat that Kit Bond, a Republican, is relinquishing, wanted ever so to be there but she had to wash her hair, or buy a stamp, or couldn't find a taxi to get to the airport for a flight home. Or whatever.

Blanche Lincoln of Arkansas, the most vulnerable Democratic incumbent, got roughed up at a tea party and is running now against the Democratic Party. "I don't answer to my party," she says. "I answer to Arkansas." Actually, she slavishly answered to her party until she stumbled into the tea party, and, as they say down on the farm, "got a little religion." Her free fall in the public-opinion polls continues.

The president no doubt feels her pain, since it's similar to his own. A new Gallup Poll finds that the president's approval rating has fallen to 46 percent, against a 45 percent disapproval. Some polls find bad news worse than that. Some Democrats ask bluntly whether Mr. Obama is losing his base. Indeed, the only people more contemptuous of the president than the conservatives are the liberals on the president's left-most flank. A growing number of them, even those who insist on calling themselves progressives, warn - or boast - that they've had it with the messiah of Hyde Park and intend to pay him back in November with the handiest club they can find, i.e., sacrificial congressional candidates.

"The liberal wing of the Democratic Party is now in shock," Chris Bowland of Santa Rosa, Calif., once a community activist like Barack Obama, tells USA Today. "It's very clear that the party hates us and has no respect for [the] base. ... Obama has broken his campaign promises and now, 'We've had it. I'm done.' "

The conventional rap on the president is that he has been aloof and disengaged, reluctant to impose discipline and leadership, and allowed his radical agenda to drift into the congressional swamp presided over by Nancy Pelosi and Harry Reid.

But wait. Maybe he hasn't been so disengaged as the conventional wisdom supposes. His strategy of imposing no discipline on Congress may be a deliberate act of leadership. Barack Obama came to Washington with an agenda from his community-organizing days. He made his bones with Saul Alinsky, the evangelist of radical politics who put down the blueprint for making America over into a European-style welfare state, with commissars empowered to supervise every detail of how Americans would live lives regimented for their own good. The debate over health care reform has been messy and often chaotic, but here we are a year later and Barack Obama and his radical agenda might yet win. If it does, he will have put in place the structure for taking over everything else.

His remark several months ago that he was willing to be a one-term president if that's what it takes to reorder America was dismissed as an irrelevancy, an aside from a man having a bad hair day. But the remark revealed an insight into the man and his mission. Karl Rove, "the architect" of George W. Bush's two successful campaigns, thinks an Obama victory over Obamacare would be a pyrrhic victory, that it might insure a Republican takeover of both House and Senate. Perhaps. But it might be a price that the president is willing to pay to get his structure in place.

The Republicans could come to office determined to repeal the monstrous "reform," but that would be easier said than done. A new Republican Congress wouldn't have the numbers to override a presidential veto. Besides, boldness is not a Republican virtue. The Republican takeover of '94 is not a reassuring omen. Killing the corpse graveyard-dead is easier now.


If the Democrats break it, they bought it

If Obamacare passes this week, every American will rightly blame every problem they have with American medicine in the future on the Democrats.

Every inability to get an appointment with a specialist or even a general practitioner. Every increase in insurance rates. Every incomprehensible bill received. Every pharmacist's refusal to fill a prescription without charge or with the drug called for with the pill actually prescribed by the doctor. And especially every inability to actually get insurance or treatment.

Democrats from the president and the House speaker on down have told us over and over again that Obamacare is the salvation of American medicine. When it turns out not to be, and premiums skyrocket and the supply of doctors dwindles, the ownership of the scheme and the method of its passage -- by partisan trickery after clear expressions of voter will in polling and at polls in Massachusetts, Virginia and New Jersey -- will embed in every voter.

"You break it, you bought it" is a phrase familiar to and accepted by most Americans. Democrats are about to break American health care -- which is extraordinary in the cures it delivers and works quite well for hundreds of millions of Americans -- and they are doing so for partisan reasons.

The consequences of the jam-down, if it succeeds, will reshape American politics. Five Ohio Democratic members of Congress, for example, face a choice this week between the demands of Speaker Nancy Pelosi and the president, and the desires of their constituents.

Zack Space, Charles Wilson, Marcy Kaptur, Steve Driehaus and John Boccieri have districts that range across the Buckeye State, but each of those districts could easily turn red this fall and punish the members who voted for the deeply unpopular Obamacare. Space, Wilson, Kaptur, Driehaus and Boccieri are being asked to vote for the Cornhusker Kickback, the Louisiana Purchase and special deals for Florida's elderly, but not Ohio's. Are they that deeply in Pelosi's pocket?

At least 50 House Democrats, from Tim Bishop on Long Island, N.Y., to Gabrielle Giffords in Tucson, Ariz., are in the same bind, but the Ohio representatives come from a state that is reeling from job loss and is seeing a sharp turn back to common sense, led by the campaigns of John Kasich for governor and Rob Portman for senator. A wave is building in Ohio, and a vote for Obamacare will only increase the exposure of these incumbents.

Rank-and-file Democrats in office all across the country have to be asking themselves, why this rush to self-destruct? Not only will a "triumph" on Obamacare cost the party its huge majorities in both houses in 2010, it will saddle the party with the legacy of damaging American health care that will define it for generations.

This is the sort of risk that has brought other major legislative overhauls forward under bipartisan banners. In recent decades, the prescription drug benefit, No Child Left Behind and welfare reform advanced major change with bipartisan backing from Congress, thus immunizing either party from the political costs of major change.

But those programs were small compared with the massive assault on American medicine reaching its crucial vote this week. If enough congressional arms are twisted and the savaging of American medicine proceeds, it has "Democrat" written all over it. And from that day forward, every tragedy that isn't averted because a doctor wasn't there or a medicine hadn't been developed or a hospital had been obliged to close will be the fault of Democrats who gambled with the lives of Americans even as the country fairly screamed, "Don't do it."


Obama's sick obsession

Nationalized health care is the progressives' Golden Fleece. It is their obsession, the ultimate prize that was denied to previous administrations but is closer than it ever has been. As the ability of government to take over the health care system draws tantalizingly near, the president and leaders of the majority party have become infected with a kind of mania. President Obama and Democratic congressional leaders seem determined to ram through a severely flawed piece of legislation by any means necessary, heedless of the desires of the American people or the negative impact on the system they mistakenly say needs to be saved.

A large majority of Americans are satisfied with their current health care plans, though most also think the system could be improved. Yet proponents of the Democrats' radical health care overhaul brazenly claim the system is irretrievably broken and only radical surgery will save it. According to the latest Gallup poll numbers, less than a fifth of even those who favor health reform agree with that position. The majority of Americans are divided between those who want a scaled-back health care measure and those who want the current project dropped entirely. If any system is broken, it is the legislative process.

Long-time Democratic pollsters Patrick H. Caddell and Douglas E. Schoen warned last week that "the battle for public opinion has been lost" on heath care. Democrats have backed themselves into a corner. If the bill fails, they suffer a defeat. But if they win, they also lose because Democrats "will face a far greater calamitous reaction" in November. "Wishing, praying or pretending will not change these outcomes," they caution.

But the glittering prize is too near for such sage counsel. The liberal leadership is infused with a sense of mission. They are the midwives to history, shepherding landmark legislation that will revise the American social contract and usher in a new era, or some such foolishness. All they need to do is pass the bill, and the poor, frightened, deluded American people will see the wisdom of their decisions. Hence House Speaker Nancy Pelosi's memorable (and revealing) comment, "We have to pass the [health care] bill so that you can find out what is in it." In her imagination, once the bill is signed, voters won't remember the struggle, just the glow of the accomplishment. Rip off the bandage; you'll feel better after the sting.

The Democrats' headlong drive is leading to bouts of political insanity, such as the aptly named Slaughter rule, which potentially could allow the House of Representatives to "deem" the health bill passed without a final vote. That the Democratic leadership would consider resorting to such a stunt betrays a high degree of contempt for the electorate, whom they presumably think will not remember or care that their representatives would not go on the record on such a major piece of legislation.

Disaffected voters, however, will recognize cowardice for what it is. Add to this the Louisiana Purchase, the Cornhusker Kickback, the backroom dealing, special-interest loopholes and fundamental unsoundness of placing government at the center of the health care system, and November will be a slaughter indeed.


Betrayal of 20,000 cancer patients: British rationing body rejects ten drugs (allowed in Europe) that could have extended lives

Up to 20,000 people have died needlessly early after being denied cancer drugs on the NHS, it was revealed yesterday. The rationing body NICE has failed to keep a promise to make more life-extending drugs available. Treatments used widely in the U.S. and Europe have been rejected on grounds of cost-effectiveness, yet patients and their loved ones have seen the NHS waste astronomical sums. Last week it emerged that 」21billion - a fifth of the entire annual budget - was spent on failed schemes to tackle inequality.

NICE, the National Institute of health and Clinical Excellence, promised a year ago to make it easier for drugs for rarer cancers to be approved. But since then four drugs which could have benefited 16,000 people have been turned down outright and a further six which could have helped 4,000 more have been provisionally rejected. Just five drugs have been accepted - benefiting 8,500 people - says a damning report by the Rarer Cancers Forum. Drugs for rarer forms of cancer are often much more expensive than those for common tumours because pharmaceutical companies cannot make economies of scale.

NICE's promise to approve more drugs was in response to widespread anger over its rejection of sunitinib, also known as Sutent, for advanced kidney cancer - even though it had been proved to double the life expectancy of patients compared to standard treatments.

Andrew Wilson, chief executive of the Rarer Cancers Forum, said: 'Although progress has been made, there is still more to do. 'It is unacceptable that thousands of patients are still missing out on the treatment they need, and their doctors want to give them, because NICE has decided that their treatment does not meet some arbitrary criteria. 'The changes introduced by NICE should be benefiting more patients than they are. An urgent review of NICE's processes is needed.'

The RCF also says NICE works so slowly that it takes 21 months to decide on a drug, during which time many patients die. This is despite promises from NICE bosses to get the decision time down to six months by the end of this year. Mike Hobday, head of campaigns at Macmillan Cancer Support, said: 'The system is failing people with rarer cancers. It's time for a more flexible approach.'

NICE's treatment of rarer cancer drugs contrasts sharply with its breast cancer drug herceptin, which has received far more funding following successful campaigns. If a patient is refused a drug, they are allowed in many cases to appeal to their primary care trust. But the RCF report uncovered a huge postcode lottery, with some trusts much more likely to back down on appeal. Of 62 PCTs, 11 approved all drugs and two approved none. And while 26 per cent of English patients have their 'exceptional case' requests rejected, the figure in Scotland is just 11 per cent.

The RCF says appeals are so expensive in terms of staff time that it would be cheaper just to give everyone the drugs they want. Its report also warns: 'PCTs are frequently using inappropriate processes to determine funding applications and a small minority of commissioners may be breaking the law by operating a blanket ban on the funding of treatments outside their licensed indication.'

In Bromley, for example, cancer treatments were less likely to be funded than cosmetic procedures. Another difference between PCTs is that some reimburse the cost of any private treatment but others do not.

NICE said last night: 'We have introduced significant additional latitude in appraisal of treatments for cancer, particularly where they are designed to extend life. 'Our End of Life Treatments protocol, introduced at the beginning of 2009, has already made it possible for very expensive cancer treatments to be recommended when our standard approach would have resulted in more cautious guidance.'


British retirees died after 'hospital staff ignored warnings over their conditions'

Two patients died after hospital staff repeatedly ignored warnings over their conditions, including one who choked on his false teeth, nursing chiefs admitted. Staff at Royal Sussex County Hospital, in Brighton, East Sussex, 田ould have done better to prevent the deaths of two pensioners last year after failing to follow basic procedures, officials admitted.

After a corner痴 damning ruling that staff at the hospital were guilty of repeated mismanagement and miscommunication, officials have made "major changes" [major bulldust, more likely] to nursing care and apologised to the patients' families.

An inquest at Hove Crown Court had heard that Brian Waller, 72, died after falling out of bed in April last year while a month later Edward Warneford, 66, died in the same ward after choking on his false teeth. In her ruling Veronica Hamilton-Deeley, the local coroner, strongly criticised the Brighton and Sussex University Hospitals NHS Trust, and said changes needed to be urgently made.

The inquest last month heard that Mr Waller, who was being treated for heart problems, fell out of his hospital bed despite wearing a wrist band with "risk of falls" written on it. He had landed on his head, broke his neck and suffered a massive bleed on his brain, which led to his death six days later. It was later discovered one of the guard rails on his bed had been left down. A doctor had also allegedly missed the fracture in his neck and cleared him to return to his ward, the inquest heard.

Mr Warneford, a former engineer, from Hove, East Sussex, died because staff did not even realise he was wearing dentures, his sister claimed. April Moss, 62, from Gosport, Hampshire, claimed her brother, who had alcohol problems, then choked on them as he ate, causing him to have a fatal heart attack.

Sherree Fagge, Brighton and Sussex University Hospitals chief nurse, admitted on Friday that staff could have done better. "We are however profoundly aware that for both Mr Waller and Mr Warneford we could have done better and we have met with both their families to apologise, listen to their concerns and assure them that lessons have been learned, she said. "We have introduced some major changes focused completely on the quality of our nursing care. Every week all of our most senior nurses, including myself, are working on the wards undertaking direct patient care alongside front line nursing staff. "What I see is that the majority of our nurses are working hard and carrying out their duties with the kindness and compassion we would want for our own families.


15 March, 2010

Why the Health Bill Makes No Sense

So it's come down to this -- desperate Democratic leaders strong-arming members on the worst bill ever before they go home to explain to constituents why they decided to commit political suicide. We've said just about all we've had to say on this issue -- actually dating back to 1993-94, when we wrote nearly 100 editorials in opposition to HillaryCare. Since January of last year, we've weighed in 150 more times against the latest version of socialized medicine. But to review, here are just 15 reasons why a government takeover of the finest medical system in the world makes no sense at all:

1. The people don't want it! This, we would think, should have some bearing on decision-making. Yet the Democrats forge ahead without consent of the governed. In the latest Rasmussen poll, 53% opposed the Democrats' reform while 42% were in favor. More than four in 10 "strongly" opposed; just two in 10 "strongly" favored. This jibes with other surveys, including our own IBD/TIPP Poll, taken since last year.

2. Doctors don't want it! A survey we took last summer of 1,376 practicing physicians found that 45% would consider leaving their practices or taking early retirements if the Democrats' reform became law. In December, the results were validated by a Medicus poll in which 25% of doctors said they'd retire early if a public option is implemented and another 21% would stop practicing even though they were far from their retirement years. Even if the bill doesn't have a "public option," nearly 30% said they'd quit the profession under the plans being considered.

3. Half the Congress doesn't want it! Not a single Republican backed the health care bill that cleared the Senate on Christmas Eve 60-39. House passage was by a slim 220 to 215, and the lone Republican "aye" has since switched to "no." Columnist Michael Barone says other changes would put the House vote today at 216-215 in favor, and he has doubts Democrats can even muster 216.

House Speaker Nancy Pelosi made her job of securing yes votes even more difficult last week when she told a meeting of county officials that "we have to pass the bill so you can find out what is in it." Members of Congress aren't waiting: They've already exempted themselves from whatever they inflict on us.

4. People are happy with the health care they've got! Polls show that 84% of Americans have health insurance and that few are displeased with what they've got. Last month, the St. Petersburg Times looked at eight polls and reported that satisfaction rates averaged 87%.

5. It doesn't even cover the people they set out to cover! Supporters of government-run health care say there are as many as 47 million Americans ? 9 million to 10 million of them illegal aliens ? without medical insurance. The Democrats' plans, however, will put only 31 million of the uninsured under coverage.

6. Costs will go up, not down! Democrats say their plans will cost less than $1 trillion over the first decade. But analyst Michael Cannon at the Cato Institute puts the cost at $2.5 trillion over the first 10 years. Even if we go with the government's lower estimates, the cost is already on the rise. A new estimate by the Congressional Budget Office puts the cost of the Senate bill at $875 billion over 10 years, $4 billion more than its original projection. Imagine how fast costs would soar if one of the bills became public policy.

7. Real cost controls are nowhere to be found! The Democrats are offering no meaningful tort reform that will help push down the high malpractice insurance premiums that are a burden to doctors and their patients. Nor are they considering any other cost-saving provisions, such as allowing the sale of individual health plans across state lines or easing health insurance mandates.

8. Insurance premiums will rise, not fall! One goal of nationalizing health care is to lower costs, to bend the spending curve downward. Yet, as Democratic Sen. Dick Durbin acknowledged Wednesday, that won't be the case.

"Anyone who would stand before you and say, 'Well, if you pass health care reform, next year's health care premiums are going down,' I don't think is telling the truth," he said from the Senate floor. "I think it is likely they would go up."

An analysis completed by the CBO at the request of Sen. Evan Bayh confirms Durbin's suspicions. Insurance coverage in the individual market will "be about 10% to 13% higher in 2016 than the average premium for nongroup coverage in that same year under current law," it concluded.

9. Medicare is already bankrupting us! The Medicare trust fund, which has unfunded obligations of $37.8 trillion, will be insolvent in 2017. How can lawmakers justify another entitlement that will cost trillions when they can't pay for existing liabilities?

10. There aren't enough doctors now! Last month, 26% of physicians responding to a Web poll on, which calls itself "the largest online physician community," said they had been forced to close, or were considering closing, their solo practices. Providing coverage for an additional 31 million Americans when the number of doctors is shrinking won't improve our health care.

11. The doctor-patient relationship will be wrecked! The latest IBD/TIPP Poll, taken just last week, found that Americans, by a wide 48%-26% margin, believe the doctor-patient relationship will decline if the Democrats' plan is passed.

12. Medical care will also deteriorate! IBD/TIPP has also found that 51% of Americans believe care would get worse under government control. Only 10.5% said they felt it would improve. In our doctor poll, 72% disagreed with administration claims that the government could cover 47 million more people with better-quality care at lower cost.

13. Rationing of care is inevitable! Health care is not an unlimited resource and must be rationed, either by the individual, providers or government. In Britain and Canada, where the government does the rationing, medical treatment waiting lists are sometimes deadly and quite often excessively long.

For instance, late cancer diagnoses in an overcrowded public health care system cause up to 10,000 needless deaths a year in Britain. The reasons cited for the late diagnoses include doctor delay, delay in primary care, system delay and delay in secondary care.

14. Private health insurers will be destroyed! Added mandates and price controls will force many insurers to simply get out of the health plan business because it will no longer be profitable.

15. It's probably unconstitutional! One way to help bring down the number of uninsured is to demand that those without coverage buy health plans. But the government has never passed a law requiring Americans to buy any good or service. Constitutional scholars say any such mandate would likely draw a legal challenge.


Top Democrat Implies Obama Not 禅elling the Truth about Health Care Premiums

Senate Majority Whip Dick Durbin (D-Ill.) on Wednesday contradicted President Barack Obama on whether the health care reform bill will lead to a decrease in health care premiums. Durbin claimed that rates would go up, while the president said the rates would go down. 鄭nyone who would stand before you and say well, if you pass health care reform, next year's health care premiums are going down, I don't think is telling the truth. I think it is likely they would go up, but what we are trying to do is slow the rate of increase, Durbin said, speaking on the Senate floor.

Compare Durbin痴 remarks to what President Barack Obama said during a speech at Arcadia University in Glenside, Pa., on Monday: 徹ur cost-cutting measures mirror most of the proposals in the current Senate bill, which reduces most people痴 premiums and brings down our deficit by up to $1 trillion over the next decade because we池e spending our health care dollars more wisely, the president said. 典hose aren稚 my numbers. Those aren稚 my numbers --they are the savings determined by the Congressional Budget Office, which is the nonpartisan, independent referee of Congress for what things cost, Obama added.

But as reported, the Congressional Budget Office痴 analysis of the final Senate health care bill indicates that it would impose a mandatory $15,000 annual fee on middle-class families that earn greater than 400 percent annually of the federal poverty level. That means $88,200 for a family of four.

Among the five basic facts that the CBO analysis cites about the bill is that 添our family insurance plan if your employer drops your coverage and you are forced to buy it on your own will cost about $15,000 per year when the legislation is in full force in 2016.


Dems seek agreement, quick vote on health care

Under White House pressure to act swiftly, House and Senate Democratic leaders reached for agreement Friday on President Barack Obama's health care bill, sweetened suddenly by fresh billions for student aid and a sense that breakthroughs are at hand. "It won't be long," before lawmakers vote, predicted Speaker Nancy Pelosi. She said neither liberals' disappointment over the lack of a government health care option nor a traditional mistrust of the Senate would prevent passage in the House.

At the White House, officials worked to maximize Obama's influence over lawmakers who control the fate of legislation that has spawned a yearlong struggle. They announced he would make a campaign-style appearance in Ohio next week to pitch his health care proposals, as well as delay his departure for an Asian trip later in the month.

With Democrats deciding to incorporate changes in student aid into the bill, Republicans suddenly had a new reason to oppose legislation they have long sought to scuttle. "Well of course it's a very bad idea," said Senate Republican leader Mitch McConnell of Kentucky. "We now have the government running banks, insurance companies, car companies, and they do want to take over the student loan business." He said it was symptomatic of Democrats' determination to have the government expand its tentacles into absolutely everything."

At its core, the health care bill is designed to provide health care to tens of millions who lack it and ban insurance companies from denying medical coverage on the basis of pre-existing medical conditions. Obama also wants the measure to begin to slow the rate of growth in medical costs nationwide. Most people would have to get insurance by law, and families earning up to $88,000 would receive subsidies.

Whatever the outcome, there was no doubt the issue would reverberate into this fall's elections, with control of Congress at stake. The health care bill appeared on the cusp of passage in early January, but was derailed when Senate Republicans won a Senate seat in Massachusetts, and with it, the strength needed to sustain a filibuster and block a final vote.

In the weeks since, the White House and Democrats have embarked on a two-part rescue strategy. It calls for the House to pass legislation that cleared the Senate in December, despite numerous objections, and for both houses to follow immediately with a second bill that makes changes to the first. The second, fix-it bill would be drafted under rules that strip Senate Republicans of the ability to require Democrats produce a 60-vote majority.

Obama outlined numerous requested changes several weeks ago, many of them designed to satisfy the concerns of House Democrats. They would increase subsidies for lower income families who cannot afford insurance; give additional money to states that provide higher-than-average benefits under Medicaid, and gradually close a coverage gap in the Medicare prescription drug program used by millions of seniors.

Congressional officials said all three issued would be addressed in the fix-it bill, although other administration requests remained in doubt. The president wants creation of a commission with authority to force savings in Medicare and Medicaid, for example, and is seeking the deletion of items sought by individual senators. Those were among the issues still in dispute after days of secretive talks involving the White House and House and Senate leaders.

The decision to add far-reaching student aid changes to the bill had its roots in obscure parliamentary rules governing the Senate's debate of the legislation. But House Democrats and the White House quickly seized on it as a way to advance a top administration priority that lacks the 60 votes needed to clear the Senate otherwise. The measure would require the government to originate student loans, closing out a role for banks and other private lenders who charge a fee. Obama proposed taking the savings and plowing it into higher Pell Grants that go to needy college students. Officials said that under current estimates, the change would free as much as $66 billion over a decade, although Pelosi indicated she wanted it spread beyond Pell Grants to other education programs.

At a news conference, the speaker confessed to being disappointed that the legislation would not include a government-run health care option, but said other parts of the legislation would hold insurance companies accountable. The tussle over a public option roiled Democrats for months, but has subsided in recent weeks. "We've crossed that bridge," said Rep. Bill Pascrell, D-N.J. "Those people who were saying 'public option' are muted right now. That's done. It's not going to happen. They've hit the mute button."

At a closed-door meeting of the rank-and-file, House Democratic leaders sought to allay concerns that Senate Democrats might simply refuse to pass the fix-it bill after the House swallows the measure it doesn't like. Rep. G.K. Butterfield, D-N.C., said party leaders told the House caucus they have "a firm commitment" from the Senate to do its part.


Dereliction of Duty

How many flavors of crazy is it for President Obama and Democrat leaders to continue the forced march toward a vote on a health care bill despised by the majority of Americans? The New York Times lays out what's happening: "Leaving a meeting of the House Democratic Caucus, lawmakers said they had received few details about what would be in the [health care] legislation, on which they may be asked to vote in the next week or two".

Got that? This is legislation that would remake fully 1/6 of the US economy, and the House members who are being pushed to vote on it aren't even sure about what's in its final version. How, under any circumstances, can voting in favor of this -- given the rush, the uncertainty about the bill's contents, not to mention its effects (and including the widespread, fierce opposition to it) -- be anything other than a dereliction of duty?

Pat Caddell and Doug Schoen warn that passing the legislation will be a political disaster for the Democrats. Frankly, the point is so obvious that it's frightening that it needs to be made.

But the bigger problem now, for Democrats, is that their interests and President Obama's diverge. Many Blue Dogs can save themselves (and their party) if they take a principled stand against ObamaCare. But the President needs this victory -- in a sense, just to stay in the game. Without it, he's revealed as politically impotent. With it, he can at least comfort himself with his "historic" expansion of the welfare state.

Overall, though, the President's in trouble either way this goes. Even if he wins, he's paid a heavy price. First, he's lost the trust of the American people by his willingness to say anythign to get the bill passed; second, he's shown himself willing to ignore the expressed wishes of those he governs; and third, he's revealed himself as arrogant enough to believe that opponents are too stupid to understand what's in the bill -- but once ObamaCare is foisted upon them by the "platonic guardians" in The White House and on Capitol Hill, the ignorant rubes will love it.

A President can come back from political defeat. Recovering after losing the trust of the people is much more difficult.


Health-Care Hell

by Jonah Goldberg

The time for talk is over. So proclaimed the most talkative president in modern memory. I can't remember when Barack Obama said that. Maybe it was during the first "final showdown" on health care. Or maybe it was the third. The fifth? It's so hard to tell when pretty much every week since the dawn of the Mesozoic Era, Obama or Nancy Pelosi or Harry Reid has proclaimed that it is now Go Time for health-care reform. So you'll forgive me if I'm somewhat skeptical about the possibility that the health-care reform debate is about to come to an end.

The president recently said, "Everything there is to say about health care has been said, and just about everybody has said it." But wait. If everything, pro and con, has been said about the subject, by everybody, that means someone isn't telling the truth, right? I mean, if you've said X and not-X, that means you've probably said something that isn't true.

That, at least, is the impression I got this week listening to Obama make his closing arguments for health care at rallies in Pennsylvania and Missouri. It's telling that the president -- long in favor of a single-payer system -- is selling his health-care plan on the grounds that it will increase "choice" and "competition," reduce "government control" and "give you, the American people, more control over your own health insurance."

You know your sales pitch for a government takeover of health care hasn't worked when you have to crib rhetoric from free-market Republicans. And that's after you've already tried to pin your plan's unpopularity on the ignorance of the American people.

Obama's talking points track reality about as well as the screenplay for "Avatar." Indeed, the same week he was hawking competition, choice and less government, Obama backed a new Health Insurance Rate Authority that would do even more to cement big health insurance companies into their new role as government-run utilities.

This latest gambit is of a piece with the White House's demonization of the health-insurance industry. I have no love for that industry myself, but let's get some perspective. As of August, the health-insurance industry ranked 86th in terms of profit margins -- behind anemic industries such as book publishing (38th) specialty eateries (71st) and home furnishing stores (84th), according to data compiled by Mark Perry of the American Enterprise Institute.

Insurance companies account for less than 5 percent of American health-care spending -- less than hospitals (31 percent), doctors (21 percent) and medicine (10 percent). But because health-insurance companies are unpopular, Democrats are beating up on them, even though if Democrats are serious about containing costs, the cuts will have to come from those other slices of the pie.

But enough with the substance. The health-care debate ceased being about substance a long, long time ago. Fair or not, the Democrats' plan is unpopular, period. There is simply nothing Obama can say that will change that fact before Democrats vote for it. That hasn't stopped him from talking out of every side of his mouth. But outside the Obama bunker, no serious pollster, pundit or pol in Washington disputes this basic point: Obama cannot take the stink off this thing.

And that's why the Democrats are contorting themselves like a yoga swami in a hatbox trying to figure out how to pass it. (Note: If it were simply popular among Democrats, it would have passed months ago.) The latest idea involves the "Slaughter Solution" -- named after House Rules Committee Chairwoman Louise Slaughter -- which would allow the House to fix-and-pass the Senate version of the bill without ever voting on the senate version, or something like that.

But here's the thing: There is no "over" to this debate. Obama, Pelosi & Co. have demonstrated time and again that no deadline is final if it means losing. Meanwhile, if ObamaCare passes, Republicans will run on a promise to repeal it, and that means we'll be debating health-care reform at least through 2010. Then, depending on how the election goes, the repeal debate will become part of the legislative process. That will in all likelihood carry the debate into the 2012 presidential election. In other words, there will be time for talk as far as the eye can see.

Now, part of me thinks this is too cruel a future to contemplate. I can't remember whether it was pederasts or mattress-tag removers, but I'm pretty sure someone in Dante's Inferno is condemned to spend eternity listening to a C-SPAN panel on community rating, preexisting conditions and rate pools. But it's a better prospect than losing. That's one point that has bipartisan support.


Baby twins put in NHS hospitals 50 miles apart

Because of very limited facilities for premature births

The parents of two-month-old twins have criticised the NHS for placing their poorly daughters in separate hospitals, 50 miles apart. Stephanie Dawson, 25, and her partner Martin Collins, 38, have to take a 121-mile trip to visit Ruby and Krystal Dawson-Collins, which they said leaves them with just 10 minutes with each daughter.

The twins were born at just 26 weeks in Maidstone Hospital, Kent, weighing 1lb 9oz and 2lb 4oz respectively. They were suffering from Twin to Twin Transfusion Syndrome, where one twin gets more blood in the womb than the other. Following their birth by Caesarean section on January 18 they were transferred to a specialist neonatal unit at St Peter's Hospital in Chertsey, Surrey. After a few days Krystal was deemed well enough to be transferred to Pembury Hospital in Tunbridge Wells, Kent, and split up from her sister.

Her parents, who do not have a car, said they were struggling to visit each baby while still caring for their two other children Mitchel, 10, and Kym. They said that even with the help of friends and family the distance means they can only see their frail daughters twice a week as they cannot leave their Maidstone home until they have collected Mitchel from school. Mr Collins said: "We only get about 10 minutes with each of them, a quick update and a stroke of their heads, before we have to get going.

"It is so awkward getting up through Pembury then into Surrey. "I would have thought it was better for them to be together and it would be easier for us if they were in one place, even if that was in Surrey. "It's like no one realises we are miles away and don't have a car. It is a real struggle, but for the sake of our family, we cannot lose it."

A spokesman for the Maidstone and Tunbridge Wells NHS Trust said the girls needed very specialist care only provided in a handful of hospitals in the South East. He said: "We recognise this is a tough time for Stephanie and Martin and are helping them in any way we can."

Dr Paul Crawshaw, clinical director for paediatrics at the Ashford and St Peter's NHS Trust, Surrey, said the separation was a short-term situation. He said: "We always regret the separation of twins and are well aware of the difficulties it is causing the family. "We hope to get them reunited in the very near future."


Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!