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30 September, 2009

Britain's NHS? It's about as good as the health system in Slovenia

The National Health System is on a par with Slovenia and the Czech Republic, according to an analysis by European researchers. The NHS came 14th out of 33 European countries, making it one of the worst systems in Western Europe. The study - the Euro Health Consumer Index - found the NHS performed particularly badly on waiting times, even though these have fallen thanks to Labour targets. The survey says that the NHS is dragged down by waiting lists but the Department of Health claims the report is 'flawed'

It is also one of the least efficient, delivering less service per pound put in. The annual survey is by HealthConsumer Powerhouse, which campaigns for social insurance type systems rather than nationalised models such as the NHS. It ranks 33 systems on 38 factors such as patient rights, waiting times and access to medicines. Total possible score is 1,000 points and the Netherlands tops the list with 875, followed by Denmark (819) and Iceland (811). The UK, with 682 points, ranks just behind Ireland's 701. Lowest ranking of all was Bulgaria's 448 points. The NHS ranking was just above former Communist states Slovenia and the Czech Republic but below France, Germany and Ireland. It did rank better than Italy however.

The Netherlands is the only country which has consistently ranked in the top three during the five years the survey has been carried out.

But the UK's has been steadily increasing. It could have been higher this time, but the report comments: 'A mixed performance is shown by the UK: the overall UK score is dragged down by waiting lists and uneven quality performance'.

A spokesman for the Department of Health said: 'Once again, the European Consumer Health Index report is based on flawed methodology and old data. 'There is a lot of credible and up-to-date evidence available showing just what great strides have been taken, on the back of record investment, in improving NHS services across the country. 'The NHS is treating more people and saving more lives than at any time in its history with waiting times at their lowest levels since records began.' 'Twelve years ago it was not uncommon for patients to have to wait over 18 months for an operation. 'Record investment and dedicated staff have given patients the shortest waits since NHS records began with average waits from referral to start of treatment at around eight weeks for admitted patients and four weeks for non-admitted patients.' [We won't mention the many "fudges" used to produce those figures]

SOURCE




Senior British hospital doctor could face charges after jury rules patient died of gross neglect

A consultant could face a manslaughter investigation after a cancer patient died when she was mistakenly prescribed a lethal overdose of chemotherapy, an inquest heard. Anna McKenna, 56, was given four times the recommended daily amount of Idarubicin to treat her bone marrow cancer. Mother-of-five Mrs McKenna should have taken 60mg of the drug over four days, but was told to take 60mg per day.

Yesterday Avon Deputy Coroner Brian Whitehouse heard a jury return a narrative verdict of manslaughter due to gross neglect after a jury returned a majority decision of eight to two. The ruling now means that the CPS will review its decision that there was no criminal case to answer.

Anna's family told the five-day hearing that blundering doctors ''panicked'' and tried to ''cover up'' the error by refusing to tell them she had been given the wrong medication. The overdose destroyed Anna's infection-fighting white blood cells, leaving her immune system powerless against disease. She developed renal failure and died at the Bristol Oncology Centre three weeks later on April 18 2006.

Dr Jacqueline James, a consultant haematologist at Frenchay Hospital in Bristol, admitted the blunder at the inquest and said she was ''very sorry'' for what happened. Recording a verdict of manslaughter due to gross neglect yesterday, Avon deputy coroner Brian Whitehouse said: ''I offer my sincere condolences to the family."

Mrs McKenna, a housewife from Knowle, Bristol, was diagnosed with multiple myeloma, a cancer of the bone marrow, in March 2006 and prescribed a course of chemotherapy tablets. Her condition was terminal, the treatment was administered in the hope of prolonging her life. Without the medication, doctors gave her just two years to live. But Mrs McKenna was given a prescription for 60mg of Idarubicin per day, instead of the usual 15mg or 20mg per day. The drug left her in agonising pain, suffering with vomiting and diarrhoea. It also sparked a high fever and led to renal failure.

Her daughter Nancy McKenna said: ''It was such a traumatic experience for my whole family seeing our mum like that. You wouldn't treat your dog the way they were treating her. ''Mum was rushed to hospital after being so ill for many days. When we got there we told the doctor that she had been given an overdose and she told me to go home and bring in the medication mum was on. ''I brought it in and the doctor looked at it. I kept on and on as did the rest of the family about the fact she had been overdosed but no one was listening. ''We told the doctors treating mum that we thought she had been given the wrong dose of Idarubicin and we maintain that."

Dr James admitted prescribing four times the recommended dose and said: ''I am very sorry that a mistake was made.'' Verdict: Manslaughter due to gross neglect.

Outside court a family statement, read by solicitor Kerstin Scheel, said: ''The family of Mrs McKenna have been absolutely devastated by her sudden and unnecessary death in April, 2006. ''They feel extremely angry not only that such a serious mistake was made in her prescription but also that this was not found by the pharmacist who was supposed to act as a safety net to the patient. ''They greatly hope that this will never happen again to another patient and that the new safeguards in place will make a difference for others in the future. ''Anna was a devoted wife, mother and grandmother and is sorely missed by her whole family.''

Chris Burton, medical director of North Bristol NHS Trust, said: ''North Bristol NHS Trust would like to take this opportunity to repeat it's sincere apologies and condolences to Mrs McKenna's family and friends. ''The trust has cooperated fully with external investigations into the circumstances surrounding Mrs McKenna's death. ''Patient safety is our priority and following Mrs McKenna's death we made immediate and significant changes to our procedures around prescribing and issuing Idarubicin.''

A spokesman for Avon and Somerset police said: ''South Gloucestershire police investigated the circumstances surrounding the death of Anna McKenna in 2006 and prepared a file for the Crown Prosecution Service. ''After consideration by specialist lawyers, the CPS decided that there was not a criminal case to answer and police submitted a file to the coroner. ''Following the verdict of unlawful killing, the case will be reviewed in liaison with the CPS. South Gloucestershire police again offer their sincere sympathy to the family of Anna McKenna for their loss.''

SOURCE




Poll: Support for Obamacare at New Low

Only 41 percent of voters now support President Barack Obama and the Democrats' healthcare reform proposal — down from 44 percent two weeks ago and the lowest level of support yet measured by Rasmussen Reports. Rasmussen's nationwide telephone survey also found that 56 percent of voters are now opposed to the plan. Just 33 percent of senior citizens favor the plan, while 59 percent are opposed. Other findings of the poll:

# 46 percent of respondents believe the reform plan will likely pass and become law this year, but 47 percent think it will likely not pass, including 15 percent who say it is not at all likely to pass.

# While 23 percent of voters "strongly favor" the legislative effort to reform healthcare, 43 percent are "strongly opposed."

# 24 percent of respondents say the quality of healthcare will improve if the plan passes, and 55 percent say it will get worse.

# 54 percent say passage of the plan will increase the cost of healthcare, and 23 percent say it will lower the cost.

# The overwhelming majority of voters — 78 percent — believe that every American should be able to buy the same health insurance plan that Congress has.

# 53 percent think tort reform will significantly lower the cost of healthcare.

# 48 percent of respondents want a prohibition on abortion in any government subsidized program, and 13 percent want a mandate requiring abortion coverage.

"The most important fundamental is that 68 percent of American voters have health insurance coverage they rate as good or excellent," Scott Rasmussen, president of Rasmussen Reports, wrote recently in The Wall Street Journal. "Most of these voters approach the healthcare reform debate fearing that they have more to lose than to gain."

SOURCE




Blue Dogs in the Doghouse over the Public Option

With the debate over ObamaCare proceeding into the month of October, and still no vote in the House on H.R. 3200, there is no question that House Speaker Nancy Pelosi remains dedicated to pursuing the so-called public “option.” She says it could “save enormous amounts of money.”

Her latest defense of the public “option”—which is not at all optional since it requires every American to have insurance—are a part of her attempts to woo the 52 member House Blue Dog caucus, 40 of whom have sworn up and down not to vote for a plan that adds a single cent to the deficit. The validity of her promise to “save” money is critical.

How much in savings is House leadership promising? According to the Wall Street Journal, “Congressional aides said including a government-run plan for people under 65 in the health overhaul could save as much as $100 billion, if such a plan were to pay health-care providers the low rates used by Medicare…”

Which is funny. The House version of the plan makes eligible some 45 million people not currently covered under government-run health care, taking the number from 80.3 million currently covered to some 125.3 million. It’s simple math. An average premium goes for about $4,700, and adding 45 million to the government rolls, as envisioned under the House bill, would actually add $211.5 billion a year.

Nobody thinks this is deficit-neutral. Except for Barack Obama, the House majority, and a few sycophants who wish to maintain a talking point. By the House majority’s standard, that means the nation will wind up actually “saving” money. “[E]normous amounts of money.” But everyone else knows this will be costly very costly.

And unless House Blue Dogs wish to go from the people’s House to the doghouse, they had better make good on their promise not to add a cent to an already out-of-control debt—now some $11.8 trillion.

SOURCE




Health Care Analogies

It is good that the President has ceased attempting to sell his public option health care initiative on the strength of a comparison to the United States Postal Service. Americans will not soon be convinced of the economic viability of an expansion of public healthcare when it is compared to an entity on track to lose $7 billion this year. This past summer the Government accountability office put the postal service on its high risk list because of its “increasingly shaky financial footing,” and in the spring Post Master General John Potter asked Congress for permission to cut delivery service back to 5 days per week and close 700 offices nation wide. This is not the sort of talk that inspires confidence that a government takeover of the healthcare industry is the answer to our fiscal tribulations.

It is bad that the President, demonstrating what can only be described as intellectual density, has chosen instead to compare his public option to our system of state colleges and universities. This is particularly ironic given the fact that the cost of higher education has been skyrocketing for years and has in fact outpaced that of healthcare. Even more ironic is that according to the College Board's annual tuition survey, the rate of growth of the price of public 4 year colleges has been faster than at private 4 year colleges; a trend that has persisted for 3 decades.

The Los Angeles Times recently reported that the California State Board of Regents has asked for an increase in fees for undergraduate residents that would be 44% higher than they were in 2008. In addition they are considering “ideas to reduce freshman enrollment by an additional 2,300 students…and to charge extra fees for some upper division undergraduate majors, such as business and engineering.” A quick Google search reveals similar stories being reported across the country.

Our public institutions of higher learning struggle with rapidly rising costs and they do so for many of the same reasons as their private competitors, which as it happens are similar to those responsible for increases in the cost of healthcare: inflated demand and over reliance on third party payers and subsidies.

In fairness to the President, one of the points he is trying desperately if unsuccessfully to make is that public and private entities can co-exist. The point his detractors are making with increasing success is that if the problem we are attempting to address is the rising cost of healthcare, a “public option” is not a solution. The presence of a state run university system has not curtailed the rising cost of education in general nor has the “public option” slowed the rise in the cost of Public education specifically.

Of course Obama insists that taxpayers will not be subsidizing his public healthcare option; that it will be “self-sufficient” and “financed solely by the premiums it collects.” Revealing a disturbing lack of economic literacy he insists this can be accomplished because the public option will reduce waste and overhead and will not be burdened by the need to make a profit. (As if profit were some arbitrary and evil charge added onto a product or service. In fact it is the engine that drives the efficiency and cost cutting the president claims to be seeking. If it were not so we would have seen over the years non-profit organizations taking away the customers of profit seeking enterprises. Alas the opposite has been true. But I digress.)

Inquiring minds are dying to know A) why no one else has ever thought to reduce waste and inefficiency and B) what will account for the difference between the true cost of health care services and the price his public option will charge in order to make it “affordable.” Raise your hand if you hear Joe Wilsons voice echoing in the background. Rather like how public universities make higher education affordable to the masses the “public healthcare option” will be subsidized by taxpayers!

And like the public university system, when the government, which will be responsible for setting the price of care (as it sets the price of education at public schools), limits its financial commitment the institution must respond by raising its price and/or cutting and rationing its services. As the price is forced to better reflect the true cost of the service it will become less “affordable,” and like in higher education higher prices will increase the demand for financial aid, which according to both education and health care economists is a major driver of price inflation.

It is not fear of a Black Planet (as has been suggested by several new left apologists) that has sparked public opposition to the President’s ideas for health care reform. For an increasing number of Americans “Obamacare” is analogous with a slow-to-respond or unresponsive bureaucracy, suffering cost over-runs and seeking service reductions, and lay-offs in order to shore up its increasingly “shaky financial footing.”

SOURCE




Democrats unable to quell health care revolt among seniors

Senior citizens are putting the Democratic Party's 2010 election prospects and their health care reform proposals on a collision course. Outraged over Democratic plans to cut between $400 billion and $500 billion from Medicare in the next decade, voters over the age of 65 are poised to make the party suffer even steeper losses at the polls than have already been predicted for the midterm election. "Seniors bear the brunt of these bills as they are currently funded," said Betsey McCaughey, a former Republican lieutenant governor of New York and conservative health care policy expert. "It's a medical assault on seniors."

Democrats argue that Medicare is going bankrupt and must be reined in, and the cuts on the table will for the most part address wasteful spending and not take away benefits. But many seniors, who tend to make up a larger proportion of the electorate in off-year elections, are not convinced. They turned out in huge numbers at town hall meetings this summer, and poll numbers support what appears to be wide opposition among them.

A new survey from Rasmussen Reports found only 33 percent of voters over the age of 65 are in favor of the Democratic health care plan outlined by President Obama -- eight points lower than the electorate as a whole. Of those seniors against the Obama plan, 46 percent said they "strongly oppose" it.

At the center of the debate is a plan to slash spending on a program called Medicare Advantage, which is administered by private insurers and offers benefits beyond regular, government-administered Medicare plans, such as dental and vision coverage in exchange for larger premiums. It is used by about 10 million seniors, roughly 20 percent of all Medicare recipients. In the Senate, lawmakers are drafting a bill that would cut about $123 billion from Medicare Advantage over the next decade, which the Congressional Budget Office estimates would slash extra benefits seniors receive under the Medicare Advantage plans by half and that enrollment would drop by 2.7 million.

Democrats argue that Medicare Advantage costs too much and is driving Medicare toward insolvency, but Republicans are now seeking to protect it, which will undoubtedly help secure votes from this group in 2010.

Overall cuts to Medicare outlined in the Senate bill now being drafted include a $211 billion reduction in payments to hospitals, nursing homes, home help and hospice care, in addition to the cuts in Medicare Advantage. The Medicare reductions are making Democrats nervous, which some health care experts believe will result in a bill with far fewer cuts to the program. Sen. Bill Nelson, D-Fla., has introduced an amendment that would spare those currently enrolled in Medicare Advantage from any new cuts. "I can tell you this senator does not want to be in a position that I am taking away benefits from existing senior citizens," Nelson told the committee.

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29 September, 2009

Plans for swingeing hospital cuts as British system on brink of 'Armageddon'

Health service managers warned of an "Armageddon scenario" facing NHS finances as they draw up secret plans for swingeing hospital cuts. Senior officials have set "aggressive" targets to reduce the number of patients referred to specialists, or treated in Accident and Emergency departments, while GPs will be asked to cut down on the amount of time spent in consultations.

The plans are being issued as senior managers warned that the NHS is about to face the greatest financial pressures since its inception. They fear that when the current spending round ends in 2011, the impact of an anticipated real terms freeze or cuts – coming as the demands on the NHS of an ageing population increases – will be devastating.

The NHS Confederation, which represents NHS managers, will tell this week's Labour Party conference that the impending challenge is so great that hospital closures and job cuts must be enforced across the country. It comes as two leading think tanks predict a future funding gap of between £20bn and £40bn within six years of 2011. Regional health authorities have ordered hospitals and primary care trusts to draw up plans for cuts worth billions.

In London, NHS trusts have been told to divert more than half of A&E patients, and those seeing specialists, to cheaper "polyclinics" run by groups of GPs. Meanwhile, family doctors will be asked to speed up their consultations, reducing the average time per patient from 12 minutes to eight.

The instructions drawn up by NHS London, and seen by The Sunday Telegraph, order trusts to demonstrate that they can deliver an "aggressive scenario" in response to funding pressures. Under its "affordability assumptions," already controversial plans to reduce the number of patients treated in hospital are given more demanding targets in an attempt to cut costs.

Sixty per cent of activity which now takes place in A&E departments should happen in community clinics within five years, the document says, along with 55 per cent of outpatient treatment. Thirty per cent of outpatient appointments will be stopped altogether. Managers say not all appointments are necessary, though many doctors argue it is impossible to know in advance which patients do not need to be seen. The number of diagnostic tests carried out will be cut by 15 per cent, while the amount of surgery will be reduced by seven per cent.

Although the "polyclinic" model, to reduce demand on hospitals, is supposed to shift more treatment into the community, GPs will be told to reduce their average appointment time by one third, from 12 minutes to eight.

Senior managers in other regions, who will draw up their own plans later this year, said rural communities faced particular pressures, with small maternity and district general hospitals likely to struggle in the funding crisis.

In a speech tonight to the Labour Party conference in Brighton, the NHS Confederation will warn that the service across the country faces unprecedented difficulties, which require "bold and decisive measures". Its policy director Nigel Edwards told The Sunday Telegraph: "The NHS has never experienced a financial challenge of this magnitude or duration in its history". He said improving the operation of the NHS, and treating more patients earlier in primary care, would not be enough to balance the books. Delegates will be told: "Savings only start to become available when we can shut entire buildings, sites and reduce staffing numbers."

The organisation, which represents NHS managers, will also call for "uncomfortable decisions" to be made to limit staff pay. Under a three year deal already agreed, nurses will receive a rise of 2.25 per cent in April. Sir Robert Naylor, chief executive of University College Hospital in London, said pay should be frozen for NHS staff after that point. If it was not, every one per cent pay rise could cost 10,000 job cuts, he said.

The chief executive said that while he supported plans to treat more patients in the community, he was concerned that PCTs were planning to cut back on hospital services before alternatives were put in place. "The investment in those services has to come first or where do the patients go?" he said, criticising "over simplified" analyses which failed to take into account of increasing public demand.

Dr Laurence Buckman, chairman of the British Medical Association's GP committee, described the plans as "desperate and inadequately thought through". Dr Buckman, who works as a GP in London, said targets to reduce outpatient appointments by 30 per cent would put patients at particular risk. He said: "All this means is that those people who are refused a referral to a specialist will be forced to go privately, or go nowhere. This will be difficult for doctors, but patients will be the real victims." While some specialist referrals turn out to be unnecessary, GPs only asked for a specialist opinion when they needed it, Dr Buckman said.

A study by the King's Fund and the Institute for Fiscal Studies forecasts a funding gap of between £20bn and £40bn by 2017, if funding for the NHS receives no increase, or gets a real terms freeze which only keeps pace with inflation. Sue Slipman, director of the Foundation Trust Network, which represents the best hospitals, warned of an "Armageddon scenario" which could unfold without decisive action on pay, and terms and conditions. She said: "There is a trade-off between saving jobs, and pay increases, and in the current climate, protecting jobs needs to be a priority."

Katherine Murphy, from the Patients Association, accused NHS managers of wasting billions on management and repeated organisational restructuring during the boom years of record investment. She said there was no evidence that plans to shift patients into the community would provide safe care. "Elderly patients often require intensive support which often means lots of staff, in hospitals. The need is only going to get greater – these plans look like madness," she said.

A spokesman for NHS London said its documents provided planning scenarios, rather than forecasts, to cope with a changing economic environment. He said the NHS was investing heavily to ensure care was provided in the most appropriate setting. [Blah, blah, blah!]

SOURCE




NHS dental crisis: Can the rot be stopped?

As new figures reveal over 40 per cent of the population has no NHS dentist can a new review finally fix the system once and for all?

Not that long ago we were queuing in the streets for an NHS dentist, with scenes of hundreds of patients camping overnight likened to the January sales. Now, new figures suggest that many of us have given up, and are paying for private treatment or simply going without care if we cannot afford it. Data from the NHS Information Centre released last month shows that only 58.3 per cent of the population saw an NHS dentist in the two years ending March 2009, with the number of complex treatments, such as root canals and crowns, falling dramatically, by 40 and 50 per cent respectively, since 2004.

Ironically, the parlous state of NHS dentistry seems to have been exacerbated by the very attempt to overhaul it – the 2006 dental contract. The new contract was intended to end the old "drill-and-fill" practice whereby dentists were paid for each treatment they carried out, so the more procedures they undertook the higher their earnings. The idea behind the new contract was to encourage dentists to spend more time on preventative work, teaching patients how to care for their own teeth, thereby reducing future treatment.

Dentists are now paid a fixed contract value for the amount of work they do each year. Work is measured in UDAs (units of dental activity). Dentists now essentially have "UDA targets" to meet each year. Under the new contract, their salaries have not been cut as they had been in the early Nineties, which led to an exodus to the private sector. Dentists are free to choose whether to provide NHS or private treatment, or a combination of the two. While many NHS dentists' basic pay is around £90,000 in large practices, but in areas where NHS practitioners are few and far between, they can make a lot more.

Around 400 practices earn up to £300,000 a year, shared among several dentists. Private dentists earn little more – one survey in 2005 by the Health and Social Care Information Centre estimated the gap at no more that £800 a year. Most claimed to have left the NHS due to the pressure of working harder for less money, with less time to spend on each patient.

Local Primary Care Trusts (PCTs) were given responsibility for providing dental care in their areas. It is they who employ dentists, and it means that managers can offer incentives to dentists to work in their area, and thus increase patient access, eradicating once and for all the problem of how to get on an NHS dentist's list.

But, despite these good intentions, the situation appears to have deteriorated further. According to figures from the NHS Information Centre, last year nearly 50 per cent of NHS dentists did not take on any new patients. In addition, 2,000 dentists have left the NHS since 2006. So what has gone so badly wrong?

The flaws are fundamental, says Liberal Democrat health spokesman Norman Lamb. "Many good dentists have become fed up with NHS bureaucracy, voted with their feet, and left the profession. So there is a danger that while not all the NHS dentists left are second rate by any means, we could end up with a two-tier profession."

Lamb believes that the financial disincentive to carry out complex work is so serious it threatens to "de-skill" the profession and that far from encouraging the public to look after their teeth, "there is no incentive for the dentist to do preventative work at all."

The public are not happy, says Dr Anthony Halperin of the Patient's Association."Simple procedures can end up costing the patient more than before, while there is no incentive for dentists to perform complex and time-consuming treatment. Most of all, the overwhelming public complaint is access."

The majority of dentists are unhappy, too. One complained: "If you take on a new patient who has not been to the dentist for a few years, they might need a lot of work, and you are effectively penalised for doing it. Under the new contract, whether a patient needs one filling or 10 fillings, the dentist gets paid the same."

Another said: 'Dentists are unwilling to take on new patients whose teeth are in a poor state. They know they will be paid the same as if they treated a patient who needs very little work. This is very sad for patients. It means that those who are most desperate for treatment are finding it most difficult to get a dentist."

Dr John Milne, chair of the British Dental Association, the professional association and trade union for dentists, adds that many complain that "the target-driven nature of the existing contract has made life difficult". If a PCT has set targets for the number of procedures it expects to be completed, many dentists are left with no time to teach their patients about hygiene.

So what is the answer? Professor Jimmy Steele, Head of the School of Dental Sciences at Newcastle University led the recent independent review of NHS dentistry, which has just published a set of recommendations aimed at redressing the problems of access and receiving appropriate treatment (for patients) and bureaucracy and pay (for dentists). It has been Prof Steele's unenviable task to pick apart the 2006 contract and put it back together, making it work at no extra cost to the taxpayer.

"The 2006 contract was intended to make fundamental changes in thinking. Dentistry had been pretty much unaltered since the birth of the NHS in 1948," he says. "The idea was that the PCT would be able to buy what they wanted on behalf of their patient, making better use of resources. Previously dentists had been able to move around to where they wanted there was no ability to fit services to local needs."

In effect, dentists could set up an NHS practice where they wanted to live, not necessarily where one was needed. "The idea of local commissioning is sensible," he adds. "Access problems should have been addressed in time."

The new contract also aimed to simplify payments. Previously, dentists billed the NHS centrally for any one of 400 different procedures. The more work they did, the more they got paid. "The new system, where contracts are paid on UDAs in three bands is probably too simple," says Prof Steele. "The payment bands are wide and differ depending on where the dentist is located, on their history, sometimes on their negotiating skills."

Dentists earn one UDA (worth between approximately £17 and £40) for a simple procedure such as a check-up, three UDAs (worth about £75 on average) for any number of fillings (in one appointment), or 12 UDAs (worth about £300) for crowns or dentures, in addition to any other treatment.

"The system is open to misuse," says Prof Steele. "It is possible to take one tooth out and make an impression for a denture and then charge 12 UDAs which is clearly not as complex or difficult as root canal work which pays only a quarter of the fee."

Incentives to take on new patients are not having the desired effect. Far from encouraging dentists to see more patients, it has become easier to make a living seeing existing patients more often. One of the biggest problems is taking time to put a mechanism in place for centrally collecting data, so it is difficult to know where and how the system isn't working.

So do we need to start again from scratch? Prof Steele thinks not: "When we carried out the review it became clear that access is improving, but there is a communication problem. The public didn't know how to find an NHS dentist. Meanwhile the PCT claimed that they were running plenty, and that all the public needed to do was ask. The public would then be saying, 'what's a PCT?' Better communication could sort that problem out easily."

Prof Steele is also recommending improvements in payment methods. "We need a blended contract, where a dentist is paid for every person on his list, and also for every treatment he carries out. We don't want people under-treated any more than over-treated. There also needs to be a reward for quality so we need to get data back into the system."

While Prof Steele approves of the scheme of local commissioning, Norman Lamb warns that PCT managers may not be ready. "We need to train them better, a lot of them are far too passive. You do get pockets of excellence but many don't have the skills they need."

Shake-ups, however worthy, cost money, and increased investment is unlikely. Dentistry is threatened by the spectre of financial cuts, as part of cuts in public services, regardless of who wins the next election.

So while the Patients Association has welcomed Prof Steele's review, Dr Halperin, a dental surgeon who does both NHS and private work in central London, says: "We are concerned that because of funding problems, once again there will be no real improvement in the dental contract and subsequently no improvement to the services for our patients."

The biggest challenge says Dr Milne, is to get all political parties to recognise the value of Prof Steele's report. "We need to embrace it; it is our best chance of providing a dental service of which we can all be proud."

Dr Milne is also optimistic: "The number of dentists in training is increasing, but we need to make the NHS an attractive place to work. And dentists who have left will only return if the NHS offers them the chance to treat their patients properly. Some might even be quite excited at the chance."

SOURCE




Australia: Penny-pinching government healthcare system refuses to save seriously ill young woman

Forcing her into expensive but successful private treatment. In their "kind" socialist hearts, they condemned her to death. Now they are in coverup mode and refusing to admit error -- even though she is living proof of their wrong call

THE Department of Human Services has been accused of abandoning a Victorian woman with a brain lesion who survived only because of life-saving surgery interstate. Victorian medicos ruled her condition was inoperable and the DHS has refused to pay $300,000 for the surgery in a private NSW hospital.

Alicia Withington was sent home to die, but the 30-year-old is living proof the Victorian system failed her.

In another twist, the state Opposition has accused the department of hiding documents relating to Health Minister Daniel Andrews' decision not to fund her operation. Details of the case come after a string of controversies involving the DHS, including:

REVELATIONS vulnerable women in state-monitored care homes were trading sex for cigarettes, or being raped.

CLAIMS the DHS was aware of violence in the home of a toddler six months before she died after an assault by her father.

SHOCK details of a man fathering four children with his daughter who he used as a sex slave for 30 years.

Mrs Withington said Victoria's top neurosurgeons refused to operate on her arteriovenous malformations (AVM) - a tangled mass of abnormal blood vessels 12.5cm long in the right side of her brain. "I had a ticking time bomb in my head about to explode and I was told it was too risky to operate," she said. "I feel I was sent home to die at the age of 27."

But Mrs Withington, now 30, who runs a cafe in Ocean Grove with husband Daniel, sought a second opinion. Sydney specialist Prof Michael Morgan agreed it was risky, but operated in March 2008. "No one should have ever said my AVM was inoperable, because here I am today walking, talking and very much alive," Mrs Withington said.

Mrs Withington and other family members have taken out second mortgages on their homes to pay the bill. "The Health Minister, Daniel Andrews, refused to pay it because he said I had gone through the private system in NSW," she said. "It's not like I went to another country." She says the Victorian Government should have funded the operation because it should have recognised it could be successful.

Opposition community services spokeswoman Mary Wooldridge has taken up Mrs Withington's cause, applying under Freedom of Information for documents held by Daniel Andrews and DHS. Officials told her there were no documents held by Mr Andrews' office on Mrs Withington, in correspondence seen by the Sunday Herald Sun. But in a letter obtained by the paper, Mr Andrews discusses with a Labor MP why the Government would not fund Mrs Withington's treatment. A tribunal has ordered the department to answer requests for information.

A spokesman for Mr Andrews said: "It would not be appropriate for the Government to selectively fund private treatments." He said the minister's letter discussing Mrs Withington's plight was not in Mr Andrews' office, but held by the DHS.

SOURCE




Canada's healthcare limitations good for brokers

Richard Baker is known as a critic of the Canadian health care system, but he's the first to acknowledge that it represents a real bargain for those with routine afflictions.

"In Canada, if your wife is pregnant, you have great prenatal care, great postnatal care, and the delivery is free. If you have the flu, your exam is free. If you break a leg, you can go to the emergency ward, and they'll set it immediately," Mr. Baker said. The trouble starts when patients need treatment that isn't so routine. That's where Mr. Baker comes in. A British Columbia medical broker, he takes patients who find themselves on long waiting lists for procedures such as MRIs and surgeries, and connects them with specialists who can handle their cases immediately. Most of the time, his clients wind up in the United States - and business is booming.

"That's what Americans need to know about the Canadian system," Mr. Baker said. "It's not that we have poor-quality health care - the quality is perfectly good. It's that we have poor access to health care."

Mr. Baker, founder of Timely Medical Alternatives, is among the featured speakers at a conference Monday in Vancouver, British Columbia, aimed at exposing weaknesses in the Canadian single-payer system. The event, billed as a one-day fact-finding trip, is sponsored by the Independence Institute, a Colorado-based free-market think tank that has opposed the Obama administration's push for a public option in U.S. health care. "The idea is to look at real human stories about how the public option treats people with serious medical conditions," said Independence Institute President Jon Caldara. "If we're moving toward the public option, we ought to know what it looks like."

Scheduled participants include Cheryl Baxter of Edmonton, Alberta, who wound up traveling to an Oklahoma City hospital for a hip replacement, and Christina Woodkey of Calgary, Alberta, who had her spinal surgery performed by a Montana doctor. Both paid for their procedures out of pocket, at costs of $30,000 and $50,000, rather than wait a year or longer to undergo the same surgeries free of charge in Canada.

In Canada, the public and private sectors have moved to address the long surgical waiting list. In July, Alberta Premier Ed Stelmach acknowledged the increase in wait times for hip and joint surgeries after deep cuts in the province's medical budget, saying the government would soon address the issue, according to CTV News.

Private health care clinics have begun cropping up despite a Canadian law that makes it a criminal offense for a private provider to charge patients for medically necessary procedures. Doctors avoid breaking the law by going through a third party, such as Mr. Baker's company, to collect their fees. "The other way they get around the law is they say, 'This patient has been on a waiting list for three years for hernia or bunion surgery, so it must not be medically necessary,' " Mr. Baker said. "On the other hand, if you have a life-threatening condition such as cancer, you can't be treated in these private centers." Such clinics are increasing in number but still account for less than 1 percent of all surgeries, he said.

Supporters of the Canadian health care system remind naysayers that the majority of Canadians receive prompt, high-quality care at virtually no cost. Their neighbors to the south may opt to avoid treatment if they don't have adequate insurance. Canadian Sen. Grant Mitchell, a Liberal Party member who represents Alberta, spoke in Washington earlier this month to remind U.S. lawmakers of the Canadian system's virtues. "The reality is that our health care system costs less and delivers more, and each and every Canadian has health care coverage, regardless of their wealth or status," Mr. Mitchell said in a statement. "Further, and importantly, it acts as a competitive advantage in international competition for international investment and markets."

For Mr. Caldara of the Independence Institute, the issue goes beyond policy. His 5-year-old son, Chance, has Down syndrome and has undergone eight operations, including open-heart surgery to repair a hole in his heart. Under a Canadian-style system, Mr. Caldara said, Chance likely would have wound up on a waiting list and could still be waiting for life-changing or even life-saving procedures. "This is not about some wonky public-policy issue; this is personal," he said. "This is about saving my son's life."

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Congressional liberals seek health-care access for illegals

Fearful that they're losing ground on immigration and health care, a group of House Democrats is pushing back and arguing that any health care bill should extend to all legal immigrants and allow illegal immigrants some access. The Democrats, trying to stiffen their party's spines on the contentious issue, say it's unfair to bar illegal immigrants from paying their own way in a government-sponsored exchange. Legal immigrants, they say, regardless of how long they've been in the United States, should be able to get government-subsidized health care if they meet the other eligibility requirements.

"Legal permanent residents should be able to purchase their plans, and they should also be eligible for subsidies if they need it. Undocumented, if they can afford it, should be able to buy their own private plans. It keeps them out of the emergency room," said Rep. Michael M. Honda, California Democrat and chairman of the Congressional Asian Pacific American Caucus. Mr. Honda was joined by more than 20 of his colleagues in two letters laying out the demands.

Coverage for immigrants is one of the thorniest issues in the health care debate, and one many Democratic leaders would like to avoid. But immigrant rights groups and the Democrats who sent the letters say they have to take a stand now. President Obama has said he does not want health care proposals to cover illegal immigrants. The bill drawn up by Sen. Max Baucus, Montana Democrat and chairman of the Senate Finance Committee, excludes illegal immigrants from his proposed health care exchange.

Mr. Honda and his allies, though, say illegal immigrants should be allowed to pay for insurance if they can afford it, even if it comes through a government-established exchange. As a generally young, healthy part of the population, illegal immigrants could help reduce overall costs for those who buy into health exchange plans, the lawmakers said. The Democrats' letters, however, do not issue ultimatums or threaten to withhold support for the bills if their requests aren't met.

The National Council of La Raza launched its own "flood their voice mail" campaign last week to put pressure on Mr. Baucus to expand coverage in his proposal to include all legal immigrants and to drop verification language in the legislation that would prevent illegal immigrants from obtaining coverage.

Mr. Honda told The Washington Times that he's not pushing for illegal immigrants to gain access to taxpayer-subsidized benefits. "That's an argument that's been done already," he said.

Rep. Steve King, Iowa Republican, said proposals that include government coverage for illegal immigrants leave him incredulous. "If anybody can, with a straight face, advocate that we should provide health insurance for people who broke into our country, broke our law and for the most part are criminals, I don't know where they ever would draw the line," he said. Mr. King, who opposes Democrats' health care plans in general, said illegal immigrant access in legislation "would be a poison pill that would cause health care to go down" to defeat.

Twenty-nine Democrats signed on to the letter on legal immigrants, while 21 signed the letter on covering illegal immigrants. Although the leadership of the Congressional Black Caucus signed the legal-immigrant letter in their capacity as CBC officials, they signed the other letter as individual members of Congress.

Under the 1996 welfare law overhaul, Congress restricted most federal benefits to longtime holders of green cards - those who have been in the country at least five years. But Democrats chipped away at that rule when they reauthorized the State Children's Health Insurance Program earlier this year and allowed states to cover all immigrant children and pregnant women, regardless of how long they've been in the country.

In their letter, the Democrats said health care costs are much lower for legal immigrants than for native citizens. "Immigrants are part of our families, our communities, our economy, and contribute to the fabric of America," they wrote. "It is simply wrong that their taxes would pay for public health insurance programs to which they are not allowed access." [How many pay taxes? Very few]

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Max's Mad Mandate

The Baucus health bill will break 50 state budgets via Medicaid

The more we inspect Max Baucus's health-care bill, the worse it looks. Today's howler: One reason it allegedly "pays for itself" over 10 years is because it would break all 50 state budgets by permanently expanding Medicaid, the joint state-federal program for the poor.

Democrats want to use Medicaid to cover everyone up to at least 133% of the federal poverty level, or about $30,000 for a family of four. Starting in 2014, Mr. Baucus plans to spend $287 billion through 2019—or about one-third of ObamaCare's total spending—to add some 11 million new people to the Medicaid rolls.

About 59 million people are on Medicaid today—which means that a decade from now about a quarter of the total population would be on a program originally sold as help for low-income women, children and the disabled. State budgets would explode—by $37 billion, according to the Congressional Budget Office—because they would no longer be allowed to set eligibility in line with their own decisions about taxes and spending. This is the mother—and father and crazy uncle—of unfunded mandates.

This burden would arrive on the heels of an unprecedented state fiscal crisis. As of this month, some 48 states had shortfalls in their 2010 budgets totaling $168 billion—or 24% of total state budgets. The left-wing Center for Budget and Policy Priorities expects total state deficits in 2011 to rise to $180 billion. And this is counting the $87 billion Medicaid bailout in this year's stimulus bill.

While falling revenues are in part to blame, Medicaid is a main culprit, even before caseloads began to surge as joblessness rose. The National Association of State Budget Officers notes that Medicaid spending is on average the second largest component in state budgets at 20.7%—exceeded only slightly by K-12 education (20.9%) and blowing out state universities (10.3%), transportation (8.1%) and prisons (3.4%).

In some states it is far higher—39% in Ohio, 27% in Massachusetts, 25% in Michigan, Rhode Island and Pennsylvania. Forcing states to spend more will crowd out other priorities or result in a wave of tax increases, or both, even as Congress also makes major tax hikes inevitable at the national level.

The National Governors Association is furious about Mr. Baucus's Medicaid expansion, and rightly so, given that governors and their legislatures will get stuck with the bill while losing the leeway to manage or reform their budget-busters. NGA President Jim Douglas of Vermont recently said at the National Press Club that the Baucus plan poses a "tremendous financial liability" and doesn't "respect that no one size fits all at the state level." He added: "Unlike the federal government, states can't print money."

Mr. Baucus hopes to use his printing press to bribe the governors, at least for a time. Currently, the federal government pays about 57 cents out of every dollar the states spend on Medicaid, though the "matching rate" ranges as high as 76% in some states. That would rise to 95%—but only for five years. After that, who knows? It all depends on which budget Congress ends up ruining. Either the states will be slammed, or Washington will extend these extra payments into perpetuity—despite the fact that CBO expects purely federal spending on Medicaid to consume 5% of GDP by 2035 under current law.

As for the poor uninsured, they'll be shunted off into what Democratic backbencher Ron Wyden calls a "caste system." While some people will be eligible for subsidized private health insurance, everyone in the lowest income bracket will be forced into Medicaid, the country's worst insurance program by a long shot. States try to control spending by restricting access to prescription drugs and specialists. About 40% of U.S. physicians won't accept Medicaid at all.

Why? One reason is that Medicaid's price controls are even tighter than Medicare's, which in turn are substantially below private payers. In 2009 or 2010, 29 states will have either reduced or frozen their reimbursement rates to providers. Democrats love Medicaid because is it much cheaper than subsidizing private insurance, but that is true only because of this antimarket brute force. Of course, such coercion will be extended to the rest of the health market under ObamaCare.

The states aren't entirely victims here. Both Republican and Democratic state houses regularly game the Medicaid funding formula —which itself is designed to reward higher spending— to steal more money from national taxpayers. Then when tax collections fall during downturns, budget gaskets blow all over the place. This dynamic helps explain the spectacular budget catastrophes in New York and California. We'd prefer a policy of block grants, which would extricate Washington from state accounting and encourage Governors to spend more responsibly.

That's not going to happen any time soon, but the least Mr. Baucus can do is not make things worse. Instead, his Medicaid expansion is a disaster on every level—like the rest of ObamaCare.

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28 September, 2009

Give market forces room to breathe, and costs will decrease

The dirty little secret is that "Obama-care" isn't about reducing healthcare costs or making coverage more secure. It's about robbing Peter to pay Paul.

How many young and elderly people can we rob to subsidize coverage for the uninsured? How can we leverage the 50% of health spending that government already controls to push payments below costs among the other 50%? How many special interests should we bribe along the way? (Answer: all of them.)

Supporters from President Obama right down to you assure us that consumers will come out ahead. The only losers, you assure us, will be the insurance industry.

The opposite is true: Democrats in Congress are taxing workers to pay off insurance companies. Democratic Sen. Max Baucus (D-Mont.) just proposed $774 billion in subsidies for private insurers. (Somehow, that's supposed to be more moderate than House Democrats' $773 billion in subsidies.)

The outrage at the August town halls came from voters realizing that under Obama-care, they're not Paul -- they're Peter.

"Almost every political pronouncement now emphasizes cost reduction as a central object of healthcare reform," writes Stanford health economist Victor Fuchs. "The policy recommendations that follow, however, frequently aim at cost shifting rather than cost reduction." Cost shifting, Fuchs reminds us, "does nothing to reduce the real cost of care."

Real reform would reduce costs by letting individual consumers control their healthcare dollars and choose their health plans. Eliminating the tax preference for job-based coverage would let workers control the $4,000 to $10,000 of their earnings that employers now control and choose secure coverage that stays with them between jobs. Converting Medicare to a voucher program, with larger vouchers for the poor and the sick, would protect seniors from government rationing.

Consumers will spend that money more wisely than employers or government ever could. They will drive costs down because they will personally reap the rewards.

Real reform would further reduce the cost of coverage by letting workers purchase coverage from other states. As Cal State Northridge economist Shirley Svorny suggests, real reform would also make medical services more affordable by eliminating barriers to competition by nurse practitioners and other mid-level clinicians.

Those two steps would not only increase competition and reduce costs. They would improve many dimensions of quality by helping the Kaiser Permanente model spread to other states. That sounds better than summarily kicking Kaiser out of Medicare Advantage, doesn't it?

Our healthcare sector is a mess. Countless Americans are suffering and dying -- yes, dying -- because well-intentioned government interventions are driving costs higher, blocking innovation and leaving us with insecure coverage.

Yet the greatest strength of America's healthcare sector is that it shows what competition can do when market forces are given room to breathe. What do you say we give market forces a little more breathing room?

But first, let's stop the kleptocrats and kill this insurance-company bailout.

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BaucusCare: A NICE Alternative to ObamaCare

Viewed by some as a better alternative to ObamaCare because of its much-touted lack of the controversial Public Option, the Baucus plan may seem, with a little tweaking and fine-tuning, to be a promising route to a possible be-partisan compromise on Health Care Reform.

The Public Option in ObamaCare has given rise to fears of government rationing of Health Services. Could the Baucus Plan now lay them to rest? Clearly not everyone thinks so. One mainstream news commentator has remarked that Republicans in particular were staying away from it, in part because it would make significant cuts to Medicare, hurting Seniors.

Those fears are justified and wildly understated. BaucusCare launches an all-out frontal assault on Medicare and legally sanctions exactly the sort of rationing of health services most feared by those leery of the public option in ObamaCare.

Last week we observed that Comparative Effectiveness Research, which would recommend the provision of health services based on the results of a cost-benefit analysis, inevitably leads to rationing and denial of services. These and similar phrases thus become mere euphemisms for rationing.

Senator Baucus showed awareness of this on June 9th when he quipped before a Brookings Institution-sponsored conference that the phrase “Comparative Effective Research” may just sound a little too ‘ominous’ and suggested substituting a softer expression like “patient-centered outcomes research” in its stead. Or, he jokingly claimed, just call it “Fred.”

According to a December 2007 CBO Paper Entitled “Research on the Comparative Effectiveness of Medical Treatments,” now “under current policy and law, Medicare generally covers any treatment or procedure that has net medical benefits---that is benefits that outweigh the risks of the procedure---regardless of its costs….”(32).

Additionally “Medicare is effectively precluded from taking costs into account when making decisions about coverage” and would need “new legal authority”(29) to do so. The Baucus Plan would give Medicare exactly this authority.

And what it now gives to Medicare it would like to see extended throughout the whole health system. As pointed out in a White Paper outlining the essentials of BaucusCare entitled “Call to Action: Health Reform 2009,” “Many of the proposals in the plan are based in the Medicare program because of its unique ability to lead the way for system-wide changes.”(36)

To carry out the comparative effectiveness research, the Baucus Plan would set up the “Health Care Comparative Effectiveness Research Institute” as an independent entity shielded from Congressional or other government oversight.(56) It would perform functions similar to those of the British National Health Services’s “National Institute for Health and Clinical Excellence (NICE), namely assessing “the full spectrum of clinical interventions, including pharmaceuticals, medical devices, procedures, services and other therapies”(56) and making binding recommendations on its findings intended to guide clinical decisions by specifying a range of approved drugs and procedures. But, the CBO paper observed, “to reduce health care spending, the results of comparative effectiveness analysis would ultimately have to change the behavior of doctors and patients---that is, to get them to use fewer…or less expensive services.”(30)

To force doctors to fall in line behind the Institute’s recommendations, the Baucus Plan would change Medicare’s payment structure from the current fee-for-service [pay-for-reporting] reimbursement system to what it calls a “pay for quality” model(42) because it says the former offers doctors little incentive to work toward quality and efficiency improvements(49). The change would reward physicians for following the Institute’s recommendations and penalize them for not doing so, giving them a significant financial incentive for essentially rationing care.

Now, NICE is mentioned in the CBO paper as, “Perhaps the best known example of an agency that assesses comparative effectiveness….” (6) Yet, it is for others also the best known example of a rationing board, because of its practice of screening drugs and procedures for approval via quality-adjusted life years (QALYs), a decision procedure which decidedly favors the interests of the young over the old. It is for Sarah Palin the very paradigm of a “Death Panel.”

Thus, if you would like to see health care decisions in the US governed by a rationing board similar to that which governs them in the British National Health Service then, for you, BaucusCare is a NICE alternative to ObamaCare!

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The second-best solution to health care: Do nothing

The second-best solution for the health-care crisis? Do nothing. Of course, that drives the interventionists crazy. “Do nothing?” they cry! “Don’t you realize that we’re in a crisis? We can’t afford to do nothing!”

What they fail to realize is a fundamental principle about interventionism: It produces more crises. Therefore, any new health-care intervention, whether termed “reform” or “modification” or “improvement” is only going to make things worse than they already are. New interventions will produce new and bigger crises, thereby producing calls for more “reform” in the future.

What ultimately happens is that as the crises and interventions grow in number and intensity, people get so frustrated that they end up supporting a complete government takeover of that particular segment of society. In fact, that’s already happening in the health-care debate.

So, if doing nothing is the second-best solution for the health-care crisis, what’s the best solution?

The answer to that question depends on figuring out the root cause of the problem. In a sense, that task is no different from that which a physician faces when an ailing patient comes to visit him. The doctor examines the patient, arrives at a diagnosis, and issues a prescription. The correct prescription usually depends on a correct diagnosis. Get the diagnosis wrong, and more often than not the prescription will be wrong.

It’s really no different in principle with ailments that afflict the body politic. Get the diagnosis wrong and it’s likely that the prescription will be wrong.

The diagnosis that interventionists have reached in America’s health-care crisis is that the crisis is caused by too much freedom and free enterprise in the heath-care arena. Thus, their prescription is not surprising: Socialism and interventionism.

The problem with this diagnosis, however, is that the diagnosticians fail to account for the critical factor in the ailment of the patient: massive socialism and interventionism in health care in the past. It simply never occurs to these people that those things could be the root cause of what ails the body politic — the root cause of the health-care crisis. To socialists and interventionists, it is inconceivable that socialist and interventionist programs are anything but positive, healthy things for a society. That’s why they consider them the medicine, not the source of the ailment.

That, of course, leads us to an opposing diagnosis — that it’s not freedom and free enterprise that have caused America’s health-care crisis but instead the socialism and interventionism that have infected every aspect of the health-care field.

First, on the demand side of health care you’ve got ever-growing Medicare and Medicaid expenditures, which have placed an enormous upward pressure on health-care costs.

Second, you’ve got massive government regulation of both the medical and insurance industries, adversely impacting both the demand side and supply side of health care.

Third, you’ve got income-tax manipulation that has perverted the market with respect to employer-provided health-care insurance.

Fourth, on the supply side of health care you have occupational-licensure laws, which have strictly limited the supply of health-care providers.

Therein lies the root cause of America’s health-care crisis. Thus, the prescription is obvious: radical surgery by removing all of this cancerous material from the body politic. No reform. Simply an immediately repeal of Medicare, Medicaid, health-care and insurance regulations, and medical licensure. End all government involvement in health care. Given the positive power of the free market and the enormous resiliency of human beings, the body politic will immediately begin recovering.

That is the only solution to America’s health-care crisis. But if Americans cannot bring themselves to rid the body politic of all this socialist and interventionist cancer, then the second-best solution is to do nothing at all. Because infecting the body politic with even more cancer will only make the condition worse.

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Health Problems Health Care Can't Fix

President Obama and Michael Moore's inconvenient truth

Maybe President Obama has watched too much "Sicko" because he sure likes to reiterate Michael Moore's bromides. In his joint address of Congress, he said: "We spend one and a half times more per person on health care than any other country, but we aren't any healthier for it."

But as Mr. Obama is fond of saying, that simply is not true.

While Americans may have a lower life expectancy than other affluent countries, the disparity is mainly due to Americans' poor personal health-care practices -- not to any flaw in health-care treatment. "The U.S. actually does a pretty good job of identifying and treating the major diseases. The international comparisons don't show we're in dire straits," says University of Pennsylvania's Dr. Samuel Preston, a researcher who has studied the matter.

The real problem, it turns out, is that Americans are accident-prone, health unconscious slobs. Until the mid-1980s, the U.S. had the highest per capita cigarette consumption in the developed world, and the U.S.'s obesity rate today is more than twice that of Canada and ten times that of Japan. These aren't problems of the health care system (i.e. in the diagnosis and treatment of disease). These are problems of behavior. Adjust that data for the higher U.S. incidence of homicide and obesity, and Americans actually have the highest life expectancy in the developed world.

This is the kind of inconvenient truth that the somewhat lax Mr. Moore is accustomed to overlooking. A svelte gym rat like Mr. Obama should know better.

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Death panels coming to Australia

Courtesy of a Leftist government, of course: The same folk who brought you eugenics in the first half of the 20th century. This already happens in England and is much feared by opponents of ObamaCare -- after evil Ezekiel proposed such measures

DYING cancer patients could be weaned off taxpayer-funded drugs as the Federal Government is confronted with spiralling health costs. Health Minister Nicola Roxon wants debate about the moral challenge as the Pharmaceutical Benefits Advisory Committee plans trials to determine when costly drugs become ineffective and should no longer be dispensed.

Talks between the PBAC and oncologists are part of a broader debate on how taxpayer money could be better spent, as doctors brace themselves for a rising tide of cancer patients, an ageing population and growing health expenses.

Ms Roxon is also believed to be talking to doctors and pharmacists about diverting patients to some cheaper generic drugs. It could spark greater competition and save the Government millions of dollars. [But see here]

Ms Roxon argues that relief from cancer drugs in the last months of life should not be underestimated, but says some are not cure-alls. "Would the community support looking at mechanisms to better control the use of these medicines so that they are only used when the evidence shows they are truly effective, balanced by greater investment in palliative care, so we can better meet the needs and preferences of patients at the end of life?" The question recently put to doctors in Sydney comes as PBAC chairman Lloyd Sansom stressed that moves to keep the Pharmaceutical Benefits Scheme sustainable would not impeach or impair patient safety. The PBS costs taxpayers $8 billion a year for more than 3500 subsidised medicines.

Prof Sansom said more information was needed. "We need trials to be done ... to address any advantages in continuing with drugs when the patient (cancer) has progressed. If there is any benefit," he said.

The Australian Medical Association vice-president Steve Hambleton said the issue was sensitive and some doctors had trouble saying "no" to patients. "If you're on your last legs, there's no point in having expensive chemotherapy if there's no clinical benefits," Dr Hambleton said.

But apart from cancer drugs - which can cost taxpayers up to $50,000 a patient - Ms Roxon is asking why doctors dispense expensive, subsidised drugs to patients when cheaper generics are prescribed.

Ms Roxon told The Courier-Mail yesterday the Government had to be smarter in how health dollars were allocated. "The current pharmacy agreement negotiations are very important," she said.

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27 September, 2009

Fears that NHS switch to cheaper drugs could put millions of British patients at risk of side-effects

Millions of patients could face life-threatening side-effects under a scheme which will swap branded drugs for cheaper versions. More than five million asthma sufferers and up to 500,000 with epilepsy could be hit by the change, while patients with conditions such as Parkinson's, bipolar disorder and hypertension may also be affected.

Pharmacists will be expected to substitute a brand of drug written on a prescription with a generic, cheaper version. For the first time, outside an emergency situation, they will not have to consult with a doctor to change a patient's prescription. The plan is expected to save the NHS up to £70million a year, but critics claim it may end up costing more in treating side-effects unless certain medical conditions are exempt from the rules.

Generic products are developed to cash in when branded drugs lose patent protection. Although generics are meant to be identical, the active ingredients can vary within an agreed percentage and inactive ingredients, such as colourings, may also differ.

In epilepsy even tiny changes in bioavailability - the amount of active medication absorbed into the body - can have serious consequences. NHS guidelines on epilepsy drugs currently warn against changing the brand for individual patients because of 'increased potential for excessive side-effects'.

Doctors claim it is vital the 5.4million asthma sufferers in the UK are protected from having their inhalers automatically switched to cheaper versions. Dr Mike Thomas, chief medical adviser to the Asthma UK charity, said: 'Patients should only be swapped to another inhaler in a face to face consultation with a doctor or nurse. 'Generic substitution means asthma control may be lost and asthma that is not well controlled puts the patient at risk of an attack. 'An opt-out scheme will not be good enough, we need asthma inhalers to be exempt from the regulations.'

And Simon Wigglesworth, deputy chief executive of Epilepsy Action, said a survey of members revealed around 10 per cent had suffered more seizures as a result of changes to their anti-epileptic medication. 'We know people's epilepsy gets worse after their medication changes and seizures are life-threatening,' he said. 'Epilepsy patients should receive the same version of an anti-epileptic drug whenever they get a repeat prescription, from the same manufacturer and the same country of manufacture. 'The only safe way to bring in this scheme is to exempt anti-epileptic medication. 'The financial savings to be made from prescribing generically rather than by brand may not outweigh the cost of extra A&E admissions and hospital stays.'

Other countries with generic substitutions allow doctors to tick a box to indicate that a branded drug must not be changed. Around 86 per cent of NHS prescriptions are already written for generic drugs and Britain has one of the lowest levels of spending on drugs per head of any developed country.

David Fisher, of the Association of the British Pharmaceutical Industry, said savings from using cheaper drugs must go back to the NHS.

A spokesman for the Department of Health said: 'Currently, there is nothing to prevent the prescribing of a particular generic or brand of drug if the prescriber considers it essential for the patient to receive a specific product. Our proposals for implementation of generic substitution will maintain this position.'

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Northern Ireland public hospitals cannot afford treatment that patients need

Patients being treated in the Belfast Health Trust will no longer be referred to the private sector for operations because the Trust cannot afford them. Patients throughout NI are often referred to private clinics for knee, hip, heart and cataract operations, helping to reduce waiting lists. The trust's Chief Executive William McKee said the move was temporary but it would impact on waiting times.

The Vice Chair, Eileen Evason, said the health service was "in real trouble". She said: "I don't think we can manage financially. We cannot sustain the service unless we get help and get it soon." The Belfast Trust paid for 7,000 private operations last year and commissioned another 4,000 so far this year.

Mr McKee said: "It doesn't appear, at this stage, we have enough money to meet the activity we were able to do last year." He told BBC Radio Ulster: "This is hopefully a brief pause while we take stock of how much money is available and how much more we can do internally." He admitted that the trust was finding things "very difficult" financially and said hard choices would have to be made.

The Trust needs to save £130m over the next three years. Earlier this week it emerged it may cut 152 beds at two hospitals in the city.

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Obamacare: Taxes for Everyone

Now that the various healthcare plans are being reduced to print, the financial details are emerging and with them a fundamental conclusion is becoming evident: The Obama plan is a giant tax increase for much of the American people (not just the rich).

Start with the mandate that falls on those whose welfare is the supposed object of the entire program -- the uninsured. According to the Congressional Budget Office, the average uninsured person or family will have to pay between 15 and 20 percent of his or their total income on health insurance (counting premiums, deductibles and co-payments) before any of the subsidy in the Baucus bill kicks in. Even in the more generous House bill, the tab that the uninsured must pay is very, very high.

Most uninsured would likely be quite happy to avoid paying this much of their income for health insurance. But they will be forced to shell out the money under the program. Others would want catastrophic coverage (which for the young would likely not be too costly) but the Obama program requires comprehensive insurance that is costly to satisfy the government requirement.

Having spent the entire campaign speaking about "affordable" coverage, it turns out the program is not at all affordable, but a massive new tax on the average uninsured American.

Then there is the tax on health insurance premiums that is to finance about a quarter of the subsidy for the uninsured. This tax, billed as only to be levied on "gold-plated" policies, will, in fact, reach down to the average American. The Baucus bill specifies that the tax of 35 percent would be put on all premiums over $8,000 for an individual and on proportionately higher premiums for families. Current estimates are that about one-tenth of the current health insurance policies would be taxable. But the $8,000 premium level that will trigger coverage is not indexed for inflation, let alone for medical inflation, which typically runs twice as high. ObamaCare will take effect in 2013. By then, the percentage of Americans subject to the tax will doubtless expand dramatically. Indeed, this trigger is a new Alternative Minimum Tax waiting to happen. As inflation pushes more and more Americans into tax eligibility, it will become a universal health insurance excise tax of 35 percent. While the tax will be imposed on health insurers and employers, it will, obviously, be passed along to the policyholders.

So if you are insured, you will increasingly have to pay 35 percent more for the privilege. And if you are uninsured, you will have to pay one-fifth of your income in premiums, deductibles and co-payments before any subsidy kicks in.

And then there is the final piece of the puzzle -- the $500 billion cut in Medicare that will pay for the bulk of the subsidy under the bill. We are literally slicing services to the elderly in order to transfer healthcare to others. Obama's claim that only "waste and inefficiency" in Medicare will be cut is, at best, disingenuous. Most of the cuts will be in reimbursement for doctors and hospitals. That will lead to less care, shorter office visits, fewer tests, fewer surgeries and less care. And it will lead to fewer doctors. As a result, a survey by the Investor's Business Daily indicates that 45 percent of all doctors would "consider retiring or closing their practices" if the Obama bill passes. The result will be a greater scarcity of medical services, even as the patient load expands by at least 30 million people.

Each of these fiscal pieces is movable. The left will pressure Obama to increase the subsidy to the uninsured. But that will necessitate raising the Medicare cut borne by the elderly or increasing the tax on health insurance policies -- or adding to the deficit. Any of these options will alienate moderate senators. Balancing these competing priorities only works if the taxpayers don't know what is going on.

If the average middle-income American family realizes that it will have to pay one-third more for health insurance or the uninsured learn that they will have to pay a fifth of their income to get insurance, they will make their dissatisfaction felt by their Democratic senators.

All of which begs the fundamental question: How willing are Democratic congressmen to commit political suicide? Are they willing to lose the elderly and to antagonize the uninsured as the health insurance cops chase them around the block? When does JFK's comment kick in: "Sometimes party loyalty asks too much"?

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Don't want Obamacare? Go to jail!

This doesn't happen often enough.

Sen. John Ensign (R-Nev.) received a handwritten note Thursday from Joint Committee on Taxation Chief of Staff Tom Barthold confirming the penalty for failing to pay the up to $1,900 fee for not buying health insurance.

Violators could be charged with a misdemeanor and could face up to a year in jail or a $25,000 penalty, Barthold wrote on JCT letterhead. He signed it "Sincerely, Thomas A. Barthold."

The note was a follow-up to Ensign's questioning at the markup.

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Is emergency care a failed market?

In response to my recent article on health-insurance mandates, I received many emails from readers who argued that mandates, as unappealing as they may be, are necessary to prevent market failure in emergency medical services.

Specifically, they argued that there is a "free-rider problem" in emergency care because individuals are currently able to visit the emergency room (ER) without insurance or the means to pay, receive care, and then skip out on the bill. Such free riders force the hospital to either accept the losses or spread the costs to other patients. Therefore, the readers reasoned, there is a market failure in that health insurance is under-demanded and ER care is over-demanded, increasing health care costs and dumping them onto those consumers who do purchase insurance and pay for their visits.

As accurate as this common depiction of the symptom is, however, it misdiagnoses the disease. The free-rider problem in ER care is not a market failure, but a government failure. The Hippocratic Oath notwithstanding, hospitals only accept all patients irrespective of their ability to pay because they are required to by government regulations. These laws, which are in place in countries around the planet, result in a simple welfare scheme whereby the costs of the uninsured are transferred to insured patients. With this reality in mind, it is easy to see that the free-rider problem in ER services is not a market failure, but rather a government failure.

How, then, would truly free-market hospitals handle patients who are now free riders? There is every reason to expect that these uninsured, mostly low-income people would be treated more humanely and with greater dignity than they are in the current quasi-socialist system.

Without government regulations on their payment collection methods, hospitals would be free to offer more flexible prices and payment options, and to negotiate contracts with individual consumers. Those patients with little financial leverage would be able to form creative payment plans, and those without any savings or insurance could even contract to pay for their services with labor.

Furthermore, in a truly free market for medical care, even patients who intentionally try to skip payments and thus dump the costs on others cannot. This is because, in the absence of supposedly compassionate hospital legislation, to admit oneself or someone else to emergency care is to agree to the terms and conditions of service at that hospital — most importantly, to pay for treatment.

Thus, in the libertarian society, checking out without arranging payment would constitute a violation of contract, and therefore these malicious free riders would be held accountable. In the current situation, however, such predatory patients are subsidized by others in the name of social compassion.

Another advantage of contractual enforcement of payment for ER services on the free market is that it removes hospitals from financial responsibility for those patients who are admitted to the ER by another party while incapacitated. Which party will be held responsible for the hospital bill in each case would be decided by negotiation between the two parties and perhaps even by court arbitration. Which party eventually pays is not important for this matter, though; what matters is that the hospital will be paid either way, and that other patients will no longer be stuck with the bill.

Now that we've seen that the free-rider problem does not exist in a free market for medical care, we can address other readers' concern that the profit-driven market process is unsympathetic to the suffering of those patients who are truly unable to pay in any way and can't afford market insurance, but who shouldn't simply be left to suffer.

To argue that the market discards those it regards as undesirable is to both ignore the prevalence of private charity and deny the existence of the entire public-relations industry. Indeed, setting socialist doctrines aside, we can see that affectionate treatment of the poor and downtrodden is actually a very profitable endeavor.

In every market, firms of all sizes expend resources to maintain a positive public image. There are few actions better received by a community than healing and treating their vulnerable and disabled at a discounted or zero price. As such, it is absolutely foolish to believe that hospitals would not take in such customers for treatment.

In fact, if we examine the nature of prices and income differentials closely, we arrive at another instance of destructive government intervention. Price discrimination of almost every form is illegal in almost every market, and health care is certainly no exception.

Price discrimination may feel unfair, but if allowed by law it can lead to much more efficient market outcomes and higher market quantities of all goods and services. Using price discrimination, hospitals would be free to provide additional and cheaper services to low-income consumers without decreasing the price for high-income consumers.

Price discrimination would benefit the hospitals as well, because they would not only increase the quantity of services they perform and add potentially loyal new customers, but would also be able to increase the price of services to their high-income patients without losing their business.

Viewing the converse of this market outcome, then, we can observe that laws against price-fixing necessarily decrease quantities of goods and services, and squeeze marginal consumers out of the market. In the health care market, this means that those who are most in need of low-cost care are forced out of the market in the name of social justice.

In contemplating competition between medical service providers, we can deduce that the market will indeed treat people who are now free riders with dignity, but that those consumers will no longer actually be free riding on others. Instead, they will provide a valuable good to society — namely, the satisfaction that comes with supporting others in their time of need. While it may seem strange to think of this as an economic good, it certainly is, as evidenced by consumers' willingness to forgo other forms of consumption in favor of charity.

While caring for these patients would still redistribute costs to other consumers, it would do so only to the extent that these paying consumers would tolerate it by continuing to purchase care and services. That is to say that consumers' choices between competing hospitals' services would, just as in any market, force those hospitals to provide equilibrium quantities of charitable care.

This efficient market quantity would therefore be determined by the charitable inclinations of insured and higher-income patients. And in a truly libertarian market, which would lack taxes, we can say that these individuals would inarguably be more giving of their own income.

Perhaps the best feature of the free-market process in a libertarian health market is that it would allocate charitable funds to their best use. In our emergency services case, this axiom of market behavior implies that hospitals will spend their charity budgets on the most destitute and impoverished patients.

Whereas government funds are allocated according to political cronyism and electoral opportunism, free-market hospitals will always attempt to maximize the benefit to their public image — nothing more than profit maximization — by providing for those patients who are most in need.

Conclusion

With rigorous examination, we can see that emergency medical services function like any other market, and that the free-rider problem is the result of a government failure. Furthermore, we can safely expect that the free market would treat the most deserving of these free riders more humanely than does the supposedly compassionate central health administration.

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Obama’s New Claim That 30 Million 'Cannot' Get Health Insurance Not Supported by Census Bureau

In his Sept. 9 speech to Congress, President Barack Obama unveiled a new claim that 30 million Americans “cannot” get health insurance, but this statistic is not supported by the government's latest definitive data produced by the Census Bureau on Americans lacking health insurance.

In his speech to Congress, Obama said, “There are now more than 30 million American citizens who cannot get coverage” – presumably taking into account conservative critics’ observation that Obama's earlier claims that 46 million Americans lacked health insurance was contradicted by Census Bureau data that indicated that more than 9 million of that number were not in fact U.S. citizens.

In a Sept. 10 blog posting, Office of Management and Budget (OMB) Director Peter Orszag explained the president's new claim that 30 million Americans "cannot" get insurance, saying that the figure was based based on Census Bureau data.

That study, “Income, Poverty, and Health Insurance Coverage in the United States, 2008,” was released Sept. 10 as part of the Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS). “With the two different numbers, there has been some confusion as to which is accurate,” Orszag wrote. “Well, both are--and the President’s version is more focused on the relevant target population for health reform since it excludes unauthorized aliens. “The Census report indicates that of the 46 million uninsured individuals, 34 million were native born and 2.8 million naturalized citizens. The report thus shows that there were 36.8 million uninsured U.S. citizens (native born and naturalized) in 2008.”

Orszag explained that Obama was merely playing it safe and using a lower-than-reality figure in his speech. “To be conservative, the President thus stated that ‘more than 30 million American citizens’ cannot get coverage.” While that explanation accounts for why Obama used the figure of “30 million," it does not account for why he claimed those 30 million "cannot" get insurance coverage.

The Census Bureau report cited by Orszag does not contain any data about why people don’t have health insurance. It does not distinguish between people who cannot get health insurance and people who freely decide not to get it. The only question it asks is whether or not a person had health insurance during the previous year. If someone had coverage for part or all of the year, the Census Bureau counted them as “insured”--if they didn’t, they were counted as “uninsured.”

The Census Bureau also says that insurance coverage is often underreported, with people more likely to answer “no” if they are currently without coverage even if they were covered for part of the previous year--meaning they should have answered “yes.” “[H]ealth insurance coverage is underreported in the CPS ASEC for a variety of reasons,” the Census Bureau noted. “For example, some people may report their insurance coverage status at the time of their interview rather than their coverage status during the previous calendar year.”

In fact, a spokesperson in the Census Bureau’s health insurance division told CNSNews.com that there is nothing in the health insurance report that has anything to do with why people are uninsured. “There isn’t. The survey that that report is based on, the Current Population Survey, doesn’t ask any questions about why [people lack coverage]. We really don’t ask any questions about why.”

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26 September, 2009






Australia: Another government hospital doesn't give a damn

WHEN the family of Emilia Chatterjee complained to Gosford Hospital that she had contracted an infection after being left in urine-soaked clothes, the hospital apologised to the 84-year-old and said the issue had been addressed. The only problem was that Mrs Chatterjee was dead.

In a shocking bungle that heaped insult upon injury, the hospital acknowledged that staff had not cleaned rooms as they should have, nor listened to the requests of her daughters, who were forced to maintain a round-the-clock vigil on their mother to ensure she was looked after.

The family said nurses told them that the urine she was left to lie in had given her an infection - one that took her life on August 28, seven weeks after she entered hospital.

Yet when the Central Coast Health Service wrote three weeks later to say the issues had been addressed it was clearly under the impression that the great-grandmother was still alive. "The Nurse Unit Manager has asked that I extend her apologies to you and Mrs Chatterjee for any distress caused as a result of the actions of nursing staff," CCHS divisional manager Andrew Roberts wrote.

Mrs Chatterjee's daughter Giorgina Neilson said the family was horrified at the conditions her mother was in. "The hygienic condition of the hospital was totally unacceptable. We were horrified," she said. "She wasn't being fed, she wasn't being cleaned regularly . . . The hospital did acknowledge, some of the nurses did acknowledge to my sister that it was because she lay in the urine that she got the infection."

Yesterday the State Government was again forced into a grovelling apology. "Central Coast Health general manager Matt Hanrahan extends his sincere apologies on behalf of the health service for the distress experienced by the family of Mrs Chatterjee," it said in a statement. "Mr Hanrahan said that the failure to acknowledge the death of Mrs Chatterjee in correspondence with the family related to concerns regarding her care was regrettable."

The bungle was also a baptism of fire for new Health Minister Carmel Tebbutt, who yesterday ordered a full departmental investigation.

SOURCE




Snowe to Reid: Whats the Rush?

Harry Reid is once again threatening to invoke reconciliation, whereby only 51 instead of 60 votes would be needed to pass the government-run health care proposal, ObamaCare. Apparently, the democratic system is not working fast enough for Reid’s taste. This time, Reid has threatened to eliminate the filibuster should Republicans halt consideration of the bill in committee. “If we can’t work this out to do something within the committee structure, then we’ll be forced to do reconciliation,” he said, calling the tactic a “last resort.”

“Railroading” might be a better term. However, the haste that Senate Democrats want to move on Senator Max Baucus’ public-private insurance “co-ops” proposal —which would provide taxpayer-subsidized health care to 26 million— has Olympia Snowe scratching her head.

As the Senate Finance Committee prepared to vote on a measure that would have required the language of the bill to be posted online prior to a committee vote (which would have given the Congressional Budget Office (CBO) time to properly estimate the cost of the bill) she actually got angry at her Democrat colleagues who refused.

Said Snowe with no small amount of displeasure, "I truly do not understand the skepticism about this request, the reluctance and the reticence. This is about doing our job. If it takes two more weeks, it takes two more weeks. We're talking about trillions of dollars in the final analysis. What is the rush? Is there something happening in two weeks?"

She might justifiably have added the word “bums”—as in, “What’s the bum’s rush?”

According to the CBO, a reliable cost estimate of the bill will not be quantifiable without the final proposed language, as opposed to the conceptual language the committee normally works with. Nonetheless, in a party line vote of 13-10, the committee agreed to only give the CBO the conceptual language, which would likely throw cost estimates off, according to the CBO.

The icing on the cake is Harry Reid’s thuggish threats to Senate Republicans to invoke reconciliation if they do not vote the legislation out of committee—despite the fact that neither they nor Reid has any idea about how much it will actually cost.

In recent weeks, Reid has threatened to use reconciliation repeatedly. At one point, Reid spokesman Jim Manley said, "The White House and the Senate Democratic leadership still prefer a bipartisan bill. However, patience is not unlimited, and we are determined to get something done this year by any legislative means necessary."

Senator Minority Leader Mitch McConnell predicted a public backlash if the bum’s rush tactic were used. He said, “Let me say…budget reconciliation has never been used to structure one-sixth of the American economy. If that option were chosen, there would be a severe, negative, and I think appropriate reaction from the American people… If you thought the American people were upset in August, you haven’t seen how upset they will be if this device is chosen.”

McConnell is not off-track. Some 56 percent of Americans currently oppose Democrats’ health care proposal, according to Rasmussen Reports. If Democrats now choose to eliminate the time-honored filibuster to nationalize the health care system, the consequences will be dire, both for Democrats, and for the country.

The filibuster has been used as a means of giving the minority party in the Senate a voice. It has been an effective tool for slowing down debate and allowing cooler heads to prevail for more than 150 years. Without it, a majority party could rule things like a mob. Which is what Reid apparently intends to do.

Senate Republicans need to answer in kind. They should make a threat of their own to Harry Reid: If he invokes reconciliation on ObamaCare, they will shut down and boycott the Senate altogether. Then the Senate will not work as fast as the Obama-Reid Cabal wants. In fact, it will not work at all. And the nation can heave a great sigh of relief.

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Health plan would push millions out of Medicare program

President Obama's repeated pledge that senior citizens would not lose benefits under his proposed cuts to Medicare has been officially contradicted by an independent congressional analyst whose dire prediction could put the latest Senate health proposal in jeopardy.

The $856 billion health care reform bill now being drafted in the Senate Finance Committee would be paid for in part by slashing $125 billion from the Medicare Advantage program, which is used by about 9 million people, or nearly 20 percent of all Medicare recipients.

The cuts would come from the additional benefits Medicare Advantage enrollees receive, Congressional Budget Office Director Doug Elmendorf told the committee, and would amount to reducing those benefits by "a little more than half."

Under Elmendorf's estimates, Medicare Advantage enrollees would receive about $42 monthly in additional benefits in 2019 under the current health care proposal, not the more than $84 in benefits they would get without the cuts.

As a result, Elmendorf said, about 20 percent of Medicare Advantage users, approximately 2.7 million, would drop out of the program and would instead use standard Medicare.

Medicare Advantage refers to the various private health care options available through the government-run Medicare system. Often, Medicare Advantage plans include prescription drug coverage and other benefits. Generally, Medicare Advantage plans feature more benefits and lower co-pays than standard Medicare coverage, but include limitations on which doctors and hospitals a patient can visit. Insurers have warned that premiums may go up for seniors enrolled in Medicare Advantage under President Obama's health care reform proposal. The president has promised seniors will continue to receive the same level of coverage after reform is passed.

"Because the competitive bidding process would reduce the benefits that would be made available, fewer would choose Medicare Advantage and more would choose fee-for-service," which is standard Medicare, Elmendorf said.

One Democrat, Sen. Bill Nelson, of Florida, will offer an amendment to protect Medicare Advantage benefits, and at least one other Senate Democrat may be prepared to vote against the bill if the cuts go through. That could put passage in jeopardy, because no Republicans on the panel are likely to back the plan.

"I have real doubts that Congress ultimately will take as large a cut out of Medicare Advantage," said Joseph Antos, a health care scholar at the free-market American Enterprise Institute. "You are going to take 20 percent of the Medicare population, who are probably more active voters than the average Medicare beneficiary, and tell them that you can't have what you had last year. President Obama is telling you you can't keep what you want."

But without making drastic cuts to Medicare, Democrats are left without enough money to fund the massive reform plan.

"If they don't make the cuts, where are they going to get the $120 billion?" said Bob Laszewski, president of Health Care Policy and Strategy Associates. "There is pretty good agreement about what the benefits of health insurance should be, but where there really isn't agreement is how they are going to pay for it."

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Doubling Down on a Flawed Insurance Model

Obama's plan takes the problems of the current system—mandates, runaway spending and more—and makes them worse

"What this plan will do is make the insurance you have work better for you. . . . And here's what you need to know, I will not sign a plan that adds one dime to our deficits—either now or in the future. Period."

So spoke President Barack Obama in his address to Congress earlier this month, for the first time laying out more specific goals for health-care reform. To persuade the American people to support his health reform agenda, the president has made two simple promises. First, his plan will benefit everyone who already has health insurance. Second, his plan will not add to the nation's yawning budget deficit. Both claims are essentially false, and examining them offers economic lessons for reform.

The administration's plan will impose mandates that employers provide coverage, mandates that individuals obtain coverage, and mandates about the form this coverage will have to take. These will remove the freedom to choose one's health-insurance plan, because government, in its effort to correct perceived inequities, will dictate which health-care services must be covered and which health-care providers must be used.

The proposed unprecedented intrusion of government into private markets will have adverse effects on people with insurance in both the short and the long run.

The mandates will lead to large increases in the cost of health insurance for everyone. Research studies have shown that as people become insured, especially under a health plan that offers broad coverage and low copayments, they consume more health-care services. The best estimates indicate that each newly insured person will approximately double his or her health spending.

With 30 million to 40 million newly insured persons under the administration's plan, aggregate health-care demand will increase significantly. But when demand expands prices increase. We estimate that the higher demand will increase health insurance premiums for the typical family plan by about 10%. Because an employer-sponsored family insurance plan cost $12,680 in 2008, this translates into an increase of about $1,200 in the typical annual premium.

The mandates will also have adverse additional longer-run consequences. According to provisions in both House and Senate bills, mandated plans must have low copayments and provide coverage of health-care services that is at least equal in scope to a typical, current employer-sponsored plan. But these are the very flaws that are responsible for high and rising health-care costs, flaws that stem directly from the misguided tax exclusion for and the extensive state regulation of health insurance. By locking in these flaws, the mandates will inhibit precisely the innovation needed to reform U.S. health care. Ultimately, as government seeks to rein in costs, it will curtail access to health-care services by erecting barriers between patient and health-care provider.

The current House and Senate bills will also break the president's second promise—not to add to the deficit. In part because the health insurance that the administration's plan forces people to buy is expensive, the plan proposes to give individuals large financial subsidies to partially offset the cost. The entitlement-based subsidy, combined with the proposed Medicaid expansion, would add between $700 billon and $1.2 trillion to federal spending over the next decade, according to the Congressional Budget Office. The new entitlements would come on top of existing federal health-care entitlements that the government has been neither able to control nor finance.

A portion of the additional spending is to be financed by savings from the existing federal health-care programs. But, thus far, the alleged savings come mainly from cutting future Medicare payment rates. If history is any guide, the savings won't materialize.

For the past 25 years, Congress has repeatedly "cut" payment rates. Yet Medicare's expenditures have continued to outstrip its dedicated revenues. New taxes have been required but revenues still can't keep up with expenses. Recall that in the early 1990s Congress removed the cap on Medicare's taxable wage base. Today, the Medicare Board of Trustees projects that the Hospital Insurance Trust Fund will be bankrupt in eight years.

More important, cutting payment rates is not reform. Ultimately, such price controls will lower the quality of health care and reduce the supply of health services, just as price controls have in every market where they've been tried. Congress's near-exclusive reliance on such cuts is revealing. It is a clear demonstration that the federal government has no idea how to reform its current insolvent health-care programs, much less how to properly design a new one.

Reform will be partly financed by higher taxes. The House bill proposes to raise the highest personal income tax rate by 5.4 percentage points. This is on top of the Obama administration's plan to raise the top rate by another 4.6 percentage points next year. The combined 10-percentage-point increase raises the top income tax rate to 45%—an economic growth-destroying level not seen since the early 1980s. Sen. Max Baucus (D., Mont.) proposes, instead, to tax some health insurance premiums.

In neither bill do higher taxes finance the proposed additional spending. Should the Medicare savings fail to materialize, as we believe they will, the spending in either bill will add more than $100 billion per year in perpetuity to the already soaring national debt.

Returning to President Obama's address: "We did not come to fear the future. We came here to shape it." But shaping needs a well-thought-out plan. To move forward, the country must begin to have two separate debates. The first debate centers on how to improve current health insurance arrangements in order to rein in the epidemic of health spending that too often fails to provide good value for money.

The second debate should center on additional steps to improve access to health care for those who cannot afford it. However, this debate must be separated from the issue of insurance coverage. Many currently insured Americans, no doubt, would be willing to pay some additional amount if extending health insurance coverage actually improved the health of the uninsured.

The hard reality is that there exists little evidence that it does. Helen Levy and David Meltzer, in a 2008 review of research in the Annual Review of Public Health, summarize the overwhelming conclusion of academic research by concluding: "The central question of how health insurance affects health, for whom it matters, and how much, remains largely unanswered at the level of detail needed to inform policy decisions." We must experiment with alternatives, such as further expansions of community health clinics, special assistance for the chronically ill, and other programs that might not supply traditional services but could have a big impact on people's health.

Comprehensive, low-deductible, low-copayment insurance has brought us to where we are today. The administration's plan to expand and lock-in this flawed paradigm will ultimately defeat the goal of making health services more affordable for everyone. Fortunately, there are other options, many of which have appeared on these pages. These include policies that encourage more cost-conscious health-care choices, greater competition among health insurers, and reduce the practice of defensive medicine.

President Obama claims to support these ideas, but the plan he outlined is not consistent with these claims, and neither is the Senate Finance Committee bill. The American people should ask for a second opinion.

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Bad Medicine: ObamaCare is hazardous to your health

By PETE DU PONT

President Obama addressed Congress two weeks ago on the issue of health care, and on the same day an Associated Press GfK poll showed that the proportion of Americans who strongly approve of the way he is doing his job has fallen from 41% in December to 24% now. And the percentage of people who strongly disapprove of his performance has risen from 6% to 35%.

Those serious declines no doubt have to do with many issues--economic decline, the massive spending increases (enacted and proposed) of $6.5 trillion over the next decade, the coming massive tax increases that are presidential and congressional priorities, and currently most important, the proposed governmental takeover of health care. On that matter, more than 1.3 million people have signed and sent to Congress the Salem Radio Network's Free Our Health Care Now! petition to make sure individuals, not the national government, make their health care decisions. (Disclosure: The petition incorporated information form the National Center for Policy Analysis, of which I am chairman.)

But the Democratic congressional leadership, led by Sen. Max Baucus of Montana, has now offered a bureaucratic, government-intrusive health care proposal. The details change daily as the bill works its way through the Finance Committee, which Mr. Baucus chairs, for there are more than 500 proposed amendments being considered. But the bill would start off by imposing annual fees of $6.7 billion on health insurance companies, $4 billion on medical device producers, $2.3 billion on drug manufacturers and $750 million on clinical laboratories, all of which would surely be passed on to consumers in higher prices. The insurance companies' $6.7 billion fees alone would come to some 60% of the industry's after tax earnings.

And then American families who do not have health insurance--the people the Democrats claim they're trying to help--would be assessed finds of between $750 to $1,900 a year. All this reflects Congress's simple objective: government rather than individual control of our health care.

But America's health care is not doing badly. Indeed a National Center for Policy Analysis study from last March shows how much better we are doing than countries like Canada, Britain, and other European nations that have government health care control:

* Breast-cancer mortality is 52% higher in Germany and 88% higher in Britain than in the U.S.

* Prostate-cancer mortality is 457% higher in Norway and 604% higher in Britain than in the U.S.

* Eighty-nine percent of middle-aged women in the U.S. have had a mammogram, compared with 72% in Canada.

* Fifty-four percent of men in the U.S. have had a prostate-specific antigen test, compared with 16% of Canadian men.

As for the availability of health care, another study shows that 74% of those in the U.S. meet for scheduled doctors appointments within four weeks, while only 42% of British and 40% of Canadians do. Only 10% of Americans wait longer than two months, while 33% of Brits and 42% of Canadians wait that long.

On average, doctors in a survey say neurosurgery should be performed within 5.8 weeks, but in Canada it takes about 31 weeks. And orthopedic surgery should be within 11 weeks, but in Canada it takes 37 weeks. So it is pretty clear that government health-insurance monopoly is dangerously inefficient.

The government-operated Baucus plan would impose big costs on Americans, in terms of both money and freedom..

First there is the original proposal of a 35%--since raised to 40%--excise tax on companies that offer health-care plans that cost more than $8,000 for individuals or $21,000 for families, just to make sure that government can control costs and health care plan contents.

The individuals' cost of the required Baucus health care plans are very high, As The Wall Street Journal pointed out the other day, for a family of four making $42,000 the "government would subsidize 80% of their premium and pay $1,500 to offset cost-sharing," but the family would "still pay $6,000 a year--or 14.3% of their total income." As family incomes slowly rise, so would their health care costs--to 17% or 18% of income. In committee, the subsidies will likely be increased, but the individual's cost will still be too high.

The plan would cut some $500 billion from Medicare and Medicaid, including the excellent Medicare Advantage plan that gives 10 million senior citizens private health-care options. Giving choices to seniors is simply an anathema to government-control believers.

The federal government would also likely follow the lead of states and impose a list of benefits that must be included, even if all patients don't need them. There are now about 2,100 state-based mandates, for such services as acupuncture, wigs, massage therapy and in vitro fertilization.

Finally, Mr. Obama also believes in community rating, a requirement (already existing, in one form or another, in 11 states) that limits the differences in what companies can charge people for their coverage, regardless of their age or medical condition. That means younger, healthy people would pay much more than their care would cost--yet they would pay big fines if they don't take this bad bargain.

So what is a better solution? First, allow everyone to purchase health insurance across state lines (difficult under current law, as you must buy your insurance in your own state), so that they can get the best possible policies at the best possible prices.

Second, individuals should get the same tax break that companies get when they supply health insurance for their employees. All policy payments should be tax deductible, either to the company or the individual.

Third, health insurance should be portable. Companies should help their employees own their own insurance so that it travels with them from job to job, state to state, and is under their control.

Fourth, Congress should enact tort reform so that doctors can do what is best for their patients instead of practicing costly legal defensive medicine.

And finally, let people purchase insurance that meets their needs, rather than requiring intrusive, one-size-fits-all federal government mandates.

SOURCE




Senate considers aiming low on health care

As a deadline to pass a health care bill gets closer with no end in sight to the discord in Congress, some lawmakers want to scrap the proposals that are now on the table and try to pass a much smaller bill. "People feel that it may be very hard to get such a large bill done this year," said Sen. Joe Lieberman, I-Conn., after a closed-door meeting with Senate Democrats.

Lieberman said many Democrats appear "open" to the idea of trying to pass a far less ambitious legislation than the $900 billion plan on the table in the Senate Finance Committee, where lawmakers have lined up more than 500 amendments in an attempt to reshape the bill. "We've never adopted a reform package this large in one legislative act," Lieberman said. "We ought to begin this year putting parts of reform in and then make it better and better as time goes on. More than one senator suggested that as a possibility."

With just weeks remaining on the legislative calendar, both the House and Senate may ultimately have little choice but to take up a smaller bill. In the House, Speaker Nancy Pelosi must merge three similar, $1 trillion bills into one piece of legislation that that can garner the 217 votes needed. But she has no plans of bringing it to the floor yet, which would require twisting the arms of her skittish Democratic moderates and freshmen who have problems with the bill. Instead, Pelosi will wait and see if the Senate can pass a bill and then try to pass House legislation around the same time, a leadership aide said.

But Pelosi may have to wait a while for the Senate. Even after the Senate Finance Committee gets through its giant stack of amendments, Majority Leader Harry Reid, D-Nev., will have to find a way to combine the bill with a much more liberal and partisan health care proposal passed earlier this summer by another committee, and that final product must win the support of all 60 Democratic votes (Massachusetts is likely to soon appoint a Democratic replacement for the late Sen. Edward Kennedy), or alternatively pick support among a few Republicans.

Some Democrats are beginning to think it may be an impossible task. "I suggested that earlier this year we ought to take up something incrementally, because of the challenge," Sen. Ben Nelson, D-Neb., said. Nelson and other Democrats agree that Congress has to pass some kind of health care reform this year, even if it is a much smaller plan. Nelson suggests first passing a bill aimed a bringing down the cost of health care, which many Democrats in the closed-door meeting on Tuesday said is the biggest priority. If a bill is whittled into something smaller, the end product would focus on medical costs.

Reid repeated a warning that he may use a procedural move to pass a health care bill with just 51 votes, which would require breaking up the bill. He cited the need to bring down health care costs as the reason for the urgency. "Too many people waited too long for Congress to rein in skyrocketing costs, and we have to do something about it," Reid said. "That's what the debate's all about."

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25 September, 2009

McConnell blasts regime over Humana “gag order”

The federal government resorted to bullying tactics when it ordered an investigation of Humana -- one of the country's biggest private insurers -- for its decision to send customers a letter alerting them about pending health reform legislation, a leading Republican charged Wednesday.

U.S. health officials launched the probe after the Louisville-based company mailed a letter to patients enrolled in its Medicare Advantage plans -- private options that replace standard Medicare -- warning that President Obama's health overhaul could eliminate important benefits of the program.

Humana said in its letter that if Medicare Advantage funding gets cut, "millions of seniors and disabled individuals ... could lose many of the important benefits and services that make Medicare Advantage health plans so valuable."

Republican Senate Minority leader Mitch McConnell blasted the investigation of Humana on Wednesday, calling it a "federal gag order" that seeks to silence a health provider that disagrees with the administration. McConnell said he's called for a complete legal justification of the probe. "This is so clearly an outrage," McConnell said on the Senate floor. "For explaining to seniors how legislation might affect them, the federal government has now issued a gag order on that company, and any other company that communicates with clients on the issue, telling them to shut up -- or else. "This is precisely the kind of thing Americans are worried about with the administration's health care plan. They're worried that government agencies which were created to enforce violations even-handedly will instead be used against those who voice a different point of view," he said.

The investigation was first suggested by Senate Finance Committee Chairman Max Baucus, whose committee has jurisdiction over Medicare. The Centers for Medicare & Medicaid Services (CMS) -- which officiates over the Medicare program for seniors and Medicare Advantage options -- ordered a "cease and desist" order on all of Humana's health care mailings until the investigation is concluded.

Baucus has called the Humana letter a "scare tactic" meant to distort the current reforms under consideration. The CMS alleges that Humana's letter may have violated federal regulations, but the information distributed by the health provider was supported by the nonpartisan, independent analysis of the Congressional Budget Office.

Obama has insisted that despite planned cuts to Medicare providers, seniors would not see their benefits reduced under a health care overhaul. But CBO Director Douglas Elmendorf contradicted that Tuesday under questioning by Finance Committee Republicans, saying seniors in the private Medicare Advantage plans could see reduced benefits under Baucus' legislation. Proposed changes "would reduce the extra benefits that would be made available to beneficiaries through Medicare Advantage plans," Elmendorf said.

Humana spokesman Jim Turner said Wednesday that the company is cooperating with CMS in its investigation. But, Turner added, "We also believe Medicare Advantage members deserve to know the impact that funding cuts of the magnitude being discussed would have on benefits and premiums."

A Republican aide told FOXNews.com that the investigation is a clear breach of First Amendment rights and said the Republican leader is asking the CMS to provide legal justification for its investigation. The aide said CMS's investigation follows a pattern of intimidation put forth by the administration for any kind of dissent in the health care debate.

The Democratic Senatorial Campaign Committee lashed out at McConnell's charges Wednesday, saying, "If there was ever any doubt who Republicans are looking out for in the health care debate, Mitch McConnell has offered conclusive proof: the insurance companies. "Republicans jeopardize their own credibility when they choose to defend big insurance companies trying to make false claims about senior citizens," the DSCC said in a press release.

Nine months into Obama's administration, no administrator of the CMS has been named -- leading some Republicans to question whether the White House had a direct hand in silencing Humana.

While the administration referred all questions about the investigation to CMS, White House spokesman Reid Cherlin said the confirmation of a CMS administrator "is a priority for the administration." CMS did not immediately answer requests for comment.

House Ways and Means Committee ranking member Rep. Dave Camp, R-Mich., has called on CMS to provide additional information on the so-called gag order, including the person or persons who authorized the agency to issue it. "I have never seen anything like this and I question if politics was the deciding factor," Camp said in a press release. "Given that the administration has failed for more than eight months to nominate a director for CMS, I wonder if undue political pressure may have been applied on the CMS staff. "It is Congress' responsibility to find out the facts and protect the interests of the American people. We need to know who contacted CMS, when they did it and what was said," he said.

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Mandatory insurance: Yes, it’s a tax

By Jeff Jacoby

IT WAS A PERFECTLY straightforward question. The answer was anything but. President Obama vows not to raise taxes on any American family earning less than $250,000 a year. Yet he backs legislation that would force every American to carry health insurance or pay a hefty penalty to the IRS. Such an “individual mandate’’ is included in all the major health care bills making their way through Congress, including the legislation unveiled by Senate Finance Committee Chairman Max Baucus last week. So when ABC’s George Stephanopoulos interviewed the president on Sunday, he raised the obvious challenge: “Under this mandate, the government is forcing people to spend money [to buy insurance], fining you if you don’t. How is that not a tax?’’

Obama replied that the individual mandate “is absolutely not a tax increase,’’ since, in his view, there is good reason to impose it. He stuck to that position even when confronted with Merriam-Webster’s definition of “tax’’ - “a charge, usually of money, imposed by authority on persons or property for public purposes.’’

“George,’’ chided Obama, “the fact that you looked up Merriam’s Dictionary . . . indicates to me that you’re stretching a little bit right now.’’ But the only one “stretching’’ was the president, whose position was at odds with the legislation itself. “The consequence for not maintaining insurance would be an excise tax,’’ notes the committee staff report on the Baucus bill. “The excise tax would be assessed through the tax code and applied as an additional amount of Federal tax owed.’’

Obama isn’t the first politician to maintain that a mandate to buy health insurance isn’t just another middle-class tax. Mitt Romney did so as governor of Massachusetts, boasting in 2006 that thanks to his signature health care law, “every uninsured citizen in Massachusetts will soon have affordable health insurance, and the costs of health care will be reduced. And we will need no new taxes . . . to make this happen.’’ But isn’t the penalty that law imposes on the uninsured - a penalty that this year will run as high as $1,068 per person - a tax? Gosh, no, enthused Romney: “It’s a personal responsibility principle.’’

Whatever it’s called, it hasn’t transformed Massachusetts into an Eden of universal coverage. According to the Department of Revenue, nearly 200,000 state taxpayers remained uninsured at the beginning of 2008. And the individual mandate hasn’t made insurance in the Bay State more affordable: Massachusetts has the highest health insurance premiums in the nation.

Far from holding insurance costs down, “reform’’ in Massachusetts seems to have had the opposite effect. “Insurance premiums rose by 7.4 percent in 2007, 8-12 percent in 2008, and are expected to rise 9 percent this year,’’ notes Michael Tanner of the Cato Institute. “By comparison, nationwide insurance costs rose by 6.1 percent in 2007, just 4.7 percent in 2008, and are projected to increase 6.4 percent this year.’’

However tempting it may seem, universal health coverage cannot be achieved by waving a legislative wand and ordering every citizen to buy insurance. Supporters of an individual health-insurance mandate like to compare it to the nearly universal requirement for auto insurance, but far from proving their point, it undermines it. True, auto insurance is mandatory almost everywhere. Yet nearly 15 percent of motorists remain uninsured.

Requiring that drivers be insured, Obama told Stephanopoulos, “is a fair way to make sure that if you hit my car . . . I’m not covering all the costs.’’ Auto insurance is required, however, only if you choose to own a car and drive it on public roads. Under ObamaCare (as with RomneyCare), health insurance would be compulsory no matter what you did or didn’t do.

It is a myth that those who don’t buy health insurance are basically free riders who unload their medical costs onto the backs of more responsible Americans. In truth, most of the uninsured are young, fit, and unlikely to need medical care. Why should they be forced to pay for expensive insurance they don’t need?

The right way to expand coverage is not to scourge the healthy with new taxes, but to win them over with lower premiums. Deregulation is a far better strategy than compulsion. If insurers were free to compete for business across state lines, for example, and if states would repeal the excessive benefit requirements that have driven up the cost of insurance, premiums would shrink and so would the ranks of the uninsured.

Coercive insurance mandates are a prescription for more misery, not less. Massachusetts is learning that lesson the hard way. The rest of America doesn’t have to.

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Are We Really all Healthcare Collectivists Now?

“We have to do something about health care.” The scariest word in that sentence is not something. It’s we. The first-person plural form is not merely a convenience, as in “We’re in for a cold winter.” It indicates that decisions about “the healthcare system” should be made collectively, with one decision binding everyone. That’s collectivism.

So why is virtually everyone a collectivist when it comes to health care? I do not exaggerate. Every prominent participant in the current debate over how to “reform” the medical industry approaches the issue in collectivist terms. They have differences at the margin–tax increases versus tax credits, a government-run “public option” versus subsidized nonprofit cooperatives–but there is no disagreement that “we” must have a policy.

But why must we do anything about health care? Why can’t you do what you want, I do what I want, and he and she do what they want? Isn’t that what’s supposed to happen in a free society? Reformers would say that costs are rising too much and some people can’t afford insurance. But that is no answer. It tells us only that possibly ameliorable conditions exist, not that collectivism is a good approach.

When we see problems in other important markets, most of us don’t expect televised presidential town-hall meetings, congressional committees, and omnibus legislation to give us the answer. We individually adjust our behavior in the marketplace and anticipate that entrepreneurs will cater to us. Solutions, with inevitable tradeoffs, are micro, marginal, and tailored to individual needs, not macro, holistic, and procrustean. Out of this arises an orderly marketplace–without a conscious overall plan. No one has found a better way to make masses of people better off.

Why is health care different? Must we collectively reinvent the industry? The social knowledge problem that F. A. Hayek spelled out should make us wary of any collective response.

The reformers’ stock answer is that this is something only we, acting through the “democratic process,” can handle. That’s an assertion. Where’s the proof? What if earlier collectivist decisions gave us rising medical and insurance costs?

In fact they did. Nearly every aspect of medicine and health insurance that the politicians say needs fixing is the result of “our”–that is, politicians’–previous attempts to fix something. Much of the escalation of prices comes from consumer demand freed from normal cost constraints thanks to third-party payers: government-privileged insurance companies, Medicare, and Medicaid. While that intervention boosts demand by eliminating cost consciousness, others constrict supply: occupational licensing, insurance mandates and barriers to entry, patents on drugs and devices, FDA regulations, certificate-of-need requirements, and more.

So let’s hear no more about what we–collectively and coercively–must do about health care. If government would get out of the way, we–individually and cooperatively–will figure out what to do. Collectivism and government planning trample freedom and foster social stupidity. Individualism and free markets respect each person’s dignity and liberty while getting the most out of the “wisdom of crowds” in the marketplace.

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Cap and Trade Legislation Would Increase Uninsured By Millions

The U.S. Senate can increase the number of Americans with health insurance by tens of millions -- at zero cost to taxpayers -- by rejecting cap-and-trade legislation passed by the U.S. House, according to a policy analysis just released by The National Center for Public Policy Research.

In June, the U.S. House of Representatives approved the American Clean Energy and Security Act -- commonly referred to as the Waxman-Markey bill after its principal sponsors, Henry Waxman (D-CA) and Edward Markey (D-MA) -- which seeks to reduce U.S. greenhouse gas emissions by more than 80 percent by 2050.

The National Center for Public Policy Research contends the Waxman-Markey bill would increase energy prices, slow the economy and result in higher unemployment. This, in turn, the group says, would increase the number of uninsured.

"For every one percentage point increase in unemployment, 1.1 million Americans lose their health insurance coverage," said David A. Ridenour, Vice President of The National Center for Public Policy Research. "With the Waxman-Markey legislation projected to cost an average of 1.15 million jobs annually between 2012 and 2030, this could translate into tens of millions of Americans losing their health insurance coverage. The best health care reform is doing nothing at all -- at least on cap-and-trade."

Loss of health insurance coverage, however, is only one of the negative health consequences that would result from a Waxman-Markey-style bill, according to Ridenour.

"The stress and loss of self-esteem that accompanies job loss can lead to unhealthy lifestyles, including substance abuse and poor eating habits," said Ridenour. "The unemployed are more likely to be diagnosed for hypertension, heart disease, diabetes and stroke, and because discretionary income drops with the loss of a job, so too do routine screenings that might prevent late-stage diseases."

Ridenour cites a study by Kate Strully of the State University of New York at Albany showing that involuntarily unemployed factory workers are 83 percent more likely to develop a new health problem than those who keep their job.

A full copy of Ridenour's analysis can be found at http://tw0.us/1ou

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How Missouri Cut Junk Lawsuits

By MATT BLUNT

There has been a lot of talk in Washington about cutting wasteful health-care spending, but it is troubling that such talk has not created a sense of urgency for national tort reform. It is especially frustrating because states have already shown that curbing junk lawsuits can cut costs, create jobs, and increase the quality of care available to patients. I know this because that is exactly what happened in Missouri when, as governor, I helped to enact comprehensive reforms.

I took office in January 2005 at a time when runaway lawsuits were driving up the cost of doing business in my state and forcing doctors and other business owners to close their doors. The U.S. Chamber of Commerce Institute for Legal Reform keeps a list of states ranked according to their legal environment. At the time, Missouri ranked among the 10 worst. "Venue-shopping," a tactic that involves shifting a case to a friendly court regardless of where the injury occurred, was common. Defendants could be made to pay 100% of a judgment even if they were only 1% responsible for the injury. And caps on damages had been rendered meaningless by state court decisions.

This legal environment raised the cost of health care for everyone and imposed stiff costs on businesses. It also forced doctors to close their doors. For example, the eastern half of Jackson County, one of Missouri's largest, lost its only neurosurgeons in 2003 due to high malpractice insurance costs. Many other parts of the state suffered from a lack of doctors able to deliver babies. One obstetrician who delivered more than 200 babies annually was forced to quit after his annual insurance premiums skyrocketed 82% in just one year. Making matters worse, few new doctors wanted to move to Missouri. One Kansas City area doctor sent letters to more than 400 physicians finishing their residencies and did not receive a single response back.

To counteract these problems we required that cases be heard in the county where the alleged injury occurred, and we changed the law so that defendants could only be forced to pay a full judgment if their fault exceeded 50%. We put a $350,000 cap on noneconomic damages and created rules to prevent baseless cases from getting off of the ground. Previously, personal injury lawyers could file cases if they got a written affidavit from any qualified health-care provider claiming that there was negligence. We tightened that by requiring that the affidavit come from an active professional practicing substantially the same specialty as the defendant.

We also took another common-sense step. Doctors often express empathy to a suffering patient regardless of fault. Saying you are "sorry" for someone's plight is a testament of good character, and should not be used against you in court. But tort lawyers were claiming that such statements were an admission of guilt. We stopped that abuse.

Tort reform works. Missouri's medical malpractice claims are now at a 30-year low. Average payouts are about $50,000 below the 2005 average. Malpractice insurers are also turning a profit for the fifth year in a row—allowing other insurers to compete for business in Missouri. This will drive down costs, which will save government programs money as well as improve the system for patients. It will also leave doctors with more resources to invest in better care. Since 2005, Missouri has moved up to 31st on the Chamber of Commerce Institute for Legal Reform's list.

Because we passed tort reform, cut taxes and controlled state spending, Missouri's economy is now in better shape than it would have been. During the four years I was in office, about 70,000 net new jobs were created in my state.

Texas has seen similar success from its 2003 tort reforms. The number of doctors applying for a license in that state has increased by 57% and doctors' insurance rates have declined by an average of 27%. There are now more doctors in Texas providing care in previously underserved areas.

There is no reason that the success that Missouri, Texas and other states have experienced cannot be replicated nationally. States are demonstrating that tort reform lowers costs, expands access, and creates jobs. The time to get behind national tort reform is now.

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24 September, 2009

NHS vendetta against whistleblower

No concern over whether staff were qualified, apparently. "Shoot the messenger" approach instead

A senior NHS nurse faced a “witchhunt” and was threatened with having her house burnt down if she did not drop a complaint against a colleague, an employment tribunal has been told.

Jenny Fecitt, who worked at an NHS walk-in centre in Wythenshawe, South Manchester, said that at the time of a phone call in which the threat was made she was in dispute with her employer after raising concerns over another nurse’s qualifications.

Mrs Fecitt had complained to bosses at NHS Manchester over one of the staff on her team, Daniel Swift, whom she claimed “misrepresented” his training and should not have been treating adult patients. But her concerns were ignored by trust bosses, it is alleged, and she was subjected to a “character assassination” before receiving the threatening call. “The substance of the call was if I did not drop the case against Daniel Swift that our house would be burnt down,” Mrs Fecitt told the employment tribunal, sitting in Manchester.

Mrs Fecitt, along with Annie Woodcock and Felicity Hughes, her fellow nurses, is taking NHS Manchester to the tribunal, claiming that they were victimised after voicing their concerns. The tribunal heard that problems began on March 3, 2008, after Mrs Woodcock approached her about Mr Swift’s qualifications.

Mrs Fecitt said that during a casual conversation among staff he maintained that he was qualified as both a child and adult nurse. She called the Nursing and Midwifery Council and was told that he was qualified to treat only children. Mrs Fecitt spoke to her line manager and, the next day, Mr Swift is alleged to have called her in an “aggressive and confrontational” manner.

She told the tribunal that it was her “moral and professional” obligation to report Mr Swift to the nursing council. She also contacted the trust’s officer responsible for corporate governance and whistleblowing in April 2008 and an investigation was started. But the following month she was relieved of her management responsibilities.

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Australia: Coverup of bullying at NSW government hospital

The New South Wales Opposition says nurses who have complained of bullying at a far south coast hospital would not mind if findings of an investigation were made public. Bega MP Andrew Constance says an external investigator's report on bullying and operational issues at Pambula Hospital should be given to the community.

The Greater Southern Area Health Service says the report will not be released publicly. However, a summary and set of recommendations will be released. Its eastern sector general manager, Ken Barnett, says staff and appropriate unions will be consulted before it is considered whether to implement recommendations.

Mr Constance says if unions are entitled to know the findings, so should the broader community, and nurses names could be omitted from the documents. "You don't necessarily need to disclose names but the community are entitled to know what occurred at the facility and what is going to be done about it in the future," he said. "The only way that the confidence can be regained by the community in what's occurring at Pambula Hospital is for that availability of the information and that openness and transparency around what's happened."

He says not releasing the investigation findings to the community will further erode public confidence in the health system. "I think nurses want accountability in the system. They want to be able to raise issues of concern and I think there's been enough secrecy clouding the hospital as is without it being furthered by a government not willing to be open and transparent about this report," he said. "The community is aware of the investigation. It's important that the community have the recommendations and the findings of that investigation."

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Barack Obama Cannot Walk on Water, and Neither Can ObamaCare

As Barack Obama travels across the fruited plain and sucks up all the air on every Sunday network news show—except for FOX News Sunday—attempting to repackage his plans to take over the health care industry by force of law, one thing has remained constant. According to Dr. Obama, under his “plan,” tens of millions more Americans will receive taxpayer-subsidized health care, the quality of medical care will increase, and it will all occur at no extra cost to taxpayers. After that, he plans to walk on water.

In reality, of course, there are more than a few problems with the Obama Administration’s claims. Namely, the numbers simply do not add up. Expanding health coverage is a costly venture, and the American people are not fooled. They know they will wind up paying through the nose for this massive expansion of federal entitlements. And that these will add substantially to the national debt, which now totals some $11.8 trillion.

The House plan, which 45 million people qualify for, at an average cost of $4,700 per premium according to the National Coalition on Health Care, would add on $211.5 billion in extra costs to taxpayers every single year once fully implemented. That’s $2.1 trillion over ten years.

It doesn’t get much better even under the so-called “bipartisan compromise” legislation—that not a single Republican supports—now being floated by Montana Democrat Senator Max Baucus. Under his plan, an additional 26 million individuals would receive government-subsidized health care, which at $4,700 for a premium, adds up to $122 billion extra every year, or $1.2 trillion over ten years.

All of which will be piled atop the greatest budget deficit in human history: $1.85 trillion.

Both plans attempt to hide the unfunded entitlement costs by means of a deceptive scheme stalling fuller implementation of the public “option” on the House side, and the government-regulated co-ops on the Senate side. Each is delayed not to start until 2013. This execution is designed purely to keep the ten-year projections of each plan under the $1 trillion mark, thus providing political cover for members from more conservative districts and states.

The Baucus plan in essence attempts to deliver an ObamaCare Lite proposal that subtracts out the so-called public “option,” cutting the proposed increase of coverage by about 20 million individuals. His purpose is to find the votes necessary for Senate Democrats who are queasy about voting for what amounts to government-run socialized medicine.

In truth, they should still feel nauseous about casting Yay votes. The proposal establishes government-run ‘co-ops’ that will provide health care in place of private options. It still has a rationing board. It still requires Americans to be insured or else pay a fine. It still does not allow for competition across state lines to purchase medical insurance. It still expands Medicaid. It still increases taxes. It still has no tort reform. As noted above, it still adds to an already unsustainable debt. And, it will still ultimately result in a government-run system, no matter how much Barack Obama denies it.

Particularly devastating to both plans is that they will still inevitably result in rationing—one way or another. The American people are prospective in their outlook, and they are cautious about supporting a proposal that threatens to decrease the high quality of care they are used to receiving.

And Obama has not helped himself on this front.

Writes Dick Morris in a recent column in response to Barack Obama’s joint session of Congress address, “In his hour long speech on health care, [Obama] failed to spend even a moment rebutting the central critique of his program: His inability to provide quality medical care for 30 million new patients without any additional doctors or nurses… The result of expanding the demand for medical services without augmenting the supply of doctors or nurses must be the rationing of medical care. And rationing will inevitably take its greatest toll among the elderly, forcing them to forgo elective surgery or, if their remaining quality years are likely to be limited, to do without vital life-prolonging treatment. Inevitably, we will all have to wait many more days, weeks, months or years for care we now receive on demand.” During which time, one should add, they will die.

Another reason that both plans will result in rationing is that both contain provisions forcing insurers to take on riskier patients without charging more for the premiums. As a result, the costs will be passed on to everybody and distributed throughout the entire system.

In short, that means rates will go up. At the same time the quality of everyone’s coverage will decrease. And individuals will have no choice but to buy the watered-down plans. Soon, more will be allotted in benefits than can be collected in revenue. The program would then turn to borrowing and printing more money to fund it, as have Medicare and Social Security—a flawed approach that will bankrupt the public treasury.

And in the end, Washington will decide who gets care and who does not.

According to Rasmussen Reports, 56 percent of voters now oppose the plan, demonstrating a growing trend of opposition to the takeover. And Barack Obama’s public disapproval has sunk to the 52 percent mark for the first time in his term.

The fact is, the more Barack Obama parades around on television attempting to redesign and repackage his proposals to make them sound more appealing, the more the American people oppose him and his socialist designs. He has not deviated from the unsustainable path of socialized medicine he has chosen. He still cannot walk on water. Which is why his health care scheme is sinking like a rock.

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Obamacare: Quintessential socialism

The overriding characteristic of President Obama's healthcare proposal is forced equality of consumption, a major step in the direction of egalitarian distribution of income. Emphasis is upon the word forced.

As we see with the widespread town hall protests against the President's proposed healthcare proposals, people do not willingly surrender the fruits of many years' labor to the government in the name of an undefined abstraction called the common good. Particularly is this true when it is liberal-progressive bureaucrats who decide arbitrarily what constitutes the common good.

In a Wall Street Journal op-ed essay, Martin Feldstein, Harvard economics professor and former chairman of President Reagan's Council of Economic Advisors, sums up Obamacare: it's all about the raw power to decide who gets what treatment, while cramming everyone into identical little boxes in order to eliminate any efforts in the direction of individuality. And the bureaucratic mechanism for eliminating individuality is rationing medical care.

Despite the repeated lies by the President and his spokesmen, as Professor Feldstein writes, the healthcare bill pressed by House Speaker Nancy Pelosi clearly contemplates rationing.

Many supporters of Obamacare argue that healthcare already is rationed by money availability, because Medicare, Medicaid, and insurance companies will pay only certain amounts for care and will refuse to pay for some specialized treatments or prescription drugs. This ignores the obvious fact that individuals are free to make choices to pay for such care themselves and that it was individuals who selected the insurance payment programs they have.

Under Obamacare, all private insurance would eventually be compelled to offer exactly the same scope of insurance as the so-called public option. Everybody will be compelled to have the same coverage program, whether he is old, young, in poor health, or in good health.

The argument that medical care already is rationed also reflects a deep-rooted aspect of the liberal-progressive-socialist paradigm: the idea that individuals possessing more money than others is an inherently unjust social condition.

Michael Walzer's analysis of that paradigm is typical. Professsor Walzer, one of liberal-progressive-socialism's most prominent theorists, is co-editor of Dissent, a leading socialist journal.

Walzer contends that possession of money amounts to power and that such power is both unjust and unjustly used. It enables the rich to purchase every sort of social good. Why should these goods be distributed to people who have a talent for making money? This, he says, is morally implausible and unsatisfying.

Nor would it be better if we gave money to people on the basis of their intelligence, strength, or moral rectitude. There is no single talent or combination of talents that entitles a man to every available social good.

In the socialists' view, all that should count is need. If people need certain things (leaving aside how that need is determined), they should simply be given them, without regard to their ability to pay. This is what is meant, in Professor Walzer's sense, by social justice. Whenever equality in this sense does not exist, we have a kind of tyranny in which the strong, the well-born, and the wealthy get social goods in amounts that have little to do with their personal qualities or needs.

With respect to medical care, Walzer believes that it should be distributed only to those who are sick, without regard to wealth, intelligence, or righteousness. But in America today, it closely follows the income curve. "From each according to his abilities, to each according to his needs," would, however, be a fine slogan for medical care, he says. Taxes paid by all of us should pay doctors and other medical care providers. This, says Professor Walzer, necessitates a national health service of a sort to which Obamacare inevitably leads.

It isn't that every man should get what he deserves, as in the old definition of justice. The new standard is egalitarian: that is, everyone should have free and equal access to all the goods and services produced by our economy.

Liberal-progressive-socialists' goal is to restructure our political system to make a society of equals that is worth having. The starting point must be to end the tyranny of personal wealth.

A good doctor deserves society's praise, according to Professor Walzer, but that is no reason to pay him any more than any other worker. Why should a steelworker have to work much longer than a doctor for the money to have a home or an automobile? There are rewards intrinsic to the doctor's job, like the pleasure of using his specialized knowledge for the common good. That ought to be enough. There is no meritocratic defense for differences in pay.

As liberals like Professor Walzer see things, the rewards of the good life are social goods that the rich have habitually taken for themselves, without regard to any personal merit. They are merely the rewards that the upper classes throughout history have been able to seize and hold for themselves. Affirmative-action quotas are a way of redistributing these rewards by redistributing the social places that conventionally get the rewards. National Socialist healthcare is another.

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The truth about the public option

It's a Trojan horse — just look at student loans

When will the press notice President Obama’s hypocrisy when it comes to the “public option”?

Speaking at a community college in Troy, N.Y., on Monday, Obama slammed the banking industry for opposing his education bill, which passed the House last week. The bill would change the way the government subsidizes student loans. Under current law, the federal government insures banks against losses on the fixed-rate student loans known as Stafford loans. The government also pays banks a subsidy on these loans to offset their capital costs. In addition, the government offers a “public option,” under which students can borrow directly from the government at the same rates.

This option has been available since 1993, but students and universities overwhelmingly prefer the banks: The government’s share of new federally backed loan originations peaked at 30 percent right after the direct-lending program was created and has fallen steadily to 20 percent since then.

Obama wants to change that by making the government the sole provider — the “single payer,” if you will — of all federally subsidized student loans. He couches this policy change as cutting off an “unwarranted subsidy for the big banks.” So far, however, the press has failed to make the connection between this rhetoric and Obama’s pitch for health-care reform. The changes he wants in health care would make the market for health insurance look a lot like the market for student loans.

If Obamacare were to become law, everyone would be required to purchase a health plan. Those who couldn’t afford one would get a subsidy. Obama also wants to create a government-run public option so that people could purchase health insurance directly from the government. He says this would promote competition and keep the private insurers honest — which is exactly how Democrats defended the public option in student loans when it was created.

So let’s compare: Obama’s health-care plan would create a subsidy for private health-insurance companies akin to the subsidy for banks that he now calls “unwarranted” — the only difference is that the health-insurance subsidy would be delivered indirectly, by requiring people to purchase care and then paying for those who can’t afford it. Obama’s health-care plan would also let employers and individuals choose between private insurance and a public option, akin to the one the Democrats set up for student loans in 1993.

Here’s the question the press should be asking: If Obama thinks this arrangement is such a wasteful and inefficient way to subsidize student loans, why does he want to make it the way we subsidize health insurance? First, Obama is right to point out that subsidizing student loans costs the government a lot of money. But cutting out the banks merely allows the government to use accounting gimmicks to hide the costs.

Meanwhile, the subsidies are captured by the universities in the form of ever-rising tuition. Whether the government insures banks against default or, as Obama’s bill would do, directly assumes that risk, students who might not be good candidates for college are nevertheless approved for large amounts of financing. The resulting increase in demand has driven the cost of higher education skyward; worse, it has encouraged students to take on enormous debt loads that, depending on their aptitudes, they might not be able to repay. This is one lesson we can draw from the world of student loans and apply to Obama’s health-care plan: Government subsidies drive costs up, not down.

Another, even more important lesson to be drawn is this: “Public options” are Trojan horses for nationalization. Obama’s position on the public option for student loans and his position on the public option for health insurance are directly at odds. Why won’t anyone in the press call him on it?

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23 September, 2009

One in six NHS patients 'misdiagnosed'

As many as one in six patients treated in NHS hospitals and GPs’ surgeries is being misdiagnosed, experts have warned. Doctors were making mistakes in up to 15 per cent of cases because they were too quick to judge patients’ symptoms, they said, while others were reluctant to ask more senior colleagues for help.

While in most cases the misdiagnosis did not result in the patient suffering serious harm, a sizeable number of the millions of NHS patients were likely to suffer significant health problems as a result, according to figures. It was said that the number of misdiagnoses was “just the tip of the iceberg”, with many people still reluctant to report mistakes by their doctors. There was a call for better reporting methods to ensure that each misdiagnosis was recorded and monitored properly.

Prof Graham Neale, of the Imperial Centre for Patient Safety and Service Quality at Imperial College London, who is carrying out research into cases of misdiagnosis in the NHS, said it was a problem that was not being adequately dealt with. “There is absolutely no doubt that this is being under-reported,” he said. “But more importantly they are not being adequately analysed. “Trainee doctors are too quick to judgment, that is one of the problems that we face.” He added, however, that in many cases, the medical errors were rectified within 48 hours.

The experts drew on research published in the American Journal of Medicine that estimated that up to 15 per cent of all medical cases in developed countries were misdiagnosed.

Earlier this year, the Healthcare Commission found that missed or wrong diagnoses were a major cause of complaints to the NHS. Of more than 9,000 complaints analysed, almost one in 10 related to a delay in diagnosis or the wrong diagnosis being made. Separate research also suggested that one in 10 patients in hospital was harmed because of the care they received.

Peter Walsh, the chief executive of Action Against Medical Accidents, a campaign group, said his charity received 4,000 calls a year from people who thought that their condition had been misdiagnosed. “This is just the tip of the iceberg,” he said. “There is no mandatory reporting of missed diagnoses so the true scale cannot be known. “There are very few reports to the National Patient Safety Agency (NPSA) and we would like to see it become a legal requirement for all missed diagnoses to be reported.”

Dr Robert Hendry, head of medical services at the Medical Protection Society, said misdiagnosis was a factor in two thirds of complaints against GPs. “It’s a very significant problem for the NHS,” he said. The NPSA runs a database that records medical errors, patient incidents, mistakes in medical notes and near-misses on a voluntary basis. Between April 2008 and March 2009 there were 39,500 reports of incidents involving clinical assessment. Those included missed or wrong diagnosis but also related to scans that could have been misinterpreted or where the wrong body part was scanned or tests where patients’ samples could have been mixed up.

Dr Kevin Cleary, the medical director of the NPSA, said there were a number of reasons that a diagnosis could be missed or be inaccurate, including a lack of training, test results that were misinterpreted, poor communication and diseases that had similar symptoms. “Missed diagnosis is one of the most complex issues in medical reporting,” he said. “There are some illnesses, like flu for example, where the symptoms for a number of conditions are very similar, especially early on, so it is not always possible to make a diagnosis immediately.”

A spokesman for the Department of Health said more than one million “patient safety incidents” were reported every year, the vast majority of which caused patients no harm. “We are examining a move to obliging the NHS as a whole to report to the National reporting and learning system run by National Patient Safety Agency,” the spokesman said. “The NHS already collects data on safety incidents including misdiagnoses through the National Patient Safety Agency's reporting system and uses this data to learn from incidents."

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NHS farms surgery out to cowboy private operators

They were trying to get a cheap deal by bypassing the established private hospitals and a cheap deal they got -- not so cheap in the long run, though

People having hip replacements at private treatment centres brought in to cut waiting times are up to 20 times more likely to need painful and expensive repair work. Many operations are having to be redone in NHS hospitals, at great cost and with serious staffing implications for the health service.

A study by orthopaedic surgeons in Cardiff found that of 113 hip operations on patients sent from their NHS trust to Weston-super-Mare NHS Treatment Centre between 2004 and 2006, two thirds showed clear evidence of poor surgical technique, such as poor cementing of the hip. In the three years since the operation, 18 per cent had undergone revision or were awaiting an operation — 20 times the 0.9 per cent NHS-wide revision rate at three years. A study on knee operations at the unit, conducted earlier this year, recorded a tenfold increase in revision rates.

Since the Independent Sector Treatment Centre (ISTC) programme was introduced in 2003, dozens of centres have been set up, mainly conducting orthopaedic surgery, cataracts and diagnostic screening. A total of 44 are described as NHS centres — though they are often staffed by independent sector contracts — and 23 are provided by private companies.

Leading surgeons said that this new data underlined the need for a significent overhaul of the multimillion-pound programme, which was introduced with great fanfare by the Government to reduce waiting times and increase patient choice.

They said a total lack of supervision of the sector and its clinical outcomes was a dereliction of duty by the Government, which had put a premium on reducing numbers rather than patient care. Early concerns about poorly vetted overseas doctors carrying out the work had not been addressed, they said.

The Cardiff study, published in the Journal of Bone and Joint Surgery, offers the most compelling evidence to date of problems with care in the sector, and the lack of proper auditing.Surgeons told The Times that the data backed anecdotal reports from elsewhere in the country, although it was likely to be at the high end. They said that NHS trusts were being left to manage the extra workload created.

While a hip replacement costs £6,000, the more complex repair operations, with more expensive implants, bone grafts and longer hospital stays, cost between £10,000 and £15,000. In an accompanying editorial in the journal, Fares Haddad, a consultant orthopaedic surgeon based at University College Hospital, London, says that the whole programme is in jeopardy because of the lack proper audit and follow-up. He adds that were such performance data available — and even if revision rates were lower — it would still “make the economic argument for ISTCs untenable”.

Mr Haddad told The Times that the disruption caused by the errors had an acute impact on hospitals, budgets and patients. He said that a revision rate of 3 per cent would still be unacceptable as it was “200 per cent greater than the NHS norm”, and even more so given that most treatment centres were sent the easier orthopaedic cases. “We all want to cut waiting lists and give excellent care to patients,” he said. “But this was introduced without data to show that it worked. We are now seeing the studies to show that.

“We have all had work increased by this, and the cost implications are huge too. Revision work costs two or three times the cost of a primary replacement. What is more, the failure of a joint replacement is often worse than the arthritis that led to the original operation. Mr Haddad added that if it were compulsory to register every operation on the National Joint Registry, trends would quickly emerge. “We would start picking up on those that were failing,” he said.

Tony Hui, chairman of the British Orthopaedic Directors Society, which represents heads of NHS orthopaedic departments, said that care in his area of South Teesside had also been affected. “We are seeing patients that have been treated elsewhere and they have problems and end up back at the NHS. The work has been suboptimal, and we have to do the revision which is time consuming, risky and expensive. With each case that comes along it’s another half day of operating — which could be two other patients.”

Steve Cannon, a surgeon at the Royal National Orthopaedic Hospital, Stanmore, northwest London, said the scheme had been about “speed of getting through the numbers” and was an “iniquitous waste of money”.

David Worskett, director of NHS Partners Network, which represents independent providers, said that the sector was being unfairly portrayed by surgeons and many were offering care of an excellent standard. He said that he could not comment on the case of Weston-super-Mare because, although private provision of care was involved, it was organised by the NHS.

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Obamacare Preys on the Young, Flouts the Constitution

Ask the Obama administration why it is pushing legislation to conscript the young, and it will likely deny doing any such thing. But how else to describe individual mandates, the latest twist in the White House's nationalized health care scheme?

It's bad enough that the federal government is expanding its own power in telling citizens that they absolutely must pay for health insurance, like it or not. The most sinister element is that politically unpopular tax increases can be delayed or minimized by taking healthy young people and shoehorning them into a massive entitlement system. The youngest taxpayers would have to swallow their mandated insurance like bad medicine.

We've seen this movie before with Social Security, which has been in a perpetual state of crisis for years and for President George W. Bush became the third rail of politics. Why would Congress want to impose another similarly disastrous scheme on the American people? Probably because it's the only way to ensure the support of special interests in the pursuit of universal health care. Forcing everyone to purchase insurance from government-approved plans would be a boon for the industry: It's not so much guaranteed coverage as it is guaranteed profits.

Too bad for Democrats, there's a higher authority than America's Health Insurance Plans -- the U.S. Constitution. David B. Rivkin Jr. and Lee A. Casey wrote in the Wall Street Journal on Friday that constitutional limitations on congressional power prohibit Sen. Max Baucus, D-Mont.'s, most recent plan.

If the legislative branch wants to remake or reform the health care industry, it must do so according to the Commerce Clause. Regulation can occur only when activities are shown to substantially affect interstate commerce. And charging people to opt out of a federal imposition is mere euphemism for regulating every American into performing what the government wants him to do. With that precedent set, "Congress could evade all constitutional limits by 'taxing' anyone who doesn't follow an order of any kind."

Not that Americans are counting on Democrats to follow the rules anyway. The financial crisis has seen to it that politicians will stop at no law, no limitation on power, to look like they're solving problems. It's only natural when they don't think the American people can solve their own.

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ALG Slams Baucus Bill as "Socialized Medicine in Trick or Treat Garb"

Americans for Limited Government President Bill Wilson today slammed Senator Max Baucus’ “chairman’s mark” on the Senate Finance Committee’s version of the “ObamaCare” proposal as “just another means to the end—socialized medicine in trick or treat garb.” Baucus sought to create a plan without the so-called “public option” as a means of garnering support for health care legislation that could pass this year. Wilson said it doesn’t matter.

“This is still a government takeover of the health care industry,” Wilson said. “The proposal creates government-run ‘co-ops’ to administer care in place of private options. It still sets up a rationing board. It still forces Americans to be insured or else pay a fine. It still does nothing to allow Americans to purchase insurance across state lines. It still expands Medicaid. It still increases taxes. It still has no tort reform. And it still adds to an already unsustainable debt.”

“It may move a little slower toward the goal of a single-payer system, but there is no question that under the Baucus proposal, Americans would be tricked into getting a treat that would crush our health care industry,” Wilson added.

Wilson said the proposal would ultimately result in Americans “being forced off of their current health care plans—which are excellent—and into a government-regulated co-ops that will drastically increase in costs since insurance policies will no longer be based on individual risk.”

Wilson pointed to provisions that force insurers to take on riskier patients without charging more for the premiums. “As a result, the associated risk costs will be passed on to everybody, distributed throughout the system, which means rates will go up. At the same time the quality of everyone’s coverage will be watered down to pay for the uninsurables. And individuals will have no choice but to buy the plans per the mandate.”

Wilson said that the system would not be pay for itself, and would lead to greater taxpayer-subsidized health care. “To make up for the inevitable shortfalls and deficits that will be endemic throughout the system, taxes under the plan will be raised on businesses and individuals.”

The Baucus bill is said insure an additional 26 million individuals that Wilson says could cost as much as $1.22 trillion over ten years. The average cost for an insurance premium is $4,700, according to the National Coalition on Health Care. “That’s about $122 billion extra every year we don’t have. That’s on top of ‘stimulus’ and TARP and all the rest of Barack Obama’s record-setting $1.85 trillion deficit. Under the Baucus proposal, the American people will be dealt yet another unsustainable entitlement that over time will totally consume the public treasury,” Wilson said.

Wilson credited concerned citizen efforts nationwide, including ALG’s 400,000 member activists, who have called, emailed, wrote letters to, and visited with Congressmen at their offices and town hall meetings for persuading many elected officials to vote against the bill. He said public opposition to the bill “is the only reason lawmakers are now considering removing the public ‘option.’ Only, the American people still do not want the total destruction of private health care now being proposed.”

According to Rasmussen Reports, 56 percent of voters now oppose the plan. And Barack Obama’s public disapproval has sunk to the 52 percent mark for the first time in his term.

“Harry Reid still doesn’t have the 60 votes needed in the Senate for cloture on the so-called ‘public option,’ and so Senate Democrats have begun watering down their proposal. Really, this is the beginning of the end—they are fleeing for the lifeboats on a political Titantic. Nobody wants to be left without a seat,” Wilson concluded.

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ObamaCare’s Smoke and Mirrors: Huge Costs Paid for by Imaginary Savings

Obama’s health care plan uses imaginary savings to finance massive new spending. His claim that it will not increase the deficit is based on the notion that he can squeeze $2 trillion in savings out of the current health care system to finance his plan’s huge costs.

Washington Post columnist Charles Krauthammer, who once practiced medicine, points out in his column that these savings aren’t real, and that politicians falsely promise to pay for new programs through imaginary savings all the time:

“Obama said he would largely solve the insoluble cost problem of ObamaCare by eliminating ‘hundreds of billions of dollars in waste and fraud’ from Medicare. . . .That’s just an insult to our intelligence. Waste, fraud and abuse as the all-purpose piggy bank for budget savings has been a joke since Jimmy Carter first used it in 1977. Moreover, if half a trillion is waiting to be squeezed painlessly out of Medicare, why wait for health-care reform? If, as Obama repeatedly insists, Medicare overspending is breaking the budget, why hasn’t he gotten started on the painless billions in ‘waste and fraud’ savings?”

Even staunch Democrats admit the president’s claims are questionable. Tennessee Governor Phil Bredesen (D) is criticizing Obama’s health care plan as “the mother of all unfunded mandates,” saying it will force states to massively raise taxes or run big deficits. Earlier, one of Obama’s own economic advisers said his health care plan would explode the federal budget deficit and lead to “crippling deficits” and “higher taxes.”

The Associated Press said Obama’s proposals would “would drive up the deficit by billions of dollars.” The Washington Post, which hasn’t endorsed a Republican for president since 1952, noted that “the expanded coverage would add more than $1 trillion to the deficit.”

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22 September, 2009

Obama: It’s only a tax increase if I call it one

President Obama insists that requiring Americans to get health insurance does not amount to a tax increase. In a testy exchange on ABC's "This Week," broadcast Sunday, Obama rejected the assertion that forcing people to obtain coverage would violate his campaign pledge against raising taxes on middle-class Americans. "For us to say you have to take responsibility to get health insurance is absolutely not a tax increase," Obama said in response to persistent questioning, later adding: "Nobody considers that a tax increase."

A proposal going before the Senate Finance Committee this week includes the mandate for health coverage. Obama has praised the plan in general, and indicated in the interview conducted Friday that he could back the coverage mandate. He noted that consumers currently pay higher health insurance premiums due to the costs run up by hospitals and other facilities providing care to uninsured people.

Those unable to afford health insurance should get government help, Obama said, but others who can afford coverage but choose not to get it should face coverage requirements similar to those for auto insurance. "What it's saying is ... that we're not going to have other people carrying your burdens for you any more than the fact that right now everybody in America, just about, has to get auto insurance," he said. "Nobody considers that a tax increase. People say to themselves, that is a fair way to make sure that, if you hit my car, that I'm not covering all the costs."

Asked again about critics calling the requirement to pay for health insurance a tax increase, Obama said: "My critics say everything is a tax increase."

On another aspect of his desired health care reform, Obama said cutting billions of dollars in government subsidies for Medicare Advantage would not reduce essential coverage for senior citizens in that program. The government cites the proposed subsidy cut for Medicare Advantage -- an enhanced program within Medicare -- as an example of how it can reduce health care spending while expanding coverage to millions of uninsured Americans.

Republican opponents say cutting Medicare costs will reduce benefits for senior citizens, a claim Obama has denied as misinformation. When pressed on that issue in the interview, Obama said Medicare Advantage provided essentially the same level of medical care as regular Medicare while costing the government much more due to the subsidies.

Insurance companies were "overcharging" for the service, Obama said, insisting that the change would mean senior citizens will get the same level of coverage at a lower cost to the government. "Now, they package these things in ways that, in some cases, may make it more convenient for some consumers, but they're overcharging massively for it," Obama said. "There's no competitive bidding under the process."

He said people currently signed up for Medicare Advantage would still get regular Medicare coverage "and the same level of benefits, but they may not be having their insurer get a 14 percent premium." "And will the insurers squawk? You bet," Obama said, rejecting claims that those enrolled in Medicare Advantage would be left with substandard benefits. "These folks are going to be able to get Medicare that is just as good, provides the same benefits, but we're not subsidizing them for $18 billion a year."

Republican response to Obama on Sunday called the president's promises of expanded health coverage at lower costs too good to be true. "It's just not believable," said Michael Steele, the Republican National Committee chairman, on the CBS program "Face the Nation." No matter what Obama says, Steele added, "Taxes are going to go up for the middle class because they have to."

Sen. Lindsey Graham, R-South Carolina, said on the NBC program "Meet the Press" that Obama "is selling something that people quite frankly are not buying." "This is not about tone -- this is about policy," Graham said.

Also appearing on the show, House Minority Leader John Boehner, R-Ohio, said health care reform as proposed by Obama and the Democrats was dead in Congress. "At some point when these big government plans fail -- and it will, the Congress will not pass it -- it's really time for the president to hit the reset button," Boehner said.

For his part, Obama offered a different perspective on the Republican position, telling Univision in an interview broadcast Sunday that Republicans -- for political reasons -- "are just not going to support anything."

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There’s no free health care

Obamacare will raise costs--and everybody knows it

Give President Obama credit for persistence. And stubbornness. And lack of imagination. He declared again last week that his health care plan "will slow the growth of health care costs for our families and our businesses and our government." And this historic achievement will be accompanied by a dazzling array of new medical benefits that everyone will receive--guaranteed by law. Okay, you've heard this before. But that's the president's story, and he's sticking to it.

The question is, why? Does he think we're stupid? His argument has failed to persuade a sizeable majority of the American people precisely because they're not stupid. They understand the laws of addition and subtraction. When you offer more--much, much more in this case--of a good, it's going to cost more. Somebody has to pay for it. Yet Obama says we'll all be paying less, and that includes businesses and government.

If he could actually pull off this feat, he would indeed be the One we've been waiting for. But he can't. This is apparent whenever Obama explains where the "savings" will come from. They're from eliminating "hundreds of billions of dollars" in waste, fraud, and abuse (WFA) in the health care system. Surely, he knows better. Everyone in Washington recognizes these savings are imaginary. They're offered with a wink. They never happen. President Reagan promised to slash WFA in the 1980s. The result: zilch. Where Reagan failed, Obama is not likely to succeed.

Obama may be unaware, but there are three programs--in Maine, Massachusetts, and Tennessee--currently testing his idea of get-more-pay-less. The evidence is already in: Expanded health care coverage costs more, an awful lot more. There are no known exceptions.

The test cases mirror Obamacare in one way or another. In 2003, Maine decided to cover the uninsured by expanding the state's Medicaid program and creating a government-run "public option" to provide health insurance with subsidized premiums. Controls on hospital and doctor costs would lead to reduced premiums and savings for everyone, without tax increases, or so it was claimed. Five years later, "the system that was supposed to save money has cost taxpayers $155 million and is still rising," the Wall Street Journal reported. Meanwhile, Medicaid enrollment has doubled to 22 percent of the state's population, and access to the public plan has been capped.

In Massachusetts, "universal" coverage was enacted in 2006 along with a requirement that everyone be insured or pay a fine. (By 2009, the fine was up to $1,068.) Again, the claim was made--a claim Obama repeats--that costs would decline once everyone was covered. Today, 97 percent of Massachusetts citizens are covered, the highest rate in the country. But costs have soared to the point the New York Times characterized them as "runaway." Spending on the state's health insurance program has risen by 42 percent. A major cause shouldn't have surprised anyone: The newly insured have flooded doctors' offices for medical care paid for by others. Now Governor Deval Patrick, a close ally of Obama, wants to impose cost controls.

The Tennessee experiment began in 1994 with one thought in mind: curbing the rise in health care costs. TennCare was established to cover everyone either on Medicaid or unable to obtain insurance. Rather than bend downward, the cost curve has steeply climbed. In a decade, spending surged from $2.5 billion to $8 billion. To cope with this, the state is cutting the TennCare rolls and reducing benefits. The program still consumes a higher share of the state budget than any Medicaid program in the country.

More here




Baucus’s insurance bill is a dose of bad medicine

AFTER MONTHS of work, Senate Finance Chairman Max Baucus has come up with a health bill that pleases neither Republicans nor many Democrats, but insurers must be smiling broadly.

It’s no surprise that his bill includes no public sector insurance plan. Instead, the only competition that giant insurers face will come from tiny co-operatives - and even then, to qualify for federal funding, they must be fledglings. Established co-ops will not qualify for help. Thus, private insurers can count on controlling the marketplace as millions of new customers who don’t have job-based coverage are required by law to come their way, tax subsidies in hand.

But what is shocking is that under the Baucus plan, a 50-year-old single parent could wind up paying far more for health insurance than a 28-year-old single adult who earns twice her salary. The Baucus bill won’t let insurers hike premiums because a customer suffers from a pre-existing condition. But it lets insurers charge older Americas five times as much as younger customers.

In a July letter to House leaders, the trade group America’s Health Insurance Plans called for the 5 to 1 ratio, saying anything less than that would force many young people to pay more to “heavily subsidize the naturally higher health care costs of older individuals.’’ House Democrats refused. The House bill, like Massachusetts, says that insurers can charge older adults no more than twice what they bill younger ones.

The Baucus legislation also imposes a penalty on single-parenthood. If you live alone with one child, you will be asked to shell out 80 percent more than a childless adult.

Of course it makes sense that coverage for a mother and child would cost more than the premium for a single person. But since children typically use much less health care than adults, 80 percent is a steep surcharge for single-parenthood - especially since a couple with children would pay only 50 percent more than a childless couple.

The Baucus bill also punishes smokers, adding 50 percent to their premiums. No doubt many would argue that this is only fair. But the vast majority of adults who smoke are poor. Many will qualify for full subsidies; others will be eligible for partial subsidies to help them pay for their premiums.

So who will pay 50 percent more for their health care? You, the taxpayer. If the smoker receives a subsidy, the 50 percent surcharge isn’t likely to induce him to stop. This rule seems designed primarily to funnel more taxpayer dollars to private sector insurers.

Single parents also tend to cling to the lower rungs of the income ladder. Many will qualify for at least a partial, if not a full subsidy. Who lays out the extra 80 percent? That’s right - you and I.

Finally, if under the Baucus bill, insurers can charge middle-income 50-somethings five times as much as even the most affluent 20-somethings, a great many of those older customers are going to need fat subsidies, sending more tax dollars to Aetna.

Granted, premiums are capped at 13 percent of income if you earn somewhere between 300 percent and 400 percent of the federal poverty level. But this means a 56-year old couple with joint income of $58,000 could wind up paying premiums of more than $7,500 - plus out-of-pocket expenses. Couples earning more than 300 percent of poverty ($43,710 in 2009) don’t qualify for subsidies.

Under the more generous House bill, couples earning up to 400 percent of poverty (or $58,280) would be eligible for federal help. Tax increases for the top 1.5 percent of earners would help fund the subsidies. By contrast, under the Baucus plan, middle-class and upper-middle class Americans who buy insurance but don’t qualify for subsidies would help foot the bill for those who do.

The irony is that in the end, neither conservatives nor progressives are backing the Baucus proposal. The senator’s goal was bipartisan reform. But he has failed to achieve that. Instead, by eliminating a public option that might have set a benchmark for high quality, affordable care and by offering stingy subsidies that exclude many middle-income families, he has watered down reform without pleasing either side of the aisle.

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Healthcare reform is more corporate welfare

by Ron Paul

Last Wednesday the nation was riveted to the President’s speech on healthcare reform before Congress. While the President’s concern for the uninsured is no doubt sincere, his plan amounts to a magnanimous gift to the health insurance industry, despite any implications to the contrary.

For decades the insurance industry has been lobbying for mandated coverage for everyone. Imagine if the cell phone industry or the cable TV industry received such a gift from government? If government were to fine individuals simply for not buying a corporation’s product, it would be an incredible and completely unfair boon to that industry, at the expense of freedom and the free market. Yet this is what the current healthcare reform plans intend to do for the very powerful health insurance industry.

The stipulation that pre-existing conditions would have to be covered seems a small price to pay for increasing their client pool to 100f the American people. A big red flag, however, is that they would also have immunity from lawsuits, should they fail to actually cover what they are supposedly required to cover, so these requirements on them are probably meaningless. Mandates on all citizens to be customers of theirs, however, are enforceable with fines and taxes.

Insurance providers seem to have successfully equated health insurance with health care but this is a relatively new concept. There were doctors and medicine long before there was health insurance. Health insurance is not a bad thing, but it is not the only conceivable way to get health care. Instead, we seem to still rely on the creativity and competence of politicians to solve problems, which always somehow seem to be tied in with which lobby is the strongest in Washington.

It is sad to think of the many creative, free market solutions that government prohibits with all its interference. What if instead of joining a health insurance plan, you could buy a membership directly from a hospital or doctor? What if a doctor wanted to have a cash-only practice, or make house calls, or determine his or her own patient load, or otherwise practice medicine outside the constraints of the current bureaucratic system? Alternative healthcare delivery models will be at an even stronger competitive disadvantage if families are forced to buy into the insurance model. And yet, the reforms are sold to us as increasing competition.

What if just once Washington got out of the way and allowed the ingenuity of the American people to come up with a whole spectrum of alternatives to our broken system? Then the free market, not lobbyists and politicians, would decide which models work and which did not.

Unfortunately, the most broken aspect of our system is that Washington sees the need to act on every problem in society, rather than staying out of the way, or getting out of the way. The only tools the government has are force and favors. These are tools that many unscrupulous and lazy corporations would like to wield to their own advantage, rather than simply providing a better product that people will willingly buy. It seems the health insurance industry will get more of those advantages very soon.

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High Cost Of Care

Medicare: As Democrats try to remake the health care system in the face of bitter opposition, the federal public option for the elderly is preparing to cut benefits. This should be part of the debate, but of course it's not.

Supporters of the health care revision tell us that its $1 trillion price tag won't add a dime to the national deficits. But the reality is, any program that expands Washington's reach into health care will cost far more than the rosy projections we're hearing. History shows that the bureaucracy always spends far more on programs than the Beltway experts say it will.

One program that has spun wildly out of control is Medicare, enshrined as an entitlement in 1965. Actuaries projected its cost for 1990 at $10 billion. Yet actual outlays were $107 billion. Now the program is spending more than it is taking in through the payroll tax that funds it, leaving Washington with only two options: ration Medicare or raise taxes.

Don't make the mistake of thinking that brilliant minds in Washington will figure out a way to avoid rationing before it becomes necessary. Those heads are busy looking for places to slash now. Medicare, for instance, is considering cutting $1.4 billion in benefits beginning on Jan. 1, 2010. If the new schedule is adopted, the reductions will be in fees paid to cardiologists and oncologists.

At the same time that fees for heart and cancer physicians will be trimmed by 10%, fees paid to family doctors will be boosted by 8% and reimbursements paid to nurses will rise 7%. The administration believes that moving the fees toward primary care will be a boost for preventive care.

There are two points to take away from this mostly ignored news. One, any scheme passed by this Congress and signed into law will cost taxpayers dearly. Two, the government will have to ration care because it cannot possibly pay for a nation of 305 million demanding its "free" medical care.

If the rationing is adopted, it will have a direct effect on patients, particularly those who are suffering from two of the most serious illnesses. Heart and cancer specialists, who will be expected to accept Medicare reimbursements that are less than some procedures cost, are already reporting that they will either close their practices or limit care. Some will simply stop treating Medicare patients.

Anyone who believes Washington can improve health care by increasing its involvement is not thinking clearly. Its solutions tend to create bigger problems. Yes, a government takeover may improve care for a small segment of the population. But it will be far worse for everyone else.

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21 September, 2009

Senior British politician chooses private hospital rather than the NHS

NICK CLEGG, the Liberal Democrat leader, last night admitted he had paid for private healthcare partly because of his frustration at NHS waiting times.

Clegg, who said he had occasionally “coughed up” so one of his sons could see medical specialists quickly, becomes the first political leader to break the Westminster taboo about going private. “I understand the sensitivity but I feel fervently that I am a dad before I am a politician,” said the Lib Dem leader in an interview with The Sunday Times.

Clegg’s admission contrasts with the position of Gordon Brown, who has always used the NHS for his two sons, one of whom has cystic fibrosis. Similarly, David Cameron, the Conservative leader, has praised the way the NHS treated his disabled son Ivan, who died earlier this year. However, other members of the Tory front bench have refused to say whether they pay for medical insurance.

Clegg, 42, who is married to a high-flying Spanish lawyer and has three young sons, said his family did not have private health cover. But he added: “If you ask, has there been an occasion where we have paid for a consultation, then the answer is yes.” Asked why he had opted out of the NHS, he said: “Because we were very keen to see a particular consultant for a particular problem very quickly.” He refused to elaborate on the details of the medical problems concerned. “As far as my children’s health or education is concerned, I am simply not going to hold them hostage to make political points,” he said.

Speaking on the eve of the Lib Dem annual conference in Bournemouth, he claimed both Labour and the Conservatives were ducking serious discussion on the future of healthcare. “Why on earth is the NHS as centralised as it is? Why is there layer upon layer of centralised bureaucracy?” he said. He asserted that while the NHS had areas of excellence, there were also serious failings. “Mental health, for example, is a Cinderella service,” he said.

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Health reformers targeting 'enemies'

Protest events tightly scripted. Civility not envisaged

The plan for a series of grass-roots demonstrations Tuesday to promote President Obama's health care agenda calls for tightly scripted events and an "escalation" of efforts against "enemies" of reform. Organizers insist there is no comparison to rowdy summer town hall meetings and recent "tea party" protests that have challenged White House policies.

But Health Care for America Now (HCAN), which is backed by a coalition of labor unions and liberal groups including ACORN and MoveOn.org, organized the protests to target insurance companies and drafted the plan, which describes the demonstrations as part of its "insurance enemies project."

The document, a copy of which was obtained by The Washington Times, details specific talking points, tactics, props and strategies to stage the protests. It lists goals that include action that "mobilizes our base by animating existing anger about private insurers."

The HCAN field plan dictates that each protest will include a minimum of 30 participants, target only health care insurers CIGNA, WellPoint and United Health Care and showcase what it calls "victims," or people who have either lost insurance, can't afford it or were denied coverage because of pre-existing medical conditions. "We built a campaign to win health care reform and that is exactly what we are working on," said HCAN national spokeswoman Jacki Schechner, who authenticated the documents. But she asserted: "There is nothing top-down about this."

The field plan says the protests should attract media coverage that "creates villains or enemies that serve as a contrast with our side; validates the need for affordability and the public health insurance option; [and] forces the other side to respond."

David Palombi, senior vice president of corporate communications for WellPoint, said the "enemies project" is counterproductive to the debate and will do nothing to expand access, reduce costs or improve the quality of health care in the United States. "It is extraordinarily disappointing that it comes at a time when [House Speaker Nancy Pelosi] and others are calling for a civil discussion." Mrs. Pelosi, California Democrat, became emotional at a news conference Thursday when she expressed fear that the harsh rhetoric of the debate would lead to violence.

More here




Values voters poke fun at health reform

2,000 gather for D.C. summit

Minnesota Republican Gov. Tim Pawlenty, once considered a moderate by some social conservatives, was the headliner at the Values Voters Summit in Washington on Friday evening, quoting from the Bible and bringing the nearly 2,000 social and religious conservatives to their feet. "We need to be sure we are a force for wise values, not just wisecracks," Mr. Pawlenty told the activists from 49 states. "We need to humbly ask God to bless the United States," said the two-term governor, who had announced more than three months ago he would not seek a third term. He has been traveling the country looking very much like a potential presidential nomination seeker.

Poking fun at President Obama's health care plan, Tony Perkins opened the summit Friday morning by quipping that he fears the plan will produce a system with the empathy of the Internal Revenue Service and the efficiency of the Federal Emergency Management Administration. Mr. Perkins, Family Research Council president, got the expected laughter and applause from the nearly 2,000 religious and social activists gathered at the Omni Shoreham Hotel for a good but godly time.

Rep. Mike Pence, Indiana Republican, took the podium to toss out a few one-liners before settling down to criticize his own party for what he thinks are its unprincipled excesses of the past. "On Election Day last year, only 22 percent of Americans described themselves as liberal, but our nation went forward to elect the most liberal one-party government in American history," he said. "So, what happened? Well, some blame the war in Iraq. Some blame Republican scandals. Well, I think the real scandal in Washington, D.C., was runaway federal spending under Republican control."

The religious-social right has never been about fire and brimstone but about moral behavior by government and citizens. Legalized abortion and same-sex marriages rank at the top of the movement's must-stop agenda.

The next speaker was former Arkansas Gov. Mike Huckabee, who proceeded to rock the house with humor. Dismissing the health care "reform" approach of Mr. Obama and the Democratic Congress, Mr. Huckabee compared the "real" health problem to "an NFL game on Sunday [with] 22 people down on the field desperately in need of rest and 70,000 in the stands desperately in need of exercise." "There is America's health care problem right there," he said.

Mr. Huckabee, who ran second to Arizona Sen. John McCain in the Republican presidential nomination contest last year, has been an increasingly important figure in the religious-social right movement that bemoans what former Education Secretary William J. Bennett has called the "coarsening of American culture." Now a Fox News talk-show host, Mr. Huckabee let fly with such zingers aimed at Mr. Obama as "The audacity of hope has become the audacity of hypocrisy," and America is being trivialized and demeaned into "land czars, clunker cars and Hollywood stars."

Mr. Huckabee, who complained about the unequal footing financially between him and opponent Mitt Romney in the 2008 presidential nomination contest, took a swipe at the former Massachusetts governor who enacted statewide health care reform before leaving office. "A couple of states have already tried government-run medicine: Tennessee and Massachusetts. Both plans went bankrupt," Mr. Huckabee said. "The only thing inexpensive is $50 for an abortion in Massachusetts. No thanks."

As for Mr. Obama's claim that his health care reform will not increase the federal debt or deficit because it will offset new costs by "squeezing $500 billion out of the Medicare program. If he can do it now, why hasn't he already done it?"

SOURCE




More Cowbell

We wrote about the original "more cowbell" here. Lately, the phrase has come to denote the Obama administration's efforts to promote the Democrats' health care plan (whatever it is). Personal appeals by the President are the "cowbell." Today Michelle Obama got into the act, proclaiming that the current health care system "crushes women":

First lady Michelle Obama sought support for the administration's health-care plans from family advocacy groups and health-care professionals, saying the treatment of women under the current system is "unacceptable." ...

Michelle Obama said women are being "crushed by the current structure of our health care" because they often are responsible for taking care of family illnesses, arranging checkups and monitoring follow-up care.

"Women are the ones to do it," she said to an audience of 140 people, including representatives from groups such as the Women's Chamber of Commerce and the National Council of Negro Women. "Mothers are the ones that do it. And many women find themselves doing the same thing for their spouses."

I really don't understand this. Under Obamacare, will someone other than mothers (or fathers) arrange checkups for their kids? Take care of family illnesses? Make sure the kids are taking their medicine and get follow-up care if they need it? Is there really anything like this in any of the Democrats' proposals? If mothers (and fathers) don't arrange their kids' checkups, who will? Someone else's mother or father, apparently. No doubt they'll care more and do a better job.

The Obama administration seems to be bringing a whole new meaning to the phrase "nanny state."

SOURCE (See the original for links)




Separating 'He Lied' From The 'Elides'

You lie? No. Barack Obama doesn't lie. He's too subtle for that. He . . . well, you judge.

Herewith three examples within a single speech — the now-famous Obama-Wilson "you lie" address to Congress on health care — of Obama's relationship with truth:

1. "I will not sign (a plan)," he solemnly pledged, "if it adds one dime to the deficit, now or in the future. Period."

Wonderful. The president seems serious, veto-ready, determined to hold the line. Until, notes Harvard economist Greg Mankiw, you get to Obama's very next sentence: "And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize."

This apparent strengthening of the pledge brilliantly and deceptively undermines it. What Obama suggests is that his plan will require mandatory spending cuts if the current rosy projections prove false. But there's absolutely nothing automatic about such cuts. Every Congress is sovereign.

Nothing enacted today will force a future Congress or a future president to make any cuts in any spending, mandatory or not.

Just look at the supposedly automatic Medicare cuts contained in the Sustainable Growth Rate formula enacted to constrain out-of-control Medicare spending. Every year since 2003, Congress has waived the cuts.

Mankiw puts the Obama bait-and-switch in plain language. "Translation: I promise to fix the problem. And if I do not fix the problem now, I will fix it later, or some future president will, after I am long gone. I promise he will. Absolutely, positively, I am committed to that future president fixing the problem. You can count on it. Would I lie to you?"

2. And then there's the famous contretemps about health insurance for illegal immigrants. Obama said they would not be insured. Well, all four committee-passed bills in Congress allow illegal immigrants to take part in the proposed Health Insurance Exchange.

But more importantly, the problem is that laws are not self-enforcing. If they were, we'd have no illegal immigrants because, as I understand it, it's illegal to enter the United States illegally. We have laws against burglary, too. But we also provide for cops and jails on the assumption that most burglars don't voluntarily turn themselves in.

When Republicans proposed requiring proof of citizenship, the Democrats twice voted that down in committee. Indeed, after Rep. Joe Wilson's "You lie!" shout-out, the Senate Finance Committee revisited the language of its bill to prevent illegal immigrants from getting any federal benefits. Why would the Finance Committee fix a nonexistent problem?

3. Obama said he would largely solve the insoluble cost problem of ObamaCare by eliminating "hundreds of billions of dollars in waste and fraud" from Medicare.

That's not a lie. That's not even deception. That's just an insult to our intelligence. Waste, fraud and abuse — Meg Greenfield once called this phrase "the dread big three" — as the all-purpose piggy bank for budget savings has been a joke since Jimmy Carter first used it in 1977.

Moreover, if half a trillion is waiting to be squeezed painlessly out of Medicare, why wait for health care reform? If, as Obama repeatedly insists, Medicare overspending is breaking the budget, why hasn't he gotten started on the painless billions in "waste and fraud" savings?

Obama doesn't lie. He merely elides, gliding from one dubious assertion to another. This has been the story throughout his whole health care crusade. Its original premise was that our current financial crisis was rooted in neglect of three things — energy, education and health care.

That transparent attempt to exploit Emanuel's Law — a crisis is a terrible thing to waste — failed for health care because no one is stupid enough to believe that the 2008 financial collapse was caused by a lack of universal health care.

So on to the next gambit: selling health care reform as a cure for the deficit. When that was exploded by the Congressional Budget Office's demonstration of staggering ObamaCare deficits, Obama tried a new tack: selling his plan as revenue-neutral insurance reform — until the revenue neutrality is exposed as phony future cuts and chimerical waste and fraud.

Obama doesn't lie. He implies, he misdirects, he misleads — so fluidly and incessantly that he risks transmuting eloquence into mere slickness.

Slickness wasn't fatal to "Slick Willie" Clinton because he possessed a winning, near irresistible charm. Obama's persona is more cool, distant, imperial.

The charming scoundrel can get away with endless deception; the righteous redeemer cannot.

SOURCE





20 September, 2009

Bungle after bungle kills woman in British public hospital

Woman bleeds to death after doctor accidentally punctures jugular while inserting a drip - and no blood is available for transfusion

A young woman died in hospital after waiting almost two hours for a blood transfusion that could have saved her. Sally Thompson, 20, bled to death after a doctor accidentally punctured her jugular vein during a bungled procedure. Despite an urgent request to the blood bank at Manchester Royal Infirmary, she died one hour and 45 minutes later, before any arrived.

Speaking after her inquest, her father John, 62, said she would still be alive if the blood had been available sooner. The retired farmer said: 'This hospital is supposed to be the cornerstone of the NHS in Manchester, but they couldn't get any blood for two hours. 'We have never had any answers about why it took so long. I feel very let down by the hospital.'

Coroner Nigel Meadows said the inability to supply the blood was a 'significant failure' and he would write to hospital bosses. If a patient needs a transfusion, blood is tested first by type and then further tests, known as crossmatching, are performed to check antibodies in the blood. But in an emergency when there is no time for crossmatching, blood of the same type as the patient's - in Miss Thompson's case O-negative, one of the most common types - can be given. The inquest was told that doctors did eventually request non-crossmatched blood, but by then it was too late.

Miss Thompson, an administration assistant for Rochdale Council, had suffered from a rare blood disorder, hemophagocytic lymphohistiocytosis (HLH), since she was eight. The condition caused her immune system to fail and doctors said she would eventually need a bone marrow transplant.

On August 22, 2005, she collapsed at home in Middleton, Manchester, and was admitted to the Royal Infirmary. Doctors stabilised her, but two days later she had a series of fits and was transferred to intensive care. The following evening, and with the fits still going on, doctors decided to start her on a course of chemotherapy. They decided to insert a tube called a central venous catheter into her jugular vein to administer the chemotherapy drugs directly into her bloodstream.

Dr Jaydeep Mandal, a critical care specialist registrar, who no longer works at the hospital, used a technique known as 'landmark' to find the blood vessel. But when the tube was inserted, it caused internal bleeding.

The inquest heard that the landmark technique, which involves mapping out the features of the neck to find the vein, was contrary to guidelines, which recommend using an ultrasound scan to find the vein. Ultrasound equipment was available.

However, Dr Mandal had used the landmark technique 300 times and consulted colleagues before it was agreed that it should be used on Miss Thompson, the inquest was told.

Her father said: 'It punctured Sally's vein and, unbeknown to them, she was bleeding into her chest cavity for almost an hour. 'When they did find out they sent an order down for blood but the bank said they were having trouble finding any crossmatched blood because of her disorder.'

Miss Thompson died before any blood arrived after having a heart attack caused by the internal bleeding.

Coroner Mr Meadows, who recorded a narrative verdict, said he would ask hospital bosses to review the procedure relating to central venous catheters. 'No crossmatched or uncrossmatched O-negative blood was supplied, despite it being requested during the resuscitation, and this was a significant failure,' Mr Meadows said. 'Blood salvage was organised but not initiated until towards the very end of attempts to resuscitate the deceased.'

A hospital spokesman said it had reviewed procedures concerning CVCs and was investigating why no blood was ever supplied for a transfusion.

SOURCE




Government Medicine vs. the Elderly

Rarely has the Atlantic seemed as wide as when America’s health-care debate provoked a near unanimous response from British politicians boasting of the superiority of their country’s National Health Service. Prime Minister Gordon Brown used Twitter to tell the world that the NHS can mean the difference between life and death. His wife added, “we love the NHS.” Opposition leader David Cameron tweeted back that his plans to outspend Labour showed the Conservatives were more committed to the NHS than Labour.

This outbreak of NHS jingoism was brought to an abrupt halt by the Patients Association, an independent charity. In a report, the association presented a catalogue of end-of-life cases that demonstrated, in its words, "a consistent pattern of shocking standards of care." It provided details of what it described as "appalling treatment," which could be found across the NHS.

A few days later, a group of senior doctors and health-care experts wrote to a national newspaper expressing their concern about the Liverpool Care Pathway, a palliative program being rolled out across the NHS involving the withdrawal of fluids and nourishment for patients thought to be dying. Noting that in 2007-08, 16.5% of deaths in the U.K. came after "terminal sedation," their letter concluded with the chilling observation that experienced doctors know that sometimes "when all but essential drugs are stopped, 'dying' patients get better" if they are allowed to.

The usual justification for socialized health care is to provide access to quality health care for the poor and disadvantaged. But this function can be more efficiently performed through the benefits system and the payment of refundable tax credits.

The real justification for socialized medicine is left unstated: Because health-care resources are assumed to be fixed, those resources should be prioritized for those who can benefit most from medical treatment. Thus the NHS acts as Britain's national triage service, deciding who is most likely to respond best to treatment and allocating health care accordingly.

It should therefore come as no surprise that the NHS is institutionally ageist. The elderly have fewer years left to them; why then should they get health-care resources that would benefit a younger person more? An analysis by a senior U.K.-based health-care expert earlier this decade found that in the U.S. health-care spending per capita goes up steeply for the elderly, while the U.K. didn't show the same pattern. The U.K.'s pattern of health-care spending by age had more in common with the former Soviet bloc.

A scarcity assumption similar to the British mentality underlies President Barack Obama's proposed health-care overhaul. "We spend one-and-a-half times more per person on health care than any other country, but we aren't any healthier for it," Mr. Obama claimed in his address to Congress last Wednesday, a situation that, he said, threatened America's economic competitiveness.

This assertion is seldom challenged. Yet what makes health care different from spending on, say, information technology —or any category of consumer service —such that spending on health care is uniquely bad for the American economy? Distortions like malpractice suits that lead to higher costs or the absence of consumer price consciousness do result in a misallocation of resources. That should be an argument for tackling those distortions. But if high health-care spending otherwise reflects the preferences of millions of consumers, why the fuss?

The case for ObamaCare, as with the NHS, rests on what might be termed the "lump of health care" fallacy. But in a market-based system triggering one person's contractual rights to health care does not invalidate someone else's health policy. Instead, increased demand for health care incentivizes new drugs, new therapies and better ways of delivering health care. Government-administered systems are so slow and clumsy that they turn the lump of health-care fallacy into a reality.

According to the 2002 Wanless report, used by Tony Blair's government to justify a large tax hike to fund the higher spending, the NHS is late to adopt and slow to diffuse new technology. Still, NHS spending more than doubled to £103 billion in 2009-10 from £40 billion in 1999-2000, equivalent to an average growth rate of over 7% a year after inflation.

In 1965, economist (and future Nobel laureate) James Buchanan observed of the 17-year old NHS that "hospital facilities are overcrowded, and long delays in securing treatment, save for strictly emergency cases, are universally noted." Forty-four years later, matters are little improved. The Wanless report found that of the five countries it looked at, the U.S. was the only one to be both an early adopter and rapid diffuser of new medical techniques. It is the world's principal engine driving medical advance. If the U.S. gets health-care reform wrong, the rest of the world will suffer too.

SOURCE




Obamacare will hit workers in the pocket

If U.S. health reform efforts lead to higher costs for employers, employees may end up bearing the brunt, according to a new survey. Employers will not absorb higher costs, choosing instead either to reduce benefits, lower salaries or cut jobs, the survey from professional services firm Towers Perrin said on Thursday. Eighty-seven percent of employers said they were very likely or likely to cut benefits if reform leads to higher costs. Only 11 percent said they would accept lower profits. "They simply don't have money and margins today to absorb additional healthcare costs," said Dave Osterndorf, chief health actuary at Towers Perrin.

Should reform reduce benefit costs to the companies, 78 percent they were very likely or likely to retain the savings in the business.

The survey of more than 430 human resource executives at medium and large businesses taken in July was designed to gauge opinions on reform as legislative efforts were heating up.

Congress is weighing bills that would overhaul the healthcare system, which is President Barack Obama's top legislative priority. Proposals that might drive up employer costs include those that would force employers to expand their coverage, such as to part-time workers, or those that would allow healthy workers to find coverage elsewhere, leaving employers to pay for sicker, more expensive employees, Osterndorf said.

Although the ultimate outcome of reform efforts remains uncertain, nearly one in four companies in the survey are already rethinking changes in light of possible reforms. Of all the goals of health reform, cost containment was listed most frequently as an absolutely critical or high priority among the businesses in the survey, which ranged in size from roughly 1,500 to 100,000 workers.

But, Osterndorf said, employers believe that issues such as expanding access to coverage and reforming certain insurance practices have received more attention. "Employers are saying, 'These are important social issues that are being addressed, but they don't necessarily hit on the issues that we're facing as employers,'" Osterndorf said.

Of the healthcare proposals, 53 percent of employers believe research on effectiveness of treatments will help their business by influencing the quality of care.

Employers had varying responses to how they would react to proposals mandating they offer coverage to meet certain minimum standards or pay a penalty -- called "pay-or-play" mandates. Thirty-seven percent of employers would provide company-sponsored coverage that substantially exceeds the standard. But 29 percent said they would end company-sponsored health coverage and pay the assessment if the per-employee costs to the government were much lower than current costs.

SOURCE




Rationing By Any Other Name...

We critics of ObamaCare may have been doing ourselves a bit of a disservice over the past few months by focusing on health care “rationing.”

Yes, “rationing” best describes some of the most disconcerting effects of government run health care, and it strikes a chord with the general public. But it is rarely used by our duplicitous opponents, leaving the door open for them to argue that we are just raising a general alarm over nothing.

But rationing does not have to be called such to be rationing. So, perhaps, we should shift our focus away from language that we prefer and toward illuminating language used by our opponents when, in cloaked words, they discuss what we all know is nothing more (and unfortunately, nothing less) than cold and calculated government rationing.

Ezekiel Emanuel heads the Federal Council of Comparative Effectiveness Research, whose job it is, we are told, to save the government money. The GLG Group observes that, “The Commonwealth Fund…has estimated that establishing a Center for Comparative Effectiveness Research could save up to $634 billion between 2010 and 2020…” And just how would it do this?

Well, in sum total, “effectiveness” in this context is merely another term for rationing. Emanuel makes it clear that the “effectiveness” of a new drug, device or procedure is not measured by whether it works to heal a patient and save lives, but by whether it is effective relative to its cost. A drug, for instance, that adds half a year of life on average to cancer patients, but costs the Obama government $50,000 cost would not receive government backing. It’s all a matter of a cold and heartless cost-benefit analysis.

Astute readers may notice that in real life, Ezekiel Emanuel now actually heads an organization that has essentially the same function as his envisioned Institute for Technology and Outcomes Assessment, which we discussed last week. From this we could glean that the word “outcomes” is another buzz word used for rationing. Only those health services whose “outcomes” justify their costs are worth Big Government’s time and money. So, in short, under Obamacare, you and your loved ones are reduced to mere dollar figures

Other words occur when members of the Obama administration, or the President himself, talk about eliminating “waste” and “inefficiency” as Obama did last week and on July 22: “We also want to create an independent group of doctors and medical experts who are empowered to eliminate waste and inefficiency in Medicare on an annual basis.”

Contrary to White House denials to the effect that this board, “will not be authorized to propose or implement Medicare changes that ration care or affect benefits, eligibility or beneficiary access to care,” the CBO has recommended that the Independent Medicare Advisory Council (IMAC) have exactly those powers in order to “improve the efficiency of the health care system.” And improving “efficiency” again means weighing costs over benefits in ways that produce rationed care.

The fact is, as Gertrude Stein opined, “A rose by any other name is still a rose.” And government “rationing” by any other name is still a death warrant for the elderly and infirm.

SOURCE





19 September, 2009

'Disgusting' British hospital food gets a serve on 'bingo' blog

A British hospital patient was so disgusted with the quality of his food that he took photos of the meals, posted them on the internet and asked people to guess what was dished up. His followers failed to identify correctly half of the 35 meals he posted on the Hospital Food Bingo game that he has featured on his blog.

The patient provided a daily review of the dishes, along with the photos taken on his mobile phone, and described one attempt at macaroni and cheese as something that "could have been used as wallpaper paste".

"You could have slapped a splattering of the stuff on to a pair of white overalls, stuck them on the underside of a plane and then zipped a man into them before taking off for a spin and a couple of loop-the-loops," he wrote.

The patient, who has only identified himself as Traction Man, has been in hospital since February suffering from a rare bone infection.

SOURCE




Joe Wilson was right

Let's count the lies, in just the few words Obama spoke prior to the interrupt:

"There are also those who claim that our reform efforts would insure illegal immigrants. This, too, is false. The reforms I'm proposing would not apply to those who are here illegally."

Yes, there are plenty who claim that. Let's pick a few key words from these three sentences.

1. "Reform." Oops! Lie! (Or rather, terminological inexactitude.) True, in a literal sense any change to anything is a "reform", because it necessarily re-forms it; if you break somebody's nose, you are re-forming him, giving him a different shape. But in most contexts including this one of health care, the word carries the connotation of improvement, not just of re-shaping; and that's where the mendacity makes it entrance. Over a century ago, government prohibited the practice of medicine by any without a license it approved, so limiting competition and causing costs to rise ever since. Again and again government has intervened in the industry, to mandate this and prohibit that, each such intervention boosting the price spiral every time; as I wrote here recently, the very notion of making health care appear cheaper than it is causes demand, and therefore total cost, to rise. So government participation has been an unrelieved disaster, and Obama is proposing more of it; therefore, without a shadow of doubt, his proposals or any variant on them are the very opposite of "reform" and he was lying absolutely, and Joe Wilson was right.

2. "Insure." No, it's not; that's another lie. An insurance contract is about a slight risk of large loss, with a low premium paid each by many so as to prevent any one party being wiped out; and it's a contract, a voluntary and rational way to spread that risk. It became popular among ship owners a few hundred years ago; to lose a ship at sea would be a disaster that might affect any of them--but most probably, it would not. Lloyd's coffee house in London gave birth to the solution. Discussions in today's coffee houses are less creative. Today's health "insurance" charges often impossibly heavy premiums, and pays for risks which are usually minor and very likely to occur; it has turned the concept of insurance exactly upside down. Everyone needs to visit the doctor's office from time to time; all that insurers do is to pay the charge and charge a profit.

How did that madness begin? It did so in the mid-20th Century, when government taxed wages so heavily that employers competed for workers by offering non-taxable benefits instead of cash, including free or subsidized health care. Among other ill effects, that single decision brought about the demise of the then-prosperous US automobile industry half a century later. One of the others is that the coverage is often not portable; if you want to change jobs, you may lose health benefits. There are people today who take a job solely or primarily because it provides them, since individual policies are now prohibitively expensive, when they'd really much rather be home minding the children or building a home-based business. To the extent that that deprives young children of parental care and leaves them to the mercy of the government's youth indoctrination system, the distortion goes on and on.

3. "Illegal" immigrants. The idea that a human being is somehow culpable if he chooses to offer his labor at Point B on the surface of the planet instead of Point A (where he might happen to have been born) is repugnant to the whole idea of self-owning, free human beings. How can such a thing possibly be "illegal"? Yet it often is, so I suppose I must reluctantly concede that here, technically, the President was not actually lying--though he would have been lying if (as he often does) he described this country as a "free" one, while prohibiting such mobility of labor. Yes, government has erected a legal barrier to such movement, and the Constitution allowed it, so don't just blame the modern border Nazis; the concept was in at the birth of this State and the outrage is that it (or the Constitution) should ever be confused with liberty.

Notice, immigrants lacking certain government paperwork are doing no harm; their "illegal" status is a victimless crime, every bit as much as selling pot or sexual favors. They are not forcing anyone to employ them against their will, and if nobody chooses to hire them, they will migrate elsewhere. They are, however - as Anthony Gregory recently pointed out in another forum--being forced to pay for benefits they may not receive, and are therefore subsidizing us, contrary to the fiction that anyone here might be subsidizing them. That such harmless people should be branded as criminals is a lie, even though it's not a lie that they are, in fact, so branded.

4. "Not Apply". President Obama said his health-care changes would not bring benefit to these contributors to the wellbeing of this society, as if that were something to be said in their favor, and of course Joe Wilson agrees with that. For the reasons just stated, I do not. But Obama was lying again, because while some benefits may be denied to them, it's impossible to deny them even the benefits being delivered already by the government-controlled health care industry. If an "illegal" five-year-old breaks an arm and reaches the emergency room, she will have it set regardless of her parent's government paperwork, and very likely without charge. Just recently I had occasion to visit an ER, and saw a notice on the wall to the effect that all there present had a "right" to treatment regardless of our ability to pay. That's another lie, of course, government cannot confer any such "right"--but it can and does force other people to pay for it anyway, in part by denying operating licenses to hospitals that do not treat the penniless. In practice, since they mostly obtain Social Security numbers, driver licenses and government paperwork other than a valid visa, there is no way to stop such immigrants finding free treatment, and the more government manages the operation, the more it will designate such treatment as a "right" and so the less it will be able to charge for it in practice. He knew all that, and so he was lying; Joe Wilson knew it too, and so was correct to call him a liar.

So there we have it: truth-telling in Congress is hazardous to one's reputation, making a terrible system even worse is an improvement, massive theft is redesignated "insurance", offering one's labor for sale is a criminal act, with-holding medical care from the needy is recommended by our nation's President, but when he promises to do so he is lying, and the guy who names the lie must be a racist. Alice , welcome to the wonderland that government built.

SOURCE




Max Baucus's errors and lies

In a Wall Street Journal op-ed yesterday, Senate Finance Committee Chairman, Max Baucus (D-MT), lays out his lies case for his version of health care “reform”.

The beauty of the recent turn of events/tone in the health care debate is that the public is now actually listening to the content of the Democrats’ statements, including those of Dear Leader, rather than just the mellifluous sound of his voice. So when Max Baucus now starts with the same drivel, it’s actually hard to respond with anything but a chuckle. I’m going to go through Baucus’s tragi-comic opinion in some detail for purposes of showing just how much BS can be in one article by one senator.

Baucus says “At the current rate of growth, health-care spending will double in less than 10 years taking $1 out of every $5 we spend.” What he doesn’t tell you is that 47% of health care spending is already done by the government. What he also doesn’t tell you is that by underpaying medical providers for government-paid health care, it forces up the cost for everyone else as doctors and others must raise prices outside of Medicare/Medicaid to stay in business. So just why should we support a plan that would obviously make the problem worse rather than better? As Robert Woodson said at the Steamboat Institute conference last month, “If you keep on doing what you’re doing, you’ll keep on getting what you got.”

Baucus says “And every day another 14,000 Americans lose their health insurance.” And IBD editorial about health care “reform” misinformation answers Baucus’s claim well:

A little math shows this is just a scare statistic. Multiply it out, and it comes to 5.1 million people losing coverage in a year. Sound scary? Consider that, according to the census, 46.3 million Americans don’t currently have insurance — 600,000 more than last year. That means that, along with 14,000 Americans losing their coverage each day, another 12,400 Americans are signing up for it — even in the middle of a brutal recession.

Baucus says “The reality is that our plan controls spending without adding to the federal deficit, expands coverage, protects consumers from unfair insurance industry practices, and puts choice back into the hands of consumers and businesses.” OK, that’s laugh-out-loud funny. He goes on to explain each one, so let’s tackle his lies claims:

Baucus says “For starters, our plan pays for every cent of new spending without using additional tax dollars. Our plan would lower costs and would not add to the federal deficit. In fact, it would begin reducing the federal deficit within 10 years by containing costs through industry reforms. These reforms would focus on preventing diseases before they become costly to treat and paying health-care providers for the quality of care they deliver not the number of tests they order.”

However, the AP, hardly a bastion of conservatism, says Baucus’s bill “would cost $856 billion over 10 years” and that “(t)he plan would be paid for with $507 billion in cuts to government health programs and $349 billion in new taxes and fees, including a tax on high-end insurance plans and fees on insurance companies and medical device manufacturers.” Maybe what Baucus meant is that he doesn’t plan to raise income taxes to cover the cost of his “reform”…but even that would be a lie because nobody really believes that the savings Obama and Baucus claim are available will actually be found. The public believes Baucus is lying as well, with a Gallup survey just this week saying that 60% believe the Democrats’ “reform” plans can’t be accomplished without tax hikes or hurting the quality of care.

As for reducing the deficit within 10 years, while we haven’t seen the CBO’s scoring of the Baucus bill yet, I’d bet money it won’t validate that claim. The scoring of the House’s health care “reform” bill, HR3200, which has been publicized as showing the measure increasing our deficit by a cumulative $239 billion over 10 years massively understates the fiscal impact of the bill. This is because the first few years of the bill might lower the deficit through huge tax increases without actually increasing spending on health care whereas after the 4th year of the plan, the deficit explodes, increasing every year, to an estimated $65 billion in the 10th year alone. In other words, the plan is designed to make the deficit increase look modest for the 10-year scoring period. But in fact, the next 10 years would likely cost closer to $1 trillion if the CBO scored that far into the future. And does anybody believe that the true deficit from government-run medicine won’t be even higher than the CBO scoring, given the lessons of history?

As far as saving money through preventative medicine, that is simply a myth. This letter from the non-partisan Congressional Budget Office says “Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.” (I am not saying that preventative medicine is a bad idea, just that it is not a cost-saving strategy.)

Baucus says “Our plan would give businesses the freedom to offer any policy they choose, so long as it meets a basic quality standard.” In other words, “our plan would limit the freedo of businesses to offer any policy they choose.” Can you imagine the effect of a national “basic quality standard” given the effect of mandates in many states on the price of health insurance in those states? For example, NFIB studies the effect of mandates in New York State and concluded that:

Health insurance benefits mandated by the Legislature cost small businesses annually more than $1,000 per employee. Individual policyholders currently pay $445 and family policyholders pay $1,066 extra every year just to cover state mandates. These policies affect the ability of our small businesses to provide health insurance to their employees and their families, and place the future of employment-based health insurance at risk.

Studies show that for every 1 percent hike in premium, up to 30,000 people are priced out of insurance. Currently, more than 30 different benefits are mandated in New York, and every year dozens more are proposed and legislation is passed without any objective study to determine their true cost. The resulting higher premiums are making the cost of health insurance simply unaffordable for too many.

Given the coziness between big business and government (and don’t be fooled that business only likes Republicans), odds are that the ability of the federal government to decide on a “basic” standard will be extremely costly to the wallets and the freedom of Americans.

Baucus says “Our plan would promote healthy competition and put real choices back in the hands of consumers.” If the Democrats really believed in competition in health care, they would not have fought against the competitive aspects of the Medicare “Part D” prescription drug benefit which is the primary reason that plan has not been costing the government as much as originally forecast. And more importantly, they would support allowing interstate purchase of health insurance – the single most important reform needed to increase competition and choice and bring down cost.

Baucus says “Our plan would take the guess work out of buying insurance so consumers could make informed decisions about the insurance policies they buy. Through state-based “insurance exchanges,” individuals and small businesses could shop for plans offered within their zip codes and determine their eligibility for tax credits to buy insurance.” But anyone with an internet connection can already just search for “Colorado health insurance” or “Ohio health insurance”, for example, and find multiple web sites which access multiple insurance companies and allow consumers to compare policies and prices. The “insurance exchange” is simply the federal government’s way to get its nose under the tent as a first step toward Democrats’ goal of “single payer” health care. There is no part of an “insurance exchange” that can’t be done cheaper and better by the private sector…and probably no part of an insurance exchange that isn’t already being done by the private sector.

Baucus says “Our plan would force insurance companies to compete on price and quality, and it would stop them from selecting out the healthiest among us and hiding benefit limitations that only become apparent when a person gets sick.” But all that needs to happen to force competition is to allow competition. You don’t have to force GM to compete with Ford. You don’t have to force Compaq to compete with Dell. They compete because they can and because they must. The only reason we don’t have enough of that dynamic within the health insurance industry is because government regulations prevent it!

As for “selecting out the healthiest among us”, there is something to that. For people who are basically healthy with just an occasional minor issue, allowing interstate purchase of health insurance will take care of them because of the tremendous competition it will create. For those with serious pre-existing conditions, who says that it’s just or sensible to allow them to buy insurance at the same price the rest of the population pays? Do we or should we let people buy car insurance right after an accident so that the insurance has to cover the repairs? Remember, insurance is basically “mutual insurance” or shared risk over a pool of participants. Allowing someone with a pre-existing condition to simply jump into the pool at no increased cost for his condition is nothing more than a penalty on the rest of the pool. This is particularly true for a pre-existing condition which was acquired during a time when a person was uninsured.

We certainly do need to find some solution for people with congenital or chronic conditions who are being denied coverage. But in a sense that shouldn’t even be called “insurance” which by its nature is intended to help cover the costs of unexpected events or illnesses. Maybe there is even a role for government here, though my libertarian tendencies of course lead me to be skeptial. In any case, the number of people we’re talking about is far lower than what one should think necessary to even discuss a government takeover of our health care system. And that is what Baucus’s bill presages, no matter how much he denies it.

Baucus says “Our plan would not restrict, in any way, the treatments patients receive. Nor would it inhibit the free-market innovations that have contributed to the exceptional medical advances Americans have benefited from in the last century.” Hang on a second…I have to stop laughing before I type any more… In the stimulus bill, a new bureaucracy has already been created which is the first step down the certain road to health care rationing. Obama’s chief health care advisor, Ezekiel Emanuel (brother to chief-of-staff Rahm Emanuel) has publicly called for restricting care to the elderly in the interest of “sustainable medicine”. (It should also be noted that Dr. Emanuel has said that “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely ‘lipstick’ cost control, more for show and public relations than for true change.” Even a blind squirrel finds an occasional nut…)

And how can Baucus say that his bill would not inhibit medical advances given the massive tax he plans to impose on medical device makers? What type of policy could conceivably inhibit innovation more than that? Among the many lies and contradictions in Baucus’s op-ed, this is one of the most important even if one of the least widely known, particularly if you’re concerned with whether American health care actually helps people live longer or better lives. The trade association of medical device companies has released an aggressive statement against the proposal with the title “Innovation Tax Will Stifle Medical Progress.” In a sense, the medical innovation tax is a remarkably boneheaded idea, but it also shows a lot about Democrats, namely about their stupidity and their fascist economic tendencies – by which I mean their desire to force nominally private companies to behave in the service of their government. They already came to a “deal” with drug companies – which leading Democrats almost instantly said wasn’t worth the paper it was unwritten on. Now they’re going to try to force the medical device companies to cave in and do something, though exactly what remains unclear. This medical device tax is nothing short of shameful…and I hope that even most Democrats see it that way. I believe that there will be enough pushback from Democratic senators that Baucus will be forced to pull this provision…which will be yet another crack in his dam of health care reform lies.

Baucus says “Our plan would not put government between patients and doctors, and it wouldn’t force anyone to change his or her coverage. If you like the care you have today, you can keep it.” I’ve already dealt with the first statement: A bureaucracy has already been created which does exactly what Baucus says he won’t do. Furthermore, both England and Canada ration care, which is precisely putting government between patients and doctors. And what choice do they have? After all, when you subsidize something, you get more users of it. In order not to bankrupt the country when they make medical care “free” or even “cheap”, they will have to come between patients and doctors. And to the extent that Baucus’s bill is like HR3200 (or gets modified toward HR3200 in conference), the idea that you can keep your coverage is basically a lie. In the House bill, you can keep your coverage only until anything about it changes; then you have to switch to a government-approved plan.

Finally, Baucus says “The time has come for action. And we will act. In the next several weeks, the Senate Finance Committee will do its part to control costs, protect consumers from unfair insurance industry practices, and put America back on a path toward fiscal sustainability.” The first thing that needs to be emphasized regarding “time for action” is that those of us who oppose Obamacare (or Baucuscare) are not supporting the status quo. We agree that something needs to be done. But that something needs to be policy changes that encourage competition and remove the dead hand of government, whereas the government’s plans do just the opposite regardless of their rhetoric.

There is NO Democrat bill that will control costs or put America back on a path toward fiscal sustainability. None. And as for “unfair insurance industry practices”, that’s not going to sell well with the public either. Yes, we know the insurance companies do some things we don’t like. But we also know that the vast majority of Americans are happy with their health care and even their insurance. And we know that, with Medicare as an object lesson, there is no reason to think that government will do anything but get in the way, raise costs, discourage doctors from working (as this IBD editorial and survey describe), and generally destroy the world’s best, if still quite imperfect, health care system.

As I said at the beginning of this rather long note, the public is now listening with a skeptical ear to the words of the Democratic leadership. There are a lot of reasons to believe they’re lying and few reasons to believe that they’re truthful…and fewer reasons to believe they understand the industry they’re trying to “reform”.

What we’ll really need to see is whether the Democrats’ health care bill will cover the plastic surgery necessary to remove all their extra nose tissue following the daily barrage of lies and misinformation they’re dumping on the American people.

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Congress Veers Left on Health Care

The Baucus bill has been rejected by Democrats too

Senate Finance Committee Chairman Max Baucus unveiled his long-awaited health-care compromise this week to the sound of one hand clapping. You wouldn't know it from the White House, which soothingly spun the Baucus bill as a breakthrough on the forced march to reform. We were told it was a good thing that the only person in Washington who liked Max Baucus's bill was . . . Max Baucus. That everybody was unhappy meant we were getting somewhere. What matters is that the Senate now has a "common sense" product to serve as a "building block" for bipartisan legislation. Uh-huh.

Mr. Obama has the same problem he's had since the start, only magnified. That would be the left wing of his party, which is about to rip up the Baucus bill, making an ugly product grotesque. He also has the same Republican Party, only now it's so alienated as to uniformly oppose the effort. And he has the same crowd of vulnerable Senate and House Democrats who continue to pay as much attention to the dismal polls as they do to their president. Nothing new to see here, folks. Move along.

Mr. Baucus took until mid-September to release his bill because he spent months coaxing Republicans. This wasn't done out of kindness, but political necessity. The other congressional bills were so extreme as to cause a Democratic revolt. If Mr. Baucus could get buy-ins from Sens. Chuck Grassley, Mike Enzi and Olympia Snowe, he would give nervous Democrats cover.

Instead, our bipartisan White House grew weary of the bipartisan process and pressured Mr. Baucus to produce. He jettisoned his colleagues and pushed out a product that Messrs. Grassley and Enzi promptly condemned. The White House did such a good job of suggesting that Ms. Snowe was its GOP patsy—a Republican who'd vote for a ham sandwich, if only they asked—that even the miffed Maine senator has stepped back.

The result is two-fold. With no, or little, GOP support, the only way Mr. Baucus can pry his bill out of committee is to allow the left to have its way. The White House knows this, which is why the president—despite seizing on the Baucus legislation in his speech last week—is already abandoning the finance chief and his bill to the tender mercies of West Virginia's Jay Rockefeller and New York's Chuck Schumer. The White House wants a bill, any bill, and this bloc now holds all the votes in committee. Pity Mr. Baucus, who just got used.

All the more so, given that the finance chief liberal-ed up his bill—with new subsidies, new taxes, new regulation—specifically to make nice to his committee's left. Rockefeller and Co. have condemned the $775 billion legislation as too skimpy and not tough enough. By the time they are done amending, the bill will be flirting with a $1 trillion price tag, contain a raft of new taxes, and a string of new regulations. Mr. Rockefeller may be savvy enough to hold back on adding a public option, but the bill that emerges will be as liberal as he dares.

Daring is the word, as the other result of ditching the GOP is that the Blue Dogs and swing-state senators are on their own. The Baucus bill will come out looking more like the other toxic Democratic products than not, and it will now, finally, contain the unpleasant details for public review. The political risks are immense.

Does Arkansas Sen. Blanche Lincoln, up for re-election next year, with an upside-down approval rating, vote to proceed with a trillion in spending on the back of a $9 trillion deficit over the next decade? Does Florida's Bill Nelson vote to stick it to his state's Medicare Advantage participants? Does Colorado's Michael Bennet vote for billions in new health-care user taxes, or penalties on the uninsured? This is where the health-care rubber meets the road, and Majority Leader Harry Reid has but a few feet of pavement. With Ted Kennedy's seat unfilled, and Robert Byrd an uncertain presence, 60 cloture votes are not guaranteed.

What has changed is Mr. Obama's determination to push a bill through, regardless of what his party, or the public, thinks. The White House will make the case to waverers that the political fallout of a health-care failure will be worse than backlash that comes with voting for a bill. Maybe. Behind that is the further threat that Dems will go this alone, via 50-vote reconciliation, if necessary.

They'd like to avoid it, as reconciliation will be messy, uncertain and carry political fallout. Yet if the Baucus bill has done anything, it has brought the White House further down this road. The president may yet regret he didn't hit the restart button.

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Fables for Adults

by Thomas Sowell

Many years ago, as a small child, I was told one of those old-fashioned fables for children. It was about a dog with a bone in his mouth, who was walking on a log across a stream.

The dog looked down into the water and saw his reflection. He thought it was another dog with a bone in his mouth-- and it seemed to him that the other dog's bone was bigger than his. He decided that he was going to take the other dog's bone away and opened his mouth to attack. The result was that his own bone fell into the water and was lost.

At the time, I didn't like that story and wished they hadn't told it to me. But the passing years and decades have made me realize how important that story was, because it was not really about dogs but about people.

Today we are living in a time when the President of the United States is telling us that he is going to help us take that other dog's bone away-- and the end result is likely to be very much like what it was in that children's fable.

Whether we are supposed to take that bone away from the doctors, the hospitals, the pharmaceutical companies or the insurance companies, the net result is likely to be the same-- most of us will end up with worse medical care than we have available today. We will have opened our mouth and dropped a very big bone into the water.

While I was told a story in my childhood to help me understand something about the real world, today adults are being told things to reduce them to childish thinking. The most childish of all the things being said in the august setting of a joint session of Congress last week was that millions of people can be added to the government's health insurance plan without increasing the federal deficit at all. If the President of the United States could do that, it is hard to imagine what he would do as an encore. Walking on water would be an anticlimax.

What is equally childish is the notion that the great majority of Americans who have medical insurance, and who say they are satisfied with it, should be panicked and stampeded into supporting vast increases in the arbitrary power of Washington bureaucrats to take medical decisions out of the hands of their doctors-- all ostensibly because a minority of Americans do not have medical insurance.

There was a time, within living memory, when most Americans did not have health insurance-- and it was not the end of the world, as so many in politics and the media seem to be depicting it today. As someone who lived through that era, and who spent decades without medical insurance, I find it hard to be panicked and stampeded into bigger and worse problems because some people do not have medical insurance, including many who could afford it if they chose to.

What did we do, back during the years when most Americans had no medical insurance? I did what most people did. I depended on a "single payer"-- myself. When I didn't have the money, I paid off my medical bills in installments. The birth of my first child was not covered by medical insurance. I paid off the bill, month by month, until the time finally came when I could tell my wife that the baby was now ours, free and clear.

In a country where everything imaginable is bought and paid for on credit, why is it suddenly a national crisis if some people cannot pay cash up front for medical treatment?

That is not the best way to do things for all people and all medical treatments, which is why most Americans today choose to have medical insurance. But millions of other people choose not to-- often young and healthy people, sometimes deadbeats who use emergency rooms and don't pay at all.

Is this ideal? No. But if every deviation from the ideal is a reason to be panicked and stampeded into putting dangerous arbitrary powers into the hands of government, then go directly to totalitarianism, do not pass "Go", do not collect $200. And go ahead and drop your bone in the water, in hopes that you can get somebody else's bigger bone.

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Public Option Is Not The Worst Aspect Of ObamaCare

Much of the hullabaloo over President Obama’s health care speech to Congress last week focused on his endorsement of a “public option” — that is, a government-run, not merely government regulated health insurance plan for the non-elderly middle class. Throughout the August congressional recess, it appeared as though the White House was ready to abandon the public option, since that was a major source of contention among congressional Republicans, Blue Dog Democrats, and a sizeable portion of the American public. In his speech, Obama paradoxically came out firmly in support of a public option, while acknowledging that his support was not so firm that he wouldn’t be willing to bargain the public option away.

Still, the public option is not the worst aspect of the various Democratic health reform proposals, the mandatory purchase requirement is. Under each of the three bills moving through Congress, every person living in the United States would be required by law to have insurance. And, if your employer doesn’t provide you with it, you’ve got to buy it yourself or pay a fairly stiff monetary penalty. What’s more, each of the proposals would eliminate some of the options that are available now — particularly the low-cost insurance plans that cover only catastrophic health events and have substantial cost-sharing features. And, depending on which bill would eventually be enacted into law, Congress, state insurance commissioners, and/or a federal Health Choices Commissioner would be empowered to determine whether any given plan even “qualifies” as health insurance. The end result will be higher, not lower costs, for almost every person living in the country.

President Obama knows this, of course. During the presidential campaign, he roundly criticized Hillary Clinton for proposing essentially the same thing. As today’s Wall Street Journal points out:

“The political irony here is rich. If liberal health-care reform is going to make people better off, why does it require “a very harsh, stiff penalty” to make everyone buy it? That’s what Senator Obama called it in his Presidential campaign when he opposed the individual mandate supported by Hillary Clinton. He correctly argued then that many people were uninsured not because they didn’t want coverage but because it was too expensive. The nearby mailer to Ohio primary voters gives the flavor of Mr. Obama’s attacks.

And the Baucus-Obama plan will only make insurance even more expensive. Employers will be required to offer “qualified coverage” to their workers (or pay another “free rider” penalty) and workers will be required to accept it, paying for it in lower wages. The vast majority of households already confront the same tradeoff today, except Congress will now declare that there’s only one right answer.”

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18 September, 2009

Lucky Brits: The government is at long last thinking of giving them a choice of doctor

Patients will be able to register with a GP anywhere in the country in a radical move to abolish restrictive catchment areas, Andy Burnham, the Health Secretary, will announce. GP practices often run very tight boundaries and refuse to take patients who live even 100 yards too far away or on the wrong side of the road and people who move house are forced to change their surgery. But within the next year patients will be able to choose to remain with a favoured doctor when they move house or register with one near work or school if they choose.

Under new plans to be announced in a keynote speech in London Mr Burnham will say GPs will not be able to refuse to take patients because they live too far away. The changes aim to drive up quality of care by prompting more competition between doctors to attract patients with the most successful practices being able to expand. Meanwhile patients will have more choice and control over their own healthcare.

The idea was proposed in the review of the NHS led by Sir Ara Darzi, a surgeon and until recently a junior health minister. It is envisaged that most patients will still want to register with a GP near home for convenience, especially those with long-term illnesses, but some will want to see a doctor near work or family and others may want to remain with a favoured family doctor even when they move house.

Mr Burnham will say: "In this day and age I can see no reason why patients should not be able to choose the GP practice they want. "Many of us lead hectic lives and health services should be there to make things easier. A busy mum needs flexibility – she may want to register at a practice near her children’s school. "Equally, a commuter may want to register near to work. I want to them to be able to do this whilst ensuring that access to home visits won't be affected, wherever someone ends up registering."

The details are still being finalised but it is thought patients who want to register with a surgery a long way from their home may have to accept some services such as home visits are not practical.

A large proportion of practice income is based on the number of patients on its list so funding will increase with the number of patients but new patients are worth less to surgeries than existing ones. Some popular surgeries will be unable to expand for logistical reasons and will have to close their lists to new patients.

In his first major speech as Health Secretary, Mr Burnham will set out his vision for the future of the health service at the King's Fund think tank, saying although it is now unrecognisable from the "poor state it was in 12 years ago" more reform is needed to ensure patients have greater choice and improved quality of care.

As well as changes to primary care, Mr Burnham wants to see hospital trusts rewarded for providing good care and penalised financially for poor treatment. Trusts that provide a high quality patient experience from the way patients are spoken to by NHS staff, to clinical quality, to compassion and respect will be reflected in payments made for treatment. But it means that budgets will suffer at hospitals that receive low ratings and where patients report poor care.

Mr Burnham will add: "In the last decade, the NHS has gone from poor to good. In the next, I want to help it go from good to great. "That will mean a relentless focus on quality and people-centred care. I also want to use financial incentives to change the way care is provided – for example it can often be cost effective and better quality to provide dialysis or chemotherapy in people's homes."

Dr Laurence Buckman, chairman of the General Practice Committee at the British Medical Association said GPs will support the moves but added that the law, the National Health Service Act, will have to be changed to allow the people to have a GP who would not be able to visit them at home. He said: “The idea of getting rid of practice boundaries altogether has been discussed many times in the past, and we are happy to discuss it again. “However, major logistical barriers would need to be overcome. “Home visits with a GP a long way away would become difficult, and costly for the NHS to fund. “Practices in rural and suburban areas could lose significant numbers of young, healthy, patients, destabilising their funding and threatening their viability. "Meanwhile, city centre practices would be inundated with requests for appointments at lunchtime and evenings, which would effectively limit patient choice."

He said other services like district nursing still have defined boundaries. “These problems are not insurmountable but will need a lot of careful thinking if they are to be solved,” he said.

The plans were welcomed by patients groups but there was a call for more information to help patients choose their surgery more effectively. A spokesman for the Patients Association said: "This idea was proposed years ago so we need a clear timetable for introduction-it can't fall by the wayside again. "Action speaks louder than words. Patients do not have easy access to meaningful information so choice at the moment is relatively meaningless as it focuses on things like convenience and location. "We welcome the proposal but there needs to be real progress on information to support genuine patient choice."

Andrew Lansley, the shadow health secretary, said the Tories have already announced similar plans. He said: “We’ve always argued that it was ludicrous for the Government to talk about giving people a choice of GP when they restricted that choice based on their postcode. That is why we announced plans to abolish practice boundaries two years ago. “So this is a step in the right direction, but just a small one. It is only a small part of the much bigger package of reform that we need to make to our system of family doctors.

"We need to remove the perverse disincentives that currently exist which dissuade doctors from taking on new patients. We also need to give GPs much greater responsibility for managing their patients’ care when they refer them on for hospital treatment, including control of the money that funds that treatment."

Norman Lamb, the Liberal Democrat health spokesman, also supported the changes. He said: "The current system breeds complacency, there isn't any effective competition which can potentially drive up standards and ultimately it gives the patient no choice. "There is a certain reality that in rural areas, in particular, the extent to which patients have a real choice is inevitably limited by geography, for the elderly especially and there are limits on how far you can expect GPS to go on home visits. "But in general it must be right that individuals should be able to choose which practice they want to register with and the money should follow the patient."

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That compassionate, sensitive British socialist system again

'I only wanted to change the appointment': Dementia patient's wife asked to see doctor nearer home ... hospital wrote back asking for his brain for research

The wife of a television comedy writer now suffering from dementia was shocked to receive a letter from his consultant asking if they'd donate his brain for research after he died. Mike Craig, who worked with the likes of Morecambe and Wise and Ken Dodd during a long showbusiness career, needs to be looked after around the clock after developing a rare condition called Pick's disease.

But when the 74-year-old's devoted wife Susan called the hospital he attends to say he was too ill to travel there, she was shocked to receive a reply asking her to consider brain donation.

Yesterday she said that while she understood the need to carry out research on sufferers' brains, the letter was deeply insensitive as all she had wanted to do was find a doctor closer to their home.

Mr Craig worked as a producer or writer on more than 1,000 classic episodes, helping to script such much-loved moments as Angela Rippon's 1976 appearance with Morecambe and Wise. He also worked with Des O'Connor and Roy Castle and went on to become a popular after-dinner speaker, making appearances on cruise ships talking about his experiences in the 'golden age of comedy'.

However around seven years ago his family became worried that his behaviour was becoming rambling and obsessive. He was eventually diagnosed with Pick's disease, a rare and terminal form of dementia which initially targets the personality more than the memory. There is no medical treatment available, and Mr Craig has to be watched around the clock by his wife as he his liable to turn the gas on or leave taps running.

He continued making once-a-year trips to a consultant at the brain unit at Salford Royal Hospital, six miles from his home in Timperley, Greater Manchester. But when his wife was notified of an appointment there next January, she rang to say he had deteriorated and was too ill to travel there. However she was shocked to receive a letter which said they had changed hospital records to note that he 'will no longer be coming here' in future.

The consultant went on: 'Having perused Mr Craig's notes I don't think that we ever discussed the brain donation research programme with you and your family. 'I wonder whether it would be in order for us to contact you to discuss this issue?'

Yesterday Mrs Craig said she was horrified to have the question of donation raised so baldly and without any offer of alternative medical support or monitoring. 'I am all for research and I would be happy to discuss tissue donation with Mike's children because I would support anything which might help find a treatment for this awful disease, but I was shocked to get this letter,' she said. 'I thought the doctors might make alternative arrangements to see Mike. We were surprised they would write to us about tissue donation rather than speaking about it in person or on the phone. 'I would have thought if they want him to be part of a research study it would be important for them to see him regularly, to chart how the condition affects him.'

Last night the hospital apologised, saying the letter had been sent by mistake and that the sensitive issue of brain tissue donation always ought to be raised face-to-face. A spokeswoman said: 'We are very sorry to have caused Mrs Craig any distress through our recent communication, we acknowledge that this was insensitive and we would like to offer assurance that this will never happen again.'

Medical campaigners say new guidelines are needed on how to encourage the families of people with dementia and similar conditions to agree to donate their brains after their death without making the trauma they face even worse.

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Australia: Incredible NSW hospitals bureaucracy again

More than 130 doctors at one of the state's most dilapidated hospitals have threatened to walk off the job after being told the Health Department is impotent to change their ''slum-like conditions'' but is demanding they slash up to $9 million from their budget and cull staff.

Doctors at Hornsby Ku-ring-gai Hospital went public in the Herald last month, upset that wards were stained with possum urine, dangerous cabling snaked across floors and operating theatres were too small for modern equipment and lacked emergency arrest buttons, putting staff and patients at risk. Possums had also been found living among open boxes of medical supplies in the intensive care unit.

But, after a visit by the then health minister John Della Bosca, hospital management was this week told to slash up to $9 million from its budget, lose 23 staff and close a ward. Doctors had planned to discuss the proposed cuts with the chief of the Northern Sydney Area Health Service, Matthew Daly, yesterday but the meeting was cancelled at short notice, leaving staff fearing they have been sidelined.

''Is this punishment for bringing the Hornsby debacle to the public?'' the chairman of the medical staff council, Richard Harris, asked yesterday. ''They are all hoping this will blow over, but we are … determined to make sure it doesn't blow over,'' he said.

The hospital's clinical director of surgery and anaesthetics, Pip Middleton, said doctors would give the Government six weeks to agree to a rebuild before considering withdrawing their services. ''In less than two years this hospital will become unsafe and unworkable so it is fast getting to the point where the only thing we can do is walk out. It's not something we'd do lightly but it may be the only thing they understand.''

Dr Middleton, who has previously labelled conditions at the hospital as medieval and offensive, said a recent offer by the area health service to renovate a ward was ''Chinese finance''. ''Sticky tape and a lick of paint does nothing to improve the conditions for anyone here. If they can't rebuild completely, they are throwing good money after bad. We need some firm evidence they are doing something rather than stalling, or we're out,'' he said.

A cardiologist, Jason Sharp, said staff were tired of dealing with '' a dysfunctional bureaucracy that can't achieve anything''. He said the recent resignation of the hospital's general manager had left staff feeling more demoralised. ''Administration is in disarray at a hospital level, an area health service level and a state level. They are immobilised and it leaves us disappointed.''

The hospital's executive clinical director, Sue Kurrle, said staff were perplexed at being told to cut the budget. ''This is one of the most cost-efficient hospitals in the state. There's nothing to cut.''

Dr Harris has called for a meeting with the new Health Minister, Carmel Tebbutt, and wants representatives from the Australian Medical Association and the Royal Australasian College of Surgeons to tour the hospital.

SOURCE




The follies of job-based health insurance

A small note: In Australia, ALL health insurance is bought directly by individuals, I have a very high level of cover for myself and my son but pay only $241 a month. It's about what the average smoker would spend on cigarettes

The other day, I was trying to figure out why the paycheck deduction for my health insurance was higher than I had expected. When I called my insurer to ask what the total premium was, the customer service representative said it was none of my business.

Three-fifths of Americans, the share with employer-provided health insurance, are in the same situation: Since someone else buys insurance for them, using money they would otherwise receive as wages, they are in no position to shop around and typically do not even know the true cost of their coverage. This disconnect between payment and consumption is one of the central problems with the current health care system, contributing to rapidly escalating costs, insecurity, and the general lack of choice and competition. Yet both Democrats and Republicans insist upon preserving it.

Outlining his health care reforms last week, President Obama was at pains to reassure the public that "nothing in this plan will require you or your employer to change the coverage or the doctor you have." In fact, he said employers should be forced to provide health insurance (or, alternatively, contribute to a fund that subsidizes premiums).

Obama presented himself as the protector of job-based medical coverage against those "on the right" who "argue that we should end employer-based systems and leave individuals to buy health insurance on their own." That approach, he warned, represents "a radical shift that would disrupt the health care most people currently have."

Meanwhile, the Republicans, whose last president and last presidential candidate both proposed eliminating the tax incentives that encourage employers to offer health insurance in lieu of higher pay, seem to have abandoned that idea. One of their main complaints about Obama's plan is that it would reduce the number of Americans covered through their jobs.

Senate Minority Leader Mitch McConnell, R-Ky., warns that one Democratic health care bill "would cause 10 million people with employer-based insurance to lose the coverage they have." The Republican National Committee claims "over 88 million people" who are covered through work "would lose current insurance under government-run health care."

It's no mystery why each party portrays the other as bent on destroying employment-based medical coverage. Surveys find that a large majority of people who have such insurance are happy with it. According to a recent Zogby poll, 77 percent of Americans oppose "taxing employer-provided health care benefits."

Yet it's the tax-free status of those benefits that favors them over cash compensation, maintaining a bizarre system in which most Americans get their health insurance -- unlike their car, life or homeowner's insurance -- through their employers. As a result, they are insulated from the actual price of their insurance and are more likely to have plans with low deductibles that cover routine medical expenses as well as large, unpredictable costs. In choosing among providers, drugs and courses of treatment, they have little incentive to economize and usually do not even know the relative costs of the various options.

The artificial dominance of job-based plans, along with misguided restrictions on where insurers can sell policies and what types of coverage they can offer, has stunted the development of alternatives. Even so, the large price difference between the job-based and individual insurance markets (some of which may be due to differences in the age and health of policy holders) suggests the savings that are possible when people decide how to spend their own money: In 2007 the average annual premium for nongroup health insurance was about $2,600 for single-person coverage and $5,800 for family coverage, compared to $4,500 and $12,100, respectively, for job-based plans.

In addition to enhancing competition and controlling costs, cutting the link between employment and health insurance would relieve the insecurity that many Americans feel about going without coverage when they lose or leave their jobs. Obama is right that it would be "a radical shift" -- radical in the sense that it goes to the root of the current health care mess.

SOURCE




Rx for money woes: Doctors quit medicine

Some physicians, fed up with the costs of their practice, are ready to hang up their stethoscopes and shift careers. How is Obama going to fix this? How is he going to provide more health care with fewer doctors? Republicans are pushing for tort reform but are getting nowhere and Obama actually wants to REDUCE the pittance that doctors get from Medicare

Some 5,000 patients suddenly found themselves without an ob/gyn last November when Dr. Tara Wah closed her practice in Tallahassee, Fla. Wah, 55, informed her patients in a letter that she could "no longer afford to make ends meet." After 24 years, "I'm working longer hours than ever," she wrote. "Insurance payments for patient care have stayed virtually the same for the last 15 years, while the cost of doing business, including health insurance, staff salaries and supplies have risen."

The rising cost of malpractice insurance, particularly for her specialty, was the straw that broke the camel's back. "My malpractice insurance was $125,000 a year, and going up," said Wah. "The only way to get the extra money was to cut back on my salary."

But it wasn't always like that. Being a doctor was once thought to be a path to a cushy lifestyle. Six years after she started practicing, Wah hit her "peak" income year in 1990. Then she took a pay cut every year from 1993 onward, to eventually take no salary for two months prior to permanently shutting her office.

Wah no longer practices medicine. Instead, she designs and repairs jewelry. "I feel guilty. I dream about [medicine]," she said. "[But] I am so angry. I think, 'What a waste of my training.' "

Wah's situation sheds light on a troubling trend of physicians leaving medicine for a career outside of health care, said Kurt Mosley, a staffing expert with Merritt Hawkins & Associates, a physician search and consulting firm. A first-ever survey of 12,000 primary care physicians conducted last October by Merritt Hawkins and the Physicians' Foundation, an organization that represent the interests of physicians, showed that 10.1% of respondents planned to seek a job outside of health care in the next one to three years. "That is a big number. It's just very sad," said Mosley, especially in light of the shortage of primary care doctors in the United States today.

The American Medical Association said it is aware of this trend, citing the survey, but said it does not have data to show how many doctors have already prematurely exited the profession.

Regardless, Mosley said it's a waste of training, skill, talent and money when a doctor leaves the profession in mid-career. It takes a minimum of 10 to 12 years of training to become a doctor. In Wah's case, she underwent 10 years of training, including medical school and residency, before she entered the workforce.

While some enter medicine because they believe it pays well, most choose it as a career because they feel it's their calling. "For many it's not about the money. They have a passion for it, to take care of people," said Mosley. "It's not easy to feel that passionately for another career after medicine."

It's also a waste of taxpayer money when a physician opts out. "We are all paying out of our pockets to produce doctors," said Mosley. That's because medical residency programs are mostly funded by Medicare to the tune of $9 billion to train about 100,000 residents annually, according to the Medicare Payment Advisory Commission. "It's Medicare that funds hospital costs to house residency programs, pay salaries of residents and sometimes pay faculties' salaries," said Mosley.

Dr. Patricia Perry, 44, a dermatologist based in Burbank, Calif., operates a solo practice. She mostly performs medical procedures such as skin biopsies. Perry said she's "seeking to get out" of her profession because she's fed up with insurance reimbursement challenges while struggling to cover other costs associated with being a doctor. "When you get to a point where you feel unappreciated and you're arguing with people about being paid, it takes away the passion for what you do," Perry said.

Daryl Richard, a spokesman for insurer UnitedHealthcare (UHC), said his company is taking steps to address some of providers' concerns. "We agree 100% that there is too much paperwork" tied to reimbursement claims, he said. Richard said UnitedHealthcare offers a Web-based application to all of its providers that will enable the company to adjudicate claims to determine a reimbursement and a patient's out-of-pocket expense "by the time the patient makes it to the (doctor's) front desk." "This takes away some of the unknown for both providers and consumers," he added.

Perry pays $2,500 a year in malpractice insurance. "I am licensed in three states. To maintain my license I have to pay a fee every one to two years in each state," she said. She also pays a considerable amount of money every year to attend annual trade conferences required by her specialty to update and hone her skills. She said many physicians are scared to speak out about their money woes because they don't want to be perceived as "greedy." "I have news for you. You are already being perceived that way," she said.

Dr. Kenneth Cohn, a general surgeon with an MBA who tours the country advising doctors on non-clinical job options, says there's a high-level of angst among U.S. physicians. "There's absolutely a greater number who are looking for other job opportunities," he said. It's a reality that we have to deal with, Cohn said. The implication of it on the health care system, he said, is that doctors may have to increasingly use nurse practitioners and physicians assistants to fill in the gaps. They may also need to look to newer delivery concepts such as medical homes, in which doctor take more of a managerial role in a patient's health care.

More here




Doctors Threaten to Go Galt if ObamaCare Passes

It would be a miracle of biblical proportions if Big Government’s minions could decrease costs while increasing coverage, as Democrats have been promising to do when they seize control of the healthcare industry. What will make cost savings even more improbable is that they will have to do it with a radically reduced supply — because doctors unwilling to labor as government slaves have promised to go Galt:

Four of nine doctors, or 45%, said they “would consider leaving their practice or taking an early retirement” if Congress passes the plan the Democratic majority and White House have in mind. More than 800,000 doctors were practicing in 2006, the government says. Projecting the poll’s finding onto that population, 360,000 doctors would consider quitting.

The IBD/TIPP poll also found that 2/3 of doctors oppose ObamaCare, despite the lies being spewed on your dime by NPR.

The poll contradicts the claims of not only the White House, but also doctors’ own lobby — the powerful American Medical Association — both of which suggest the medical profession is behind the proposed overhaul. …

It also differs with findings of a poll released Monday by National Public Radio that suggests a “majority of physicians want public and private insurance options,” and clashes with media reports such as Tuesday’s front-page story in the Los Angeles Times with the headline “Doctors Go For Obama’s Reform.”

Surprisingly, only 71% of doctors answered “no” when asked whether they could swallow that “the government can cover 47 million more people and that it will cost less money and the quality of care will be better.” The rest must be Democrats, like they all will be after ObamaCare passes and hospitals turn into the DMV.

Becoming a doctor isn’t easy. Who is going to do it in the future, when our socialist rulers have destroyed every incentive? It will make more sense just to apply for a job at the post office than endure the rigors of medical school and residency. This is yet another reason that socialism simply does not work. But at least we’ll have no shortage of useless bureauweenies telling us how to live and when to die.

SOURCE





17 September, 2009

Government health insurance already hard at work in America

Instead of a check, VA sends widow a profanity-laced screed, denying her payments she is entitled to and admitting that they have deliberately lost the medical records she needs to support her claim

Following my Aug. 25 column ("Does government-run health care work? Ask vets"), I got a call from Bessie Krone, the widow of a World War II Navy veteran. She faxed me a copy of a shocking letter she said she recently received from the Department of Veterans Affairs' regional office in Montgomery, Ala.

The profanity-laced screed, date-stamped Sept. 3, 2009, and stapled to Form 4107 ("Your Rights to Appeal Our Decision"), brazenly admits that VA employees deliberately removed medical records from her late husband Robert's file.

"Mrs. Krone, are you that f...ing stupid?" asked the letter, supposedly signed by triage assistant coach Mark Carter, who acknowledged that the VA owed her late husband eight years of back pay in addition to a special monthly disability allowance he never got: "I still do not know why the previous team did not give that to him in September 1997. It was an oversight (maybe) but not likely. ... Your husband's application that he placed back in 1987 and his doctor's statement is still safely tucked away until you give up. Then it will be placed back into the file."

The letter also stated that Carter's boss, service center manager Amy Hill, repeatedly lied when she promised to approve Krone's overdue benefits if she dropped her complaint with the VA's Office of Inspector General: "You have personally spoken to Amy several times now, and both times she b-slapped you while looking straight into your eyes. She told you that if you would trust her and not ask for a OIG investigation, that she would grant your claim. What a truckload of s... that was.

"As you know an appeal would take years to achieve, only to be denied again," the letter continued. Hill "wanted you to trust her because [regional office director Ricardo] Randall told her to make you go away and to clean up her s... Randall and Amy both know what a s... load of trouble they are in and you Mrs. Krone are once again the toilet paper."

The letter added that Carter was told to "give the impression that you do not have a claim, no matter what you do or how you may respond."

When Krone personally asked Hill three times if she was aware of the shocking content of the letter, Hill allegedly said she was. I called Hill myself Friday, but she quickly said, "I can't comment," before referring me to the VA's public information office, which said that the matter was under investigation by the OIG. On Monday, Krone called again to say that her entire $35,000-plus claim had been deleted from the system.

Whom to believe? A woman with crippling arthritis who spent a year demonstrating in front of the Montgomery regional office demanding benefits the VA still owes her and thousands of other military families?

Or a government agency that, the U.S. Court of Appeals noted in a landmark Aug. 12 ruling, illegally altered disabled Vietnam veteran Philip E. Cushman's medical records to avoid paying his decades-old $100,000 claim? That's a no-brainer.

More here

UPDATE

Make a complaint about government employees, and you – not them –could end up as the target of a criminal probe. That’s exactly what happened to Bessie Krone, a 62-year-old disabled widow from Montgomery, Alabama who recently received a expletive-filled letter from the Department of Veterans Affairs.

Instead of finding out who sent her the vile letter and why, the VA’s Office of Inspector General, Division of Criminal Investigations is apparently investigating her!

Krone told me that Special Agents Humes and Hudson from Atlanta interrogated her for nearly an hour and a half at a nearby Arby’s restaurant. “A hamburger does not get as much grilling as I got today,” she told me. “They knew everything about me – how many brothers and sisters I had, when I was born, where my son lives, the number of grandkids I have, my cell phone number, when I went to the store this morning, even the exact time I called The Examiner.”

“So I told them: ‘You’ve investigated me real good. Now go investigate whoever sent that letter and leave me alone.’”

The agents kept pressing her again and again for the name of her alleged accomplice, Krone told me, but she didn’t budge. “They told me that I knew somebody in the VA who was feeding me this information and I needed to tell them who it is. If I didn’t cooperate, I could be charged with being an accessory to conspiracy. I kept telling them, ‘I do not know anybody in that VA office.’”

“They said I had a ‘friend,’ a VA employee who was trying to help me get my claim settled. I said, ‘You just showed me a letter showing that my claim was denied,’” she added.

Krone said she did tell the agents that the only person at the VA to whom she had given her new post office box was service manager Amy Hill, who refused to discuss the letter when contacted by The Examiner.

“Why did you go to the newspaper with this?” Krone said one of the agents asked her.

“My past experience with the VA, sir,” she replied.

“The VA has begun my punishment already,” Krone told me. When she called the VA’s 800 number to get an update, she was told that her claim number had been ordered removed by the same regional office she complained about.” Without a claim number, she won’t get her modest widow’s pension on Oct. 1.

“I will be a 62-year-old disabled homeless person next month,” Krone told me. “My small Social Security check will not be enough to live on and I will have to live in my car or go back to living in a rental shed like I did after my husband (a WWII Navy veteran) died.”

This is how our government treats the widows of men who fought and died for this country. As the daughter of a WWII Army vet myself, I am sickened and appalled.

SOURCE




Obamacare will hit the wallets of the middle class

The chairman of the Senate Finance Committee said Monday that he will propose an overhaul of the nation's health-care system that addresses a host of GOP concerns, including blocking illegal immigrants from gaining access to subsidized insurance, urging limits on medical malpractice lawsuits and banning federal subsidies for abortion.

But even after Max Baucus (D-Mont.) spoke optimistically of gaining bipartisan backing, lawmakers continued to haggle over a question at the heart of the debate: How can the government force people to buy insurance without imposing a huge new financial burden on millions of middle-class Americans?

Even within his own party, Baucus confronted a fresh wave of concern about affordability. Sen. Ron Wyden (D-Ore.) declared himself dissatisfied with the chairman's plan, which, like other congressional reform proposals, would require every American to buy health insurance by 2013. "Additional steps are going to have to be taken to make coverage more affordable," Wyden said, "and my sense is that will be a concern to members on both sides of the aisle."

Under the Baucus plan, described in a "framework" he released last week, as many as 4 million of the 46 million people who are currently uninsured would be required to buy coverage on their own, without government help, by some estimates. Millions more would qualify for federal tax credits, but could still end up paying as much as 13 percent of their income for insurance premiums -- far more than most Americans now pay for coverage.

People further down the income scale would receive much bigger tax credits, effectively limiting their premiums at 3 percent of their earnings. But experts on affordability say even those families could find it difficult to meet the new mandate without straining their wallets. "We're talking about the equivalent of a middle-class tax increase," said Michael D. Tanner, a health-care expert at the libertarian Cato Institute. "Yes, they're paying it to an insurance company instead of to the government. But, suddenly, these people are paying more money to somebody."

A plan drafted by House Democratic leaders would offer more generous tax credits, but it would cost more than $1 trillion over the next decade.

Baucus's team of three Democrats and three Republicans from the Finance Committee has labored for months to cut that cost as it crafts a reform plan that could win support from both parties. By squeezing the size and scope of the subsidies, the negotiators have lowered the cost to a more politically palatable $880 billion -- within the range President Obama specified last week in a speech to Congress.

But a smaller bill would mean less help for people -- particularly those who earn too much to qualify for Medicaid but too little to easily slip the equivalent of a second rent payment into their budgets.

According to the latest Census data, about three-quarters of the uninsured earn less than 300 percent of the poverty level, or about $32,500 for an individual and $66,150 for a family of four. Nearly half are childless adults. In surveys, many say that they are not offered coverage by their employers or that they simply cannot afford it.

The centerpiece of the Baucus proposal is a series of "exchanges" where people without access to affordable coverage through their employers could apply for government subsidies and choose among a range of private insurance options. The plan would not, as liberals have demanded, create a government-run insurance option to compete with private firms, but would finance the creation of state or regional cooperatives run by consumers -- a concession aimed at winning over Republican lawmakers.

Baucus and his colleagues wrangled Monday in the hopes of persuading Republican Sens. Charles E. Grassley (Iowa) and Mike Enzi (Wyo.) to support the measure. The two conservatives have stayed at the bargaining table all summer, despite GOP leaders' strong opposition to the reform effort.

Baucus said the strategy is working. "Senators on and off the committee, their comfort level is starting to come up a bit," he told reporters. "I believe, in the end, we'll have some significant bipartisan support." But the chairman said Monday night that he will move forward Wednesday with or without Grassley, Enzi and Sen. Olympia J. Snowe (Maine), the most moderate Republican involved in the negotiations. He said the bipartisan group, known as the Gang of Six, would continue to negotiate until the full committee begins work on the bill next week.

Baucus said he will comply with Republican demands that illegal immigrants would receive "no benefits" through the new insurance exchanges. Meanwhile, negotiators are crafting a provision that would authorize states to start pilot projects to try to lower health-care costs by reducing the number of malpractice lawsuits, an approach similar to the one Obama outlined in his speech. "States would be given resources to help them experiment with what works best," said Sen. Kent Conrad (D-N.D.), another participant in the talks.

Also unresolved Monday was the question of how to pay for an expansion of Medicaid to cover every U.S. citizen whose income falls below 133 percent of the federal poverty level, about $14,500 for an individual or $29,500 for a family of four. Governors in both parties strongly oppose an expansion that is not fully financed by the federal government. The Senate negotiators are scheduled to brief governors by conference call Tuesday afternoon, and Baucus predicted they would be "pleasantly surprised."

"The Medicaid costs," he said, "are not going to cost states near as much as feared."

Under the Baucus plan, subsidies would be offered to people who earn up to 400 percent of the poverty level ($43,000 for an individual or $88,000 for a family of four) in the form of tax credits that would be paid directly to the insurance company of the person's choice. The credit would be calibrated on a sliding scale to ensure that people at the bottom of the income range paid no more than 3 percent of their earnings for premiums while those at the top would be liable for as much as 13 percent.

That would amount to more than $700 a month for a family of four making $66,000 a year -- significantly more than most people at the same income level now pay, according to research conducted by Linda Blumberg, a senior fellow in the Health Policy Center at the Urban Institute. Families earning less than 300 percent of the poverty level also would be eligible for assistance with deductibles and other out-of-pocket expenses, but families who earn more would be on their own. "That group does spend in the neighborhood of 12 percent of their income. But it's not just the premium. It includes out-of-pocket spending," Blumberg said, adding that the Baucus plan "is going to be somewhat of a wakeup call."

Families that do not purchase insurance would face penalties on their annual tax returns of up to $1,500 a year if they make less than 300 percent of the poverty level, or $3,800 a year if they make more. But Senate Finance Committee negotiators are quick to point out that a hardship waiver would be available. "We're doing our very best to make the insurance requirement as affordable as we possibly can," Baucus said, without driving up the overall cost of the bill.

SOURCE




Health care reform faces inconvenient questions

Now that President Obama has outlined his goals for an overhaul of the American health care system, Democrats are trying to fashion new legislation that will include all of Obama's aims. The president wants a new government-run insurance program, additional regulations for the insurance industry and rules requiring all Americans to buy insurance if they can afford it or be given coverage if they can't. Obama's plan draws elements from the multiple bills in Congress. But in trying to merge the ideas into a compromise bill, Democratic leaders face a series of inconvenient questions:

1. Who would foot the bill for extending health insurance to 30 million more Americans?

Obama's plan draws heavily from a proposal in the Senate Finance Committee that would tax insurance companies that provide expensive health plans. There would be new taxes on drugs and health care providers. The House would impose a tax on incomes of more than $280,000 for individuals and $350,000 for couples. No proposed plan would cover all the costs.

2. Would doctors and hospitals be able to cope with the expected influx of millions of new patients?

Advocates say that many new enrollees would be young and not in need of frequent medical care and that preventive care would help stave off diseases that require more services. But many of the newly insured would also be poor and suffering from chronic conditions. Critics expect long waits for medical services as in Europe and Canada.

3. Wouldn't illegal immigrants still get care, often for free, in hospitals?

No bill would block free hospital care for illegal immigrants. The House bill would not allow illegal immigrants to receive subsidized care, but there is nothing in the bill that would prohibit illegals from buying insurance policies or joining the government option. The Senate bill will likely block subsidized coverage for illegals.

4. Who would enforce the requirement that individuals have coverage?

The IRS would be the chief enforcer of the individual mandate. That's because the government would impose an additional income tax on those who do not purchase coverage. The IRS would verify coverage claims with the names and Social Security numbers of customers provided to the agency by insurers. The IRS would also evaluate individual incomes to determine eligibility for subsidized coverage.

5. Will employers stop providing health care coverage if a public plan is available?

There is no plan in Congress to prevent this. The Congressional Budget Office found that if one Democratic plan in the Senate becomes law, "about 6 million people who would have employment-based coverage under current law would not have such coverage under the proposal."

6. How can spending less on Medicare produce better care for participants?

The president says that cutting $500 billion from Medicare in the next decade will rid the system of waste and fraud and increase access to care. But members of both parties are worried about the president's plan to give an appointed board power to make the cuts, as well as access to care in rural areas.

7. What other programs would need to be cut if Obama's promised savings don't materialize?

The president said in his address to Congress that if the hundreds of billions of dollars in government health savings don't materialize, he would find savings in other areas. But only 38 percent of the federal budget is subject to cuts, and that includes hard-to-trim departments like Defense, Transportation and Education.

8. Similar plans have failed in several states. How would a federal plan avoid the same fate?

Critics of the Democratic plans say the outcome would be similar to public plans initiated in several states that have either failed completely, like Hawaii, or are struggling, like Massachusetts, where the program has been deemed too costly for residents and too expensive for the state to afford. Advocates say savings and efficiencies are possible if all 310 million Americans are subject to the plan.

9. Can the president make good on his promise not to "add one dime" to the national debt?

The Congressional Budget Office estimates the House health care bill will increase the deficit by $239 billion over the next 10 years, while the Senate bill would add more than $1 trillion to the national debt in the next decade. Democrats discount those figures, saying they do not include the savings they anticipate.

10. The president says that he can save $500 billion in waste and fraud in Medicare. Has the government ever succeeded in such an ambitious cutting effort?

The government has never been able to save money on this scale. Most recently, Obama's effort to make cuts at the Cabinet level yielded about $267 million in savings. And the government's biggest effort yet, initiated by then-Vice President Al Gore in 1993, claimed savings of just $12.3 billion after four years.

11. Is it true, as the president and Democratic leaders have argued, that "special interests" are trying to block reform?

The pharmaceutical industry has already cut a deal with the administration to lower drug costs for seniors and will be paying for $150 million in pro-reform advertising. The American Medical Association last week approved the Obama plan. AARP, one of the nation's largest insurers, has spent millions of dollars on pro-reform ads.

12. Do we need "demonstration projects" on medical malpractice reforms to find effective ways to control lawsuit costs?

In Texas, 2005 limits on damages in malpractice cases has led to a 27 percent decrease in malpractice premiums. An additional half-dozen states have cut frivolous suits through similar means. Obama's decision to do yet more state testing, rather than propose legislative changes, leaves critics worrying that he has no intention of implementing nationwide reform.

SOURCE




The New Third Rail

Why 'death panels' are a political killer

If Hogwarts were a school for politicians, there would be a required class on "Defense Against the Dark Arts of Demagoguery." President Obama considers his health reform effort a target of this dark art--indeed, he seems to view it as the main reason reform has faltered on Capitol Hill.

Here is the defense he mounted in his big speech to Congress this week: "Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple."

Professor Snape would not be impressed. At issue, of course, are the two words "death panels," uttered widely in opposition to Obamacare, most famously by Sarah Palin, the prominent politician to whom the president alluded. The phrase may indeed be "cynical" shorthand for a new government role in deciding on appropriate care as one nears the end of one's life; certainly it is polemical. And it may even be "irresponsible"--in exactly the same way that Democratic political operatives for decades have irresponsibly tried to frighten the elderly into believing Republicans were going to take away their Social Security benefits. But "laughable" is precisely what it isn't. End-of-life care is beginning to look a lot like a new third rail of American politics. Republicans will be happy to let Democrats learn this lesson the hard way.

Now, it is true that none of the proposed reform legislation calls for convening panels of government bureaucrats to make life-and-death decisions about the elderly on a case-by-case basis, with the power to shut off their medical care. Unfortunately for Obama, that doesn't make "death panels" a "lie, plain and simple." Rather, it is an exaggeration. When Obama responds to an obvious exaggeration with the rejoinder that it is not literally true, he is missing the point. The question is what this exaggeration is getting at. And the answer is that it is getting at something very real, the primal anxiety people feel about the end of their own lives.

It is just folly to pretend that this anxiety is anything but genuine among those who are getting on in years or who have received a diagnosis that looks to be life-threatening in the absence of treatment, and perhaps even with. And it is disingenuous in the extreme to pretend that the current reform effort doesn't have potentially large-scale implications for treatment decisions for the old and sick. Obama would like to ignore both points while blaming Republicans for making the whole thing up, but it won't work.

Since, as we all know, health care is expensive and the demand for it is vast, there has to be some way of settling the scarcity question. The current system is an unlovely hybrid with major deficiencies, but it has a couple of core virtues: Quality of care is first among them, but another important one is that for those with insurance or Medicare or Medicaid, care decisions are (within limits) mostly between people and their doctors, who take their Hippocratic Oath seriously. Even the limits have the virtue of being mostly known or knowable. True, people get unpleasant surprises from time to time about what's covered and what isn't; the system senselessly ties insurance to employment, inhibiting mobility, especially when "preexisting conditions" come into the picture. And it's not like the cost of insurance coverage and copays is going down. But there is an intelligibility and reliability to the system as it exists for those who are in it.

At a minimum, Obamacare introduces a major element of uncertainty. Of course nobody really knows what Obamacare is, including Obama; the term is a catch-all for whatever (if anything) Congress comes up with that the president can sign. But that's just another way of saying that overall uncertainty is high and rising, including on the issue of "end-of-life" care. And it won't do to try to alleviate the concern here by pointing to specific provisions of possible pieces of legislation and saying, "See, it's not there." Everything is up for grabs, and people don't like it when everything is up for grabs.

Then we have the more specific reasons for people to be concerned about who will be deciding what for them as they become sick or grow old. It is hardly fanciful to suppose that in a system in which resources are limited, global treatment protocols are going to decide eligibility for care in a way they do not currently. Likewise, people who are eligible for a particular treatment are going to have to wait in line until it's their turn. If there is any currently existing national health care system, such as the left dreams about, that does not contain these features, it's strange that no one has pointed to it to prove that health care, unlike everything else, need not involve tradeoffs.

The point for single-payer advocates, including in their "public option" guise, is that equality is the highest virtue, and that means equal access to what is available. It's simply unjust, in their view, that some people can afford high-quality care while others get none: If the price of a universal system is that some lose privileges they have long enjoyed, that's the kind of a tradeoff they are prepared to make.

But old folks and sick people in the current system, or people thinking about either prospect, may not see it that way. The question they have is, "What's going to happen to me?" The baseline they have is the care the system around them currently provides. They are right to worry about changes to the system.

To the general problem of the need to find a basis for allocating finite health care resources, one must add certain specific anxiety-inducing details that have come out in the debate: First, the inclusion in some of the early legislative language of provisions funding end-of-life counseling sessions--the objective correlative of the "death panel" polemics.

Second, the quick ditching of the counseling proposal once the "death panel" rhetoric hit, fostering the impression that the proposal was indeed up to no good.

Third, Obama's own musing in a New York Times interview about whether the decision to provide a hip replacement to someone diagnosed with cancer (in this case, his grandmother) is "a sustainable model."

Fourth, his public reflections on the high health care costs associated on average with the last six months of a person's life.

Fifth, the statements of such supporters as Todd Gitlin, whose only criticism of a speech he found otherwise inspiring was: "You can say that he's still not willing to talk to Americans straight about the need to limit high-tech medicine for the very old and very frail. Presidents won't do that."

Sixth, the administration's insistent and probably misguided attempt to portray its health care reform as cost-cutting--reduced spending on the health care of whom, exactly?

At the end of Shakespeare's Tempest, Prospero, the greatest wizard prior to Albus Dumbledore, gives up his powers and prepares to "retire me to my Milan, where / Every third thought shall be my grave." People do brood about death, quite unbidden.

When they are made to brood about it, as in the case of the new focus on end-of-life care--previously known as medical care for the very sick and elderly--they are likely to resent the intrusion. And when the substance of the intrusion is a proposal that upsets the expectations they have formed on this most difficult of topics, many will be inclined to reject it. Obama's sinking job-approval numbers among seniors and the broad decline in support for the plan likely reflect these tendencies.

Obama will not dispel the anxiety by saying the rhetoric about "death panels" would be laughable were it not so irresponsible and cynical. You disrupt the expectations of the elderly only at great political peril, and there are more such Americans every day.

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Obamacare runs counter to GOP principles

The six Senate Republicans seeking a "bipartisan compromise" on President Obama's proposal for a government-run health care system are flirting with a provision - an individual mandate to buy government-approved health insurance - that runs counter to everything the GOP stands for. This "gang of six" includes senators Olympia Snowe of Maine, Charles Grassley of Iowa, Robert Bennett of Utah, Lindsay Graham of South Carolina, Mike Crapo of Idaho, and Lamar Alexander of Tennessee. Snowe has been covertly negotiating with Obama for weeks, while Grassley supports the concept of a health care insurance co-op. The other four are co-sponsors of S. 391, the Healthy Americans Act introduced by Sen. Ron Wyden, D-OR, which includes some attractive features but at its heart is an individual mandate. Individuals and fFamilies would be fined as much as $3,800 annually for not buying approved health insurance.

An individual mandate should be anathema to all GOPers for two reasons. First, the individual mandate is the fulcrum of cooperation between government-run health care advocates and the big health insurance companies that would profit immensely if it's approved. As the Social Security Institute's Larry Hunter trenchantly observed, the big insurers "desperately want an individual mandate passed and will accept anything short of having their CEOs pushed out of an airplane door to get it." Such a "public-private partnership" will work no better for health care than it has in the mortgage industry with Fannie Mae and Freddie Mac.

Second, the approach makes a mockery of individual freedom of choice because it forces everybody to buy a government-approved health insurance plan from a government-approved insurer with oversight by government bureaucrats. Finally, because of the intensive government regulation involved, mandated rationing of health care is just as inevitable under this approach as it is under Obamacare. And bureaucrats will be just as likely to make treatment choices that ought to be made by doctors and patients. Supporting such legislation will mark Senate GOPers as Republicans-In-Name-Only (RINO) enablers of the Democrats' long-sought government takeover of health care.

Senate Republicans are fools if they think they can safely get away with sprinkling some "bipartisan compromise" pixie dust on any government-run health care bill. Among the August recess lessons is that people, unlike most members of Congress, are reading the bills as never before and they aren't going to be fooled by flowery rhetoric. That is why surveys appearing this week make clear that Obama's much-ballyhooed address last week to Congress was no game-changer, contrary to predictions from the White House and the liberal media. It is also why the people will know RINOcare is just another way of saying Obamacare.

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16 September, 2009

More NHS arrogance and negligence

Treatment was "negative, unhelpful, almost inhuman"

Two devastating strokes had left him paralysed and barely able to speak, let alone feed himself. Following surgery to stop further bleeding on the brain, pop star Edwyn Collins also developed an MRSA infection. There was no denying he was desperately unwell - yet, once he was out of intensive care, he found his problems had only just begun.

The singer, who'd written the global hit A Girl Like You, spent six months in hospital. And while his family have nothing but praise for the emergency health care he received, they were alarmed and frightened by the neglect he and other chronically ill patients suffered on the wards afterwards.

'I'd come in at the beginning of visiting hours and Ed would be filthy, with an oozing head wound that was encrusted with muck, and then I'd find he hadn't been given his antibiotic,' recalls Grace Maxwell, Edwyn's partner and manager for more than 20 years. 'We saw the NHS at its brilliant best when Ed's life was in danger. But the less-glamorous, long-term therapeutic care was scarily inconsistent. And when I tried to step in and help, the nurses' response was: "Don't tell us how to do our job."

When she tried to find out more about Edwyn's treatment, the clinicians also seemed to take it as a challenge to their authority. Doctors were 'aloof, imperious, brusque - you had to screw up all your courage to persist with your questions, to face them down' - while nurses routinely treated her 'as a nuisance, as though I was making trouble for the sake of it,' she says.

In particular, no one seemed interested in treating Edwyn's aphasia, a relatively common stroke-related condition that left him unable to use or understand language. 'I have read the so-called "evidence" that people with aphasia almost never improve after the first six months,' says Grace. 'Yet no one seems to ask the question: why? What sort of therapy were these people getting? Were they feeling marginalised and withdrawn? Is that why they made no progress?'

Faced with a beloved partner apparently consigned to the scrap heap, Grace felt she had no choice but to quickly learn to play the system, using a mixture of heavy-handed buttering-up of ward staff, along with occasionally 'blowing my stack' to ensure that Edwyn's care was adequate.

Once, when Edwyn managed to yank out his much-hated feeding tube late on a Friday afternoon, it was Grace who discovered he was being put at the end of a queue to get it replaced with specialist equipment - and that if he wasn't seen quickly, he faced the risk of a weekend without food, water or drugs.

Unable to convince the junior doctor of the urgency of the situation, she recalls: 'I hauled that doctor into the corridor and threatened to go up like a rocket in a way that would completely spoil his boss's weekend.'

And when she found there was no prospect of Edwyn getting speech and language therapy for his aphasia on the stroke unit, Grace sweet-talked the ward sister to allow her to bring in a private therapist every week.

Then when another ward sister on the rehabilitation unit told her there was no possibility of switching off the heating on a boiling hot May day 'even though all the patients would soon be on drips for dehydration', Grace phoned the hospital press office and threatened to call the media. 'Heat off by close of play. Staff amazed,' she noted in her diary.

Yet she didn't always win. The rehabilitation ward's 'seemingly arbitrary' ban on visitors until 4pm was intractable because of the 'intensive' rehabilitation patients were undergoing - even though this turned out to involve long periods of inactivity, with only one or two 45-minute therapy sessions a day. Indeed, by the time she arrived, Edwyn would be mentally 'climbing the walls', having been woken at 6.30am and then spending endless hours marooned in a wheelchair, prevented by his condition from reading or even switching on his Walkman to pass the time.

'If I hadn't been there, battling daily on his behalf, I can't help feeling Ed might not have survived,' Grace says. 'I had to use every trick in the book to make sure he was looked after properly, for ever biting my tongue to avoid a stand-off with staff. I'd see other families having fierce rows with ward staff often enough to know that it was the worst possible thing to do.'

This kind of exhausting tightrope act will be familiar to anyone whose loved one has spent a long time in hospital. Not only is there the stress and anxiety of their illness to deal with, but the feeling that, as far as many medics go, you're just an irritation.

In fact, this goes against the long-established principle that hospital patients recover faster when their loved ones are involved in their care. In the mid-Eighties a key study by the Harvard Medical School showed that people get better more quickly when they are treated as human beings 'with acknowledged social and emotional needs' - and central to this is the daily involvement of family and friends.

This is something experts in the UK acknowledge. 'Patients recover more rapidly when they are less anxious, and that's more likely to happen when their relatives are involved in their care,' says Jocelyn Cornwell, director of the Point of Care programme run by the NHS think-tank the King's Fund. 'We know that is true for children in long-term care in hospital as well as in obstetrics, intensive care and post-surgery. I believe the involvement of relatives is crucial to the wellbeing of all patients in long-term care.'

Dr Mike Dixon, chair of the NHS Alliance, agrees, adding: 'Hospital patients today need their relatives to be there for them both as advocates and as daily carers more than ever before. Yet this growing concern about poor nursing seems to be making hospital staff ever more defensive in the face of criticism from relatives.'

Sometimes, however, relatives are able to provide care for their loved one almost by default. Diana Jakubowska, 57, from Cambridge, was shocked by the poor standard of nursing care when she spent three months in hospital with Guillain-Barre syndrome. 'The nursing staff were simply not interested in looking after their patients, whether because they didn't have time or they didn't care,' she recalls.

Diana's sister visited every day after work, staying until the late evening, despite having three young children. 'Hearing my sister's heels clip-clopping along the corridor was the best noise in the world. These daily visits reminded me I was a human being with a wonderful life that was waiting for me. With my family, there was never any question that I would not get better - yet I never once got that feeling from the nurses.'

It wasn't just the psychological boost this provided, but the actual care she received from her sister that made all the difference. 'Without her help I sometimes wouldn't have had my teeth brushed or my body washed,' says Diana.

The King's Fund Point of Care programme is testing ways to encourage the involvement by patients' relatives. 'We know there are no easy solutions.' says Jocelyn Cornwell. 'Nurses already feel plagued by fielding constant telephone calls from relatives. And while each family is focused on getting the best care for their own loved one, the nurse has to juggle equally important demands from all the patients on the ward.'

The answer, she says, is for staff to learn to put themselves in the shoes of those families. 'It took decades of campaigning before parents of children were made welcome in long-stay paediatric wards. It mustn't take so long with equally vulnerable adults.'

For Grace Maxwell, it wasn't simply a case of being welcomed, but actually taking on elements of Edywn's care. 'The doctors were telling me there was no chance of him having any meaningful recovery. Of course, I didn't accept that for a minute.' She refused to believe that more couldn't be done to restore the man she'd met in the mid-Eighties when he'd been the idol of the pop scene, celebrated for his songs, dandy looks and scathing wit, as she puts it.

Grace worked with the speech and language therapist, bringing in a flask of ice to stimulate sensation on the right-hand side of Edwyn's face and showing flash cards. 'Mostly, I would talk to him lots and lots.' More practically, she developed a new competence in 'changing the sheets on a bed with an immobile 6ft 1in man still in it' and becoming 'an expert shaver of a man's face'.

She noted with delight his first whispered sentence - 'Be careful with William' - a reference to their son, now 19, and a signal that both Edwyn's language and sense of family was returning. But his recovery was far from easy. Despite her efforts, when he was discharged from hospital in September 2005, Edwyn appeared to have made little progress: he was still barely able to speak, couldn't walk read or write and was unable to recognise his own home from the outside.

And so Grace insisted on a regimented programme of 'stimulus overload all the way', including speech therapy, regular walks and daily reading lessons, starting with infant readers' material. And an extraordinary 18 months later, Edwyn was back on stage, at Camden Lock in North London, earning five-star reviews for singing favourites from his repertoire.

Four years after leaving hospital, he remains partly paralysed on his right side, but sufficiently mobile to tour with his band, reliant only an elegant silver-topped stick, with eight new songs already written and plans for the future.

He is lucky, says Grace, to have been able to afford extra therapy and to have the family and friends to provide the support. But she knows only too well that the plans for new songs and tours and the fact that 'these days, we walk in the sun' is largely down to her determination to be an effective partner in his longterm hospital care. 'We are grateful for Edwyn's treatment in hospital,' says Grace. 'But large parts of it were negative, unhelpful, almost inhuman. Without me to fight his corner, our lives would be incomparably worse today.'

SOURCE




Can Obama force you to buy health insurance?

Nothing in the Constitution allows the individual mandate he proposes

Many liberals lambasted the Bush administration on detention policy and warrantless surveillance, often arguing that they violated the Constitution. Now the Obama administration is pushing ahead with plans to require every American to purchase health insurance.

Doesn't that also violate the Constitution?

The Constitution created a federal government limited to its enumerated powers. Everything Congress is allowed to do is spelled out in Article I. The 10th Amendment makes it explicit: "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

Nothing in the Constitution authorizes any federal involvement in healthcare – yet Congress may soon require everyone in America to buy insurance.

Admittedly, the Supreme Court has ruled that the language empowering Congress to "regulate Commerce ... among the several States" applies to an ever-broadening range of activity. The "commerce" clause was originally intended to prohibit interstate tariffs, a supposed problem under the Articles of Confederation.

Ironically, consumers today cannot freely buy health insurance from across state lines. If there's any legitimate application of the "commerce" clause, it would be to overturn such restrictions. But the framers never gave Congress the general power to regulate industry.

In the 1935 case Schecter v. United States, involving farming regulations, the court unanimously struck down parts of the National Industrial Recovery Act for overstepping Congress's commerce power. Liberal Justice Louis Brandeis informed one of President Franklin Roosevelt's aides to "tell the president that we're not going to let this government centralize everything."

The next year, the court ruled in Butler v. United States that elements of the Agricultural Adjustment Act, which inflated food prices by restricting supply, violated the 10th Amendment.

After FDR threatened to pack the court with additional judges friendly to the New Deal, the court lost its spine. In 1937, it upheld the National Labor Relations Act – which greatly expanded the power of labor unions and greatly diminished the freedom of contract – under the "commerce" clause.

In Wickard v. Filburn (1942) the justices even upheld the conviction of a man for growing too much wheat on his farm. The court reasoned that even wheat grown solely for private consumption ultimately had an impact on the economy, turning the "commerce" clause into a regulatory rubber stamp.

The "commerce" clause is now interpreted very broadly. Although in United States v. Lopez (1995) the court struck down a firearms law that exceeded Congress's commerce power, it ruled 10 years later in Gonzales v. Raich that federal drug policy overrode California's medical marijuana laws, despite the 10th Amendment.

Justice Clarence Thomas dissented: "If the Federal Government can regulate growing a half-dozen cannabis plants for personal consumption (not because it is interstate commerce, but because it is inextricably bound up with interstate commerce), then Congress' Article I powers … have no meaningful limits." Indeed, practically nothing is beyond the pale anymore.

Then there is the privacy issue. In Griswold v. Connecticut (1965), Roe v. Wade (1973), and Planned Parenthood v. Casey (1992) the court found reproductive freedom to be guaranteed as an implicit right to privacy. In Casey, the court reasoned that abortion entailed "the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy," and that such choices are "central to the liberty protected by the 14th Amendment."

Why wouldn't this apply to the right to decide whether to buy health insurance?

Other constitutional concerns emerge. The mass collection of medical data likely to occur under proposed reforms threatens the Fourth Amendment's "right of the people to be secure in their persons, houses, papers, and effects." Making it a crime not to buy insurance, and then forcing people to show they have not bought it, arguably clashes with the Fifth Amendment's protection against self-incrimination.

The Ninth Amendment reserves to individuals all rights not expressly denied by the Constitution. Nothing in the document curtails our right not to purchase health insurance. And being forced to fill out forms to apply for insurance is in tension with the 13th Amendment's prohibition of "involuntary servitude."

The quality we could expect from government care may also raise constitutional questions. In early August, a federal panel ordered California to release 40,000 inmates because the health services were so strained, causing one unnecessary prisoner death per week, so as to render the treatment "unconstitutional." If we all become captive consumers under federal mandate, could we not similarly argue that any shoddiness in our mandated health services is an unconstitutional burden?

Those who find such constitutional arguments unconvincing are often quick to invoke them against policies they oppose. Similarly, some of today's critics of President Obama and national healthcare brandish the Constitution as a holy document, but were silent when President George W.Bush trampled its many limitations on executive power, and even signed an expansion of Medicare.

A newfound, consistent, and lasting respect for the Constitution, across the ideological spectrum, would renew the health of our republic like nothing else.

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Compulsive Disorder

During the Democratic presidential primaries, Barack Obama argued against forcing people to buy health insurance. But on Wednesday night, he flip-flopped and endorsed the idea.

President Obama argued that people who do not have insurance raise the premiums of those who do. But careful analyses of this effect — notably that of the Democrat-controlled Congressional Budget Office — suggest that it is minuscule. (Some of the uninsured, by paying out of pocket for medical expenses, actually subsidize the rest of us.) Obama’s solution to this modest cost shifting would increase premiums far more than ignoring it, for requiring everyone to purchase health insurance would lead to a lobbying free-for-all. The experience of state regulation strongly suggests that producer interests would overwhelm consumer interests: People would pay high premiums for coverage they may not need or want, such as coverage for drug abuse.

The effect would be a tax increase for millions of people. People who have turned down their employer’s offer of health coverage in favor of higher wages would be forced to take a pay cut. Because of the predictable effects of lobbying, even those who already have insurance would be forced to part with more and more money to pay for more expensive insurance.

The president has another reason for favoring compulsion. He seeks regulations on the insurance industry that will not work unless people are forced to buy its products. If insurers have to charge the same price to all comers regardless of their health status, healthy people will have no reason to sign up. They will instead wait until they get sick and get charged the same rate. But if only sick people buy insurance, premiums will skyrocket. Insurance markets will collapse.

An order for all people to buy insurance would not so much prevent that collapse as disguise it. Once insurance companies have to sell policies to sick people and healthy people at the same rates — or to put it another way, once people are no longer allowed to buy insurance policies that give them a discount for being healthy — those policies are no longer insurance against the risk of getting sick. What “insurance companies” would instead be selling is a share of the nation’s medical resources. Viewed from this angle, the same need for compulsion presents itself. If you think that you are likely to cost less than your share of the nation’s medical expenses, and you have freedom, you may reject this bad deal. But if only the people who expect they will have higher than average medical expenses take the deal, again, the system becomes untenable. The president wants insurance to be structured in a way that cannot arise in conditions of freedom. Hence those conditions must be revoked.

Obama drew an analogy between compulsory health insurance and compulsory auto insurance. But never before has the federal government required the purchase of a product as a condition for lawful residence in this country. (No state actually forces anyone to buy a car.) An individual mandate would be an extension of federal power that raises serious constitutional issues. It may even be said that while the “public option” — the proposal, that is, for a government-run insurance program — has caused the most controversy for its socialistic aspects, it is the mandate that most clearly exposes the coercive nature of the liberal version of health-care reform.

It is not as though we had no alternative. If we want to reduce the tiny amount of cost shifting that the federal government’s requirement that all people be able to get emergency care entails, we could enable young and healthy people to purchase cheap policies to insure them against catastrophic events. Obama prefers to mulct them in order to advance his ideological agenda. There is no reason for the rest of us to share this preference.

Obama’s opposition to a mandate in 2008 did not keep him from winning majorities among Democratic voters, who make up the portion of the electorate most enthusiastic about health regulation. Congressmen and senators can oppose this coercion without any fear of adverse political consequences, and should. Republicans, in particular, have in the past voted unanimously against tax increases much less egregious than this one. If the administration has to give up the “public option,” it will merely have to settle for socialized medicine on a longer time frame. Abandoning the individual mandate would truly force it to scrap its plan and start over, as the country seems to want and the public interest requires.

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Listening to a Liar (again)

By Thomas Sowell

"Hubris-laden charlatans" was the way a recent e-mail from a reader characterized the Obama administration. That phrase seems especially appropriate for the Charlatan-in-Chief, Barack Obama, whose speech to a joint session of Congress was both a masterpiece of rhetoric and a shameless fraud.

To tell us, with a straight face, that he can insure millions more people without adding to the already skyrocketing deficit, is world-class chutzpa and an insult to anyone's intelligence. To do so after an analysis by the Congressional Budget Office has already showed this to be impossible reveals the depths of moral bankruptcy behind the glittering words.

Did we really need CBO experts to tell us that there is no free lunch? Some people probably did and the true believers in the Obama cult may still believe the President, instead of believing either common sense or budget experts.

Even those who can believe that Obama can conjure up the money through eliminating "waste, fraud and abuse" should ask themselves where he is going to conjure up the additional doctors, nurses, and hospitals needed to take care of millions more patients.

If he can't pull off that miracle, then government-run medical care in the United States can be expected to produce what government-run medical care in Canada, Britain, and other countries has produced-- delays of weeks or months to get many treatments, not to mention arbitrary rationing decisions by bureaucrats.

Obama can deny it in words but what matters are deeds-- and no one's words have been more repeatedly the direct opposite of his deeds-- whether talking about how his election campaign would be financed, how he would not rush legislation through Congress, or how his administration was not going to go after CIA agents for their past efforts to extract information from captured terrorists.

President Obama has also declared emphatically that he will not interfere in the internal affairs of other nations-- while telling the Israelis where they can and cannot build settlements and telling the Hondurans whom they should and should not choose to be their president.

One of the secrets of being a glib talker is not getting hung up over whether what you are saying is true, and instead giving your full attention to what is required by the audience and the circumstances of the moment, without letting facts get in your way and cramp your style. Obama has mastered that art.

Con men understand that their job is not to use facts to convince skeptics but to use words to help the gullible to believe what they want to believe. No message has been more welcomed by the gullible, in countries around the world, than the promise of something for nothing. That is the core of Barack Obama's medical care plan.

President Obama tells us that he will impose various mandates on insurance companies but will not interfere with our free choice between being insured by these companies or by the government. But if he can drive up the cost of private insurance with mandates and subsidize government insurance with the taxpayers' money, how long do you think it will be before we have the "single payer" system has he has advocated in the past?

Mandates by politicians are what have driven up the cost of insurance already. Politicians love to play Santa Claus and leave it to others to raise prices to cover the inevitable costs.

Politicians have driven privately owned municipal transit systems out of business in many cities, by simply imposing costs and restricting the fare increases needed to cover those costs. The federal government can drive out private insurance the same way that local politicians have driven out private municipal transit and replaced it with government-run transit systems.

Barack Obama's insistence that various dangerous policies are not in the legislation he proposes sounds good but means nothing. Unbridled power is a blank check, no matter what its rationale may be. No law gave the President of the United States the power to fire the head of General Motors, but TARP money did.

When there are "advisory" panels on what treatments to approve and the White House's existing medical advisor has complained of Americans' "over-utilization" of medical care, what does it take to connect the dots?

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International Health Care Comparisons: The WHO Numbers

In the course of the healthcare debate, supporters of change along the lines proposed by the administration have called attention to a World Health Organization study ranking the health care systems of 192 nations. A common claim is that the U.S., despite spending more per capita than any other country, still ranks only 37, behind most developed countries.

That version of the claim is at best misleading. There is a measure, "Overall Health System Performance," on which the U.S. ranks 37. But it is a measure that takes expenditure into account, downrating the U.S. precisely because it spends so much. The rank is 37 not in spite of the level of expenditure but because of it.

There is another measure, "Overall Goal Attainment," which does not take account of expenditure; on that the U.S. ranks 15, still behind a fair number of other countries but not nearly as many. So a more accurate claim would be that the U.S. ranks 15 despite its large expenditures.

Even that is misleading, however, because if one actually read the notes explaining how the numbers are calculated it turns out that "Goal Attainment" is based on five different characteristics of a health care system, only one of which is an (imperfect) measure of how much health care the system provides.

That one, "Health level," is average life expectancy, adjusted to make a disabled year count for less than a healthy year. It is an imperfect measure because life expectancy depends not only on health care but on lifestyle variables such as smoking or obesity and on factors such as the death rate from murders and traffic accidents. And even to the extent that it depends on health, health is not entirely a matter of health care; some environments are more unhealthy than others.

A second variable, responsiveness, measures how good people in each country think their health care system is, as determined by questionaires. On that one, interestingly enough, the U.S. comes in first —a fact that ought to worry the President. If Americans think the current system works better than any existing alternative, as they apparently do, they may not look favorably on changes to it.

The other variables all have to do with distribution. "Health distribution" purports to measure how unequal the distribution of health care in each country is. The authors wanted to use distribution of life expectancy but didn't have the data to do it. Instead they used a measure, never clearly explained, of the distribution of infant survival, apparently of how many infants die at what point in their first five years. Even for that, the relevant data existed for only a minority of countries; for the rest the report substituted an estimate based on variables such as poverty level.

"Responsiveness distribution" was calculated from questionaires and apparently designed to measure the degree to which respondents believed that various groups in their country were disadvantaged with regard to health care.

Finally, we have "fairness in financial contribution," defined as how nearly health costs are distributed in proportion to income minus the cost of food. That measure is obviously biased in favor of state run health care plans, since in order for both health care and its cost to be distributed in the way the authors of the report want there has to be a sizable redistribution of cost from poorer families getting health care to richer families paying for it.

My conclusion is that the numbers produced by the report are very nearly useless for purposes other than propaganda, since they do not provide much information on how good the health care systems of different countries are at delivering health care.

In fairness, I should add that I don't have any proposal for doing a much better job of comparing international health care systems, given the data limitations when trying to look at 192 different countries. Ideally, one would want a value added measure, something like the difference between actual life expectancy in a country and what life expectancy would be if there were no health care system at all. But I don't see any practical way of generating such numbers. One could simply use life expectancy, but that has the problems I have already described. One can try to look at particular outcomes heavily dependent on health care; the U.S. apparently does very well measured by cancer survival rates. But neither approach really tells you what you want to know.

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15 September, 2009

British families 'kept in the dark' as government doctors make life-or-death decisions

One in four families are not informed when doctors decide that a patient in hospital is dying under a widely used NHS scheme for palliative care, a national audit has found. Less than half of terminally ill patients and their relatives are offered religious or spiritual support in their final days and hours, while a quarter of doctors are not being trained within hospitals to deal with dying patients.

The audit, seen by The Times, comes after the NHS was accused of having a “tick-box culture” of care that defines patients as dying without questioning whether they might recover. The criticism relates to the Liverpool Care Pathway (LCP), which is endorsed by the Government and many healthcare professionals as the best way to improve treatment for dying patients with cancer or other illnesses. About 20,000 people are estimated to die each year while being cared for under the guidelines.

Under the scheme, doctors and nurses collectively agree that there is no possibility of recovery. They then remove beneficial medicines and invasive medication, such as intravenous drips. They may also sedate the patients and withhold food and drink.

However, a group of leading doctors has warned that the LCP may lead clinicians to focus too much “on the outcome of death”, when some patients might recover. Peter Millard, Emeritus Professor of Geriatrics at St George’s Hospital Medical School, University of London, among a group of doctors who have publicly criticised the LCP, said: “The risk as this is rolled out across the country is that elderly people with chronic conditions like Parkinson’s or respiratory disorders may be dismissed as ‘dying’ when they could still live for some time. If patients tell their doctors that they wish to die at home, that shouldn’t be taken as an excuse not to treat them in hospital if their condition deteriorates but they still might recover with proper care.”

The National Care of the Dying Audit found that in hospitals where the pathway was used, nearly nine out of ten patients were made comfortable in the 24 hours before death, and checked at least every four hours to make sure that they were not having medication or fluids that could do more harm than good.

But the guidance is to be updated this year to remind healthcare staff to improve communication with patients and relatives and to reassess regularly the complex decisions made at the end of life so that people can achieve a dignified and painless death.

The audit, by the Marie Curie Palliative Care Institute in Liverpool and the Royal College of Physicians, obtained details from 155 hospitals in England of the deaths of almost 4,000 patients treated on the pathway last year. Of these, 39 per cent had cancer and 61 per cent had other conditions, including pneumonia, stroke, organ failure or dementia. The average age of patients was 81, and they were cared for on the LCP for an average of 33 hours before death. The audit found that 88 per cent were prescribed drugs in anticipation of the symptoms or pain that they may develop as they neared death.

A total of 83 per cent of patients either did not need intravenous medication or fluids or had them withdrawn because they were judged to be doing more harm than good, while 37 per cent were given sedatives. Mostly these were given in low doses, but the trusts prescribing relatively high doses regularly “need to review their practice”, the audit adds. At least 40 per cent of patients were reported as being aware that they were dying, but details were not available for another 39 per cent.

Although relatives or carers were informed of the plan of care in 72 per cent of cases, and told “that the patient had entered the dying phase” in 76 per cent of cases, “there is still room for improvement”. Professor John Ellershaw, director of the Marie Curie institute, said that the pathway was used when a clinical team led by a senior doctor felt they could no longer cure a patient, but could make them more comfortable. However, the guidelines were never intended as a “one-way street” towards death and did not recommend continuous deep sedation or the withdrawal of fluids or medication. Patients should be reassessed every four hours.

Before the LCP, palliative care specialists were often called when a patient was dying, only to find relatives “confused, angry and distressed”, he added. “That three quarters of relatives and carers are now told what’s going on is encouraging, but we don’t know what’s happening in the remaining cases.” He added that patients and their carers should be offered spiritual or psychological support, for example from a priest or counsellor, if they wanted it. The audit found that a patient’s spiritual needs were reported as being assessed in only 30 per cent of cases.

End-of-life care was the cause of more than half of NHS complaints about acute hospital care between 2004 and 2006. The Marie Curie Cancer Care charity welcomed the findings but called for patients and carers to be better informed and consulted on decisions made by doctors and nurses, and said that extra funding promised by the Government for palliative care needed to be properly ring-fenced.

Jonathan Potter, director of clinical standards at the Royal College of Physicians, who was also involved in the audit, said: “Much improvement is required within busy hospital schedules for communication with and support for relatives. If we can get this right, it would make a huge difference to patients and their families.”

Joyce Robins, of the campaign group Patient Concern, said she was reassured by a new version of the pathway. “We were very concerned that the LCP had been oversimplistic, a tick-box list of symptoms to say people were dying,” she said. “But the new version is transformed and is so much better. If it is rolled out and applied properly across the NHS, there would be nowhere to hide for healthcare staff who didn’t follow it.”

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NHS to end premium-rate telephone call charges for patients

Exploiting the sick when their job is to cure them

Charges under which patients pay more than the cost of a local call from a landline are being scrapped in England after a consultation. As The Times first reported in 2007, many NHS organisations use numbers starting with an 0844 or 0845 prefix, which can be up to 30p a minute more expensive to call than a standard local number. Patients will still dial 084 numbers to get through but tariffs will be adjusted to ensure that they pay only for the cost of a local call, ministers said.

Mike O’Brien, the Health Minister, said: “We have been concerned that some people are paying more than the cost of a local-call rate to contact the NHS. For people on low incomes, and for those who need to contact their doctor or hospital regularly, these costs can soon build up. “We want to reassure the public that when they contact their GP or hospital, the cost of their call will be no more expensive than if they had dialled a normal landline number.”

A letter will be sent to NHS organisations informing them of the changes this week, while amendments will be made to GP contracts over the coming months.

Richard Vautrey, deputy chairman of the British Medical Association’s GPs committee, said: “Patients who call their surgery because they’re ill shouldn’t be penalised because they have to call an 084 number, so we’re pleased that the phone companies who supply these lines to practices have agreed to ensure that their tariffs are in line with local charges. “Combining the benefits of 084 numbers with an assurance that they won’t cost more than a local phone call is the best solution for patients and practices.”

Katherine Murphy, director of the Patients’ Association, said: “It’s great that the Department of Health has listened to patients. Asking them to pay extra costs for phone calls was unreasonable. “Patients have had to wait long enough for the ruling-let’s hope the change happens as quickly as possible.”

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20,000 British children put at risk by bureaucratic dithering over E. coli farm

Thousands of children are at risk from E. coli because the farm pinpointed as the source of an outbreak was allowed to remain open for two weeks after it first fell under suspicion. Godstone Farm, in Surrey, where children can pet and feed the animals, was finally closed at the weekend. Environmental health officials first visited it on August 28 and then again on September 3.

Twelve children under the age of 10 remained in hospital last night; three were said to be very seriously ill. A total of 36 cases have been confirmed by the Health Protection Agency (HPA) in what it said was Britain’s biggest E. coli outbreak spread by farm animals.

Up to 2,000 people, half of whom were children, visited the farm each day during the school holidays and similar numbers have visited over recent weekends.

The HPA, which said that the first known confirmed case dated from August 8, warned parents, nurseries and schools to be extra vigilant. Professor Hugh Pennington, one of Britain’s leading microbiologists, said: “The consequences of this bug can be catastrophic in young children and it can be lethal.” It was unclear when the number of cases would peak, he said, adding that there was a 12-day incubation period for this O157 strain. The professor said that the cause of the outbreak remained a puzzle. The bacteria were carried in animal faeces and could be picked up by hands, clothing and shoes. Most E. coli cases in Britain are caused by drinking contaminated water or eating infected meat.

Richard Oatway, the farm manager, defended the response yesterday. “We were told in August [that there might have been an outbreak] and we have taken the decision to close the farm [on Saturday] until the authorities have finished their investigations,” he said.

New information released by the HPA last night revealed that one person became infected with the bug after contact between visitors and the farm’s animals had been banned.

Godstone Farm’s sister premises in Epsom, Surrey, remain open. A spokesman for Horton Park Children’s Farm said that the only link between the farms was “purely financial” and there was no contact between animals.

Graham Bickler, the regional director of the HPA, said: “It is very likely that the source was animals at the farm. We know this organism is in their faeces but we need to find out how it got into the kids.” The agency defended its decision not to ask for the farm to be closed immediately, saying the scale of the problem was not immediately apparent.

Neil Wilson, an uncle of one of the sick children, said last night: “It’s been a living hell. It seems quite surreal going in and each day seeing him getting worse and worse.”

One mother who visited Godstone Farm two weeks ago said yesterday she was concerned that her 23-month-old daughter may have contracted the bug. Evelina Niedzwiedzka, 28, from Croydon, South London, said: “If the farm did know about it two weeks ago, I’m very surprised there were no warnings, especially because children are so vulnerable.”

Neil Wilson, an uncle of one of the sick children, told Sky News: “It’s been a living hell, it seems quite surreal going in and seeing him and each day seeing him getting worse and worse, feeding tubes and blood going in. It’s just awful, it’s been an absolute nightmare.”

A spokeswoman for the HPA said last night: “We have had no new cases reported today. Twelve children remain in hospital. Of those, three remain seriously ill. Six remain stable, and three children who were being looked after in paediatric units in London have recovered sufficiently to be moved to hospitals nearer their homes.”

SOURCE




Australia: Woman sent home from NSW public hospital to miscarry on her own

"Alone, in shocking pain and bleeding copiously, Rose Taylor gave birth to what might have become her third child in the bathroom of her St Helen's Park home, while her husband, son and daughter slept. Despite twice visiting the emergency department of Campbelltown Hospital with obvious symptoms of a miscarriage, Mrs Taylor, 26, was not given the option of admission, but sent home on both occasions - delivering a 14-week foetus without professional support and with only paracetamol to counter excruciating labour cramps.

''It had ears, eyes, fingers,'' she said of the traumatic loss two weeks ago. ''It was a fully formed child. That's an image you don't lose. You can't just flush it away.''

Two years after Jana Horska's miscarriage in a public toilet at Royal North Shore Hospital sparked an inquiry, NSW Health has not published promised treatment protocols for women who lose an early pregnancy, so Mrs Taylor's experience cannot be measured against a standard.

Instead, a spokesman yesterday referred the Herald to guidelines issued by the Australian College of Midwives, saying they were used by area health services ''to develop local policies for the management of patients with complications in early pregnancy''. But Hannah Dahlen, a college spokeswoman, said the advice concerned basic nursing care and did not define appropriate treatment for the one in seven pregnancies that miscarry.

In October 2007 the then health minister, Reba Meagher, pledged to respond within a month to an independent report into the Horska case that recommended urgent development of care protocols for miscarrying women. The Government funded extra early pregnancy nursing positions in emergency departments, but did not commit to specific care standards.

Late yesterday the Health Department confirmed it had circulated a draft early pregnancy care policy, understood to detail circumstances in which, for example, women with pain or bleeding in early pregnancy should have an ultrasound or pathology test. A spokesman said clinicians were already using the draft recommendations - which are not available to patients - and the document would be made public this year.

Yesterday a spokesman for Sydney South West Area Health Service, which administers Campbelltown Hospital, offered sympathy to the Taylors, but said: ''Women experiencing miscarriage are not routinely admitted to hospital unless medically necessary''.

Andrew Zuschmann, from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said women in Mrs Taylor's situation should always be offered admission. ''They need access to clinical support and psychological support, and they should be in an environment where they can get that.''

SOURCE




Technocracy in America

Obama neglects the real 'public option': listening to the public

The partisan and misleading speech that President Obama delivered to a joint session of Congress last week revealed the president's preferences--more government mandates, regulations, and taxes--when it comes to refashioning the American health care system. It also showcased the contempt for debate and smug sense of moral and intellectual superiority that is now as much a part of contemporary liberalism as sympathy with the nuclear freeze movement and the RainbowPUSH coalition was two decades ago.

The way the president expresses his disdain is telling. He assumes that, given the facts, any rational person would reach policy conclusions identical to his. "I have no doubt," he said, "that these reforms would greatly benefit Americans from all walks of life, as well as the economy as a whole." If only everybody had read Atul Gawande's June New Yorker article on McAllen, Texas, the president believes, then there would have been none of those rowdy town halls.

So why has the White House already missed its self-imposed deadline for reform? Why do more Americans disapprove than approve of the president's approach to health care? Why did Obama's approval rating drop steadily--among independents, precipitously--throughout the summer? The answer, he said, is "all the misinformation that's been spread over the past few months." There is no legitimate basis for opposition. There are only lies.

"Americans have grown nervous about reform," the president continued. "Prominent politicians" whose "only agenda is to kill reform at any cost" have spread "bogus claims" about his health care plan, scaring a gullible public into disapproval. For example, there is the "misunderstanding" that "federal dollars will be used to fund abortions." Some also "claim that our reform efforts would insure illegal immigrants," which is "false." And the idea that "we plan to set up panels of bureaucrats with the power to kill off senior citizens" is a "lie."

The president said that he "will continue to seek common ground in the weeks ahead," and if "you come to me with a serious set of proposals, I will be there to listen." Tell that to the Republicans who have been shut out from the legislative process on four of the five congressional committees working on health care.

"I will not waste time with those who have made the calculation that it's better politics to kill this plan than to improve it," Obama said, conveniently dismissing the widely held view that the best improvement to the Democrats' grandiose plans is to scuttle them and start over with a set of targeted insurance reforms--which could pass both houses of Congress with bipartisan majorities. No, Obama "won't stand by while the special interests use the same old tactics to keep things exactly the way they are," as if he did not already have the backing of all the special interests--the Pharmaceutical Research and Manufacturers of America, the American Association of Retired People, the American Hospital Association, Big Labor, etc. He "will not accept the status quo as a solution," as if that is what supporters of consumer-driven health care are advocating. "If you misrepresent what's in this plan," Obama said, "we will call you out."

Yet one could just as easily call out Obama for distorting the claims made against his proposals. In a world where money is fungible, Obamacare's taxpayer subsidies could indeed be used to purchase insurance plans that cover abortions. Furthermore, the president has not adequately explained how "the reforms I'm proposing would not apply to those who are here illegally" when (1) Democrats in the House Ways and Means and Energy and Commerce committees defeated amendments that would have withheld benefits from illegal aliens, (2) the president has not put forward an effective verification system of his own, and (3) who would ever tell José and Maria No mas when they show up at the emergency room in need of care?

The president was correct when he said that his proposals do not include "panels of bureaucrats with the power to kill off senior citizens." But that is not quite what the "prominent politician" was saying when she wrote,

Democratic health care proposals would lead to rationed care; that the sick, the elderly, and the disabled would suffer the most under such rationing; and that under such a system these "unproductive" members of society could face the prospect of government bureaucrats determining whether they deserve health care.

Indeed, in his speech last week Obama said himself that his plan will "eliminate" the "hundreds of billions of dollars in waste and fraud" in Medicare and "create an independent commission of doctors and medical experts"--a panel, if you will--"charged with identifying more waste in the years ahead." It is no stretch of the imagination to think that one man's "waste" might one day turn out to be a senior citizen's preferred medical treatment.

Like it or not, Sarah Palin is making an argument about the possible tradeoffs and unintended consequences of Obamacare. Hers is an extrapolation based on an analysis of the facts. It is not a "lie," unless "lie" suddenly means "an argument with which I disagree."

By contrast, it was wishful thinking at best when the president claimed that "reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan." Politicians have been trying to clean up after the entitlement programs in such a manner since Jimmy Carter first used the phrase, but costs keep rising. This did not stop the president from ducking behind a political cliché rather than level with the public about the real price tag of universal health insurance. Obama would rather keep company with straw men than grapple with substantive criticisms.

To acknowledge that his critics act in good faith would shake the president's oversized self-confidence. He alone is in possession of the truth, the only honest broker in a den of conservative thieves, the heir to the noblest traditions of American history. In the final passage of his speech, Obama invoked the late Ted Kennedy, whose name for many people carries associations in addition to "large-heartedness" and a "concern and regard for the plight of others." Kennedy's "passion" for unreconstructed liberalism was "born not of some rigid ideology," Obama said. Rather, Kennedy knew that "sometimes government has to step in."

Now is one of those times, apparently. "This has always been the history of our progress," Obama said, raising the question of whether he believes progress is ever possible without government. The champions of progress, Obama concluded, are always "subject to scorn" and "attacked as un-American." When progress battles with reaction, he went on, "facts and reason are thrown overboard and only timidity passes for wisdom." It gets to the point where "we can no longer even engage in a civil conversation with each other." Guess who's to blame.

In recent months the characterization of Obama's opponents as a bunch of lying name-callers who do not care about facts, do not possess reason, advocate timidity and the status quo, and cannot "engage in a civil conversation" has become all too familiar. It is the natural outcome of an unstoppable force--the angry and arrogant left-wing of the Democratic party--running up against an immovable object--the instinctual conservatism of an American populace that is skeptical of complicated and expensive government interventions.

The upshot has been liberals who cavalierly demean and degrade the sentiments of the people. Liberals contemptuous of democracy and ready to embrace from-the-top, one-size-fits-all, technocratic solutions. For such liberals, the failure to obtain their policy preferences calls into question the very legitimacy of the American polity. In August, the Washington Post business columnist Steven Pearlstein--who normally tries "not to question the motives of people with whom I don't agree"--found himself, like Howard Beale, mad as hell and not gonna take it anymore: "Republican leaders and their ideological fellow-travelers," he wrote, have "become political terrorists." Last week in the New York Times, Thomas Friedman wrote that America's "one party democracy is worse" than China's "one party autocracy," because in China "one party can just impose the politically difficult but critically important policies needed to move a society forward in the 21st century." In this week's Time magazine, Joe Klein worries that "the Limbaugh- and Glenn Beck-inspired poison will spread from right-wing nutters to moderates and independents who are a necessary component of Obama's governing coalition"; after all, if the moderates and independents knew what's good for them, they'd support Obamacare.

Isn't it possible, though, that the moderates, independents, and "right-wing nutters" who traveled to congressional town halls and voiced their opposition to the president's big-government initiatives do know what's good for them--or, at least, know that Obamacare may turn out to be bad for them? That it might be too costly and too onerous for an American economy with high unemployment and staggering fiscal imbalances? That today's reform, like others in the "history of our progress," may lead to unforeseen distortions and crises down the road? Fixated on its attempt to manipulate the economy in ways that produce its desired social outcomes, the White House has neglected the only real "public option": listening to the public. Determined to pass health care reform even over the objections of popular opinion, the Democrats are practicing a hubristic and antidemocratic politics.

And they will come to regret it.

SOURCE




The Truth About the Health Care Bills

By Michael Connelly, Retired attorney, Constitutional Law Instructor, Carrollton, Texas

Well, I have done it! I have read the entire text of proposed House Bill 3200: The Affordable Health Care Choices Act of 2009. I studied it with particular emphasis from my area of expertise, constitutional law. I was frankly concerned that parts of the proposed law that were being discussed might be unconstitutional. What I found was far worse than what I had heard or expected.

To begin with, much of what has been said about the law and its implications is in fact true, despite what the Democrats and the media are saying. The law does provide for rationing of health care, particularly where senior citizens and other classes of citizens are involved, free health care for illegal immigrants, free abortion services, and probably forced participation in abortions by members of the medical profession.

The Bill will also eventually force private insurance companies out of business and put everyone into a government run system. All decisions about personal health care will ultimately be made by federal bureaucrats and most of them will not be health care professionals. Hospital admissions, payments to physicians, and allocations of necessary medical devices will be strictly controlled.

However, as scary as all of that it, it just scratches the surface. In fact, I have concluded that this legislation really has no intention of providing affordable health care choices. Instead it is a convenient cover for the most massive transfer of power to the Executive Branch of government that has ever occurred, or even been contemplated. If this law or a similar one is adopted, major portions of the Constitution of the United States will effectively have been destroyed.

The first thing to go will be the masterfully crafted balance of power between the Executive, Legislative, and Judicial branches of the U.S. Government. The Congress will be transferring to the Obama Administration authority in a number of different areas over the lives of the American people and the businesses they own. The irony is that the Congress doesn’t have any authority to legislate in most of those areas to begin with. I defy anyone to read the text of the U.S. Constitution and find any authority granted to the members of Congress to regulate health care.

This legislation also provides for access by the appointees of the Obama administration of all of your personal healthcare information, your personal financial information, and the information of your employer, physician, and hospital. All of this is a direct violation of the specific provisions of the 4th Amendment to the Constitution protecting against unreasonable searches and seizures. You can also forget about the right to privacy. That will have been legislated into oblivion regardless of what the 3rd and 4th Amendments may provide.

If you decide not to have healthcare insurance or if you have private insurance that is not deemed “acceptable” to the “Health Choices Administrator” appointed by Obama there will be a tax imposed on you. It is called a “tax” instead of a fine because of the intent to avoid application of the due process clause of the 5th Amendment. However, that doesn’t work because since there is nothing in the law that allows you to contest or appeal the imposition of the tax, it is definitely depriving someone of property without the “due process of law.

So, there are three of those pesky amendments that the far left hate so much out the original ten in the Bill of Rights that are effectively nullified by this law. It doesn’t stop there though. The 9th Amendment that provides: “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people;” The 10th Amendment states: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are preserved to the States respectively, or to the people.” Under the provisions of this piece of Congressional handiwork neither the people nor the states are going to have any rights or powers at all in many areas that once were theirs to control.

I could write many more pages about this legislation, but I think you get the idea. This is not about health care; it is about seizing power and limiting rights. Article 6 of the Constitution requires the members of both houses of Congress to “be bound by oath or affirmation” to support the Constitution. If I was a member of Congress I would not be able to vote for this legislation or anything like it without feeling I was violating that sacred oath or affirmation. If I voted for it anyway I would hope the American people would hold me accountable.

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14 September, 2009

Yet another futile directive from the British health bureaucracy

Hospitals to be told to make patients happy. How is that going to happen given the abysmal and chaotic standard of care that is routinely provided? They are trying to run before they can walk

HOSPITALS that fail to keep their patients happy will lose money under new plans to improve the NHS. Having acknowledged that the health service is “good but not great”, Andy Burnham, the health secretary, wants hospital budgets to be linked with patient satisfaction.

The next phase of NHS reform will focus on improving patients’ “experience”, shifting the focus from basic medical care to the “extras” that help determine how happy patients are with their treatment. Ministers want hospitals to devote far more attention to issues such as the bedside manner of doctors and nurses; the warmth of welcome from receptionists; the quality of food and the cleanliness and attractiveness of wards. It will be the first time hospital budgets are affected by the “softer” aspects of patient care — as Burnham describes them.

The policy could be introduced as early as next financial year, (shortly before the likely election date) when hospital tariffs are reviewed, and is designed to end what Burnham describes as the “like it or lump it” culture in the NHS. “Sometimes hospitals are missing the point. How you are spoken to, how you are dealt with, whether you are treated in a friendly way — these things can be as important as your medical care,” said Burnham.

This new emphasis on providing “quality” care is similar to that in America, where private healthcare companies such as Premier Inc offer rewards to medical centres rated highly by their patients. It comes as Labour faces intense pressure from the Conservatives over the state of the NHS. David Cameron has sought to present the Tories as “the party of the NHS”, although many in his shadow cabinet, and backbenchers, have private healthcare.

Burnham’s assessment of the health service as “good, but not universally good” and “not yet great” marks a change of tone for the government, which previously emphasised its huge investment in the NHS, rather than acknowledging its ongoing shortcomings. Burnham’s qualified praise for the health service reflects an acknowledgment by Labour strategists that ministers need to do more than simply highlight achievements, and must set out their vision for the next stage of reform.

Burnham said that the NHS had been transformed from “poor or failing” over the past decade, but still needed to change. “Now that waiting times have come down, the NHS can start worrying about quality. We want to change the ‘get what you are given’ culture the service has bred. The NHS needs a system that pays hospitals more money when patients are pleased by their experience.”

While hospitals are already paid on results, the tariff is based on treatment and the success of operations, not on whether patients are satisfied with the way in which they were cared for. Linking payment to patient satisfaction would be a major shift in the way hospital budgets operate.

In an interview with The Sunday Times, Burnham said it was about “measuring what was truly important ... all of the softer things that contribute to the patient experience, not just hard and fast data.”

Officials have yet to determine how much hospitals would stand to gain or lose according to patient satisfaction, but Whitehall sources said “significant” sums would be involved, the new policy being at the heart of Labour’s vision for service improvement. Under a pilot scheme launching next spring in NHS Northwest, hospitals will be able to earn a premium of up to 4% of their budgets if patients are happy.

Following record investment in the health service, waiting times for operations and appointments with specialists have fallen dramatically, with waits of six months or more virtually eradicated. The catalogue of targets set by Whitehall to achieve the changes drew heavy criticism from clinicians, who claimed the pressure to “tick boxes” distorted clinical priorities. The government argues that the targets were vital and effective when the NHS was failing.

Burnham said that the target regime had now “served its purpose” and a different approach was needed to make patients happier with the way they are treated. He acknowledged that the NHS was still not as efficient as it could be, saying: “Clearly there’s a challenge there.”

SOURCE




What 'right' to health care?

by Jeff Jacoby

DURING SENATOR EDWARD KENNEDY'S FUNERAL in Boston's Mission Church last month, his 12-year-old grandson offered an intercessory prayer: "For what my grandpa called the cause of his life," Max Allen said, "that every American will have decent quality health care as a fundamental right and not a privilege, we pray to the Lord."

Opinions differed on whether a funeral was the right place to importune the Almighty for universal health care. But that He is the source of fundamental rights is in fact a core American belief. The Declaration of Independence pronounces it a self-evident truth that human beings "are endowed by their Creator with certain unalienable Rights" – rights that include life, liberty, and the pursuit of happiness. Health care isn't on that list. Should it be?

A great deal depends on the answer, for the Declaration's very next sentence affirms that the purpose of government is to "secure" those rights against infringement. If access to health care is deemed a fundamental right, then the government must be obliged to guarantee that access to every citizen. Medical treatment would have to be available on an equal basis to anyone seeking it, regardless of age or physical condition or ability to pay. Washington could no more entrust the provision of health care to private markets than it does freedom of religion: Your religious liberty, after all, is not a commodity you must purchase – it is yours by right, no matter where you live or how much you are worth. Should the same be true of health care?

Ted Kennedy was hardly alone in saying so. When Barack Obama was asked during one of the 2008 presidential debates whether health care is a right, a privilege, or a responsibility, he answered promptly: "I think it should be a right for every American." The 2008 Democratic National Platform avows in its opening paragraph that "affordable health care is a basic right." When the Harvard Community Health Plan commissioned a survey on the subject some years back, 90 percent of respondents said that everyone had the right to "the best possible health care -- as good as a millionaire."

It is not hard to understand the urgent passion with which so many people approach the issue of health care. And it would take a remarkably cold heart to be indifferent to the desperation of those who need medical help but cannot afford it. But rights do not spring from passion or need. Wanting something does not entitle you to it -- not if someone else must provide or produce that something. The rights delineated in the Declaration of Independence and the Constitution are negative rights only -- they protect our autonomy, allowing us to peacefully live life and pursue happiness, neither coercing others nor being coerced by them.

My right to free speech or to own property does not give me a claim on anyone else's time or labor or resources. But if I have a "right" to health care, someone else must be compelled to provide or pay for that care. Compulsion comes in different forms -- higher taxes, lower fees, insurance mandates, health-care rationing, intrusive regulations -- but the bottom line is the same: a universal right to health care would leave society less free.

It may sound noble to declare that health care is a fundamental human right and not a mere commodity to be left to the vagaries of the market. Of course, the same thing could be said about food or clothing -- also essential to human welfare -- yet not even Ted Kennedy would have suggested that Washington nationalize US food production or overhaul the clothing industry. It is precisely because food and clothing are seen as commodities, because we do leave their availability to the market, that they can be had in such abundance and diversity.

To be sure, some people will always need help. No decent person or society ignores the cries of the sick or hungry or poor. Happily, there is no better system for achieving the widest possible access to health care -- or any other good or service -- than the one that requires the least degree of political interference: the normal interplay of supply, demand, and competition. Health care is too important to be left to the marketplace? No, it is too important not to be.

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AARP’s ObamaCare Ad Raises Serious Questions

Two weeks after an AARP health care town hall in Dallas went “South,” news outlets reported 60,000 membership cancellations. Hoping to stem their losses, spokespersons for the organization — which purports to represent the interests of American seniors — were quoted during the days that followed as saying the group does not back “everything” in President Barack Obama’s so-called health care reform package (a.k.a., “ObamaCare”). One would hardly know it by looking at the group’s online advertising.

In search of news related to today’s Tea Party activities in Washington, D.C., I stumbled across the ABC News web site and noticed the AARP banner advertisement above near the top of the page. The text of the banner ad: “Health Care Reform Will Be A Government Takeover”, was soon stamped with the word, “FALSE”.

When I clicked to open the ad, the image below appeared, revealing more about the AARP’s stance on ObamaCare: “Health care reform isn’t socialized medicine. You’ll still be able to choose your own doctor and insurance plan.”

Apparently not wanting to lose any more members, it appears AARP is following the same path as President Obama. In other words, the group is lying in open forums and, in places frequented primarily by liberals (i.e., the ABC News web site), they show their true colors. As a result, I’m forced to echo the words that appeared in a recent headline at Human Events: “Who Does the AARP Represent in Health Care Debate?”

SOURCE (See the original for graphics)




Democrats stifle Republican health care plans

Rep. Tom Price, the Georgia Republican who heads the House GOP Study Committee, came to President Obama's speech Wednesday night itching to make a point. Price, who also happens to be an orthopedic surgeon, has often heard the president accuse Republicans of criticizing Democratic health care proposals while having no plans of their own. He expected Obama to do the same Wednesday night.

"We knew the president would at some point say something like, 'and the other side has no ideas,' " Price says. So Price and his Republican colleagues brought with them copies of the more than 30 health care reform bills they have proposed in the House this year.

Obama didn't directly accuse Republicans of not having a plan. But he did say he would welcome "serious" health care proposals. "My door is always open," Obama said. That's when Price held up the sheaf of papers he was carrying -- a copy of H.R. 3400, the Empowering Patients First Act, which Price and the Republican Study Committee proposed in July. Other GOP lawmakers held up their own bills. Some raised a list of all the health care bills -- there are more than 30 -- proposed by members of the Study Committee.

Why use the props? "To say in a quiet and respectful way, 'Here are our ideas,' " Price says. "To say to the president, 'You're not being honest with the American people when you say that there haven't been ideas put forward, and that you've listened to them, because you haven't.' "

The small Republican protest got a bit of coverage, although it was overshadowed by the hubbub over GOP Rep. Joe Wilson's "You lie!" outburst during the president's speech. But the larger problem remains. Republicans have authored a number of health care bills -- serious legislation addressing portability, pre-existing conditions, cost and other issues that most trouble American consumers -- and hardly anyone has noticed.

Republicans don't really blame Nancy Pelosi. The speaker is as partisan a Democrat as they come, and no one is surprised that she has used her power to stifle Republican efforts. But they do blame the Obama administration. "The White House, in spite of saying they look forward to meeting with anybody who wants to solve these challenges, has rebuffed us at every turn," Price says.

They also blame the media. Somewhere in this extended health care debate, Republicans believe, reporters might have noticed that there are real, substantive GOP proposals out there. So far, though, it hasn't happened. A search of the LexisNexis database of newspapers, magazines, television programs and major blogs finds about 3,000 mentions of the major House Democratic bill, H.R. 3200, in the past six months. (Those are just the stories that refer to the bill by its House number; there have been thousands more stories referring generally to the Democratic legislation.) A similar search found 60 mentions of H.R. 3400, the Price bill.

Another Republican bill, H.R. 2520, the Patients' Choice Act, by Wisconsin Rep. Paul Ryan, received 12 mentions in the same time period. And two other bills, H.R. 3217 and H.R. 3218, the Health Care Choice Act and the Improving Health Care for All Americans Act, by Rep. John Shadegg, together received 20 mentions.

The virtual embargo on reporting Republican legislation has allowed Democrats and their allies in the media to keep up the "Republicans have no plan" attack. Just hours after the president's speech, for example, the Democratic National Committee released a new commercial claiming that Republicans "refuse to offer a plan" to reform the health care system. "It's frustrating," Price says. But Republicans believe that in the end, the public won't buy the administration's line. "The American people are smarter than that," Price says. "They know there are alternatives out there. That's what August was all about."

SOURCE




Health care faces some big legislative bottlenecks

The fierce national debate over health care is entering a new phase, with advocates on all sides focused on a few legislative bottlenecks that will determine the ultimate overhaul of the $2.5 trillion medical care system.

President Barack Obama's prime-time address to Congress on Wednesday reassured some nervous Democratic lawmakers, and he aligned himself more closely with certain proposals. While Obama's words seemed to halt and possibly reverse the momentum that conservative groups had gained in August, they did not resolve all the concerns of centrist Democrats who will play pivotal roles, especially in the Senate.

Obama's speech "was a game-changer when it came to the message," said Sen. Ben Nelson, D-Neb., one of the moderates. "But it's not an automatic change on the legislative side."

Some version of a health care overhaul must squeeze through five key gates this fall if a final package is to become law by year's end. Advocates would be shocked if the Democratic-controlled Congress failed to pass some version. At a minimum, they say, it would bar insurers from dropping customers who become sick and require them to cover people already with medical conditions. But Obama and most congressional Democrats want more:

_granting subsidies to help low-income people buy health insurance;

_requiring nearly all U.S. citizens to have insurance and requiring large employers to contribute;

_creating greater competition for private insurers, possibly through a government-run option;

_imposing more efficiency in Medicare and other programs, where experts say too much money and effort are wasted.

Obama is pressing the case with a rally Saturday in Minneapolis, an appearance Sunday on CBS' "60 Minutes" and trips in the week ahead to New York, Ohio, Pennsylvania and Maryland. But the health care issue is mainly in Congress' lap. Knotty issues include whether to establish a government-run insurance plan and how to control costs.

Perhaps the easiest early hurdle will be in the House. But even there, divisions between liberal and conservative Democrats worry leaders, and Republican opposition appears absolute. Three House committees have approved portions of a far-reaching health care bill, but it will be changed before it reaches the full House.

In essence, Obama encouraged House leaders to tweak their bill when he embraced several Senate proposals absent from the House version. He also set a 10-year spending target of $900 billion, which may prove hard to meet.

Conservative Democrats may try to remove the government-run insurance option, which is dear to liberals. Still, many lawmakers expect the public option to stay in the House bill.

Things are more complicated in the Senate, where procedural rules make it much harder for the majority party to impose its will. Obama's remarks revitalized efforts by Senate Finance Committee negotiators to shape a compromise bill that can attract at least one Republican's support.

The first Senate showdown is expected in about two weeks, when that committee debates and votes on the bill. Liberals may try to add a government-run insurance option, similar to the House's. More likely to survive are nonprofit insurance cooperatives, designed to compete with private industry and give consumers more choices.

The committee-approved bill will be merged with a second committee's version and sent to the full Senate, the third legislative choke point. Lawmakers expect emotional debate and numerous bids to amend the measure. To avoid a bill-killing filibuster by Republicans, supporters must assemble 60 votes in the 100-seat chamber. With Sen. Edward M. Kennedy's death, Democrats hold 59 seats. Their best hope for a GOP crossover is Sen. Olympia Snowe of Maine, one of the Finance Committee negotiators. But Snowe may be loath to be the only Republican supporter and the crucial 60th vote. "I'm not going to speculate" on the possibility, she said Friday. "That is very dangerous territory."

If Snowe balks, the ultimate Senate bill may need a lower price tag or other changes to attract a few other Republicans, such as Ohio's George Voinovich, who is retiring. Liberals would chafe at such concessions.

Senate Democrats could try a contentious tactic, called "budget reconciliation," to pass portions of the health care package with simple majorities that are not subject to filibusters. Some liberal groups urge this strategy. Senate insiders consider it unlikely.

With Congress on track to pass substantially different bills, a yet-to-be-appointed House-Senate conference committee will meld them into one. This small group, dominated by Democrats, will wield extraordinary power, including the right to add provisions that neither the House nor Senate passed. Some lawmakers think the panel could try to split the difference on the public insurance question. A possible compromise would be to replace the House's public option and the Senate's cooperatives with a "trigger" or "fallback" public plan, which would take effect only if private insurers fail to meet targets for providing affordable policies. Snowe backs such a plan, and some lawmakers think it must be included in the bill at some point to win her vote.

In the fifth hurdle for the legislation to clear, the conference committee would send its reconciled bill to the House and Senate for a final yes-or-no vote, with no amendments allowed. House liberals might be furious over various concessions, but Democrats think they would hold their noses and pass the bill.

In the Senate, opponents could try one last filibuster. If so, the bill's backers would need at least one GOP vote, as before. And they would need all, or virtually all, of the Senate Democrats to agree to let the bill reach the floor, even if some plan to vote against it on final passage, which requires only a simple majority. House and Senate Democrats might find plenty to complain about in the final bill produced by the conference committee, said Richard Kirsch of the liberal Health Care for America Now. But they will feel tremendous pressure to vote for a long-sought health care overhaul, flaws and all.

SOURCE





13 September, 2009

Doctors Against Obamacare – Rally in D.C.

Below is a report of an event that you won't have read about in your newspaper. It would have got blanket coverage if it had been pro-Obama. Excepts only below. Lots of pictures at the source

On September 10, 2009, doctors, nurses and other medical professionals came to Washington, D.C. from across the country to show their opposition to Obamacare. This rally exploded the government-created myth that there is unanimity amongst health care professionals for Democrat plans to take over health care. The Association of American Physicians and Surgeons came to D.C. to present a petition from doctors to lawmakers. The AAPS has been a voice for private physicians since 1943. Their motto is omnia pro aegroto, “all for the patient”. The doctors met with the representatives from their respective states and argued for a platform that avoids unnecessary bureaucratic intervention in health care.



Dr. Shannon Norris, a radiologist from Atlanta, holds a People’s Cube poster describing Obamacare as offering “the efficiency of the Postal Service, the sustainability of Social Security and all the compassion of the IRS”.

Dr. Steven Ellison, a cardiologist from Georgia, displays graphically how doctors feel about being targeted by a party and president that slander and demonize them. On the podium, speaker after speaker talked about the slurs President Obama has made about doctors performing unnecessary amputations and tonsillectomies out of greed. Not only is it untrue that doctors profit from these procedures, but the premise that they would do such harm to their patients is an insult to doctors.

Hal Scherz, a pediatric urologist from Atlanta, founded Docs for Patient Care to voice doctors’ opposition to the “big rush” for a big government solution to health care reform. The organization of doctors suggests practical proposals such as tort reform, insurance reform, and opening up insurance pools between states.

Their petition to Congress can be found at TakeBackMedicine.com:

Physicians can no longer allow medical care in this country to be controlled by government and insurance companies. Current reform options purport be “cure-alls” for every American. But we know that every patient is different, and just like patients, there is no single big-government solution to change health care in this country. Instead, we need more diversity in solutions. Therefore, I support changes that address the following issues:

Petition point: 1. INDEPENDENCE: Doctors are professionals. They answer to their patients, not the government or an insurance company or any other third party. Treatments should be decided by doctor and patient exclusively. “We are not the enemy,” said Dr. Joyce Lovitt, a pediatrician from Georgia.

Petition point: 2. VALUE OUR SERVICES: Physicians have a right to be paid a market-based fee for their services, and to be paid at the time of service or within a reasonable period. Dr. Lovitt: “Patients, we will cover your backs if you do not tie our hands behind our backs.”

Petition point 3. DOCTORS ARE NOT INSURANCE BILLING CLERKS: Physicians should not be forced to act as billing or collection agents for third-parties, whether private insurance or the government.

Petition point 4. REGULATIONS GET BETWEEN PHYSICIANS & PATIENTS: Excessive regulatory burden on physicians is interfering with patient care. We must decrease regulations, not pass more.

Petition point 5. LIABILITY COSTS MUST BE REDUCED: Costly defensive treatment and tests, and predatory litigation result in excessive liability costs for physicians and patients alike.

Petition point 6. AUTONOMY: Neither physicians nor patients should be forced to participate in government nor private health care plans or programs.

Petition point 7. RIGHT TO CONTRACT: Neither physicians nor patients should be prohibited from entering into mutually agreeable private contracts for services and payments.

Petition point 8. PRIVACY: Physicians must not be forced to disclose patient records without the express consent of patients.

Dr. Michael Schlitt, a neurosurgeon from Seattle. He spoke about a woman in England who had an aneurism and was told by the National Health Service that there was nothing they could do for her. They told her to enjoy her last few days. She came to the U.S. and was treated by Dr. Schlitt and is fine today. “Show me a place where patients can get MRI’s the same day.” and the crowd responded with a rousing “U.S.A.! U.S.A.!” ”Who’s got the best medical care in the world?” “U.S.A.! U.S.A.!”

More here




Senate's 'Gang of Six' near closure on health bill

Malpractice, illegals in focus

The Senate Finance Committee's "Gang of Six" is working to strengthen the citizenship requirements for obtaining health care coverage - a hot topic highlighted by Rep. Joe Wilsons "You lie!" outburst during President Obama's congressional address. The group also is looking at a new medical-malpractice provision, pursuing Mr. Obamas call for such a money-saving measure that is coveted by Republican lawmakers.

Committee Chairman Max Baucus, Montana Democrat, also said Friday that members of the bipartisan negotiating team could have a response to Mr. Obama's proposal on Monday. Mr. Baucus plans to release a formal health care overhaul proposal early next week, with or without Republican support. "We are starting to reach closure," he said, adding that Monday could be the Gang of Six's last meeting.

The group of three Republicans and three Democrats has been trying to find a bipartisan compromise for weeks, but hope that all six will sign on is dimming. Mr. Baucus said he planned to work through the weekend to settle the final points of contention, which include how to expand Medicaid and to what extent. To that end, the group will speak Monday with state governors, who would face the bills from new enrollees.

The medical malpractice provision likely will help encourage Republican support. The group is working on a variation of legislation introduced in 2007 by Mr. Baucus and Sen. Michael B. Enzi of Wyoming, one of the Republicans in the room. That bill would have issued grants to states to set up alternatives to the current tort litigation system, with the goal of bringing down costs by communicating errors early and setting "reasonable" limits to compensation.

The group also is reviewing provisions that would prevent illegal immigrants from obtaining government health care subsidies or from getting on a government plan, said Sen. Kent Conrad, North Dakota Democrat and member of the Gang of Six. The group's plan would require individuals to use their Social Security numbers to obtain a low- or middle-income tax subsidy or to sign on to a cooperative insurance plan, but it's working on how to extend coverage to legal residents without a Social Security number.

Mr. Conrad said illegal immigrants would be able to purchase private insurance, as they are now, but would not be able to get government assistance to help pay for it. "There's a high degree of confidence that we have an outline to prevent anybody here illegally from benefiting from these initiatives," Mr. Conrad said.

The chairman's framework, distributed last week, said people in the country illegally wouldn't get assistance, but the issue got new attention Wednesday when Mr. Wilson, South Carolina Republican, shouted "You lie!" when Mr. Obama said illegal immigrants wouldn't get aid. Critics say there will be no way to prevent illegal immigrants from accessing the government insurance programs, whether it's a public insurance plan or a cooperative insurance program.

The nonpartisan FactCheck.org said it is possible that 5.6 million of the estimated 9.7 million uninsured immigrants are in the country illegally, though they said there is no "hard data" to verify it.

The other members of the group include Democrat Sen. Jeff Bingaman of New Mexico and Republicans Sens. Charles E. Grassley of Iowa and Olympia J. Snowe of Maine.

SOURCE




The Biggest Liar of All

Barack Obama is lying. And there is no need to apologize for telling it like it is, as Congressman Joe Wilson (R-SC) did after he shouted “You lie!” as Obama spoke to the joint session of Congress on Wednesday. He’s a liar.

As you know, in the speech to Congress, Obama took one last bite at the apple to try and sell his government takeover of the health care sector. Therein, he attempted to dispel what he termed to be “bogus claims.” Let us review a few of his “clarifications.”

On Wednesday, Obama claimed illegal aliens would not be eligible for the government-run plan. But they are: the only eligibility requirement is income. As ALG News recently reported in “The Hidden Cost of ObamaCare,” under the House version of the so-called public “option,” individuals up to 400 percent of the poverty level, or making approximately $43,320 or less annually, will be eligible for some level of health coverage under the plan whether through the public “option,” Medicaid, or otherwise.

Or, 91.5 million people as of 2006 aged 25-65 who fell into that income bracket, according to the U.S. Census Bureau. Throw in the 35 million who were 65 and older at that time, and the total figure comes to over 125.8 million eligible for ObamaCare, compared with 80.5 million who now receive their health care from the government.

As a result, approximately 45 million more people—the exact figure the Census Bureau reports as being uninsured—will be receiving their health care from Uncle Sam. And it includes illegal immigrants! Why?

As House Republican Leader John Boehner has pointed out, there is no prohibition enforcement in the bill against non-citizens receiving coverage under the so-called public “option.” Wrote Boehner on his website, “Republicans offered two amendments in the Ways and Means, and Energy and Commerce Committees that were rejected by Democrats. The first would have prevented illegal immigrants from being automatically enrolled into Medicaid and the second would have required better screening for applicants for federally-subsidized health care to ensure they are actually citizens or legal immigrants.”

Without a citizenship verification requirement, a person would only need to prove they make less than $43,320, and they’re in. Those are the facts.

The lies do not stop there. Obama challenged opponents who believe government-run care would result in rationing. He said, “The best example is the claim made not just by radio and cable talk show hosts, but by prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens.”

To be fair, this is more than a slight misrepresentation on Obama’s part, but it is true that under the plan, there will be bureaucrats rationing treatment—and that in essence will result in seniors being denied care. And, yes, that very likely means they would die sooner than if they had received the life-saving treatment, surgery, or drugs now covered under Medicare. How do we know that?

A means of cutting “costs” that has been repeatedly touted by the Obama Administration, as reported by Politico, is “a White House proposal to empower an outside body, like the Medicare Payment Advisory Commission, to make binding recommendations for cost cuts in government-run health care programs.” That includes Medicare, which House Democrats have already said they plan on cutting by $500 billion over ten years.

On July 22nd, Obama elaborated on his plans to cut Medicare to pay for his overall plan by allowing an “independent group of doctors and medical experts” to determine how to cut the program tens of millions of seniors now depend on for medical care.

And he said it again in his speech, “[W]e will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead.” That’s it. That’s the rationing board—and Obama specifically defined what their role would be, when he defined what he viewed as “waste” in the system.

Obama was answering the question of a woman whose mother had a pacemaker installed at the age of 100 after being told she was too old. She’s now 105.

Here’s what Obama said in full response, “We’re not going to solve every difficult problem in terms of end-of-life care, a lot of that is going to have to be we as a culture and as a society starting to make better decisions within our own families and for ourselves. But, what we can do is make sure that some of the waste that exists in the system that is not making anybody’s mom better, that is loading upon additional tests or additional drugs, that the evidence shows is not necessarily going to improve care, that at least we can let doctors know, and your mom know, that, you know what, this isn’t going to help, maybe you’re better off not having the surgery but taking the pain killer.”

So, the rationing board will let doctors and individuals know what is and is not covered.

Just how would they let the doctors know? By not paying for those “unnecessary” tests and drugs. And how would those aging mothers find out? When those life-extending treatments are denied. The message, in short, will be: take two aspirins and call the undertaker.

And Barack Obama knows it. Most importantly, seniors know it.

More here




Utopia: The Land of Ideal Health Care

Now boys and girls, I want to tell you a wonderful fairy tale about a talismanic land where only happy endings are allowed. And all you have to do is surrender your “liberty and freedom for all.” You all know that Ezekiel “Zeke” Emanuel was aboard the Clinton Express when it tried to take us to the magical world of universal health care in the early 90s. Sadly, that train broke down on the way and never arrived at Utopia. But, not to worry, because now Zeke has boarded another train, the ObamaCare Special. And, it is leaving the station for the same destination.

Now, you’re probably wondering what you will find in Zeke’s Utopia. How will your needs be met? And what will this live-long life of lollipop and roses cost? Well, again, not to worry. You seek Zeke has already written a wonderful travel guide about his magical land of health care reform. Its title is “A Comprehensive Cure: Universal Health Care Vouchers.” And it reads a lot like “Alice in Wonderland.”

Zeke’s Utopia is an enchanted place where everyone receives a standard package of wonderful health care services, “regardless of age, income, employment, health, or marital status.” And all you need to pay for any of this is your complimentary “Health Care Voucher.” Once in Utopia, you can take your ticket to any private health plan provider or insurer, and you are guaranteed a basic benefit package. How’s that for happily ever aftering?

Now, I know you’ve heard lots of scary stories about those nasty private health insurance companies turning folks away for preexisting conditions or other enrollment requirements. But Zeke would fix it so that in Utopia, they wouldn’t be able to do this anymore. In fact he would severely restrict and control which companies can accept his special vouchers so that only one in ten would be left when he is finished. And those will either do as there told, or – zip! – it’s down the rabbit hole for them.

You may be wondering, how can Zeke afford to buy everyone a “free” ticket? Where will he get the money? Well, in Utopia, everyone will help him get the money – including you – by paying a national sales tax [called a VAT] of ten to twelve cents on the dollar for everything they buy. So, the money you save on “free” health care, you’ll be able to turn over to Big Government.

And that money will also enable Zeke to set up a National Health Board and regional health boards to “define and regularly adjust the standard health benefits to reflect…fiscal realities.” If less comes in from the VAT, fewer health benefits will be guaranteed in Utopia. And Big Government will make the “tough administrative choices to be made.” This is what’s known in Utopia as “rationing.” And it could cost you your life. But, that’s a small matter.

Here is the best part about Zeke’s plans for your life in Utopia. The 10 to 12 cents Zeke and his pals take out of every dollar you have (after Big Government has already taken the 50 cents it currently takes) will also enable Zeke and his pals to set up an “Institute for Technology Outcomes Assessment.”

You see, Zeke has figured out that the problem with medical care today is that there is just too much spending that does not produce enough good results. So, in Utopia, Zeke’s new government Institute would compare the “costs of drugs, devices, diagnostic tests, and other interventions” with their relative effectiveness in saving the lives of “participating citizens” to see which benefits will be provided to whom.

Only those “drugs, devices, diagnostic tests,” and such, that produce enough good results -- that is, save the lives Zeke and his pals decide are worth saving: the young and productive, in their eyes – will considered effective and receive Utopia’s Big Government funding.

For example, let’s think about grandma for a second. And let’s say she was lying in the hospital unconscious on a respirator to help her breath. Now some selfish people (the kind Zeke definitely does not want in Utopia) would let her stay there for months at great expense to Big Government, hoping (and maybe even praying) for a miracle or an advance in medical technology that would bring her back to health.

But, not Zeke. Being of superior intellect and knowing how to properly evaluate who should live and who should die, Zeke and his Big Government pals would pull that plug so fast granny would have a tag on her toe before you could say “Sanctity of life.” And in Zeke’s Utopia, the word of the government is the unquestioned law of the land. So, there could be no legal challenge to the Institute’s decisions.

So, there you have it: a Utopian world where everyone is healthy, happy, and in the prime of life. Because, in Utopia, you see, Zeke and his pals will kill off everyone else.

SOURCE




ObamaCare: Status Quo on Steroids

Healthcare reform that isn't

Let’s begin by noting that the so-called health-insurance companies deserve little sympathy. As they exist today, they are very much creatures of the State. In fact, there’s a sense in which it can be said that if we didn’t have health-insurance companies, we wouldn’t need them.

Economist William Niskanen writes, “We did not have a health care crisis in 1940 when few people had health insurance.” In fact, that year only 10 percent of Americans had such insurance (henceforth imagine ironic quotation marks). But World War II was a bonanza for the industry, especially Blue Cross Blue Shield. Government economic controls prohibited firms from attracting or keeping workers with higher wages. So someone hit on the idea of supplementing wages with noncash compensation, specifically, health insurance. The government said okay and the rest is history. Employee insurance was untaxed, creating a bias toward employer-provided health plans. If an employer bought a $5,000 plan for a worker, that worker got the full $5,000 benefit. But if the employer paid the worker $5,000 in cash, the worker would pocket $5,000 minus federal and state taxes. He’d need more than $5,000 to buy a $5,000 policy.

The government intervened in another way. According to Niskanen, “[T]ax and regulatory preferences for the Blues displaced the older form of commercial indemnity policies with policies providing cost-based reimbursement.” This act of social engineering — arrogant politicians and bureaucrats always think they know better than the collective wisdom stimulated by the free market — had huge (and presumably) unintended consequences that account for many of our current problems. Under the old-style indemnity plans (which individuals shopped and bought for themselves), contracting a catastrophic disease triggered a fixed insurance payment — to the policyholder – according to an agreed-on predetermined schedule. The money was hers. If she could find services that cost less than the insurance payment, she pocketed the difference. Of course, this provided an incentive to be cost-conscious in buying medical care. Homeowners’ and other types of insurance still works like this.

In contrast, under the Blue Cross Blue Shield model pushed by government — which began not as insurance but as a prepayment plan for doctors and hospitals — the policyholder never sees a dime. Treatment simply sets in motion a process in which the insurance company sends a check to a hospital, lab, or doctor. No treatment, no payment. The individual has no reason to shop around (there can be great variation in prices), or to question whether a test or procedure is necessary, or to even ask what anything costs. What’s the point? It would seem only to save the insurance company money.

The insurance companies take this into account when negotiating with providers and employers who buy coverage on behalf of their workers. A key problem here is the disconnect between cost and benefit (which would be aggravated by the Obama plan). In most cases employers pay for their workers’ coverage with money that otherwise would have largely gone into cash wages. To the workers, it looks like free (or pretty cheap) coverage. Because of competition among employers and the rigged tax laws, coverage has become more luxurious, including services for situations that are not even insurable. A good example is maternity benefits. Pregnancy is not a disease, is largely preventable, and usually results from a volitional act. From a true insurance perspective, it’s ridiculous to expect coverage. (It would be like insurance against gaining weight.) The same could be said for many other “conditions” that are covered today. Well-baby care? Is that insurance against a baby’s being well? (Orwell was right: corrupt the language and one can get away with anything.)

More here




Australia: The brainless Qld. Ambulance bureaucracy does it again

Paramedics get TVs, not life-saving equipment. The entire management should be fired

QUEENSLAND Ambulance Service has splashed out on big-screen TVs, sound systems and expensive lounges while paramedics go without critical equipment. Hundreds of thousands of dollars were spent on the entertainment systems for ambulance stations at the end of last financial year despite a desperate need for GPS devices, training defibrillators and replacement uniforms. The splurge has infuriated paramedics forced to cope with broken or dodgy equipment.

In at least three cases exposed by The Courier-Mail, people have died after paramedics lost their way in ambulances lacking GPS or missing a defibrillator which had been removed for training.

The QAS has refused to reveal how much it has spent on TVs, Blu-ray disc players and sound systems over the past two years, but staff estimate it could top $1 million. The QAS strongly defended its spending, claiming the items were for "training". "Education and training is essential to the development of paramedics and QAS employees and the purchase of equipment for training and development such as televisions, DVDs, and lounges in rest areas does not impact on the provision of other essential equipment," it said in a statement. {Really??}

But Brisbane student paramedic Zac Damelian, who had to buy his own GPS for work, said the $12,000 he estimated was spent on his station was over the top. "It's just ridiculous what they spend money on," Mr Damelian said. "Televisions aren't going to bring back the poor old lady (cardiac) arresting down the road." He said the entertainment systems at his station were "hardly ever used for training". "It is for recreation between jobs," he said.

Mr Damelian wasn't against paramedics having comforts, but not at the expense of essential equipment. Lifepak 12 defibrillators are "constantly in and out of service", blood glucose readers, batteries and stretchers needed replacement, and paramedics struggled to get replacement uniforms, he said. Paramedics who want to train on Lifepak 12 defibrillators at their stations must remove units from ambulances, a risky decision.

Some stations now have up to three LCD televisions and two DVD players. The Emergency Medical Service Protection Association, which represents hundreds of paramedics and ambulance staff, said it disagreed with the wasting of public money. "In times of financial crisis . . . there are more pressing priorities," vice-president Jock Ruthven said.

QAS documents obtained by The Courier-Mail under Right to Information showed a Gold Coast child who died after having a seizure was attended to by paramedics who did not have a defibrillator because it had been removed for training. Two Mackay men died of cardiac arrest after waiting more than 40 minutes for lost ambulances which didn't have GPS.

Opposition emergency services spokesman Ted Malone said money should first be spent making sure there was enough staff and essential equipment, including back-up gear, and uniforms.

SOURCE





12 September, 2009

Nasty British health bureaucrats again refuse to approve an effective liver cancer drug

They prefer to spend the money on an army of clerks and "administrators". Only a third of NHS employees are doctors and nurses

Britain's healthcare cost-effectiveness watchdog has again rejected Bayer's drug Nexavar for treating liver cancer on the state health service, despite a revised charging scheme from the company.

Wednesday's decision is a setback for Bayer and its partner Onyx Pharmaceuticals, which have already seen Nexavar turned down by the National Institute of Health and Clinical Excellence (NICE) to treat kidney cancer. Nexavar received a preliminary rebuff from NICE in May but Bayer had hoped to convince the agency Nexavar was worth paying after it put forward a patient access scheme that would have reduced the cost of treatment to the National Health Service.

Bayer said the decision on its drug, known generically as sorafenib, for the treatment of hepatocellular carcinoma was a blow to patients. "We thought we had satisfied NICE's criteria for how Nexavar would be assessed -- however, the goal posts appeared to have moved," said Nicole Farmer, the company's British head of oncology. "This proposal by NICE conflicts dramatically with the government's strategy to bring UK cancer outcomes in-line with the rest of Europe, where Nexavar is already widely available in countries such as France, Germany, Spain, Italy, Romania, and Greece."

Hepatocellular carcinoma is the most common form of liver cancer, accounting for 80 to 90 percent of all primary liver tumors. Nexavar is one of Bayer's top new drug hopes, along with anti-blood clotting pill Xarelto. It has proved successful against liver and kidney cancer and Bayer is also pursuing approvals for use against lung and breast tumors.

SOURCE




Medicare for Dummies

Contradictions worthy of the Marx Brothers

The thing about the bully pulpit is that Presidents can make the most fantastic claims and it takes days to sort the reality from the myths. So as a public service, let's try to navigate the, er, remarkable Medicare discussion that President Obama delivered on Wednesday. It isn't easy.

Mr. Obama began by depicting a crisis in the entitlement state, noting that "our health-care system is placing an unsustainable burden on taxpayers," especially Medicare. Unless we find a way to cauterize this fiscal hemorrhage, "we will eventually be spending more on Medicare than every other government program combined. Put simply, our health-care program is our deficit problem. Nothing else even comes close."

On this score he's right. Medicare's unfunded liability—the gap between revenues and promised benefits—is currently some $37 trillion over the next 75 years. Yet the President uses this insolvency as an argument to justify the creation of another health-care entitlement, this time for most everyone under age 65. It's like a variation on the old Marx Brothers routine: "The soup is terrible and the portions are too small."

As astonishing, Mr. Obama claimed he can finance universal health care without adding "one dime to the deficit, now or in the future, period," in large part by pumping money out of Medicare. The $880 billion Senate plan he all but blessed this week would cut Medicare by as much as $500 billion, mainly by cutting what Mr. Obama called "waste and abuse." Perhaps this is related to the "waste and abuse" that Congresses of both parties have targeted dozens of times without ever cutting it.

Apparently this time Mr. Obama means it, though he said this doesn't mean seniors should listen to "demagoguery and distortion" about Medicare cuts. That's because Medicare is a "sacred trust," and the President swore to "ensure that you—America's seniors—get the benefits you've been promised."

So no cuts, for anyone—except, that is, for the 24% of senior beneficiaries who are enrolled in the Medicare Advantage program, which Democrats want to slash by $177 billion or more because it is run by private companies. Mr. Obama called that money "unwarranted subsidies in Medicare that go to insurance companies—subsidies that do everything to pad their profits but don't improve the care of seniors."

In fact, Advantage does provide better care, which is one reason that enrollment has doubled since 2003. It's true that the program could be better designed, with more competitive bidding and quality bonuses. But Advantage's private insurers today provide the kind of care that Mr. Obama said he would mandate that private insurers provide for the nonelderly—"to cover, with no extra charge, routine checkups and preventative care."

Advantage plans have excelled at filling in the gaps of the a la carte medicine of traditional Medicare, contracting with doctors and hospitals to coordinate care and improve quality and covering items such as vision, hearing and management of chronic illness. If seniors in Advantage lose this coverage because of the 14% or 15% budget cut that Mr. Obama favors, well, that's "waste and abuse."

Mr. Obama did also promise to create "an independent commission of doctors and medical experts charged with identifying more waste in the years ahead." That kind of board is precisely what has many of the elderly worried about government rationing of treatment: As ever-more health costs are financed by taxpayers, something will eventually have to give on care the way it has in every other state-run system.

But Mr. Obama told seniors not to pay attention to "those scary stories about how your benefits will be cut, especially since some of the folks who are spreading these tall tales have fought against Medicare in the past and just this year supported a budget that would essentially have turned Medicare into a privatized voucher program."

This is a partisan swipe at one of the best GOP ideas to rationalize the federal budget, despite Mr. Obama's accusations that his opponents want to do "nothing." This reform would get Medicare out of the business of spending one out of five U.S. health dollars, and instead give the money directly to seniors to buy insurance to encourage them to be more conscious of cost and value within a limited budget. Democrats would rather have seniors dance to decisions made by his unelected "commission of doctors and medical experts."

Mr. Obama also called for "civility" in debate even as he calls the arguments of his critics "lies." So in the spirit of civility, we won't accuse the President of lying about Medicare. We'll just say his claims bear little relation to anything true.

SOURCE




Obama's cry aimed at Dems

President Obama on Wednesday defiantly scolded opponents of his sweeping health care reform proposal, saying "the time for bickering is over, the time for games has passed. Now is the season for action." And that was aimed just at members of his own party.

In fact, nearly his entire speech was targeted directly at Democrats, who, despite massive majorities in both the House and the Senate, have been at loggerheads over just how to overhaul America's health care system.

Having misplayed the sweltering summer, when conservatives gathered force and turned town halls across the country into angry tutorials on the expansive - and expensive - reform plan, Mr. Obama has expended nearly all of his once-boundless political capital and has been reduced to begging his own party to find consensus - any consensus.

He used fear: "More families will go bankrupt ... more will die"; he used shame: "Too many Americans [are] counting on us to succeed"; he blamed politics: "Out of this blizzard of charges and countercharges, confusion has reigned."

He all but begged. "If you come to me with a serious set of proposals, I will be there to listen. My door is always open," the president said, looking out on more than 100 House Democrats who simply cannot agree on how to move forward.

According to the latest tallies, some 45 moderate Blue Dog Democrats oppose Mr. Obama's plan, and especially its cost - upward of $1.5 trillion over 10 years. Meanwhile, 60 liberal Democrats oppose the plan if the president jettisons the "public option," or government-run health care.

In between are libertarian Democrats, some of whom oppose what they see as a power grab, and purely pragmatic Democrats, unconvinced that the federal government can oversee such an enormous undertaking (especially when it could hardly handle the "cash for clunkers" program).

Mr. Obama's speech appeared to unify Democrats as to their real enemies - not members of their own party, but the Republicans across the aisle - in the joint session of Congress, held in the House chamber. Spilling onto the other side of the aisle, Democrats repeatedly leapt to their feet in standing ovations. At times, the session had the feel of the old-time call-and-response in a boisterous church.

More here




Obama Doubles Down

Counting on the sheer inertia of Democratic and health industry self-interest in Washington to drive a bill into law

Democrats have wanted President Obama to drop some of his cool and fight for their health-care agenda, and last night they weren't disappointed. The President gave away very little on the substance of what Congressional leaders are proposing, even as he offered a rhetorical bow or two to the idea of compromise. The main message of his speech to Congress is that he is doubling down on his health-care bets and counting on the sheer inertia of Democratic and health industry self-interest in Washington to drive a bill into law.

The speech was especially notable for its use of one of Mr. Obama's favorite rhetorical devices: Noting in the first instance that his opponents have a good point, and entirely legitimate concerns, only to reject their ideas in toto when it comes to policy. Thus he endorsed the public's concern about the competence of government to manage one-sixth of the economy, only to finish with a soaring oration about the moral necessity of letting government do so.

Thus, too, Mr. Obama bowed toward the GOP concern for medical malpractice reform, even acknowledging that it is a problem. Yet his substantive offer was limited to "demonstration projects in individual states to test these ideas." His advisers surely know that many states—including California and Texas—have already improved their tort climate for medicine with caps on noneconomic damages. The problem is that the tort bar fiercely oppose such caps, and Democrats in the Senate always defeat them. Had Mr. Obama challenged Democrats to pass that kind of tort reform, he would have been serious. As it is, his offer is mainly about making it appear that he is reaching across the aisle.

Mr. Obama also deplored the "unyielding ideological camps that offer no hope of compromise"—a line meant to appeal to independents who deplore partisanship. Yet the truth is that four of the five committees writing ObamaCare largely closed off their negotiations to Republicans. The President and his party have also trashed some of the best reform ideas—advanced by the likes of Wisconsin Republican Paul Ryan, Democratic backbencher Ron Wyden and every serious health economist in the country—that would reform the tax code so that consumer health dollars are no longer laundered through third parties, inflating medical spending.

As for Mr. Obama's policy details, he offered little else that was new. His proposals closely follow the plan laid out this week by Montana Senator Max Baucus, differing from the House plan mainly in its initial ambition but not in the scope of government regulation of the private insurance market and its ultimate and enormous cost.

Instead of trillions of dollars, he put his price tag at a less politically toxic $900 billion. But that is only within the first 10-year budget window and assumes "savings" that are surely illusory.

Instead of raising individual taxes right away—as the House bill would—Messrs. Obama and Baucus say they will only tax insurers and other health-care providers. But those providers will only pass those costs through to consumers, raising the price of private insurance and thus raising the subsidies that government would have to pay to make it affordable.

Mr. Obama was especially canny as a political matter to issue a strong defense of the so-called "public option" to compete with private insurers. The rhetoric will please his left flank, even as he and they know that divisions in his own party have already doomed that idea for now. Liberals will squawk when the Senate throws the public option over the side, but they know that Mr. Baucus's plan gets them to the same destination, only over a longer period.

Perhaps Mr. Obama's most remarkable sleight-of-hand was his claim that he "will not stand by as the special interests use the same old tactics to keep things exactly the way they are." The reality is that nearly all of those "special interests" are standing with him. The doctors' lobby, the hospitals, Big Pharma, even the largest insurers have all invested enormously in government health care.

Mr. Obama's speech was less about persuading the public than it was a political pep talk to this Beltway constituency. He hopes to buy enough political breathing space with a bump in the polls—however short-lived—to steel their nerves to power ObamaCare into law. The only way to stop it now is with a giant wave of popular opposition.

SOURCE




Read the Union Health-Care Label

Get ready for Detroit-style labor relations in our hospitals

In the heated debates on health-care reform, not enough attention is being paid to the huge financial windfalls ObamaCare will dole out to unions—or to the provisions in the various bills in Congress that will help bring about the forced unionization of the health-care industry.

Tucked away in thousands of pages of complex new rules, regulations and mandates are special privileges and giveaways that could have devastating consequences for the health-care sector and the American economy at large.

The Senate version opens the door to implement forced unionization schemes pursued by former Govs. Rod Blagojevich of Illinois in 2005 and Gray Davis of California in 1999. Both men repaid tremendous political debts to Andy Stern and his Service Employees International Union (SEIU) by reclassifying state-reimbursed in-home health-care (and child-care) contractors as state employees—and forcing them to pay union dues.

Following this playbook, the Senate bill creates a "personal care attendants workforce advisory panel" that will likely impose union affiliation to qualify for a newly created "community living assistance services and support (class)" reimbursement plan.

The current House version of ObamaCare (H.R. 3200) goes much further. Section 225(A) grants Secretary of Health and Human Services Kathleen Sebelius tremendous discretionary authority to regulate health-care workers "under the public health insurance option." Monopoly bargaining and compulsory union dues may quickly become a required standard resulting in potentially hundreds of thousands of doctors and nurses across the country being forced into unions.

Ms. Sebelius will be taking her marching orders from the numerous union officials who are guaranteed seats on the various federal panels (such as the personal care panel mentioned above) charged with recommending health-care policies. Big Labor will play a central role in directing federal health-care policy affecting hundreds of thousands of doctors, surgeons and nurses.

Consider Kaiser Permanente, the giant, managed-care organization that has since 1997 proudly touted its labor-management "partnership" in scores of workplaces. Union officials play an essentially co-equal role in running many Kaiser facilities. AFL-CIO President John Sweeney called the Kaiser plan "a framework for what every health care delivery system should do" at a July 24 health-care forum outside of Washington, D.C.

The House bill has a $10 billion provision to bail out insolvent union health-care plans. It also creates a lucrative professional-development grant program for health-care workers that effectively blackballs nonunion medical facilities from participation. The training funds in this program must be administered jointly with a labor organization—a scenario not unlike the U.S. Department of Labor's grants for construction apprenticeship programs, which have turned into a cash cow for construction industry union officials on the order of hundreds of millions of dollars each year.

There's more. Senate Finance Committee Chairman Max Baucus has suggested that the federal government could pay for health-care reform by taxing American workers' existing health-care benefits—but he would exempt union-negotiated health-care plans. Under Mr. Baucus's scheme, the government could impose costs of up to $20,000 per employee on nonunion businesses already struggling to afford health care plans.

Mr. Baucus's proposal would give union officials another tool to pressure employers into turning over their employees to Big Labor. Rather than provide the lavish benefits required by Obamacare, employers could allow a union to come in and negotiate less costly benefits than would otherwise be required. Such plans could be continuously exempted.

Americans are unlikely to support granting unions more power than they already have in the health-care field. History shows union bosses could abuse their power to shut down medical facilities with sick-outs and strikes; force doctors, nurses and in-home care providers to abandon their patients; dictate terms and conditions of employment; and impose a failed, Detroit-style management model on the entire health-care field.

ObamaCare is a Trojan Horse for more forced unionization.

SOURCE




Does Obama think Americans are so gullible?

President Obama’s address to Congress and the nation Wednesday evening was yet another illustration of his seemingly endless ability to soar to genuinely impressive rhetorical heights without ever landing back on truthful ground. Nothing better illustrates this than Obama’s medical malpractice “demonstration project” gambit. Here’s the essential fact about federal demonstration projects – they are nothing more than a dodge, a deceitful way for Washington politicians to appear as if they are doing something concrete when in reality they’re tucking the idea at hand safely out of sight over in a corner. Obama might as well have said Wednesday night that he will appoint a presidential commission or have challenged Congress to create an emergency national task force on medical malpractice. The Democratic majority sitting in the House chamber would have stomped and clapped and yelled with equal delight, knowing the chief executive had just consigned medical malpractice caps to irrelevance, along with any GOP senator or representative gullible enough to think Obama was thus doing anything other than playing them for suckers.

So it was throughout this 47- minute nationally televised monument to presidential flimflam. Sometimes the prevarications were so obvious that even the president’s most ardent supporters – like the news staff of The New York Times - had to concede that he was playing fast and loose with the facts. For instance, the Times quoted Obama’s repeating of his familiar claim that “if you are among the hundreds of millions of Americans who already have health insurance, nothing in our plan requires you to change what you have.”

"That is technically true,” the Times carefully admitted, “but there is a real possibility that existing policies could change as a result of the legislation. The government, for instance, would set new standards, and employers that already offer insurance would have to bring their plans into compliance.” In other words, when, as is inevitable, the cost of providing health insurance is more than the federal fine Obama seeks for not providing it, companies will drop their employee plans, forcing millions of people into the government-run health care system against their will.

Similarly, Obama claimed “most of this plan can be paid for by finding savings within the existing health care system, a system that is currently full of waste and abuse.” If $675 billion equals “most” of the $900 billion Obama says his proposal would cost, why wait to get those savings? Finally, there is abortion and illegal immigrants. Obama said “no federal dollars” will fund abortions under his proposal and “the reforms I am proposing would not apply to those who are here illegally.” If Obama truly believes that, then he will have no objection when Democrats in Congress reverse their previous votes barring such provisions from the legislation when they were proposed by Republicans. In short, did the president sleep through August?

SOURCE





11 September, 2009

Scum British doctors let baby die

Bureaucracy seems to destroy every shred of human decency. Baby had a strong heartbeat and was moving his arms and legs when he was born, says his mother. The baby was clearly viable and would have been saved in a private hospital



A DEVASTATED mother claims doctors refused to treat her premature baby because it was born two days early. The tiny boy from the UK - born 21 weeks and five days into her pregnancy - died just two hours after being born, The Daily Mail reports. Sarah Capewell, who has suffered five miscarriages previously, said she went into early labour and was told her newborn would be dead once delivered.

But after discovering her son, Jayden, had a strong heart beat and was moving his arms and legs, she called doctors and begged them to help. Ms Capewell said doctors refused, saying medical guidelines state that "babies born before 22 weeks are not viable and are not to be helped". She claims doctors at James Paget Hospital in Norfolk told her that they would have tried to save the baby if he had been born two days later, at 22 weeks.

According to the Daily Mail, she told one paediatrician, "You have got to help", only for the man to respond: "No we don't."

"When I went into labour I was told he would be born dead, disabled and his skin would most likely be peeling off, in actual fact he was perfect," she wrote on her website Justice for Jayden. "As you can see from his pic he was born alive, he was responsive and lived without help for nearly 2 hours. "Regardless of this doctors refused to come and see him let alone consider helping him."

A hospital official said it not to blame for setting the nation's guidelines and "like other acute hospitals, we follow national guidance". [Is the thing that said that a human being??]

Ms Capewell is now campaigning to make the Government change the law. "This is down to government legislation stating that babies born before 22 weeks are not viable and are not to be helped," she said. "Now I'm asking for your help in changing legislation so other families don't have to suffer unnecessarily."

SOURCE




AUSTRALIAN PUBLIC HOSPITAL MAYHEM

Three current articles below

Alarming wait for urgent medical procedures in NSW government hospitals

WAITING lists for urgent operations such as heart bypasses and cancer surgery have blown out dramatically this financial year, with the number of operations performed statewide falling by 5260 to 32,913 in July compared to the same month last year - a 14 per cent slump. The Health Minister, John Hatzistergos, released figures on Tuesday showing an improvement in elective surgery waiting times in the March to June quarter. But surgeons said administrators had approved extra surgery during this period to meet performance benchmarks, only to slash it subsequently.

''On July 1 they took the foot off the accelerator,'' said Patrick Cregan, the chairman of NSW Health's Surgical Services Taskforce. ''There's been an enormous blowout since then.'' While this was partly attributable to the swine flu epidemic, which reduced the number of beds available for surgical patients, ''the vast bulk of it is that we've got a budget problem'', Dr Cregan said. Fully staffed operating theatres were going unused, he said, as surgery was cancelled. ''It's an enormous waste of operating capacity,'' Dr Cregan said.

Another taskforce member, Brian McCaughan, said that at the end of July, 227 people who needed urgent operations such as heart, cancer or brain surgery were still on the waiting list beyond the 30 days recommended maximum, and more than 3000 others had waited too long for less urgent operations. This was in addition to patients who finally received their operation in July after waiting longer than benchmark times.

Professor McCaughan said the swine flu outbreak affected only operations where high-level care was needed afterwards. ''We did fewer hearts, but [the epidemic] doesn't impact on colons, hernias, gall bladders or breasts'', for which waiting lists had also increased. Budget allocations presented by NSW Health to area health services show the number of operations that can be performed statewide this year will be capped at 255,000, with hospital managers financially penalised if they deviate by more than 5 per cent from the targets.

NSW Health's acting deputy director-general for health system performance, Nigel Lyons, said the figures had not been finalised but were ''indicative''. Allocations had been calculated to allow 100 per cent of patients to be treated within recommended times, he said. Western Sydney hospitals will be allowed to perform less than two-thirds the number of operations allocated to eastern Sydney region under the new budgeting method - which awards money for actual ''episodes of care'', rather than allowing area bosses to distribute funds as they see fit.

Despite their similar catchment populations of just over a million each, Sydney West Area Health Service can perform only 30,812 operations, against South Eastern Sydney Area Health Service's 48,853. Dr Lyons and the NSW Health director-general, Debora Picone, would visit Nepean Hospital today to discuss doctors' concerns about the new formula, which the chairman of the hospital's medical staff council, Peter Flynn, said illustrated ''ingrained inequity''.

He said doctors would insist the department commit to 9000 extra operations a year in western Sydney by 2011, as facilities were opened or expanded.

SOURCE

Another overstetched public hospital doctor speaks out in Queensland

I WORK at one of Brisbane's largest hospitals as a surgical registrar. I have been very close to writing this letter many times in recent years but thought it would fall on deaf ears. I often have to work several months straight. That is, leaving my home at 6.30am every day and returning at 9pm or 10pm – often later, in the early hours of the morning, to have a few hours sleep and do it again.

There have been occasions over the years where I have been so fatigued I have fallen asleep while performing surgery, literally slumping forward while standing over the patient's open body on the operating table. On other occasions, I've seen my senior consultants fall asleep while operating, such was their exhaustion. It is terrifying to watch. Imagine if the patient knew the risk they were in.

We are meant to work 38-40 hour weeks. I will often do those many hours in a single weekend on call. My true hours are 50-70 hours per week. I have done over 100 at times. In addition to this, we're supposed to have four days off for every 14 days of work and, if you looked at the roster, it would seem as though they have allowed for this. But there is also an "unspoken" roster that has meant most of us only get about two to three days for every 30 days of work.

Surgery staff don't get time in lieu. If there's no one else to do it, you just have to work. If there's no one else to cover the ward on a weekend, you just have to do it. It doesn't matter to Queensland Health that you have just worked 30 days straight and haven't seen your spouse or kids in a fortnight.

Fatigue pay is what you get when you have worked your "rostered" hours for the day (7.30am-4.30pm). But you have to do so much overtime that your next "rostered" day starts before you get a chance to have an eight-hour break. We're supposed to have eight hours (of every 24 hours) not working. Fatigue pay kicks in when you have to return to work before having eight hours off (often we don't "return" as we haven't even had a chance to leave from the previous day).

If you complain about the hours and workload, you simply will not be able to progress in your career. If you want to get on to a competitive training program, your reference "scores" might be affected and you will not be able to specialise. It sounds crazy, with such a shortage of specialists, but as I have been told many times over: "you have to play the game" if you want to get into your chosen field.

The only problem is – without any exaggeration – the "game" maims and kills patients. It destroys doctors' health, marriages and relationships with their children. In addition to this, think of patient safety – you couldn't drive a car after such long hours of work, so why are we expected to perform surgery?

Most of us are extremely disillusioned, exhausted and in fear of our jobs if we speak about it, even among ourselves. Yes, we need more doctors. We're training more at uni than ever, so we will definitely have the graduates in coming years. But we need the specialty colleges to create the training positions and the hospitals to create the training-approved positions to accommodate these doctors until they become fully qualified (which can be five to 10 years after they finish medical school).

And there are simple short-term solutions at hand that everyone in the hospital system knows about but are too afraid to talk about to the media. At the hospital I work at, there are spare operating theatres that go unused. If they were to open these theatres and have them all fully functioning for urgent cases, we could get the elective lists completed during working hours.

Most doctors I know no longer enjoy what they do. Many have dropped out of surgery. Often our patients, who we sacrifice our family time to help, simply refuse to help themselves and we know we are just beating our heads against a brick wall trying to assist them in medical intervention when they'll just go back to the same habits or self-abuse.

Forget about the pay. Most of us didn't get into the industry for money. Many years out of medical school, I am still paying off my degree. Money doesn't buy you sleep. It doesn't buy you good health or lower stress levels. It doesn't buy you a place on a training program. Nor does it save your marriage. Money doesn't even give you a chance to have dinner with your family or tuck your kids into bed – not even one night a week.

Doctors should not have to put up with these conditions. The Government must step up. There is so much that could be done to help the situation and not all involve multibillion dollar budgets. It just needs some common sense. We need some action. People are literally dying for it.

SOURCE

Study slams jargon in public hospital consent forms

MORE than 80 per cent of the consent forms patients are asked to sign before having an operation are incomprehensible to anyone without specialist medical knowledge. Ninety per cent of the forms do not make clear the purpose of the planned operation, and 95 per cent of them do not list the relevant risks to the patient, research by Australian experts suggests.

The experts, from an Adelaide hospital, reviewed hundreds of consent documents given to patients to sign since 2005, and found one in 15 did not use a single word to describe the procedure that could be understood by looking it up in a standard English dictionary.

Far from being isolated cases, they say such language is typical of consent documents used nationwide, and that such use of jargon is "unacceptable", particularly given that many patients are elderly and in frail health.

The authors of the research, published today in the Medical Journal of Australia, suggest mandatory standards should be introduced to ensure patients are better informed. Lead researcher Mark Siddins, director of the urology unit at Adelaide's Repatriation General Hospital, said many doctors appeared to think the point of consent forms was to protect them from being sued, rather than to help the patient make the right treatment choice. He said while hospital technology had been transformed in the last 20 years, the way doctors interacted with patients had changed little. "We are surprised indemnity insurers don't require that doctors give (understandable) consent information."

SOURCE




Obama makes his case for health care reform

All hot air, fantasy, abuse of those who disagree with him and no detail -- in his usual way

His prime-time speech to both houses of Congress was punctuated by standing ovations but when Mr Obama said it was "false" that his plan would cover illegal immigrants one Republican congressman shouted out: "You lie!" Representative Joe Wilson of South Carolina later apologised for his dramatic outburst, which shocked Mr Obama and drew a disapproving shakes of the head from Michelle Obama, the First Lady...

Mr Obama's speech alternated between high-minded calls for Americans to come together to show the strength of the nations character with hard-edged partisan attacks on Republicans. The time for "bickering" was over, he insisted, and asked politicians to "replace acrimony with civility, and gridlock with progress". {Progress in one direction, of course]

But he also blasted Republicans for mounting a "partisan spectacle" over the summer. "Instead of honest debate, we have seen scare tactics," he said. Some have dug into unyielding ideological camps that offer no hope of compromise." Although he did not use her name, he left no doubt that he was calling Sarah Palin, the former Alaska governor, a liar. "Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost.

"The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. "Such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple." Mrs Palin made the charge in the summer and then repeated it in an article in the "Wall Street Journal" on Wednesday.

Mr Obama told his critics: "I will not waste time with those who have made the calculation that it's better politics to kill this plan than improve it. If you misrepresent what's in the plan, we will call you out."

In a long tribute to Senator Edward Kennedy, who died last month, he referred to a last letter to Mr Obama that his mentor had arranged to be delivered after his death. "'What we face," Mr Kennedy wrote, 'is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country." Mr Kennedy's widow Vicki looked on sadly from the First Lady's box and Vice President Joe Biden, seated behind Mr Obama wiped his eye.

Mr Obama said his proposed overhaul would cut costs, improve care and regulate insurers to help protect consumers while expanding coverage. He pledged that the proposal, which would cost $900 billion over 10 years, would not increase the budget deficit by "one dime".

He reiterated his support for the "public option" of a government-run insurance plan, a favourite concept of the Left but something that has drawn strong opposition from conservative Democrats as well as Republicans...

In preparing to abandon the public option, Mr Obama is calculating that his party's Left will not be able to bring themselves to vote against a bill that would extend health coverage to millions, even if they consider it imperfect.

Some on the Left, however, might be hard to placate. Steve Hildebrand, Mr Obama's deputy campaign manager and an architect of his crucial primary victories in Iowa and South Carolina, this week became the most senior Obama ally to break ranks. "I am one of the millions of frustrated Americans who want to see Washington do more than it's doing right now," he told Politico, saying that he "needs to be more bold in his leadership" and was among Democrats in power who should not be allowed to "get away with a lack of performance for the American people".

More here. A longer account of the session here. Obama's full speech is here.




Obama shadow boxes with 'enemies' of health plan

Emmanuel Goldstein was the enemy of the state in George Orwell's "Nineteen Eighty-Four," and the target of the "Two Minutes Hate," in which the citizens of Oceania -- at the cue of Big Brother -- would rage at those undermining the state and the party. Within the novel, it's never clear if Goldstein is real or a fabricated whipping boy for party officials and angry citizens.

Unlike Big Brother, President Obama hasn't even deigned to give us a name for the enemy of "reform." He uses only ominous, vague epithets: "Opponents of health insurance reform," "well-financed forces" and "those who are profiting from the status quo."

So I asked both the White House and the Democratic Party to name these malefactors of great wealth. I called the White House last week, and asked for names, and was told to e-mail spokesman Reid Cherlin. I asked Cherlin about the WhiteHouse.gov statement, "For those who fight reform in order to profit financially or politically from the status quo, the president sends a simple message: 'Not this time.' "

And I asked about this line in Portsmouth, N.H: "Despite all the hand-wringing pundits and the best efforts of those who are profiting from the status quo ... " "Please name names," I requested. "Which businesses, lobbyists or industries is he referring to?"

Mr. Cherlin hasn't responded.

I also called Organizing for America, the heir of the Obama campaign, now run by the Democratic National Committee. In an e-mail, the group wrote: "Opponents of health insurance reform have power. Some reap huge profits from the status quo." And: "These same well-financed forces have killed reform in the past, and they're aiming to do it again."

Who were these "well-financed forces" and profiting "opponents of ... reform"? Organizing for America didn't call me back, either.

You see this nameless line of attack from Obama and the Democrats every day. It's called demagoguery.

Since Obama won't put a name on the enemies of reform, we need to do some detective work. A prime suspect "profiting from the status quo" would be the industry within the medical sector with the highest profit margins, namely the drug makers, which averaged 16.5 percent profit margins last quarter.

But the drug makers have been team players. The Pharmaceutical Researchers and Manufacturers of America, the largest industry lobbying group in the country, is shelling out $12 million for pro-"reform" ads this summer and fall. Obama has bragged that "even the pharmaceutical industry" is on board.

Doctors? Nope. Obama said in Portsmouth, "We have the American Medical Association on board." The obvious culprit remaining is the health insurance industry. Why, then, don't Obama or the DNC name the insurers, and their lobby, America's Health Insurance Plans, as the "well-financed forces" profiting from the status quo. Is the president just being polite?

More likely the president doesn't want to name the health insurers as enemies because the industry is lobbying for most of the Democrats' plans -- especially the subsidies for private insurance and the proposed mandate that everybody buy insurance. The industry dissents on only one proposal: a government insurance option.

For Obama, a nameless enemy is more useful because it allows people to imagine whatever "well-financed forces" they like as the enemy. It's visceral demagoguery.

Liberals, who see a government option as indispensable, still imagine that Obama is engaged in a death struggle with the insurers -- even though Obama has signaled he's willing to toss the government option overboard. Meanwhile, MSNBC's Rachel Maddow, tying together former House Majority Leader Dick Armey's lobbying for a drug company and his nonprofit group's opposition to Obama's reform, argued on Aug. 7 that the drug companies were the well-financed opponents of reform -- even though they're supporting it.

Obama, in "The Audacity of Hope," described himself as "a blank screen on which people of vastly different political stripes project their own views." Today, through his rhetoric, Obama has created a different blank screen, one on which he invites his allies to project not their hopes but their fears and resentments.

Obama adviser David Axelrod has convinced Obama that attacking the health insurers is good politics. But Obama still won't call them opponents of "reform" because there's a good chance he'll sign off on the insurers' agenda. Then he can claim victory over those dastardly "opponents of reform."

SOURCE




More liberal lies about national health care

By Ann Coulter

12) Only national health care can provide "coverage that will stay with you whether you move, change your job or lose your job" – as Obama said in a New York Times op-ed.

This is obviously a matter of great importance to all Americans, because, with Obama's economic policies, none of us may have jobs by year's end. The only reason you can't keep – or often obtain – health insurance if you move or lose your job now is because of ... government intrusion into the free market.

You will notice that if you move or lose your job, you can obtain car and home insurance, hairdressers, baby sitters, dog walkers, computer technicians, cars, houses, food and every other product and service not heavily regulated by the government. (Although it does become a bit harder to obtain free office supplies.)

Federal tax incentives have created a world in which the vast majority of people get health insurance through their employers. Then to really screw ordinary Americans, the tax code actually punishes people who don't get their health insurance through an employer by denying individuals the tax deduction for health insurance that their employers get.

Meanwhile, state governments must approve the insurers allowed to operate in their states, while mandating a list of services – i.e. every "medical" service with a powerful lobby – which is why Joe and Ruth Zelinsky, both 88, of Paterson, N.J., are both covered in case either one of them ever needs a boob job.

If Democrats really wanted people to be able to purchase health insurance when they move or lose a job as easily as they purchase car insurance and home insurance (or haircuts, dog walkers, cars, food, computers), they could do it in a one-page bill lifting the government controls and allowing interstate commerce in health insurance. This is known as "allowing the free market to operate."

Don't miss the August edition of Whistleblower magazine: "Medical Murder: Why Obamacare could result in the early deaths of millions of baby boomers" Plus, think of all the paper a one-page bill would save! Don't Democrats care about saving the planet anymore? Go green!

13) The "public option" trigger is something other than a national takeover of health care.

Why does the government get to decide when the "trigger" has been met, allowing it to do something terrible to us? Either the government is better at providing goods and services or the free market is – and I believe the historical record is clear on that. Why do liberals get to avoid having that argument simply by invoking "triggers"?

Why not have a "trigger" allowing people to buy medical insurance on the free market when a trigger is met, such as consumers deciding their health insurance is too expensive? Or how about a trigger allowing us to buy health insurance from Utah-based insurers – but only when triggered by our own states requiring all insurance companies to cover marriage counseling, drug rehab and shrinks?

Thinking more broadly, how about triggers for paying taxes? Under my "public option" plan, citizens would not have to pay taxes until a trigger kicks in. For example, 95 percent of the Department of Education's output is useful, or – in the spirit of compromise – at least not actively pernicious.

Also, I think we need triggers for taking over our neighbors' houses. If they don't keep up 95 percent of their lawn – on the basis of our lawn commission's calculations – we get to move in. As with Obama's public option trigger, we (in the role of "government") pay nothing. All expenses with the house would continue to be paid by the neighbor (playing "taxpayer").

To make our housing "public option" even more analogous to Obama's health care "public option," we'll have surly government employees bossing around the neighbors after we evict them and a website for people to report any negative comments the neighbors make about us.

Another great trigger idea: We get to pull Keith Olbermann's hair to see if it's a toupee – but only when triggered by his laughably claiming to have gone to an Ivy League university, rather than the bovine management school he actually attended.

14) National health care will not cover abortions or illegal immigrants.

This appeared in an earlier installment of "Liberal Lies About Health Care," but I keep seeing Democrats like Howard Dean and Rep. Jan Schakowsky on TV angrily shouting that these are despicable lies – which, in itself, constitutes proof that it's all true.

Then why did Democrats vote down amendments that would prohibit coverage for illegals and abortion? (Also, why is Planned Parenthood collecting petition signatures in Manhattan – where they think they have no reason to be sneaky – in support of national health care?)

On July 30 of this year, a House committee voted against a Republican amendment offered by Rep. Nathan Deal that would have required health-care providers to use the Systematic Alien Verification for Entitlements (SAVE) Program to prevent illegal aliens from receiving government health care services. All Republicans and five Democrats voted for it, but 29 Democrats voted against it, killing the amendment.

On the same day, the committee voted 30-29 against an amendment offered by Republican Joe Pitts explicitly stating that government health care would not cover abortions. Zealous abortion supporter Henry Waxman – a walking, breathing argument for abortion if ever there was one – originally voted in favor of the Pitts amendment because that allowed him, in a sleazy parliamentary trick, to bring the amendment up for reconsideration later. Which he did – as soon as he had enough Democrats in the hearing room to safely reject it.

If any liberal sincerely believes that national health care will not cover illegals and abortion, how do they explain the Democrats frantically opposing amendments that would make this explicit?

SOURCE





10 September, 2009

Daughter claims stroke-victim father being systematically killed by British hospital

Recovery from stroke can often be quite good -- even for the elderly -- and the fact that the man can still talk and communicate would seem to be a positive indicator. The whole British system for dealing with the incapacitated elderly is just cost-saving with a flimsy humanitarian cloak on

The daughter of a stroke victim claims that her father is to be wrongly placed on an NHS scheme for the terminally ill which experts say is causing some patients to die too soon. Rosemary Munkenbeck says her father Eric Troake, who entered hospital after suffering a stroke, had fluid and drugs withdrawn and she claims doctors wanted to put him on morphine until he passed away under a scheme for dying patients called the Liverpool Care Pathway (LCP).

Mrs Munkenbeck, 56, from Bracknell, said her father, who previously said he wanted to live until he was 100, has now said he wants to die after being deprived of fluids for five days.

Along with her sister Jocelyn Troake, 60, who lived in Bermuda until recently moving to Frimley, Surrey, to care full time for her father and her mother Edna, 93, they are convinced their father is a victim of the system.

Last week The Daily Telegraph reported a warning from experts that some patients with terminal illnesses were being wrongly put on the NHS scheme and allowed to die prematurely if they ticked “the right boxes". The pathway scheme was developed to improve the care of patients in their dying hours and ensure that they were not being "overmedicalised". The scheme encourages doctors and other health care staff to consider removing medication, fluids and other treatments that no longer benefit the patient. It also recommends discussing the situation with relatives, and if possible, with the patient themselves.

Mrs Munkenbeck said that her father was taken off an intravenous drip last week but she argues that he has as much of a right to life as anyone else. Although a spokesman for Frimley Park Hospital in Surrey says Mr Troake is not on the scheme "at the moment", it is likely he will be offered a plan of care for dying patients.

"We believe that he has been forced down this route. By withdrawing fluids he is now very weak and there's no going back from it," she told The Daily Telegraph yesterday.

Previously she had called on him to be given the treatment to "see if he can survive." "Let his body do his own job with a little bit of help. If it's not possible we don't necessarily expect him to be put on a ventilator," she said. "We don't know that he will die. He might do, he might not, but we feel that's not the doctor's decision to do that."

Mr Troake, a former accountant and Second World War veteran, was admitted to the hospital in June after suffering a stroke. Although Mrs Munkenbeck admits her father is "confused", she argues that is because of the drugs the hospital have given him. When a patient is put on the pathway the medical team looks for signs that they are approaching their final hours, which can include loss of consciousness or difficulty swallowing medication.

But doctors last week warned semi-consciousness and confusion are a side effect of painkillers such as morphine if patients are also dehydrated.

"We've been arguing with them and they don't like it," Mrs Munkenbeck claims. "They say my sister and I are cruel and are trying to hold on to our father. But this man has a right to life. "I just want him protected. He's looking at us and talking to us. He's not suffering from a terminal illness, he just had a stroke. We just feel they decided from the beginning that he's 95 so they've written him off."

A spokesman for Frimley Park Hospital said: "Sometimes, actively treating a patient who is dying can unnecessarily prolong suffering. "The decision to withhold treatment which is prolonging suffering is only taken after careful consideration by a multidisciplinary team of clinicians, in consultation with the family and, when possible, the patient. Care of a patient who is dying would include the continued treatment of symptoms which may be causing them pain or distress.

"Looking after a patient who is dying may include care in accordance with the Liverpool Care Pathway. "The Liverpool Care Pathway allows patients to face dying with as little discomfort and as much dignity as possible while they are given appropriate individualised care."

Palliative care experts including Prof Peter Millard, Emeritus Professor of Geriatrics, University of London and Dr Peter Hargeaves, a consultant in Palliative Medicine, last week warned that the LCP can mask signs that a patient's condition is improving. “Forecasting death is an inexact science,” they wrote. Patients are being diagnosed as being close to death "without regard to the fact that the diagnosis could be wrong. “As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients."

The LCP has been gradually adopted nationwide and more than 300 hospitals, 130 hospitals and 560 care homes in England use the system. Marie Curie, the charity which drew up the pathway, has defended the scheme insisting that it is not about ticking boxes and that it has improved the end of life experience for thousands of people.

SOURCE




British doctor says NHS trust branded him a 'trouble-maker' when he spoke out about cost-cutting

A leading cancer consultant who repeatedly raised concerns about the health and safety of patients at a London hospital will claim today that he was victimised by managers and had his warnings ignored. Ramon Niekrash, 50, a consultant urologist at the Queen Elizabeth Hospital in south-east London, alleges that warnings he made in a series of letters about chronic cost-cutting led to him being branded a "trouble-maker" and excluded from the hospital last year.

In his whistleblowing employment case against the Queen Elizabeth Hospital NHS Trust, Mr Niekrash will tell a tribunal that the reduction of specialist nurses and closure of the specialist urology ward damaged the care of patients.

Mr Niekrash also questioned the hospital's ability to provide a safe service, and made further allegations of widespread bullying of other staff in the Surgical Directorate when the hospital tried to cut costs.

Queen Elizabeth, in Woolwich, reopened in 2002 after a £93m rebuilding scheme funded by a Private Finance Initiative (PFI), but declared itself technically insolvent in 2006 after auditors said it was heading for a deficit of £100m by 2008-09. This year it merged with two other hospitals to form the South London Healthcare NHS Trust.

Ahead of today's employment tribunal hearing in Croydon, Mr Niekrash told The Independent: "I would have been failing in my duty as a doctor if I had not brought the matters of patient care and safety to the attention of trust management. However, as a result of so doing I have suffered the consequences and been perceived as a difficult person and trouble-maker." He added: "I believe I have suffered the consequences of having raised those issues in a trust management system, which put cost savings above the issues of patient care. The issues I raised have still not been resolved and have manifested. I am saddened by the slur that this has caused on my reputation and the perception of me within the trust, which continue to have an impact upon me."

Mr Niekrash, head of urological cancer between January 2002 and November 2007 and president of the South-Eastern Urostomy Association, was responsible for identifying problems and suggesting improvements to the service. From 2005 he wrote letters to the trust's management laying out his concerns about the health and safety of patients. He claims the "vast majority" of these went unanswered, which led him to write further letters to "a wider consultant audience" to bring proper attention to his concerns.

His lawyer, Arpita Dutt, of employment law firm Russell Jones & Walker, said her client had been victimised for acting in the public interest. She said: "The NHS's stance on whistleblowing is clear, but if someone at such a senior level can be treated like this, what message does that send to other employees with concerns to raise? "The decision to exclude Mr Niekrash was high-handed and unjustified, and has had an ongoing adverse impact on his reputation, practice and his health. Like many similar whistleblowing claims, the focus of attention was on the messenger rather than the important and unambiguous message being conveyed."

A spokesman for the hospital said the trust would fight the case: "He [Mr Niekrash] makes a number of claims against the Queen Elizabeth Hospital... the trust denies all the claims and will contest them robustly." [Leftists are good at denial]

SOURCE




British Engineer Left Blind for Three Years Awaiting 20-Minute Operation

From the National Center for Public Policy Research's new book, "Shattered Lives: 100 Victims of Government Health Care", authored by Amy Ridenour and Ryan Balis:

According to Britain’s state-managed health service, cataract surgery is a “common” and “straightforward” operation that usually should last between 15 and 20 minutes. But such a quick turnaround would have been news to Richard Adams of London, who went blind in both eyes while waiting three years for cataract surgery.

The 85-year-old retired engineer and award-winning dancer began losing his vision in 2004. That year, doctors diagnosed Adams with cataracts, but an operation to remove them was not scheduled until March 2007. His excitement in 2007 at the prospect of getting his sight and livelihood back was short-lived because doctors cancelled the surgery. “I was over the moon when I found out I had an appointment in March [2007] but when it was cancelled I just went downhill,” Adams said at the time.

Stuck in a wheelchair and suffering from asthma as well as kidney stones (also left untreated by the NHS, he said), Adams had difficulty performing everyday tasks. “I never cook anything,” Adams explained then. “It always has to be cold things like sandwiches or salad. I can’t go to the shops because I can’t see where I’m going.”

In despair, Adams said his life was “being wasted”: “I have all these ideas in my head but I can’t see to write and I can’t see to draw. All I can do is sit in my house and listen to the TV. I can’t see it and I have to turn up the volume because I can’t hear well.”

Spokesman Mark Purcell of Ealing Hospital, one of several hospitals that refused Adams treatment for his eyes, offered no sympathy. “If [Adams] has a complaint about the standard of care he has received he should write to the chief executive of the Ealing Hospital Trust.” (Whether this bureaucratic solution, which asked a blind man to write, was intentionally or inadvertently cruel is unknown.)

Adams was scheduled to receive treatment in late May, but this was little consolation for him. “I’ve been waiting for three years but they don’t seem to care. I think they’re just waiting for me to die or something,” Adams complained.

Finally, after Adams’ plight received attention from the British press, doctors removed the cataracts in one of his eyes in June 2007. “He was really pleased with the result of the operation,” said Roger Woolsey, a family friend. “When I went to visit him he would raise the eye-patch and say: I really can see again.”

Tragically, four days after the procedure that restored his sight, Adams died. He had a heart attack after developing blood poisoning in the hospital.

SOURCE




Australia: More government medical madness

New immigration regulations forcing top US surgeon out -- but publicity seems to have produced some backpedalling. Mackay hospital has had big problems. They badly need all the expertise they can get. A system that takes expertise away from them is insane.



A WORLD-famous US surgeon pulled out of retirement to fill in at a regional hospital for 12 years has been forced to sell his house and abandon Australia in an "appalling" visa bungle. Dr Frank Trost, 77, a globally recognised orthopedic surgeon, has been locked in a bitter six-month wrangle over his visa status amid new restrictions on foreign-trained doctors. Yet, despite the dire shortage of doctors in regional hospitals, Queensland Health and the Immigration Department have refused to budge.

"I feel badly used," Dr Trost said yesterday. "If I'd not gone back to work, I'd be happily retired and still living the dream. We don't want to go. This is our home. But we have no choice."

Fellow surgeons, locals and patients are outraged at the "appalling" treatment of the specialist, who will be forced to return to the US. "He has been used and abused," said Dr Don Pitchford, chairman of the International Medical Graduates Committee. "They took their pound of flesh, now they've kicked him in the guts, tossed him on the scrapheap, and told him, 'You're too old, get out of the country'. It is a disgrace."

Dr Pitchford, director of orthopedics at Gold Coast Hospital, said one solution would be to give Dr Trost an honorary medical fellowship, or to simply give him back his original retirement visa. "If this is the sort of citizen we are kicking out, we should all hang our heads in shame," he said.

Dr Trost and his wife Nancy came to Australia from the US on a retirement visa in 1996 to live by the beach in Mackay. But once word got out of his international stature as a surgeon and expert in amputations, he was asked to join the understaffed Mackay Base Hospital. Then at 65, he did so, sharing his skills and knowledge, administrating his department for more than a decade after stopping surgery because of age restrictions. Dr Trost had the added comfort of a personal letter from the then federal immigration minister reassuring him he would be allowed to go back on to his retirement visa once he finished work.

"I didn't come here to get a job," said Dr Trost, who is now on a temporary 457 work visa. "But when duty called, I felt I had a responsibility to help my fellow man. It has been nerve-racking, very stressful and strenuous, being in limbo for so long." Dr Frost said he and his wife could not get permanent residency because of new rules against foreign-trained doctors over the age of 45.

Two weeks ago, the couple sold their beachside home and are "mentally packing" to leave to start a new life near San Diego, California. He is today in his last week of work at Mackay Base Hospital after resigning in protest over a series of conditions imposed on his work. One included sitting a multiple-choice Australian Medical Council exam this month before spending two years in the wards as an intern, he said.

Mackay Mayor Col Meng said he sympathised with the highly respected medico. "He's 77 years old, they've been using him, but it shows you've got to play by the rules," he said.

An Immigration Department spokesman confirmed the couple's status was in limbo. "He's not being kicked out. No decision has been made," the spokesman said. "We've been in touch with him, we're still processing it." Mackay Health District chief executive Kerry McGovern said Queensland Health had no control over visa conditions. "The responsibility for meeting those requirements rests with the doctor, not the employer," he said. [They really sound as if they care, don't they? They are one of Australia's most malign bureaucracies]

SOURCE




Barack Obama's battle to save his blurry vision of US health care reform

Democrats are mounting a last-ditch attempt to broker a bipartisan deal to reform America's health care system as Barack Obama prepares to address Congress. The speech to Congress is seen as so important that it could make or break his presidency. With Mr Obama's poll numbers slipping and public support for his health care overhaul eroding almost by the day, Senator Max Baucus, a fellow Democrat, drew up a compromise plan designed to appeal to centrists across the political divide.

Republicans have vigorously opposed a mooted extra tax burden on highers earners to pay for medical insurance for the poor. Under the new plan, non-profit co-operatives would be set up to compete with private health insurance companies. This would replace the idea of introducing a so-called "public option" of government-run insurance, which is favoured by liberals.

The Baucus plan would cost about $900 billion (£550 billion) over 10 years - $100 billion less that the $1 trillion price tag on a previous House of Representatives proposal. This would partly be achieved by raising $180 billion from taxing insurance companies that offer the most expensive packages.

All insurance companies would be charged an additional fee according to their market share. This is intended to help pay for the reform and exact a price from insurers, who stand to gain 46 million new customers - those who are currently uninsured. Mr Baucus said that the plan was not a final one and that he hoped a deal might be reached before Mr Obama speaks to a joint session of Congress on Wednesday.

Mr Obama is following in the footsteps of President Bill Clinton, who addressed Congress in 1993 with a plea for health care reform to be passed. Although public support for his plan increased, he was ultimately unsuccessful.

Acutely aware of the mistakes Mr Clinton made, Mr Obama decided to let Congress draft legislation rather than drawing up a White House bill, as Mr Clinton did. But that has led to a sense of drift with voters not sure exactly what Mr Obama supports. Mr Obama's aides have indicated that the "public option" idea will be dropped after it became clear it was too politically contentious among the public, Republicans and conservative Democrats.

Mr Baucus's Senate Finance Committee has so far been unable to agree on legislation and he is attempting to woo three Republican senators who might be convinced. If a deal is not reached, the Senate Finance Committee could be bypassed.

Senator Chuck Grassley, one of the Republicans being courted, told CNN that the Obama administration had been "all over the ballpark" on the health issue before Congress's summer recess and that he still wanted to find a bipartisan consensus. Asked about the prospects of the Baucus plan being agreed, he replied: "We won't know until we meet. The good and the bad of the president speaking this week is we've had to speed up the work of our group to have something better ... and that's bad because we probably should have taken a little more time." He added that he was concerned that any fee charged to insurance companies would end up getting passed on to other customers but was in favour of non-profit health care co-operatives.

SOURCE




Senate leader suggests fee on health insurers

Senator Max Baucus yesterday pushed a new health care plan including an insurance industry fee to help pay for covering the uninsured, and President Obama said insurance companies must share accountability for the troubled system.

In a Labor Day speech in Cincinnati yesterday, Obama said a health insurance system should work as well for all Americans as it does for the insurance industry. “They should be free to make a profit. But they also have to be fair. They also have to be accountable,’’ the president said. “That’s what we’re talking about - security and stability for folks who have health insurance, help for those who don’t, coverage they need at a price they can afford, finally bringing costs under control - that’s the reform that’s needed.’’ [Sounds like it's a magic wand that's needed]

Baucus is part of a six-member bipartisan group trying to craft a bill satisfactory to both parties. The group is set to meet today as Congress returns from its August recess. The plan proposed by Baucus is designed to create competition in the insurance market. Insurers would be required to release the administrative costs included in premiums, as well as profits, so customers would know whether they were getting a fair deal at a good price.

It’s unclear whether the plan would win support of two key Republicans in the group: Chuck Grassley of Iowa and Mike Enzi of Wyoming. The Baucus proposal reflects many of their priorities, chief among them the decision not to include a government-run plan to compete with private insurers.

Democratic sources close to the negotiations, who were not authorized to be quoted by name, disclosed the fee and other details of the Baucus proposal. One source said the proposal included suggestions from all six members.

The fee is only a piece of a Baucus proposal that would establish a new way to purchase coverage for Americans who have trouble getting and keeping health insurance. Americans could keep their own doctors.

White House press secretary Robert Gibbs, accompanying Obama in Ohio yesterday, told reporters the administration would be pleased if the Finance Committee would “pull together the strands of many different pieces of legislation to improve health care for all Americans.’’

Under the Baucus plan, health insurance exchanges, with information on different plans and prices, would allow small groups and individuals to buy policies at lower rates. Medicaid would be expanded to cover more low-income people. Nonprofit cooperatives would be established as an alternative to for-profit insurance companies, giving consumers more choices. Tax credits would allow low- and middle-income Americans to buy private coverage. The package would cost under $900 billion over 10 years.

One Democratic source said the proposal was not final. Finance Committee members were encouraged to suggest modifications, although Baucus advised senators that any proposals that would increase costs should include provisions to offset them. If insurance companies passed the new fee along to customers, they would run the risk of losing out in a newly competitive environment, a source said.

Obama is getting no shortage of advice on what to say in his health care speech to Congress, and much of it conflicts. Liberals want him to issue a call to action - clear and bold. Conservatives hope he’ll back away from his push for sweeping changes this year and break health care legislation into smaller pieces.

More here





9 September, 2009

Thousands of critically ill patients leave British hospitals because of bed shortage

Almost 2,000 critically ill patients were discharged early from NHS intensive care units last year because of a shortage of beds, the Conservatives have claimed. Data from eight out of ten hospital trusts in England suggests that a further 20,000 patients had their discharge from intensive care delayed because there were no suitable beds in other wards to which they could be transferred.

On average, hospitals had all their intensive care beds full for almost one third of the year in 2008, the responses to questions under the Freedom of Information Act show. About 1,000 patients had to be transferred to other hospitals to get an intensive care bed, while double that number were discharged early to make room for other patients.

The Conservatives said that the findings raised concerns about how hospitals would cope with predicted demand because of swine flu and related complications this winter.

A study published in the journal Anaesthesia in July warned that hospitals across England could face shortages of crucial intensive care beds because of swine flu, especially for children. The researchers, from the University of Cambridge, the Intensive Care Society and St George’s Hospital, Tooting, found that demand for beds and ventilators at the peak of a pandemic could be 60 per cent above the number available across England. Demand would outstrip supply by 130 per cent in at least one region, the South East — but London and other areas might cope better, the researchers said.

The Government has said that it can cancel non-emergency operations to increase the overall number of beds available, but the study said that even this would not meet demand. The Department of Health said there were 364 intensive care beds for children in England and 3,637 for adults.

The Tories’ research found that hospitals had at least one of their intensive care beds closed because of a lack of staff for 25 days on average in 2008. Andrew Lansley, the Shadow Health Secretary, commented: “Over the past five years we have consistently pushed the Government to make sure the UK was ready, should a flu pandemic occur. In many areas, the UK is among the best prepared in the world, but there are some issues on which the Government has not taken action — and one of these is critical-care capacity in the NHS. “It is worrying that we have far fewer beds to treat the most critically ill patients than almost any other developed country. If the second wave of swine flu occurs when schools return, as is being predicted, this could cause real problems in the traditional flu season in the autumn.

“The Government urgently needs to review its plans in order to help the NHS provide extra beds to deal with the pandemic and ease the pressure on intensive care units. It should look at how more staff can be trained in ventilatory support and the idea of rest centres to care for patients who can’t look after themselves at home.”

SOURCE




British restrictions on prescription of osteoporosis drugs 'defy belief', says leading doctor

Thousands of women are being denied better osteoporosis drugs because of unnecessarily restrictive Government guidelines, a doctor said last night. Professor David Reid, an expert on brittle bones, said the rules are so stringent that GPs are often prevented from giving alternative treatments to those suffering side-effects from their pills.

A once-a-year jab that could save thousands from the misery of broken bones is also not going to be assessed for use on the NHS in England and Wales for at least three years, despite being available in Scotland. It means that sufferers are being denied drugs that could have a major impact on their health and their quality of life. The news will reignite the debate about the evaluation system used by drugs rationing body the National Institute for Health and Clinical Excellence. NICE has previously been criticised for banning or restricting breakthrough medicines for conditions such as breast cancer and Alzheimer's.

Mr Reid, of Aberdeen University, told the British Science Festival that the NICE guidelines on the disease were 'unnecessarily restrictive'. Up to a quarter of patients taking the first-choice drug, the £50-a-year alendronic acid, will be troubled by indigestion, with some experiencing crippling stomach pain. But under guidelines, sufferers may have to wait up to five years for their condition to deteriorate before being put on more expensive treatments with fewer side-effects.

Mr Reid said: 'The guidelines indicate that a lady can have alendronic acid at a certain level of risk. 'If that person doesn't tolerate the drug and goes back to their GP, the GP might ha