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



28 February, 2010

Those wicked ophthalmologists

The political Left worldwide seems to regard everyone but themselves as responsible for high medical costs. The vast load of paperwork that they impose on healthcare providers and drug companies is costless, apparently. And the high incomes of some doctors frequently come under jealous scrutiny.

A high income group in Australia is ophthalmologists. Everyone wants the very best chance of preserving their vision so people are prepared to pay for a high level of care in eye-doctoring. And Australia's Federal Health Minister, Nicola Roxon, was determined to rein those rogue eye-doctors in.

As part of its socialized medicine system, called "Medicare", the Australian government pays a large part of the cost of privately-contracted ophthalmological services, so Ms Roxon thought she had a good weapon to cut those rich eye-doctors down to size: She would halve the amount that her government pays for such services.

The conservatives in the Senate knocked back Ms Roxon's "reforms" however, so she eventually had to accept a compromise deal which cut the government payment by only 12%.

As it happens, all this affects me personally to a minor extent: I will shortly be having a cataract procedure on my right eye from a well established and formidably equipped private ophthalmological practice a short drive from where in live in Brisbane. So my ophthalmologist explained the cost structure to me.

The cost now includes a "facility fee" -- a fee for use of a private operating theatre that is common for most types of private medical procedures. I pay a similar fee when I go to my dermatologist to have skin cancers excised. The opthalmologist remarked to me that they used not to charge such a fee. They used to absorb it into their general fees. But after Ms Roxon's "reforms", they have instituted such a fee.

So the income of the ophthalmologists remains largely the same. Ms Roxon's attack on them has been futile. What they lost on the swings, they gained on the roundabouts.

But what about the patients? Here's the catch: Facility fees do NOT attract any government refund. So the patient pays more. The government has indeed saved itself a bit of money, but at the expense of the patients, not at the expense of the doctors: A typical "unforeseen" result of Leftist intervention.




Ailing Health Care

Make no mistake: If President Barack Obama actually wanted to be the post-partisan agent of Washington change, his health-care summit would have looked a whole lot different than the meeting he recently held across the street from the White House. Every Republican, from House Minority Leader John Boehner to maverick John McCain (the latter facing primary challenger from the right, by the way) walked into the meeting imploring the White House to start over, to begin again, to hit the reset button. If the president wanted to work with them in any way, he would have done just that.

Instead the president continues to argue -- aided by media folks from near everyone on MSNBC to even Bill O'Reilly on the supposedly all-right Fox News Channel -- that the American people just don't understand what his health-care plan is all about. In one sense, I agree with him. Given the fact that even the Congressional Budget Office said it didn't have enough details to do a proper examination of the latest version of the legislation in time for the official summit, the man has a point. But it's not voters' slowness that's the problem; it's the White House with the issues.

If the president were serious about being a different kind of leader, he would have invited governors at the White House summit on health care, as Republican politicians requested.

Instead of dismissing criticisms as he has been doing for the better part of a year now in this and other debates, President Obama should have considered what Republicans had to say. One of the best lines of the summit was: "If you're waiting for Mitch McConnell to roll in here a wheelbarrow full of a 2,700-page comprehensive health-care bill, that's not going to happen," delivered by Republican Sen. Lamar Alexander. He continued, "We've watched the comprehensive, economy-wide, cap and trade. We've watched the comprehensive immigration bill ... we've watched the comprehensive health-care bill. And they fall of their own weight."

That's a message that Washington can afford to hear. That's a message that gets back to constitutional principles of federalism. And, frankly, that's a manageable message.

As Paul Ryan, a congressman from Wisconsin, whose attention to detail is such that even the president has trouble dismissing him, explained, "We don't really believe the government should be in control of all this." Pointing to what he and others have been hearing from Americans -- in town halls since the summer and perhaps most recently in the Massachusetts special election, Ryan said to the president: "I would respectfully submit: You're not listening to them."

Not listening isn't exactly the "hope and change" people signed up for. The president of the United States is a liberal ideologue who isn't comfortable telling you the straight facts. And he ridicules those who try to highlight the truth. Without a penchant for honesty -- or even a slight openness to it -- it's just about all he's left with.

On perhaps no issue is this more obvious than abortion. And it's been so with President Obama since before he was inaugurated. During the campaign, he falsified his position and called those who talked about his record in the Illinois statehouse liars. He continues to do just that. Late last year, he audaciously accused the Catholic bishops of the United States and others who criticized various versions of the health-care legislation for providing federal dollars for abortions of "bearing false witness" on the issue. And, after refusing to invite pro-life Rep. Bart Stupak, a Democrat, to the summit, when Rep. Boehner brought the issue of abortion up, the president of the United States simply ignored the minority leader. He apparently didn't believe that an issue that threatens the consciences of millions of Americans deserved a simple explanation from the White House.

A Quinnipiac poll last year found that 72 percent of voters oppose federal funding of abortion. A recent CBS poll found that half those surveyed didn't approve of the president's job on health care.

There's something to what Rep. Ryan said. And President Obama knows it or he wouldn't be trying so hard to gloss over what he's doing, and to dismiss criticisms. His options right now are to force some plan through Congress or walk away, blaming the "party of no" for killing his health-care hopes. But his own health-care summit is already on YouTube and provides ample fodder to counter his party's obstructionist Republicans. His opposition proved themselves anything but the troglodytes "Hardball" would have them portrayed as.

And if the president does manage to get enough Democrats to go along with his politically suicidal gambit, good luck explaining why the impractical plan is not the panacea it was supposed to be. And then the American people will understand things all too well.

SOURCE




Someone Needs to Tell the President His Health Care Plan is Dead

The day before yesterday’s White House health care summit, Sen. Kent Conrad (D-ND) told reporters: “The only way this works is for the House to pass the Senate bill and then, depending on what the package is, the reconciliation provision that moves first through the House and then comes here.” When Conrad was reminded that Speaker Nancy Pelosi (D-CA) has repeatedly insisted that the House will not pass the Senate bill until the Senate passes a second bill that fixes the first, Conrad replied: “Fine, then it’s dead.”

This was the dynamic that President Barack Obama was trying to alter with his eventually-seven-hour meeting. And judging by pretty much every major news outlet, he completely failed. Rep. Jason Altmire (D-PA), who is one of the 39 House Democrats that the White House needs to switch from a “no” the first time around to a “yes” this time, told The New York Times: “I don’t see very many at all who voted no who are going to switch their votes unless there are substantial changes in the bill.”

And that reality is already spreading throughout Capitol Hill. Politico reports that while Democrats were hoping to pass Obamacare by Easter, “there were signs Thursday night that the schedule was slipping. One Democratic lawmaker involved in the negotiations, who asked not to be identified to speak candidly of the process, said the party would not, in fact, start down the path of reconciliation next week.”

That is some rare great news for the American people. As Rep. Paul Ryan (R-WI) ably explained yesterday, Americans do not want Washington dictating their health care decisions to them, and that is exactly what Obamacare would do:

The difference is this: We don’t think all the answers lie in Washington regulating all of this. … if the National Restaurant Association or the National Federation of Independent Business, on behalf of their members, wants to set up an association health plan, we think they’ll probably do a good job on behalf of their members. Let them decide to do that instead of restricting insurance competition by federalizing the regulation of insurance, and by mandating exactly how it will work, you make it more expensive and you reduce the competition among insurers for people’s business. We want to decentralize the system, give more power to small businesses, more power to individuals, and make insurers compete more. But if you federalize it and standardize it and mandate it, you do not achieve that. And that’s the big difference we have.

President Obama bristled at this analysis, responding: “Can I just say that, at this point, any time that a question is phrased as, “Does Washington know better,” I think we’re kind of tipping the scales a little bit there since we all know that everybody is angry at Washington right now.”

The President seems to understand that the American people do not want bureaucrats in Washington controlling their health care decisions, but then he seems completely oblivious to the fact that increasing bureaucratic control at the expense of every American’s ability to make their own choices is exactly what his plan does.

The American people know this. That is why support for the President’s health care plan has been steadily declining. That is why the most recent CBS News/New York Times Poll shows 53% of Americans say the United States cannot afford to fix health care at this time. It is why 52% of Americans tell Gallup they do not want to see Obamacare pass with only 50 Senators in support (Vice President Joe Biden casting the 51st vote). That is why 59% of registered voters tell Fox News they want the President to start over.

And he should. If the President truly wants to enact historic bipartisan and lasting health care reform, he needs to admit this version of Obamacare is dead. In 2011, when there is likely to be a more centrist Congress in place, then Obama should come back and start again.

SOURCE




The Democrats' Problem

The Democrats did themselves no favors yesterday. The President did plenty to diminish himself. First, there was his lack of grace-- announcing,"I'm the President!," his testy reminder to John McCain about who won the election (reminiscent of his "I won" triumphalism immediately after inauguration), most notably -- and his penchant for scolding everyone was on display. Can anyone even imagine the really great presidents behaving this way? Can you imagine Ronald Reagan, or FDR (or even JFK or George HW Bush or George W Bush) hectoring, lecturing and condescending so brazenly?

Then there was the President's demonstrated inaccuracy about the fact that, contrary to his claims, his health care plan won't bring down health insurance premiums. So much for the brilliant policy wonk. Either he's dishonest, or he's wrong.

But the President's main problem -- and that of the Democrats generally -- is that it's clear it's not about America and its people anymore. It's about them. And that's political death.

When it comes to the President, it's clear that he wants his bill to pass so that he can have his way, and claim a big achievement, and vindicate his boasting about being the last president to have to tackle health care. And, of course, grow the size of government. It no longer has anything to do with actually solving a problem, or helping people, or reform. It's all about him. And it shows.

When it comes to the rest of the Democrats, they're in a similar boat. No one can claim that they're simply trying to respond to the cries for reform from the electorate. The electorate hates this bill. What seems most apparent is that they're trying to save their own skins, politically (there wouldn't be such a need for all the sob stories, otherwise -- that's called "overcompensation").

The President and the Democrats can try to claim they're doing this to "help" Americans. But voters apparently don't want this kind of "help." So it's patently obvious this is no longer about representing Americans or doing the will of the people.

It's about an out-of-control effort by the Democrats to impose their will on Americans, contrary to the people's expressed wishes. Americans know it, and they know it isn't about them -- they're seen by Dems as nothing but a stumbling block, at this point! -- and that's why there isn't any easy way for the Democrats to improve their political position.

SOURCE




ALG Blasts Obama for “Lying about the Increased Cost of Premiums” under Plan at Health Summit

Americans for Limited Government President Bill Wilson today condemned the Obama Administration for “lying about the increased cost of insurance premiums as reported by the Congressional Budget Office at his fraudulent ‘bipartisan’ health takeover summit.”

“Yesterday, Barack Obama flat out lied to the American people, claiming that his plan would, according to CBO, lower the cost of insurance premiums,” Wilson said.

Wilson pointed to the relevant Congressional Budget Office (CBO) report, which stated, “CBO and JCT estimate that the average premium per person covered (including dependents) for new nongroup policies would be about 10 percent to 13 percent higher in 2016 than the average premium for nongroup coverage in that same year under current law… Average premiums per policy in the nongroup market in 2016 would be roughly $5,800 for single policies and $15,200 for family policies under the proposal, compared with roughly $5,500 for single policies and $13,100 for family policies under current law.”

The CBO also reported, “About half of those enrollees would receive government subsidies that would reduce their costs well below the premiums that would be charged for such policies under current law,” which formed the basis of Obama’s claim, responding to Senator Lamar Alexander (R-TN), stating, “Lamar, when you mentioned earlier that you said premiums go up, that's just not the case, according to the Congressional Budget Office.”

Wilson said Obama was “misleading the American people. This is not a case where Obama and Alexander were ‘both right.’ Obama was wrong.”

Wilson explained, “Subsidizing premiums does not lower the cost of health care, it shifts the burden of the price of health coverage increasingly to taxpayers. At the same time, ObamaCare increases the minimum requirements for insurance coverage, which forces premiums up, as noted by the CBO.”

More here




Australia: Casualty department (emergency room) shutdowns in an already overstretched Sydney hospital system

Government logic at work

MOST seriously injured accident victims in the city and eastern suburbs will no longer be taken to St Vincent's or Prince of Wales hospitals under a new trauma plan. They will be forced to travel across town to either Royal Prince Alfred in Camperdown or St George Hospital in Kogarah. NSW Health has quietly released its trauma services plan after 10 years of wrangling among doctors. Under the plan, due to start on Monday, all major trauma patients will be diverted from Nepean to Westmead Hospital.

There are concerns about the ability of RPA, St George and Westmead to take on the hundreds of extra patients. RPA is expected to be most seriously affected as it and St George will need to absorb more than 400 extra patients a year.

The NSW chairman of the Australasian College for Emergency Medicine, Richard Paoloni, said RPA already had the highest level of ambulance arrivals in Sydney and the plan would increase pressure on emergency beds.

The Health Services Union, which represents paramedics, is concerned about increased "trolley block" - where patients are banked up waiting to get into emergency - as well as increased travel times to RPA and Westmead.

Although Nepean will still take trauma patients, the most serious will go directly to Westmead, which will increase the patient load by more than 200 this year. Westmead is already struggling to see its emergency patients on time. The latest performance figures show it is failing to meet benchmarks in three of the five triage categories and has the worst record in the state for admitting patients within eight hours - 63 per cent of patients, well below the benchmark of 80 per cent.

RPA is also failing to see all its emergency patients on time, and is not meeting benchmarks for two of the five triage categories. The Garling inquiry recommended just three adult trauma centres in Sydney.

Richard Matthews, the deputy director-general for strategic development for NSW Health, said the changes would strengthen hospital trauma systems and paramedics would still have the power to exercise their best clinical judgment. "If someone is stabbed seriously on the street outside St Vincent's the ambos will take them into the emergency department there. In the end, they've got the responsibility of making the clinical decision about what's best for the patient," Dr Matthews said. He said the hospitals affected had received extra funding but did not say how much.

SOURCE





27 February, 2010

Stopping Obamacare in the House

It seems very likely that if Obamacare is going to be stopped, it will have to happen in the House. And that means turning some of supporters the deeply unpopular bill into opponents with at least enough spine to tell Nancy Pelosi and the president "No."

Thus the two lists below. The first list is of all the so-called "Blue Dogs," the alleged "moderate Democrats" in the House. Many refused to vote for Obamacare the first time around, and they need to be bucked up and made to understand that their hopes of re-election depend upon continuing to stand against the government takeover of American health care and the massive cuts to Medicare on which the takeover is premised.

The second list are the Democrats who voted for the bill in the fall but who hail from swing districts. These are the House members identified by the National Republican Congressional Committee's ReverseTheVote.org effort. The last thing they want are phone calls and e-mails from voters pledging to throw time and money at their opponents if Obamacare passes.

The Congressional switchboard works for them all --202-225-3121, but direct calls to their offices and especially their district offices are even more effective. E-mails work as well, but many of their number won't accept e-mails unless a district zip code is used, which means a little work for the dedicated anti-Obamacare activist. (Just use the zip code of their district office address if you want to communicate despite their filter.)

What matters is a wall of calls between now and the last-ditch effort to push the bill through. Some of the pro-life Demcrats led by Bart Stupak will stay strong and refuse to support the Senate bill with its public funding of abortion, but some will fold. Perhaps a Member or two will vote no as well because there is no "public option" by that name and they realize if they don't get it now they'll never get it.

But it will be a very close thing either way. Never have your calls and e-mails mattered more.

More here




Climbing the Health Summit

Yesterday, the long-awaited health care takeover summit at the White House took place, and it was not as was expected nor advertised. It was supposed to be a trap. Congressional Republicans were supposed to “compromise,” laying the groundwork for the government takeover of the nation’s entire health care system once and for all.

Only, they did not lie down. Indeed, they were well-prepared and their arguments were highly effective against ObamaCare on just about every point, even though Democrats spoke for 233 minutes compared to the GOP’s 110 minutes, according to the Senate Republican Conference. Barack Obama alone spoke for 119 minutes, which he studiously ignored as not counting towards the Democrats’ time. Said Obama, “I don't count my time because I'm the President.”

Leaving Obama’s arrogance aside, Republicans made the most of their time in the summit, and outside of it. Congressional Republicans’ messaging machine was firing on all cylinders throughout the day. They deployed a rapid response fact-checking barrage of press releases, which ALG News chronicled at its news aggregator, Washington News Alert. Everything from Obama lying about CBO’s report, which does state that ObamaCare would raise premiums; to Reid lying about the Democrat threat of reconciliation.

Congressional Democrats, on the other hand, apparently were not so concerned about getting rapid reponses out to the media at all. By design, it appears, they put all their stock on the summit selling itself, or perhaps the media promoting it for them. The truth is, their silence was telling.

Republicans, on the other hand, climbed the summit. And they came out on top. Within an hour of the summit’s opening remarks, it was clear that skeptics who thought Republicans should have sat it out were wrong. Republicans need not have walked away from this challenge. For, they hit the ground running.

Senator Lamar Alexander in the Republican opening statement made the point, quite effectively, that the summit was effectively pointless if Congressional Democrats refused to take the reconciliation threat off the table.

Said Alexander, “my request is this: before we go further today, that the Democratic Congressional leaders and you, Mr. President, renounce this idea of going back to the Congress and jamming your bill through on a partisan vote through a little-used process we call reconciliation.”

Continued Alexander, “You can say that this process has been used before, and that would be right, but it’s never been used for anything like this. It’s not appropriate to use to rewrite the rules for 17 percent of the economy. Senator Byrd, who is the constitutional historian of the Senate, has said that it would be an outrage to run the health care bill through the Senate like a freight train with this process. The Senate is the only place where the rights to the minority are protected, and sometimes, as Senator Byrd has said, the minority can be right.” Indeed.

Instead, Congressional Democrats left reconciliation — a process reserved for minor budget fixes — right there on the table as the summit continued unabated. Everything Republicans, and more importantly, the American people needed to know about the spirit of “bipartisanship” in Washington took place in those first minutes. And the meeting followed suit.

For Obama, the summit was a failure. And it failed precisely because Democrats refused to take the loaded gun off of the table. Instead, Republicans refused to simply bow to the will of Obama and his party. Republicans could have very easily just filed out of the room at that very moment, and just as much would have been substantively produced legislatively by the summit.

But, if they had just walked out then and there, or if they had not attended at all, a great opportunity would have been missed to set the record straight, which is exactly what they did. On point after point.

Obama and the Democrats may have thought they were laying a trap, but instead, it is they who have been hoisted by their own petards. So, Americans for Limited Government would like to say bravo to Congressional Republicans for standing up for the American people. They thank you.

On a bright note, reconciliation may have been an exaggerated threat all along, as reported by RedState’s Dan Perrin. Apparently, the votes may not be present in the House to pass a reconciliation bill. Why?

Senator Kent Conrad said, “I don’t know of any way where you can have a reconciliation bill pass before the bill that it is meant to reconcile passes.” Only, that is exactly what Democrats’ plan is in the House: pass the reconciliation bill first, then have that pass in the Senate, and only then would the House pass the Senate bill. Obama would then sign the Senate bill first, and the “reconciled” bill second, amending the Senate bill.

But, if a serious point of order can be raised, as it surely would, that the rule can only be applied to standing law and, importantly, that was enforced by Congress’ parliamentarian, House Democrats would be left with but one choice to enact their health takeover: vote on the Senate bill first. Except, they do not have the votes to do that.

Reports Politico, “When reminded that House Democrats don’t want to do health care in that order, Conrad said bluntly: ‘Fine, then it’s dead.’” One can only hope, Obama’s attempt at resurrecting his bill yesterday notwithstanding. Even if he ultimately succeeds at passing this monstrosity, at least the American people have a political party that fought for them, even when the cards were stacked against them.

SOURCE




After Health Debate, Obama Threatens Dem-Only Strategy

Thursday's bipartisan health care summit seemed less like an opportunity to reach across the aisle than an opening salvo in the last big battle over health care reform before the November elections. While the president and lawmakers attempted substantive policy discussions, that could not hide bitter partisan divisions.

In his opening remarks, Sen. Lamar Alexander, R-Tenn., addressed Obama on one of the issues that most irritates the GOP: "My request is before we go further today, that the Democratic Congressional leaders and you, Mr. President, renounce this idea of jamming through on a partisan vote, through a little used process known as 'reconciliation,' your version of the bill." Reconciliation is a process that takes only 51 votes to pass the Senate, instead of the 60 needed to end debate on nonbudget bills. The House would have to pass the Senate health care bill, then OK a subsequent "reconciliation" measure that altered the Senate plan.

Alexander's plea did not sit well with Senate Majority Leader Harry Reid, D-Nev. "No one has said — I read what the president has online — no one has talked about reconciliation, but that's what you folks have talked about, ever since that came out, as if it's something that has never been done before," said Reid. "Of course, reconciliation is not the only way out of this. But since 1981 reconciliation has been used 21 times, most of it by Republicans, for major things. Like the Contract for America, Medicare reform, the tax cuts for rich people."

Right-leaning blogs jumped on Reid's comments, pointing out that he said just last week Democrats were willing to use reconciliation.

Sen. Majority Whip Dick Durbin, D-Ill., said earlier in the week that Democrats were willing to move without Republicans. During the summit's break, Durbin was asked if a bipartisan deal was possible. "It's a long shot (but) it's possible," he said, "If nothing comes of this we're going to press forward. We just can't quit. This is a once in a political lifetime opportunity to deal with a health care system that is really unsustainable."

A Gallup poll released Thursday showed the public opposed to reconciliation, 52%-39%. A CNN/Opinion Research poll found just 25% support a bill similar to the one working its way through Congress; 48% say start from scratch and 25% say just stop working on health care.

Whether Congress will have the votes for reconciliation is unclear. IBD contacted the offices of two dozen moderate Democrats who voted for the House health bill in November to see if they supported reconciliation. Most declined to respond. Those who did were decidedly ambivalent. "He hopes that we can find a bipartisan way and that is his focus," said Brenden Timpe, spokesman for Rep. Earl Pomeroy, D-N.D. Asked what his boss might do if the reconciliation strategy were tried anyway, he replied: "I don't know. I haven't had a conversation with the congressman on that."

Abigail Gardner, spokeswoman for Rep. Dan Maffei, D-N.Y., couldn't pin her boss down on the issue either. She hadn't heard him say "one way or another if he is personally in favor of it or whether it would change his vote."

Rep. Kathy Dahlkemper, D-Pa., apparently isn't sure what she will do either. "Until we know it is the strategy, it is really just a hypothetical and I cannot comment on that," said spokeswoman Marie Francis.

Meanwhile, Rep. Bart Stupak, D-Mich., and a dozen or so Democrats object to the Senate health bill's abortion language. So Speaker Nancy Pelosi, D-Calif., likely will need Blue Dog moderates who voted "no" on the House bill to switch to yes. Reconciliation could give them another reason — or excuse — not to put themselves on the political chopping block.

House Majority Leader Steny Hoyer, D-Md., seemed to reflect the wobbly status of his caucus when he told reporters Tuesday that Democrats may have to break a big bill up and pass small parts instead. "We may not be able to do it all," he said.

At the halfway point of the summit, Rep. Tom Price, R-Ga., chairman of the Republican Study Committee, said, "So far the summit has illuminated what Americans have feared: Democrats fundamentally believe that medical decisions should rest in Washington, rather than with patients and doctors."

Ralph Neas, CEO of the liberal National Coalition on Health Care, not surprisingly, had a different take. "I think what we're seeing today is — and I'm sure the structure of the topics is not an accident — so much time devoted to cost containment and health insurance reform," he said. "I think you're seeing a lot of agreement on health insurance reform, whether it's the prohibition of discriminating against pre-existing conditions, or caps on benefits, or canceling of insurance."

Focusing on insurance reform could prove to be smart politics for the Democrats. The same CNN poll found that respondents favored barring insurance companies from declining coverage to those with pre-existing conditions 58%-42% and from dropping coverage of those who are sick 62%-38%. But those reforms alone could destroy the economics of the industry, experts argue, forcing premiums to surge and leaving more people without coverage.

Neas said the summit had "defied the expectations of many in terms of the relative absence of political exchanges." But policy exchanges were often characterized with heated rhetoric. Sen. Jay Rockefeller, D-W. Va., said, "The health insurance industry is the shark that swims just below the water. And you don't see that shark until you feel the teeth of that shark. ... This is a rapacious industry that does what it wants."

Rep. Paul Ryan, R-Wis., attacked the Senate bill because it's a good proxy for Obama's similar plan released Monday. "This bill does not reduce costs," he said. "The (Congressional Budget Office's) job is to score what is placed in front of them, and what has been placed in front of them is a bill that is full of gimmicks and smoke and mirrors."

At the close of the summit, Obama said the GOP needed to do some "soul searching" on health care, and that he'd proceed without them if necessary. But the GOP might not be the only ones who'll need to do some introspection. "The president and Democrat leadership have backed themselves into a politically difficult position," said Ed Haislmaier, senior research fellow at the conservative Heritage Foundation. "They want insurance reforms that necessitate an individual mandate, and that mandate is not very popular on the right, left or center."

SOURCE




Republicans find loophole in budget ploy to push through healthcare legislation

As it turns out, Senate Democrats may not be able to force healthcare legislation through the chamber on a simple majority vote. Republicans say they have found a loophole in the budget reconciliation process that could allow them to offer an indefinite number of amendments. Though it has never been done, Sen. Jim DeMint (R-S.C.) says he’s prepared to test the Senate’s stamina to block the Democrats from using the process to expedite changes to the healthcare bill.

Experts on Senate procedural rules, from both parties, note that such a filibuster is possible. While reconciliation rules limit debate to 20 hours, senators lack similiar constraints on amendments and could conceivably continue offering them until 60 members agree to cut the process off. Another option for Democrats would be to seek a ruling by the parliamentarian that Republicans are simply filing amendments to stall the process. But such a ruling could taint the final healthcare vote and backfire for Democrats in November. Or Senate Majority Leader Harry Reid (D-Nev.) could use a tactic similar to the so-called nuclear option to quash the GOP tactics.

If those options failed, and Reid couldn’t convince a single Republican to vote with his 59-member conference, Democrats might be forced to consider withdrawing the healthcare bill.

A Democratic leadership aide confirmed to The Hill that the options outlined in this article are correct. House Democrats have said they would not pass the Senate healthcare bill unless changes are made through reconciliation, which is necessary because Republicans control 41 Senate seats, enough to block legislation through the regular process. But Republicans may end up having that power even under reconciliation.

“You could keep offering amendments until you don’t have any more to offer,” said a congressional aide, who said he did not know how long senators would be willing to stay in the chamber to move the reconciliation package. “What the body’s tolerance would be is unknown.”

A former Senate Republican leadership aide said: “The limit is on debate, not on consideration of amendments.”

DeMint said he’s ready to try anything. “You’ll see Republicans do everything they can to delay and stop this process,” DeMint said. “They need to get the message the track they’re on is the wrong track.”

Reid spent significant time last year in close study of the Senate rules for fast-tracking healthcare legislation under special budget rules. Reid stayed away from the special process of passing healthcare reform with only 51 votes because he knew it would be messy.

But since Republicans won a Senate seat in Massachusetts, thereby stripping Democrats of a filibuster-proof majority, it appears Democrats will need to invoke those rules to make crucial changes to healthcare legislation.

DeMint said that using reconciliation rules to pass the House-requested changes to the Senate healthcare bill with only 51 votes is “tyrannical.” “I think you’ll see us offering amendments to get us into November, if we can,” said DeMint.

Sen. Judd Gregg (N.H.), the ranking Republican on the Budget Committee, said: “You could continue to offer amendments, I suspect. “You can offer an unlimited number of amendments on the budget after time is elapsed so it’s logical that you could also do it on reconciliation,” Gregg said.

Democrats could try to persuade Republican colleagues to back down and withdraw their amendments after several hours or days of voting. With a unified Democratic conference, Reid would need just one GOP senator to cut off the process. The most likely candidate would be Sen. Olympia Snowe (R-Maine), who voted with Democrats to advance the Senate Finance Committee bill but has since opposed the healthcare measure on the Senate floor.

Reid or another Democrat could make a point of order that using amendments to stall a reconciliation bill violates the spirit of the Budget Act of 1974, which sets up for expedited consideration of budget-related bills. Reid or another Democrat could argue that offering unlimited amendments violates the spirit of limiting debate.

The parliamentarian has ruled that the limit on debate does not allow senators to filibuster the motion to proceed to a reconciliation bill. The parliamentarian could rule that the same concept applies to amendments. No one really knows, because a lawmaker has never tried to use amendments to filibuster a reconciliation package. “We haven’t ever tried it before,” said a congressional aide.

Parliamentarian Alan Frumin could rule Republican amendments after a certain number out of order. But he could also allow the GOP amendments, since they are not expressly barred. If Frumin ruled with Republicans, Reid would be in a difficult position. He could either pull the bill off the floor or he could appeal the ruling of the parliamentarian.

With a simple majority of 51 votes, Reid could overturn the ruling of the chair and set a Senate precedent that amendments must be limited to within reason. This tactic would be similar to the so-called nuclear option Senate Republicans considered using in 2005 to overrule Democratic filibusters of judicial nominees.

SOURCE




Obama’s Health Plan – Taxes, Taxes Everywhere

The White House recently released President Obama’s health care reform proposal. The plan incorporates a mixture of the many tax increases passed by the House and Senate, hiking taxes by almost $750 billion over ten years. This is on top of $1.3 trillion in other tax increases the President recently proposed in his 2011 budget. Not that there is ever a good time to raise taxes, but doing so as the economy is still emerging from a deep recession is particularly ill-advised and will likely prolong full recovery. Moreover, the President’s proposal deviates from his stated goal to address the soaring spending and debt problem the nation faces by piling on massive new spending and taxes.

Payroll tax hikes: Obama accepted the Senate’s plan to break long-held policy by raising the Hospital Insurance (HI) portion of the payroll tax on high-income earners to pay for a new and unrelated health care entitlement. He then doubled-down on this dangerous new precedent by separately applying the HI tax to investment income for the first time. The tax code already taxes investment too much. Higher taxes still on dividends, interest and business income increases the cost of capital which will further depress investment and thus job creation. Ironic to propose this at the very time the President wants employers to create jobs.

Medicare payroll tax would hit seniors: His proposed tax hike on investment will hammer seniors particularly hard because their investment income is a major supplement to their pension and Social Security checks. Seniors also sell assets to raise income, so raising the tax on capital gains further reduces their resources. Lastly, raising the taxes on capital income and capital gains will lower asset values. Nearly 30 percent of all stocks are held in retirement savings plans. Most of the seniors that rely on the income from these plans for their livelihood are not “fat cat” investors that have been the target of other populist tax hikes. They are people that spent their working years saving money for their own retirement in mutual funds, 401(k)s, IRAs, and other savings vehicles. This would just punish them for a lifetime of careful planning and saving.

Cadillac tax: The President also adopted an excise tax on “Cadillac” health insurance plans similar to that in the Senate plan. Obama’s proposal would levy a 40% tax on plans that cost over $10,200 a year for individuals and $27,500 for families, but wouldn’t be effective until 2018. The delay will no doubt give unions and other favored groups time to negotiate their way out of the tax through collective bargaining or gain a complete legislative exemption at some point in the future before the tax kicks in. It also means delaying political pain. All the same criticisms of the excise tax apply as before. For example, insurers will embed the tax in the price of their plans. This will hide its cost from their customers. The tax will also fall heavily on middle and low-income workers whose taxes President Obama pledged not to increase. The President would have been better off capping the value of health insurance employers can provide their employees tax free. This is something that has wide support among policy experts on the right and the left and would be a real show towards openness to the bipartisan ideas he is purporting.

Still more taxes: Just like the Senate and the House, his plan incorporates a multitude of other tax hikes and fees that will go towards paying for the monstrously expensive bill. Some will raise taxes on people making less than $250,000 a year, breaking a key campaign pledge. Prime examples include:

• Excise tax on medical device manufacturers;

• Fee on brand name pharmaceuticals;

• 10 percent tax on tanning services;

• Reduce the amount families can place in Flexible Spending Accounts (FSA) and increase the penalties for non-medical deductions from Health Savings Accounts (HSA); and

• Higher taxes on health insurance companies and producers of medicine.

Each of these taxes will fall explicitly on those making less than $250,000 or will be passed down to them. And this is just a sample of the taxes that will hit those making less than $250,000 in the President’s plan. There are many more. In fact, the mandate on all individuals to purchase health insurance could also be considered another steep tax hike on those making less than $250,000.

Bottom Line: There is never a good time to raise taxes, but even the talk of doing so now continues to cause uncertainty in the economy. Sadly, the President’s plan is no better than those of the House or Senate: massive new benefits paid for by a myriad of harmful new taxes. Better to drop this plan and start over. Without crushing new taxes.

SOURCE




Report Concludes President Obama's Health Proposal Would Lead to Public Option

President Obama's new health care plan will all but guarantee the elimination of private insurance and lead to a single payer government-run health care system, says a new report, "White House Health Care Plan Contains Back Door to a Public Option" by policy analyst Matt Patterson of the National Center For Public Policy Research. Among the findings:

* The President's plan would create a new federal agency charged with monitoring health insurers to make sure that proposed premium increases are not "unreasonable" or "unjustified." This agency could compel private insurers to lower premiums, offer rebates or "take other actions to make premiums affordable."

* The President's plan would also dictate that health insurers cover those with pre-existing conditions and saddle them with billion in new taxes and fees.

* Health insurance is one of the least profitable industries America. In terms of profit margin, in 2009 it ranked a dismal 87th out of 215 industries; their overall profit margin was a mere 3.4 percent.

* The President's proposed combination of new taxes and price controls would cause a wave of health insurer bankruptcies, devastating the industry and reducing health insurance options for consumers.

* Eventually, the shrinking pool of private insurers would force the government to enact a single payer system to provide the insurance that Congress mandates that all Americans have.

Patterson calls Obama's ploy "breathtakingly audacious," noting, "Far from being able to keep the plan you like, the President's health care plan seems designed to make sure you end up with only one option for your health care - the government."

SOURCE




The recent rises in American healthcare costs are not unique

Newer drugs and procedures will cost more wherever you are

On this, we can all agree: American health care is feverishly expensive, swallowing up 17 percent of GDP. Since 2000, health-insurance premiums have more than doubled, affecting the bottom lines of businesses and hitting Middle America in the pocketbook. It’s not surprising, then, that since inauguration the administration has made the reduction of “long-term growth of health-care costs for businesses and government” its highest priority for health reform. “If we do nothing, then health-care inflation is going to keep on going up at 8 percent, 9 percent, 10 percent a year,” the president said last July, urging immediate action.

Over this past year, the administration has blamed rising costs on things that make U.S. health care different. American private insurers are too greedy. American doctors prescribe wastefully. American doctors are paid inefficiently.

The White House has pushed sweeping measures: a Medicare-style plan to compete with private insurance; new bureaucratic committees to define and oversee private coverage; expansions of public programs; and a government body tasked with bettering health care by guiding the decisions of doctors. White House budget director Peter Orszag crowed that the latest Obamacare bill “contains more cost containment and delivery-system reforms . . . than any bill that has ever been considered on the Senate floor, period.”

Of course, the very same “cost containment” systems exist in countries with socialized health care. And if the White House has confidence in a government-based solution to this problem, here’s the irony: Health-care inflation rates in the United States have been similar to those in government-managed systems that often employ the sort of regulatory policies championed by the White House.

Over the long term, the difference between the rise in costs of American health care and the OECD average from 1990 to 2006 was just 0.4 percent annually — even though bureaucrats manage most of the health spending in those other countries. Jump ahead a few years, and the trend hasn’t changed. Health care might be cheaper in socialized systems (in part, because of rationed care), but, even with their long waiting lists, costs are rising just as quickly there as here. Consider the 2009 figures:

In Britain, health costs rose 3.1 percent (and a full 5.5 percent increase in the strictly controlled hospital sector). In Ireland, the republic’s health-care system produced 2.5 percent health inflation; Irish prices declined by 5 percent across the economy, by the way. Germany’s inflation rate was at a 20-year low of 0.1 percent; health costs still rose by 1.8 percent. In Canada, health costs rose by 3.0 percent.

Canada is an interesting case study, since private insurance is banned in most of the country. Yet commentary in newspapers would be familiar to an American reader. The Toronto Star insists “something must be done” to reverse “unsustainable” spending growth. The Globe and Mail describes spiraling health costs as a “ticking time bomb.” But if costs are rising, government rationing can be felt. This month, the Province of Newfoundland’s highest elected official, Premier Danny Williams, went to the United States for urgent heart surgery, insisting the necessary treatment was unavailable in Newfoundland.

And how did the United States do with its lack of Obama-inspired Canada-Irish-German-style bureaucratic controls? Health inflation here was 3.4 percent last year, just over double the basic inflation rate. Tellingly, the worst cost increases were experienced by . . . government. Medicare costs were up 8.6 percent, and Medicaid, up 9.9 percent.

Make no mistake: That 3.4 percent may be lower than the alarmists predicted, but it’s still no cause for celebration. Whether it’s as high as other countries’ or not, health inflation is unsustainable. And international trends suggest health inflation is caused by the things that make America similar to other Western nations: worsening diet and fitness habits; higher health expectations; an aging population; costly new medical technologies; and payment systems that tend to insulate people from the economic consequences of their decisions (mainly private insurance here and public insurance abroad).

SOURCE





26 February, 2010

THREE VIEWS OF OBAMA'S HEALTHCARE "DEBATE"

Michelle Malkin:

Oba-Kabuki: A Box-Office Bomb

The Oba-Kabuki health care show at Blair House kicked off with a big lie on Thursday morning -- and it all went downhill from there. The taxpayer-funded infomercial backfired by exposing the president's thin skin, the Democrats' naked disingenuousness and the ruling majority's allergies to political and policy realities.

Responding to Sen. Lamar Alexander's opening call for Democrats to renounce parliamentary tactics designed to limit debate, circumvent filibusters and lower the threshold for passage of health care reform to a simple 51-vote majority, Senate Majority Leader Harry Reid sputtered indignantly: "No one's talking about reconciliation!" Everybody and their mother has been invoking the "R" word on Capitol Hill, starting with Reid.

In a letter on Feb. 16, four Democratic senators pushed Reid to adopt the procedure, normally reserved for budget matters. A few days later, White House Press Secretary Robert Gibbs discussed the option. Then Reid himself talked up reconciliation on a Nevada public affairs show as an option to ram the government health care takeover through in the next 60 days.

According to The Hill, Reid said that "congressional Democrats would likely opt for a procedural tactic in the Senate allowing the upper chamber to make final changes to its health care bill with only a simple majority of senators, instead of the 60 it takes to normally end a filibuster." A few days after that, Reid snapped that Republicans "should stop crying" about the abrogation of Senate minority rights, since the GOP had used the reconciliation process in the past.

So, the cleanest, most ethical holier-than-thou Congress ever is now defending the unprecedented adoption of ram-down rules for a radical, multitrillion-dollar program to usurp one-seventh of the economy on the grounds of "two wrongs make it right"? Hope and change, baby.

For his part, President Obama responded with one part pique and two parts diffidence. After the summit lunch break, Republicans pushed the reconciliation issue again in the face of the Democrats' refusal to disavow the short-circuiting of the deliberative process. "The American people," an annoyed Obama asserted, "are not all that interested in procedures inside the Senate." Oh, really? A new USA Today/Gallup poll reports that 52 percent of Americans oppose using the procedural maneuver to pass the health care bill in the Senate.

The survey also showed that Americans oppose Demcare-style health care "reform" by 49 percent to 42 percent -- with those "strongly" opposed outnumbering those "strongly" in favor by 23 percent to 11 percent. Obama's best and brightest team of Chicago strategists, new-media gurus and communications specialists still hasn't figured it out: Voters are as fed up with the corrupt process in Washington as they are with the White House's overreaching policies. It's both, stupid.

When he wasn't cutting off Republicans who stuck to budget specifics and cited legislative page numbers and language instead of treacly, sob-story anecdotes involving dentures and gallstones, Obama was filibustering the talk-a-thon away by invoking his daughters, rambling on about auto insurance and sniping at former GOP presidential rival John McCain. "We're not campaigning anymore," lectured the perpetual campaigner-in-chief.

After ostentatiously disputing the GOP's claims that health care premiums would rise under his plan, Obama walked it back. Confronted with more GOP pushback on the failure of Demcare to control costs, Obama told GOP Rep. Paul Ryan that he'd rather not "get bogged down in numbers." Not numbers that he couldn't cook on the spot without staff consultation, anyway.

Obama and the Democrats labored mightily to create the illusion of almost-there bipartisanship by repeatedly telling disagreeing Republicans that "we don't disagree" and "there's not a lot of difference" between us. But the dogs weren't riding the ponies in this show.

This was a set-up from the start. The "we're so close" mantra is the rhetorical wedge the White House will use to blame Republicans for fatal obstructionism, while whitewashing festering opposition from both pro-life Democrats who oppose the government funding of abortion services still in the plan and left-wing progressives in the House who are clinging to a full, unadulterated public option.

While Republicans came off well, the six-hour blowhard-fest was a monumental waste of time. Obamacare Theater tied up GOP energy and resources as the White House readies its "Plan B" (expanding government health care coverage, just at a slower pace) and Democratic leaders prep their reconciliation ram-down for early next week. This Washington box-office bomb is a prelude to much bigger legislative horrors still to come. Don't you love farce?

SOURCE

Jonah Goldberg:

Health-Care Humdrum

The longest week I ever spent was the six hours I spent watching Thursday's health-care summit. The better angel of my nature says that this confab is a wonderful spectacle of democracy. Serious men and women airing serious disagreements in a (relatively) respectful and substantive manner. Huzzah for democracy. Wahoo for C-SPAN. Attaboys and attagals to all involved.

My more devilish side says that this is a debacle par excellence, the policy-wonk equivalent of a show trial where the result is foreordained and the speeches are for the benefit of no one but those who don't understand what's really going on while the posturing is for the handful of Kremlinologists who care passionately about minutiae.

More to the point: It was mind-bogglingly, soul-achingly, sand-poundingly, metaphysically and ontologically boring. It's like driving through Kansas on the interstate (something I've done many times): long, vast stretches of boredom punctuated by the occasional brief promise of excitement that would require detouring from the planned route.

It reminds me of that old Monty Python skit where British soldiers are equipped with the world's funniest joke, a joke so funny that even to hear it guarantees you'll die laughing. The British army translates the gag into German (different translators for each word so as to prevent their own deaths), and has its troops read the German version as they march through Ardennes forest. Suddenly, Nazi soldiers start falling dead from the trees. Substitute "boring" for "funny" and you'll get a vague sense of how dull this summit was. At one point I could swear Mitch McConnell was counting fibers in the carpet just to stay awake.

For months, Republicans have fairly tagged President Obama for breaking his promise to put health-care negotiations on C-SPAN. That talking point was rendered moot Thursday. But now there's a better talking point: The summit showed why Obama was crazy for wanting to televise this stuff in the first place. Real negotiations never happen in front of cameras because to cut a real political deal in public is the political equivalent of cutting your own throat.

Now, just because the scripts were written beforehand doesn't mean that everyone's lines worked. Obama opened by striking a pose of plausible fairness and open-mindedness but grew more and more snarky (to use a technical political-science term) and less presidential as the event wore on. Obama's condescension to John McCain -- "we're not campaigning any more, the election's over" -- pleased everyone who already loves him and nobody who doesn't.

House Speaker Nancy Pelosi relied on the Democrats' favorite rhetorical gambit: policy-by-anecdote. Invoking the sad plight of some person no one knows can be effective, but we've been hearing such stories for a very long time, even as support for Pelosi's solutions has plummeted.

But it was Senate Majority Leader Harry Reid, mugging for his doomed re-election bid at home, who put the ugliest face on the Democratic Party. Cranky, mean and short-tempered, Reid seemed like he was sitting on a carpet tack throughout the discussion. He snapped that "no one is talking about reconciliation" -- a reference to the arcane parliamentary procedure Democrats are considering as a means to ram their unpopular bill through Congress.

That's true, save for the more than 100 House Democrats and more than 20 Senate Democrats who had already signed letters calling for reconciliation. His crotchety dyspepsia combined with arrogant dishonesty made the leader of the Senate seem like the sort of oldster who would pinch little kids for fun if he could get away with it.

The Republicans were arguably more boring than the Democrats precisely because they had to seem nicer. (Iowa Sen. Tom Harkin, who bizarrely played the race card, had no such concerns.) But when Sens. Lamar Alexander, Jon Kyl and Tom Coburn weren't contemplating committing seppuku like that Japanese soldier in "Airplane!" just to end the ennui, they succeeded in undermining the central talking point of the Democrats: that the Republican Party has no ideas on health care.

It may have been excruciatingly dull enough to force Osama bin Laden from his cave, but the Republicans patiently telegraphed an inconvenient truth: They do care about health-care reform, they just loathe Democrats' version of it (and, yes, have much to gain by blocking it). At halftime and again afterwards, when delegates were no doubt mainlining Red Bull, the Democrats' spinners took to the airwaves to insist that the Republicans "don't want anything." But anyone watching knows that's not really true.

That is, if anyone was watching.

SOURCE

"The Times" of London:

Political theater

Thirteen months into his presidency, Barack Obama invited 40 congressional leaders to a meeting yesterday to forge consensus on an issue that threatens to bankrupt the country and derail his ambition of transforming American society.

His challenge to Republicans to abandon politics-as-usual fell largely on deaf ears, but it brought moments of drama, including a rebuke of Mr Obama’s governing style over the past year from his former opponent, Senator John McCain. Mr Obama responded: “We’re not campaigning, John. The election’s over.”

Six hours of televised debate left uncertain the fate of the most ambitious social legislation in a generation: the reform of a health insurance system that accounts for nearly a sixth of the US gross domestic product. It has become a proxy for an even broader battle between liberals who last year sensed an historic chance to reinvent the federal government in favour of the poor, and conservatives determined to bury Mr Obama’s campaign promises of change and render him a one-term president. As one commentator from his home town of Chicago put it: “Obama needs a victory. Either that, or he faces irrelevancy and insurrection.”

Long before the Secret Service shut the streets around the White House to allow Mr Obama to walk to Pennsylvania Avenue to Blair House, the venue for the meeting, his opponents and even his Vice-President, warned that the event would prove to be nothing more than political theatre. Their words were justified — but it was compelling theatre.

Mr Obama opened proceedings with an appeal for bipartisanship, and for reform of a system that he said had forced his mother to argue with insurance companies from her hospital bed as she lay dying from ovarian cancer.

The Republican reply came from Lamar Alexander, the former Governor of Tennessee, who offered his story of a constituent struggling to pay for his wife’s breast cancer treatment. He argued that the solution was to tear up Democratic health reform Bills and start again. Republicans went on to propose a six-point plan that they said would cut costs and extend insurance cover without the $950 billion (£620 billion) price tag attached to Mr Obama’s plan.

Solemn undertakings to keep the affair cordial and focused on the needs of the American people quickly gave way to partisan tit-for-tat. When Mr Alexander claimed that Democratic proposals would raise insurance premiums for many, the President interrupted him twice, saying: “No, no, no, here’s what the Congressional Budget Office actually says.”

Progress towards comprehensive health reform ground to a halt last summer when conservative activists at town hall meetings successfully branded it a government takeover, draining enthusiasm among moderate Democrats worried about re-election in November. The project appeared doomed last month when the Republicans’ gain of Ted Kennedy’s old Senate seat robbed the Democrats of a majority.

Yesterday’s meeting was predictably rancorous, but by no means all scripted. “You are entitled to your own opinion, but you are not entitled to your own set of facts,” Harry Reid, the Senate majority leader, told Republicans at one point.

After a dissection of the 2,400-page Senate health Bill by Eric Cantor, one of Mr Obama’s most effective critics in the lower House, Louise Slaughter, a New York Democrat, came to the rescue with a human interest story to eclipse them all. It concerned two elderly sisters. When one died and the other lost her dentures “she wore her dead sister’s teeth”, Ms Slaughter said. “Of course, they didn’t fit. Can you believe that in America?”

A bipartisan breakthrough was always the least likely outcome of this minutely choreographed event. Playing to a live TV audience for six-hours, both sides sought to score points without seeming to and to appear conciliatory while knowing that their battle lines were already all but fixed. “We might surprise ourselves,” Mr Alexander said. He was referring to his search for common ground. He did not find much yesterday.

SOURCE




Health care: Dems just don't have the votes

Now that the White House and Democrats are making a last push to pass their so-far-unpassable national health care bills, the only thing that matters is whether they can get 217 votes for victory in the House and 50 votes (plus the vice-president's tie-breaker) for reconciliation in the Senate. Good policy doesn't matter. Bad policy doesn't matter. All that matters is votes.

The White House and Democrats have lost sight of the essential insanity of the process -- desperately searching for corners to cut so they can pass an enormous re-ordering of the American economy that Americans don't want -- because all they can think about now is passing something. It could be anything, as long as it is "comprehensive."

So where are the votes? Start in the House. House Democrats have to do two things. First, they have to pass the health care bill that Senate Democrats passed on December 24 -- Cornhusker Kickback, Louisiana Purchase and all. They could stop there and send the bill to the president's desk, but that, of course, is not going to happen. So they then have to pass a set of agreed-upon "fixes" to the Senate bill that the Senate would then pass by using the reconciliation process. (The fixes will start in the House; reconciliation bills have to originate in the House because all revenue measures have to originate in the House.)

The original House health care bill passed last November by a 220 to 215 margin. But supporters have lost four votes since then. Democrat Rep. Robert Wexler has left the House, and Rep. Neil Abercrombie is expected to leave this week. Rep. John Murtha died, and Republican Rep. Joseph Cao, the only GOP lawmaker to vote for the bill, now says he will vote against the measure. That leaves Democrats with 216 votes, one short of the 217 it will take to pass. (That number is one less than the usual 218 because of the vacancies in the House.)

In addition, it's thought that some number of Democrats who voted for the original bill will likely vote against the Senate version because it lacks the House bill's language on the subject of abortion (the president's proposed compromise doesn't help on that subject, either). Republicans estimate there may be 11 such Democrats. If there are, that takes the number down to 205, which means Speaker Nancy Pelosi will need to find a dozen "yes" votes to make up the difference. It is widely thought that she had some possible yes votes in reserve last November, to be used if they were absolutely essential to passage. Are there 12? No one knows.

And that doesn't begin to consider the Democrats who voted in favor of the House bill last November but have now finally been persuaded, by continued public opposition in the polls, the Senate election in Massachusetts, and the generally worsening political climate for Democrats, that another vote in favor of the wildly unpopular health bill would be suicidal. Can Pelosi really be willing to bet that she can get everyone who originally voted yes on the bill to vote yes again? And for the Democrats who originally voted against the bill -- does anyone believe that any are going to change their minds to vote yes?

Remember, no matter what you hear, the House will have to vote yes on the original Senate bill, outrages and all. Democratic leaders will try to arrange things so that that vote will somehow be obscured, and the emphasis will be on the "fixes" reconciliation bill, but for health care to become law, the House will have to approve the Senate bill. Do you think the Democrats' Republican opponents might mention that in the coming campaign? Of course they will. Which means Democrats will be explaining and explaining and explaining that they fixed the outrageous problems in the bill at the same time they passed it. Would you want to make that case every day on the stump?

The bottom line: Pelosi is probably many votes short of being able to pass the Senate bill, along with the still-unwritten fixes. In public Democrats are trying to create a sense of inevitability about the bill -- they've tried to do that at various times during the year-long process -- but there is absolutely nothing inevitable about the passage of their national health care plan.

SOURCE




Obama plan may pass in pieces

Antitrust measure could win bipartisan support in House

Top House Democrats on Tuesday left open the prospect of President Obama's comprehensive health care overhaul failing and passing pieces of it, a process already being used to try to repeal health insurance industry antitrust protections. The antitrust measure, which was not in the reform framework Mr. Obama released Monday, could pass the House Wednesday with bipartisan support, which would mark the first time Republicans and Democrats have been able to agree in the health debate. It would come a day ahead of Mr. Obama's health summit.

House Majority Leader Steny H. Hoyer said Democrats support Mr. Obama's outline, but if a complete overhaul bill can't get through Congress, there are good pieces that should become law. "We may not be able to do it all," he said. "I hope we can do it all in a comprehensive piece of legislation that would provide affordable, accessible, quality health care to all Americans. But having said that, if we can't, then you know me - if you can't do a whole, doing part is also good."

House Speaker Nancy Pelosi stressed the importance of repealing the antitrust protections and that Democrats can simultaneously pass a small bill alongside work on the comprehensive bill. "We will be taking up comprehensive health insurance reform shortly but we wanted to make sure that in paving the way for that legislation we paved the way for fairness, for competition, for better care, better quality, better affordability for the American people," she said.

The antitrust bill repeals the 1945 McCarran-Ferguson Act that exempted the insurance industry from federal antitrust rules. "For too may decades the health insurance companies have enjoyed monopoly protections that are enjoyed really by no other industry, with the exception of Major League Baseball," said Rep. Tom Perriello, the Virginia Democrat who introduced the bill. "The result of this has been a lack of competition and a lack of accountability that has helped send prices up for consumers and working families across the country."

It's unclear what impact the repeal would have. Democrats say it would increase competition and stop bid rigging and price fixing. Insurance companies oppose it because they say it would lead to regulatory confusion and that state law already prevents anticompetitive practices. The Congressional Budget Office, Congress' nonpartisan budgetkeeper, found that the repeal would have "no significant effects" on the federal budget or private insurance premiums.

Insurers say McCarran-Ferguson never allowed them to engage in price-fixing or bid-rigging. "Health insurance is one of the most regulated industries in America at both the federal and state levels," said Karen Ignagni, president and chief executive officer of America's Health Insurance Plans (AHIP), an industry trade group. "The Act is extremely limited in scope and has nothing to do with competition within the health insurance industry." AHIP says that insurers are subject to federal antitrust laws in addition to other state and federal regulations.

The repeal has support in the Senate as well. Nineteen Democrats signed on to a letter to Mr. Obama, Ms. Pelosi and Mr. Reid asking them to include the repeal in their final health bill.

White House spokesman Robert Gibbs said Tuesday that the antitrust bill would be done in addition to a comprehensive bill, not instead of. "This will ultimately complement health care reform in ensuring the changes that you make in the market - that the ability to look into potential anti-competitive practices, that that's not, quite frankly, illegal to do," he said. "This is not in lieu of something to make broader changes in the insurance market. This is a complementary step along the way."

Democrats on Capitol Hill say they are cautiously supportive of Mr. Obama's health reform outline, which closely follows what the Senate passed in December but includes a number of repairs designed to please the House.

The plan was written with reconciliation in mind, White House officials said. That's the complicated procedural tool Democrats could use to pass the bill with only 51 votes, circumventing a Republican filibuster. Senate Majority Leader Harry Reid said Democrats have not decided to pursue that route but chastised Republicans, who on Tuesday labeled the proposed use of reconciliation a rare procedural "trick."

"I've been told that my Republican friends are lamenting reconciliation, but I would recommend for them to go back and look at history," Mr. Reid said. "Since 1981, reconciliation has been used 21 times. The vast majority of those reconciliation efforts have been by Republicans ... realistically, they should stop crying about reconciliation as if it's never been done before."

SOURCE




With reform dead, health care debate becomes pure politics

Question: When should you start suspecting President Obama isn't serious about a health care proposal? Answer: When he doesn't have the pharmaceutical industry on his side.

The biggest changes Obama has proposed to the Senate bill -- such as price controls on insurers and higher taxes on drug companies -- don't look like moves to get Republican votes or help the bill glide thought the filibuster-proof budget reconciliation process. It looks like Obama is simply trying to push his heretofore allies (drug makers) and uneasy partners (health insurers) fully onto the other side of the fence with the Republicans, thus painting a helpful political picture for 2010.

The White House spent 2009 publicly decrying the "special interests" supposedly undermining their "reform" of the health care market. But the White House also spent 2009 privately cutting deals with drug companies -- deals that fueled public skepticism about the bill and left the president's liberal base feeling jilted.

Even the insurers made out well in last year's negotiations, successfully killing the public option, inserting insurance mandates on both individuals and employers, and securing massive subsidies for the purchase of health insurance. Former Democratic National Committee Chairman Howard Dean was exaggerating, but not all that much, when he called the Senate bill "a bigger bailout for the insurance industry than AIG."

Still, Obama portrayed his "reform" effort as a struggle against "those who profit from the status quo." For the most part, the White House never named these dastardly profiteers, possibly because industry was mostly on the president's side.

So while he spent 2009 battling imaginary foes over a real bill, Obama now might be battling real foes over an imaginary bill. Without reading minds, we can't know for sure if Obama believes he can still pass a health care bill, or if he truly sees the rough outline he issued Monday as the path toward making a bill become a law.

But there's plenty of reason to believe his current proposal is simply a political wedge: An effort to actually drive the insurers and drug makers into fierce opposition, thus helping Democrats frame the 2010 elections as "reformers" vs. "fat-cat industries." In other words, it looks to me like the president has decided to engage the same game he has accused -- not always unfairly -- Republicans of playing: Drawing political battle lines rather than trying to reform anything.

Look at the Web page the White House debuted for this week's proposal and summit. As of Tuesday morning, the page dedicated more words to attacking insurers than to laying out policies, highlighting blog posts with these headlines: "Nobody is Immune from Insurance Company Abuses," "Premiums, Profits, and the Need for Health Reform," "Putting Health Care in the Hands of Consumers -- Not Insurance Companies," "The Insurers and the Ultimate Irony."

Insurers aren't the only bad guys Obama's proposal would drive into the nay camp (that is, the GOP camp). The bill would also slap a Medicare tax on "unearned income" such as investments and rent, thus drawing more blood from wealthy investors and landlords.

We saw the first glimpses of the Democrats' 2010 strategy at Obama's rally for Massachusetts Senate candidate Martha Coakley. "Whose side are you going to be on?" Obama asked, the side of the "special interests" or of working Americans.

The "whose side are you on" motif is a favorite of Democrats going back to Adlai Stevenson. But it's an awkward one to ask about Obama's first year, in which he sided with big energy companies in backing the House climate change bill, with the largest cigarette company in signing a tobacco bill, with the insurers in signing an expansion of subsidies for children's health insurance, with the Chamber of Commerce in signing the largest spending bill in history (and Big Coal in including the largest earmark in history), with Wall Street in ramping up the bailouts of the financial industry, and of course with drug companies in backing the Senate's subsidy-packed health care bill.

This renewed push for health care reform gives Obama an opportunity to set a different stage. Proposing federal price controls on insurance premiums is bad policy, but good politics. Bad policy proposals are fine and can get plenty of Democratic votes if the package is really just filibuster bait. If Obama can't pass a reform, at least he can force the Republicans to stand with insurers, drug makers, landlords, and wealthy investors in killing a bill described as "reform."

SOURCE




Medicare is Cheating Seniors Out of Care, Says New Study

Chronically low Medicare reimbursement rates to physicians and hospitals are forcing doctors to limit the number of Medicare patients they see - or opt out of the program altogether - with devastating results to seniors' health care options, says a new study, "Medicare Doctor Shortage Endangers Seniors' Access to Care," by Matt Patterson of the National Center for Public Policy Research.

From the Southwest to Florida, from the Midwest to New York, primary care doctors and specialists at both hospitals and private practices are turning away Medicare patients because they cannot afford to treat them, the study concludes.

The report analyzes government data, health care provider statistics, and news reports from across the country to paint a frightening picture of a government program failing the most vulnerable members of our society: our seniors. Among the findings:

* Some Mayo Clinic facilities are no longer accepting Medicare patients for primary care, turning thousands of seniors away from their trusted physicians.

* 30 percent of Medicare patients seeking a new primary care doctor reported difficulty finding one, including 17 percent who claim they had "big" problems finding a new doctor.

* Only 73 percent of Medicare participating family doctors are accepting new Medicare patients.

* Only 38 percent of Texas primary care physicians say they will accept new Medicare patients in the face of low Medicare reimbursements.

* More than half of California hospitals reported operating at a loss, due in part to low Medicare reimbursements.

* Hospitals in Iowa report trouble recruiting new doctors thanks to low Medicare reimbursements, and warn that the trend may be a threat to the quality of future care.

Says Patterson, "At a time when President Barack Obama is proposing yet another $1 trillion health care plan, Medicare - the original government health insurance program - is going bankrupt, underfunding doctors, and cheating seniors out of care. Why don't we worry about meeting our existing health care obligations before we take on additional burdens?"

SOURCE




Specialist British nurses ‘ too stretched to care for all who need it’

Nurses who provide specialist services for the long-term sick are overstretched and unable to deliver care to all who need it, health unions and charities say today. The Royal College of Nursing (RCN) and other bodies said that the NHS could save millions of pounds by investing in nurses to support people with conditions such as Parkinson’s disease, multiple sclerosis and epilepsy. But despite recent pledges by the Government to provide cancer patients with dedicated care, other specialist posts were vulnerable to cuts as the health service faces several years of financial restrain, the RCN said.

The union surveyed almost 300 specialist nurses working in 60 NHS organisations and charities and found that only 36 per cent believed that all those patients who needed specialist nursing received it. Of the 49 per cent who identified problems accessing specialist care, 69 per cent said it was because specialist nurse services were oversubscribed and could not take on new patients. More than a third said that they had seen cuts in services over the past 12 months, while 57 per cent are concerned that jobs will be threatened in the near future.

Specialist nurses work in areas including cancer care, diabetes and asthma, helping to keep people out of hospital by offering advice on medication and day-to-day living. The RCN estimates that £56 million a year could be saved on care for people with Parkinson’s through greater use of specialist nurses. A further £180 million could be saved by treating multiple sclerosis at home rather than in hospital, while £84 million could be shaved off the community health budgets if specialist nurses, rather than GPs, supported people with epilepsy.

Dr Peter Carter, general secretary of the RCN, told The Times that despite pledges from ministers to help to support more people in their homes and prevent unnecessary hospital visits, nursing posts were vulnerable when local health managers sought to cut costs. “Nurses realise that whoever wins the next election will be looking to make savings and to deliver more for less. The pressure on services with the economic downturn is going to go on for several years and things are likely to get worse before they get better,” he said. “Anecdotally, at the moment there is talk of local managers ‘reviewing skill mix’, which is just a euphemism for cutting staff.”

When the NHS was last in deficit in 2006, up to 23,000 nursing posts were lost, frozen or downgraded, in many cases depriving patients of specialist advice and care, Dr Carter said. “While the temptation may be to cut or downgrade specialist nursing roles, this would be a false economy which would only add to the growing cost of treating long-term conditions,” he added. About 17 million people in Britain are living with a chronic condition.

The RCN is calling for specialist posts to be supported by guaranteed funding, underwritten by the NHS, to ensure that short term cutbacks do not jeopardise posts in the long-term. Charities supporting the RCN’s policy recommendations include the Parkinson’s Disease Society, Macmillan Cancer Support, the Terrence Higgins Trust and the MS Society.

Norman Lamb, the Liberal Democrats’ health spokesman, commented yesterday: “Cuts are already taking place in marked contrast to the Prime Minister’s commitment for cancer patients to get personal support at home from specialist nurses. “Instead of chasing headlines, the Government needs to show how it intends to improve care.”

Meg Macarthur, senior policy officer at Breakthrough Breast Cancer, another of the charities supporting the call, said: “The threat to breast care and other specialist nurses is potentially devastating to patients. “We know that these nurses play a significant role in their care and recovery, offering an invaluable service throughout their treatment journey.”

SOURCE




Australia: Private emergency room opens as an alternative to long waits at government hospitals

Patients who pay $195 can jump the queues at hospital emergency departments when the nation's largest health fund opens its first standalone clinic today. Medibank is guaranteeing patients with minor injuries and illnesses will be treated within one hour at its first Rapid Care Clinic in Brisbane. The fund is confident it will have a Sydney facility operating in June.

The clinics, staffed by specialist emergency doctors, will deal with urgent but non-life-threatening medical conditions such as broken bones, sprain, cuts and minor burns, viruses, headaches, earaches and sore eyes.

Twenty thousand patients a month wait more than the clinically-recommended one hour to be treated in the clogged emergency departments in public hospitals.

Single mother Kylie Endycott, who spent five hours at Sydney's Royal Prince Alfred Hospital yesterday after her one-year-old son Beau had difficulty breathing, said the clinics were a great idea but thought fees could be altered for different family situations.

Almost 170,000 people using a public hospital emergency department leave in frustration every year because of their wait for treatment. Medibank hopes to fill this gap. "Anybody who experienced attending a busy hospital emergency room with a minor injury or sick child, tried to get an appointment with their GP at short notice or out-of hours, will understand the Rapid Care Clinic," Medibank managing director George Savvides said.

The clinics will be open 365 days a year from 8am to 9pm to anyone, although Medibank members pay just $150 for a consultation and face no charge for X-rays, plaster or stitches. The clinics will refer conditions such as chest pain, severe breathing difficulty, acute stomach pain, severe burns, loss of consciousness, head and neck injuries or pregnancy-related conditions to the nearest hospital.

Emergency medicine specialist Dr Peter Herron - who runs the Brisbane clinic, which has been open for a week and a half - has treated seven people including several fractures, a bee sting, a laceration and an earache.

Australian Medical Association president Dr Andrew Pesce said the clinics would help those who could afford them but was disappointed that underfunding of the public hospital system had made them necessary. He is concerned they will lead to further fragmentation of patient care. Those who use these clinics can't claim for their treatment from their health fund or Medicare and must pay the full cost out of their own pocket. The Health Services arm of the fund has run similar clinics for corporate clients for years.

SOURCE





25 February, 2010

British government's Stafford Hospital caused ‘unimaginable suffering’

And the bureaucrats responsible skate, with full pockets and no move for them to face any charges. See here

Patients were routinely neglected or left “sobbing and humiliated” by staff at an NHS trust where at least 400 deaths have been linked to appalling care. An independent inquiry found that managers at Mid Staffordshire NHS Foundation Trust stopped providing safe care because they were preoccupied with government targets and cutting costs. The inquiry report, published yesterday by Robert Francis, QC, included proposals for tough new regulations that could lead to managers at failing NHS trusts being struck off.

Staff shortages at Stafford Hospital meant that patients went unwashed for weeks, were left without food or drink and were even unable to get to the lavatory. Some lay in soiled sheets that relatives had to take home to wash, others developed infections or had falls, occasionally fatal. Many staff did their best but the attitude of some nurses “left a lot to be desired”.

The report, which follows reviews by the Care Quality Commission and the Department of Health, said that “unimaginable” suffering had been caused. Regulators said last year that between 400 and 1,200 more patients than expected may have died at the hospital from 2005 to 2008.

Andy Burnham, the Health Secretary, said there could be “no excuses” for the failures and added that the board that presided over the scandal had been replaced. An undisclosed number of doctors and at least one nurse are being investigated by the General Medical Council and Nursing and Midwifery Council.

Mr Burnham said it was a “longstanding anomaly” that the NHS did not have a robust way of regulating managers or banning them from working, as it does with doctors or nurses. “We must end the situation where a senior NHS manager who has failed in one job can simply move to another elsewhere,” he added. “This is not acceptable to the public and not conducive to promoting accountability and high professional standards.” A system of professional accreditation for senior managers would be considered and the Mid Staffordshire trust might lose its foundation status.

Some NHS chief executives have received six-figure redundancy packages or moved to other trusts despite poor performance. Martin Yeates, the former chief executive at Mid Staffordshire, received pay rises that took his annual salary to £180,000, while standards at the trust deteriorated. The Liberal Democrats claimed that he had also received a payoff of more than £400,000 after stepping down last March, though Mr Burnham said he had received “no more than his contractual entitlement”.

The Care Quality Commission, the NHS regulator, said that the trust under its new management was now “safe to provide services”. But it still had concerns about staffing, patient welfare, the availability and suitability of equipment at the trust, and how it monitored and dealt with complaints. The inquiry made 18 recommendations for the trust and the wider health service, which the Government accepted in full. They include a new review of how regulators and regional health authorities monitor NHS hospitals and a report on “early-warning systems” to identify failing trusts.

But the families of those who died or suffered poor care branded the inquiry a “whitewash” and repeated calls for a full public investigation. The Conservatives accused ministers of trying to blame managers rather than taking responsibility for problems with national targets. Julie Bailey, who founded the victims’ campaign group Cure the NHS after her mother died at Stafford Hospital, said that the handling of the scandal was disgraceful and unacceptable. “It is time that the public were told the truth about the very large number of excess deaths in NHS care and the very large number of avoidable but deadly errors that occur every day.”

The NHS Confederation, which represents health trusts, said: “The responsibility for the way this hospital was run rests with its board, management and staff but, as the report says, the framework of targets, regulatory systems and policy priorities it worked within are also very important.”

SOURCE




Breast cancer victims face NHS ageism, campaigners claim

Age discrimination is rife in the care of breast cancer patients, campaigners claimed yesterday. Older women with the disease are up to 40 times less likely to be given surgery on the NHS than younger patients, research shows. They are also less likely to be diagnosed or receive standard treatments such as chemotherapy and radiotherapy.

The findings on surgery applies to women over the age of 80. When they do get surgery, it is 'significantly' less likely to be breast-conserving, with more women losing their entire breast during the operation. In addition, those over 70 are not routinely invited to breast screening, which can lead to an earlier diagnosis.

Daphne Cook was diagnosed with breast cancer aged 74, but her consultant said she did not need radiotherapy as being older might make it difficult for her to get to the hospital. Mrs Cook, now 87, a grandmother of seven and great-grandmother of six, eventually got the treatment after her daughter, a health worker, questioned the decision. 'I didn't understand the importance of radiotherapy treatment and I certainly wouldn't have pushed for it,' Mrs Cook said. She has since enjoyed more than ten years of good health.

Jeremy Hughes, chief executive of Breakthrough Breast Cancer, which carried out the research, said: 'Ten years ago women like Daphne were not being given a full range of treatment options and our research has found this is still the case today, despite many advances in breast cancer treatment. 'With nearly 12,000 women dying of breast cancer each year it is scandalous that all women are not receiving equal access to the treatments they need.'

The charity is calling for the Government to implement laws against ageism in the Health Service. Last year a survey of doctors caring for older patients found that almost half believed the NHS is 'institutionally ageist'.

The risk of breast cancer increases with age and a third of cases occur in women aged 70 and over. Nearly 46,000 were diagnosed with breast cancer last year, and experts predict this will rise to 57,000 a year by 2024 - an increase of 20 per cent.

SOURCE




"New-and-Improved ObamaCare!"



Yesterday, Barack Obama unveiled his latest, "new-and-improved" version of ObamaCare. Sadly for the American people, it's more of the same. According to the New York Times, the Obama proposal "sticks largely to the version passed by the Senate in December." This is therefore the same proposal that 58 percent of voters overwhelmingly oppose, as reported by Rasmussen Reports. A full 61 percent want Congress to simply start over.

As well they should. As Americans for Limited Government President Bill Wilson commented yesterday, "This is pretty much the same government-run health care proposal that the American people have already rejected." Indeed.

According to the Times, the White House claims the plan will cost some $950 billion atop the already swelling entitlement burden that cost $1.441 trillion in 2010 alone. It also proposes extending taxpayer-subsidized coverage to some 31 million Americans.

Unfortunately, the proposal was so vague, the Congressional Budget Office cannot even grade it properly. Writes CBO Director Douglas Elmendorf: “preparing a cost estimate requires very detailed specifications of numerous provisions, and the materials that were released this morning do not provide sufficient detail on all of the provisions.”

Rest assured, if this latest abomination is anything like the Senate version, as is reported, the true cost will be more like $2.5 trillion over ten years once fully implemented, as Senate Republicans have claimed of the bill they opposed in the Senate.

And, lest anyone doubt the veracity of that figure, such as Senator Al Franken or Talking Points Memo, just check with the Congressional Budget Office, as reported by the Weekly Standard in December: “The Democrats are irresponsibly and disingenuously claiming that the bill would cost $871 billion over 10 years. But that's not what the CBO says. Rather, the CBO says that $871 billion would be the costs from 2010 to 2019 for expansions in insurance coverage alone. But less than 2 percent of those ‘10-year costs’ would kick in before the fifth year of that span. In its real first 10 years (2014 to 2023), the CBO says that the bill would cost $1.8 trillion -- for insurance coverage expansions alone. Other parts of the bill would cost approximately $700 billion more, bringing the bill's full 10-year tab to approximately $2.5 trillion -- according to the CBO.”

Even Senator Max Baucus admitted that the bill would cost $2.5 trillion when he said, “health care reform, whether you use a ten-year number or when you start in 2010 or start in 2014, wherever you start at, so it is still either $1 trillion or it's $2.5 Trillion, depending on where you start…”

Although the White House in one breath claims the bill will be “deficit-neutral,” it is forced to admit that it will indeed be funded by taxpayers: “Millions of families will receive hundreds of billions of dollars in tax credits to help them pay for insurance in the new exchanges… The Act also provides financial assistance to reduce out-of-pocket costs for moderate and low-income eligible Americans.” Those are direct subsidies for health benefits; to call them tax credits is like calling Medicare or welfare a tax credit.

Obama’s claim to deficit-neutrality depends on the critical $483 billion in ten-year cuts to Medicare, Medicare Advantage, and Medicaid. But, a $210 billion “doc-fix” bill — kept apart from ObamaCare — that passed the House in November restores a good portion of those cuts, as reported by FOX News.

This is where the rationing comes in. As the government’s unfunded health care liabilities become increasingly unsustainable over the next several years, the growing costs of providing health benefits for everyone will assuredly eat into the benefits of providing coverage to seniors and the poor.

The greater the insurance pool, the more costly the “doc-fixes” and other subsidies will be in the future, and the less benefits there will be to go around.

This is therefore a bill that will ultimately ration care away from seniors, lower the quality of medical treatment, increase premiums, drive the American people off of their private health options and onto government-run ObamaCare, and bankrupt the Treasury with unsustainable costs. And one that Congressional Democrats intend to pass by simply eliminating the filibuster and weakening the nation’s two-party system, as ALG News has previously reported.

If one needed any more proof of the phoniness of this White House, look no further than February 25th’s health care summit, where Obama hopes to create a theater of bipartisanship, all the while hocking the same old, wretched Congressional bill that barely survived the town halls.

Of course, it’s a theater of the absurd. And the meeting is a stage for Obama to pretend that it is not. The bill is to be rammed through regardless of the summit; with or without Republican support. This “new-and-improved” proposal, its much ballyhooed summit, and the pretense of honest, faithful negotiations have more in common with a reprehensible, Orwellian, Third World banana republic than a fully mature citizen republic. This is not change, it is a fraud.

SOURCE




ObamaCare at Ramming Speed

The White House shows it has no interest in compromise

A mere three days before President Obama's supposedly bipartisan health-care summit, the White House yesterday released a new blueprint that Democrats say they will ram through Congress with or without Republican support. So after election defeats in Virginia, New Jersey and even Massachusetts, and amid overwhelming public opposition, Democrats have decided to give the voters what they don't want anyway.

Ah, the glory of "progressive" governance and democratic consent.

"The President's Proposal," as the 11-page White House document is headlined, is in one sense a notable achievement: It manages to take the worst of both the House and Senate bills and combine them into something more destructive. It includes more taxes, more subsidies and even less cost control than the Senate bill. And it purports to fix the special-interest favors in the Senate bill not by eliminating them—but by expanding them to everyone.

The bill's one new inspiration is a powerful federal board that would regulate premiums in the individual insurance market. In all 50 states, insurers are already required to justify premium increases to insurance commissioners, who generally have the power to give a regulatory go-ahead, or not. But their primary concern is actuarial soundness and capital standards, making sure that companies have enough cash to pay claims.

The White House wants to create another layer of review that will be able to reject any rate increase that is "unreasonable or unjustified." Any insurer deemed guilty of such an infraction by this new bureaucracy "must lower premiums, provide rebates, or take other actions to make premiums affordable." In other words, de facto price controls.

Insurance premiums are rising too fast; therefore, premium increases should be illegal. Q.E.D. The result of this rate-setting board will be less competition in the individual market, as insurers flee expensive states or regions, or even a cascade of bankruptcies if premiums are frozen and the cost of the care they are expected to cover continues to rise. For all the Dickensian outrage about profiteering by WellPoint and other companies, insurance is a low-margin business even for health care, and at least 85 cents of the average premium dollar, usually more, is devoted to actual health services.

Price controls are always the first resort of national health care—i.e., Medicare's administered prices for doctors and hospitals. This new White House gambit is merely a preview of ObamaCare's inevitable planned medical economy, which will reduce choice and quality.

The coercive flavor that animates this exercise is best captured in the section that purports to accept the Senate's "grandfather clause" allowing people who like their current health plan to keep it. Except that "The President's Proposal adds certain consumer protections to these 'grandfathered' plans. Within months of legislation being enacted, it requires plans . . . prohibits . . . mandates . . . requires . . . the President's Proposal adds new protections that prohibit . . . ban . . . and prohibit . . . The President's Proposal requires . . ." After all of these dictates, no "grandfathered" plan will exist.

Meanwhile, the new White House plan further vitiates the remnants of cost-control that remained in the House and Senate bills. Now the highly vaunted excise tax on high-cost insurance plans won't kick in until 2018, whereas it would have started in 2013 in the Senate bill, and this tax will only apply to coverage that costs more than $27,500.

Very few plans ever reach that threshold, and sure enough, this is the same $60 billion deal the White House cut in December with union leaders who have negotiated very costly benefits. Now it is extended to all to avoid the taint of political favoritism.

While the White House claims to eliminate the "Cornhusker Kickback," the Medicaid bribe that bought Nebraska Senator Ben Nelson's vote, political appearances are deceiving. As with the union payoff, what the White House really does is broaden the same to all states, with all new Medicaid spending through 2017 and 90% after 2020 transferred to the federal balance sheet. Governors will love this ruse, but national taxpayers will pay more.

And more again, because the White House has adopted the House's firehose insurance subsidies. People earning up to 400% of the poverty line—or about $96,000 for a family of four in 2016—will qualify for government help, and, naturally, this new entitlement is designed to expand over time.

The Administration also claims to have discarded the House's 5.4-percentage-point surtax on joint-filers earning more than $1 million a year, but it sneaks it back in by expanding the Senate's expansion of the 2.9% Medicare payroll tax to joint income above $250,000. The White House would now apply that tax for the first time to income from "interest, dividends, annuities, royalties and rents," details to come.

The larger political message of this new proposal is that Mr. Obama and Democrats have no intention of compromising on an incremental reform, or of listening to Republican, or any other, ideas on health care. They want what they want, and they're going to play by Chicago Rules and try to dragoon it into law on a narrow partisan vote via Congressional rules that have never been used for such a major change in national policy. If you want to know why Democratic Washington is "ungovernable," this is it.

SOURCE




A man with a plan

Obama seems to surmise that the American people have forgotten that he already had a plan and that it looked almost exactly like his "new" one

In his speech to a joint-session of Congress on September 9, President Obama introduced what he called "my plan" for "health care reform." The next day, the Washington Post noted that "the president for the first time Wednesday embraced a set of ideas as 'my plan.'" About the same time, Obama authored a health-care piece in which he referred to "my plan" eight separate times (nine, if you include a set-aside quote).

Now, fast-forward about six months, to just three days before the made-for-TV "health summit," and, lo and behold, the president released -- as if for the first time -- a health-care plan. Is he kidding?

Sadly, he's not. Instead, the president seems to surmise that the American people have forgotten that he already had a plan and that it looked almost exactly like...well, this one. The colossal increases in federal spending remain (last projected by the Congressional Budget Office (CBO) to total $2.5 trillion in the bill's real first decade). The cuts to Medicare Advantage (MA) remain (last projected by the CBO to tally $21,000 per MA beneficiary in the bill's real first decade). And most of the political cronyism apparently remains -- like the "Gator Aid" deal, which would exempt seniors in South Florida from those MA cuts. Also back for an encore are the tax increases that would funnel (at last count) $1.0 trillion (in the bill's real first dozen years) from American taxpayers, through the federal government, to private insurers -- alongside the mandate that Americans buy insurers' product.

To be fair, there are a couple of new wrinkles. In exchange for these generous perks, insurers would have to go through another level of review before implementing any price-increases they might have planned. State insurance regulators, such as the ones in California (hardly a conservative, free-market bastion) who didn't object to Anthem's rate increases, would now be subject to overrule by the federal government. The U.S. Department of Health and Human Services (HHS), the department that (according to the Washington Post and 60 Minutes) already manages to lose $60 billion a year in taxpayer money to Medicare fraud -- compared to $8 billion in combined annual profits for America's ten largest private insurers -- would come to the rescue. The costs to insurers from this extra bureaucratic hurdle would, of course, be passed on in higher premiums (and would probably even be factored into the rate-increase requests) -- except for when HHS refuses a rate-increase request, in which case the insurers would simply do what the government does when it wants to cut health costs: ration care.

Another new wrinkle would be to increase Medicare taxes. For the first time ever, a Medicare tax would be levied on the income of certain people (those folks who annoy Obama by making over $200,000) from investments, dividends, annuities, rentals, and royalties -- which the President lumps together and calls "unearned income." But this tax-revenue would not be used to pay for Medicare, which desperately needs to be put on more solid financial footing. Instead, this new Medicare tax would pay for -- you guessed it: the president's plan, which would cut Medicare.

When the president first mentioned what he called "my plan" for "health care reform," it was in the wake of the August voter uprisings. He spoke of it in the context of his broader message to Congress, which was that there was no need to let a little thing like voter dissatisfaction get in the way of a perfectly good plan. This week's nearly identical plan comes in the wake of Scott Brown's victory in Massachusetts. So disconnected from political currents does the President seem, one wonders whether this same plan (with a new wrinkle or two) will also be re-released -- and presented as brand-new -- in the wake of the November elections.

SOURCE




ALG Defends Newfoundland Premier Williams’ Right to “Best Possible Health Care”

Calls on Congress to Protect American Patients from “Government Takeover of the Nation’s Health System”

Americans for Limited Government President Bill Wilson today defended Newfoundland Premier Danny Williams’ decision earlier this month to receive heart surgery in America rather than in Canada, saying “Canada’s socialized, government-run system is of such low quality not even the Premier of one of Canada’s provinces wants to risk his own health there.” Williams yesterday said that “I did not sign away my right to get the best possible health care for myself when I entered politics,” describing the decision as “my heart, my choice and my health.”

Wilson said the episode was proof that “America’s system has generated a quality of medical treatment that is unparalleled in the entire world.” “Now, Barack Obama wants us to suffer the same type of low-quality care Premier Danny Williams was able to avoid by coming to the U.S.,” Wilson added, renewing his call for members of Congress to reject the Administration’s latest proposal.

“Premier Williams has a right to the best quality of health care in the world, and so do the American people, who are being force-fed a government-run system that will ration care, reduce quality, and increase costs,” Wilson said.

Yesterday, Wilson condemned Obama’s proposal as “more of the same: a government takeover of the nation’s entire health system,” calling it a “mishmash” of the House and Senate versions “with the same $2.5 trillion price tag.” “This is pretty much the same government-run health care proposal that the American people have already rejected. It’s just like the House and Senate versions that have already passed that will cost some $2.5 trillion over ten years once fully implemented,” Wilson said.

As reported by the New York Times, the Obama proposal “sticks largely to the version passed by the Senate in December.” According to Rasmussen Reports, 61 percent of voters say they want Congress to start over on any health care legislation. 58 percent oppose the bill in its current form, which only 39 percent support.

SOURCE





24 February, 2010

The Same Gov’t Takeover You Still Don’t Want - Now with Price Controls!

Democrats have spent the last year trying to sell a government takeover of health care to an American public that just isn’t buying. After failing for so long, it looks like the White House has decided to add a new wrinkle to its marketing scheme. It’s the same government takeover of health care you still don’t want…(drum roll)…now with price controls!

The plan unveiled by the White House earlier today is basically the Senate bill with a few changes. Let’s take a look to see what the Obama administration still mistakenly thinks health care reform should look like. The White House plan:

o Still levies mandates on individuals and employers.

o Still leaves $650 billion in savings on the table every year by ignoring real medical liability reform.

o Still puts Washington bureaucrats in charge of defining “quality” health care. Still cuts Medicare Advantage.

But wait, there’s more! For an unlimited time only, the White House plan also:

* Still raises taxes to pay for new entitlement programs (only this time the Medicare payroll tax increase is even higher).

* Still gives the government-run plan a beachhead to eliminate the private insurance market.

You see, it really is the same government takeover you still don’t want. Only now the Obama administration has included a “Health Insurance Rate Authority” to make sure that insurance premiums aren’t any higher than Uncle Sam says they should be. After all, price controls are as American as apple pie.

SOURCE




CBO: Obama health bill too sketchy to rate

President Obama tried to woo the GOP with sweeteners and threw out the controversial "cornhusker kickback," but the White House's first stab at resurrecting the health care overhaul was so bare-bones that Congress' budget scorekeeper couldn't put a price tag on it. In a nod to Republicans, Mr. Obama's proposal calls for a centralized database where government officials can document Medicare and Medicaid abuses — an idea from the conservative House Republican Study Committee.

The president also culled a provision from a centrist House Republican bill that would require background checks for those who provide health care services under Medicare. The plan also adds stronger sanctions such as jail time for those who purchase, sell or distribute Medicare-beneficiary information numbers.

Republicans were not impressed and continued to take aim at Mr. Obama's decision to release a plan before Thursdays televised White House summit with Capitol Hill lawmakers. "The president has crippled the credibility of this week's summit by proposing the same massive government takeover of health care based on a partisan bill the American people have already rejected," said House Minority Leader John A. Boehner, Ohio Republican.

Saying it "doesn't make sense" to start from scratch, the administration ignored calls from the Republican minority to scrap the Democratic health care bills and instead released a detailed outline based on the Senate version. At the same time, advisers insisted that Mr. Obama is heading into the summit with an "open mind." The administration did not post the bill's text on the White House Web site but outlined what the legislation would do. It said the measure would cost $950 billion over 10 years.

The information wasn't enough for the nonpartisan Congressional Budget Office, the official keeper of budget costs, to even venture an estimate of the bill's price tag. "Although the proposal reflects many elements that were included in the health care bills passed by the House and the Senate last year, it modifies many of those elements and also includes new ones," CBO Director Douglas Elmendorf said in a blog post. "Preparing a cost estimate requires very detailed specifications of numerous provisions, and the materials that were released this morning do not provide sufficient detail on all of the provisions."

Republicans and Democrats have blamed each other for the lack of bipartisanship on health care, but the pressure has been on Democrats to reach out now that they have lost their filibuster-proof majority in the Senate. While Republicans have said that true bipartisanship requires writing bills together, Mr. Obama has argued that it means the minority party must accept some things it doesn't like.

After letting Capitol Hill take the lead for the past year, Monday's proposal was Mr. Obama's first effort at a comprehensive bill. His moves are designed to answer some of the harshest criticisms of the House and Senate bills. In addition to addressing a couple of Republican ideas, Mr. Obama's version removes one of the flash points of the Senate health care bill — Nebraska's special Medicaid arrangement that guaranteed it more federal dollars than other states, which Republicans derided as the "cornhusker kickback."

The Senate bill expanded eligibility for Medicaid so that more people would qualify. But Medicaid is a shared state and federal responsibility, which means that states eventually would have to pay more to cover the new enrollees. Sen. Ben Nelson, a moderate Nebraska Democrat and a last holdout in the Senate vote last year, negotiated a deal under which his state's increased payments would be funded by the federal government in perpetuity. Although the White House removed the Nebraska provision, it left other special exemptions, even after Mr. Obama called the deals "ugly" in an ABC News interview last month. He lamented that the deals undermined public support for the bill. Mr. Obama's bill, for example, kept the $300 million in Medicaid funds that Sen. Mary L. Landrieu secured for Louisiana, according to her office. It has become known as the "Louisiana Purchase."

But White House press secretary Robert Gibbs noted that Mr. Obama's bill would allow any state in which a major disaster occurred to be eligible for additional federal Medicaid funding. "So it's not a carve-out," he said. Mr. Gibbs on Monday called on Republicans to post their own proposal online. House Republicans responded by pointing out that the text of their bill has been posted on their Web site for months.

"Mr. Gibbs needs to talk with his boss. Our health care alternative — the full text of the legislation — has been available at healthcare.gop.gov for months, which President Obama knows, since he discussed it with us in Baltimore a few weeks ago," said Michael Steel, a spokesman for Mr. Boehner.

Mr. Obama's proposal appeared to leave untouched the special treatment that Sen. Bill Nelson, Florida Democrat, and other senators helped negotiate for Medicare Advantage customers in their states, though Mr. Nelson's office said it couldn't be sure until the CBO scores the bill.

SOURCE




Premature Schadenfreude

Jonathan Chait is enjoying what you might call "pre-schadenfreude" about health care's apparent revival. One can understand the urge, given how little opportunity liberals have had to actually revel in GOP despair over the past few weeks. But I think it's more wishful than warranted.

Despite having declared the death of the health care bill before almost anything else, I don't want to say that the thing's impossible. But the House has lost three of the votes it used to pass their bill 220-215 . . . which means that you have to persuade someone (probably a Blue Dog) to vote for it, who already voted against it. Progressives have been making the almost-plausible argument that the public is going to treat a vote for the House or Senate bill as a vote for final passage, so Democrats might as well go ahead and pass the thing. But their best argument totally falls apart for those who originally voted no.

And that's the best case scenario. It assumes that you can keep Bart Stupak's pro-life caucus, even though it's unlikely that they'll be able to "fix" the Senate's more liberal abortion language in reconciliation. This is a pretty heroic assumption. If you lose many of the Stupak folks, then the bill's done; there is not a snowball's chance in hell that you are going to persuade any significant number of the prior "no" votes in the Democratic caucus to throw their careers on the pyre of Democratic health care ambitions.

Meanwhile, it's not clear how many senators are nervous. Are we sure they have 51 Democrats for reconciliation? Reid has made these sorts of claims before, only to slip another deadline.

And deadlines are yet another big problem. Reid says they'll be ready to do reconciliation within 60 days. Really? Democrats are going to pass a mongo, costly new entitlement right around tax day? The caucus might as well pass the hat for the GOP election fund. But if you delay it, you're leaving an unpopular bill very fresh in peoples' minds as they go into the 2010 elections. You're also eating up air time that senators and congressmen would presumably like to have for initiatives that are actually, y'know, popular.

I'm not seeing it. And neither are any of the people I know who opposed the bill. They're worried, but at about the level of worry you give toe fungus, not stage-three metastatic cancer. Mr Chait is going to have to wait a little while for his freak-out. Unless that's one hell of a health summit Obama puts on, he'll probably have to wait forever.

SOURCE




Cool reception for Obama health plan in Congress

President Obama's latest health care reform proposal has received a lukewarm response among House Democrats and a scathing review from Republicans three days ahead of a bipartisan summit on the issue.

The plan includes many of the elements of the Senate-passed plan the GOP opposes, but it adds a few more provisions that will stir even more Republican opposition, including language that could be used to give the government control over private insurance premiums.

House Minority Leader John Boehner, R-Ohio, put out a statement condemning the new plan, going so far as to say it jeopardizes the summit planned for Feb. 25 at Blair House

"The president has crippled the credibility of this week's summit by proposing the same massive government takeover of health care based on a partisan bill the American people have already rejected," Boehner said. "This new Democrats-only backroom deal doubles down on the same failed approach that will drive up premiums, destroy jobs, raise taxes, and slash Medicare benefits."

Boehner goes on to say the summit, "has all the makings of a Democratic informercial."

The latest version is aimed at appeasing House Democrats who did not like the bill's tax on expensive insurance plans. The new plan delays the tax for union workers and raises the threshold of those who would have to pay it.

House Speaker Nancy Pelosi, D-Calif., however, did not appear thrilled with the plan. She said in a statement that it "contains positive elements from the House and Senate-passed bills."

The proposal lacks the public health insurance option House liberals are demanding and it is not clear whether the House Democratic leaders will be able to come up with the 217 votes needed to pass it. The House will be short three members who voted "yes" on a previous health care reform bill that barely passed the House, including Rep. Neil Abercrombie, D-Hawaii, who is resigning at the end of the month to run for governor.

Democrats in the Senate were more enthusiastic of the bill, which includes most of the provision they already passed in December.

"The president needs to say, 'This is what I'm for,' and it sounds like he has done that," Sen. Tom Carper, D-Del. said. "We need to ask Republicans, 'What are you for?' And hope that they will present their ideas and we won't be dismissive of them."

SOURCE




Health Care and Hubris

Scott Brown didn’t derail health-care reform. Bad politics and policy choices did

President Obama is making a last-ditch effort to salvage health-care reform at a bipartisan meeting Thursday at Blair House in Washington, D.C. Democrats may still try and ram their unpopular bill through Congress using a budget tactic known as “reconciliation” in the Senate, but make no mistake: it’s a sign of desperation, not strength. The Democrats’ 2,000-page, $1 trillion legislation may not be dead yet, but it’s on life support.

What a difference a year makes. In November 2008, Democrats trounced Republicans. President Obama swept into office with a powerful majority in Congress and a determination to enact sweeping liberal reforms. Democrats’ long-held dream of universal health care seemed on the verge of fruition. Feeling invincible, the White House quickly strong-armed the hospital, insurance, and pharmaceutical sectors into supporting Democratic health-care reform proposals. The drug industry’s trade association even promised $100 million in advertising support. An eventual Rose Garden signing looked all but certain.

With Obamacare now in shambles, the White House and its allies are trying to shift blame to the Republicans as the “Party of No.” But the Democrats helped derail themselves. The administration made poor political decisions that resulted in a bad legislative process and even worse policy outcomes. Obamacare ultimately collapsed beneath the weight of its own contradictions.

From the start, the president set broad goals for health-care reform but left the drafting of legislation to the congressional committee heads. In the House, this meant that the most liberal members wrote the bill, lurching the whole process leftward. The House liberals produced a massively expensive and convoluted bill and ignited a public debate about a new government insurance plan—the “public option”—that predictably raised red flags for moderates and conservatives in both parties. The White House, in short, opted for a “majority only” approach to health-care reform, disdaining broad bipartisan support in favor of (potentially) picking off one or two Senate Republicans.

The legislation that congressional Democrats produced is a dog’s breakfast. Democrats can claim that it’s “deficit neutral” (a terrible standard, since current deficit projections are unsustainable) only because it’s loaded with fiscal gimmicks and across-the-board reimbursement cuts to doctors, hospitals, and nursing homes. No one really believes that these will play out as advertised. The legislation’s projected costs over its first decade are almost willfully misleading. Provisions on taxes and reimbursement cuts (to Medicare and Medicaid) kick in immediately, while outlays on coverage subsidies (including a Medicaid expansion) don’t go into effect until 2013. The legislation also includes $200 billion in Medicare physician cuts that will be rescinded once a bill is signed by the president. And union pressure gutted a “Cadillac Plan” tax that was supposed to slow the rate of health-care inflation, costing another $60 billion.

After the Senate version passed on Christmas Eve, many supporters admitted that it didn’t do nearly enough to control costs and was tarred with too many backroom deals to buy off Senate moderates, like the Cornhusker Kickback and the Louisiana Purchase. Scott Brown’s victory in Massachusetts simply reflected public unhappiness with the Democrats’ efforts to ram lousy legislation down the country’s throat.

A more sensible approach would have been to pursue reforms that enjoyed bipartisan support, such as tax-code reforms to make insurance more affordable for the uninsured, increased federal funding for high-risk pools offering guaranteed access to people with preexisting conditions, reformed medical-malpractice laws to lower health-care costs, and preventing insurance-industry abuses (like dropping policyholders after they’ve become sick). These measures would have focused scarce tax dollars on the most vulnerable uninsured Americans without exploding the deficit.

Can bipartisanship work? It has before. Someone should remind President Obama that 83 House and Senate Republicans voted for Medicare in 1965. One hundred and twenty-three Democrats voted for welfare reform in 1996. Two hundred and forty-four Democrats voted for President Bush’s No Child Left Behind legislation in 2001.

Still, the outlook for bipartisanship is currently grim. Today, just days before the bipartisan summit, the president has issued his “own” plan for health reform—basically the Senate version of the legislation, with more regulations and subsidies tacked on to make it more acceptable to House Democrats. (The Washington Post reports that the president’s changes could add $200 billion to the cost estimate for the original Senate bill.) This is clearly a prelude to a reconciliation push in the Senate, even though the underlying legislation remains deeply unpopular.

The summit will probably turn out to be to be an exercise in administration spin. But moderates and conservatives in both parties must call the president’s bluff and present their own agenda for reform. Wiping the slate clean and starting over is highly unlikely at this point. Then again, Obamacare seemed all but certain just a few months ago.

SOURCE





23 February, 2010

Crazy NHS tells old lady to go to one hospital to treat her left eye and to another hospital to treat her right eye -- even though both eyes had the same problem!

No doubt that made sense to some bureaucrat

A 79-year-old grandmother revealed today how she was told she must receive sight-saving treatment for her eyes at two hospitals that are 30 miles apart. Pensioner Mavis Eldridge must travel to another city to treat Acute Macular Degeneration (AMD) in her left eye, even though her local hospital is already treating her right one.

She was given the sight-saving wonderdrug Lucentis in her right eye at University Hospital in Coventry, where she is still being treated for the disease. But she was told doctors were too busy to treat her after she developed the same condition in her left eye, even though the injection only takes a few seconds. Mavis, from Coventry, said: 'It is well known if you get macular disease in one eye you very often get it in the other too. So why can't they treat both?'

Mavis still has monthly scans at University Hospital but the disease, caused by bleeding at the back of the eye, is rapidly ruining the sight in her left eye too. Mavis has been told to make her own way to Selly Oak Hospital in Birmingham despite her sight-loss meaning she cannot drive. Mavis's daughter Maggie Richards drove 85 miles from Marlow, Bucks, to take her mother for her first appointment at Selly Oak on Saturday. She said: 'It seems bizarre that the clinic in Coventry can monitor and scan her left eye but not actually treat it.'

It is not the first time Mavis has hit problems getting her AMD treated. Last year, she had to pay more than £600 for a private course of the high-risk drug Avastin to stop her going blind in her right eye. The NHS had waited so long to treat her deteriorating sight that she no longer qualified for free care. Luckily the drug worked and her sight recovered enough for her to be eligible for further NHS treatment.

The Macular Disease Society said it had never heard of another patient having to be treated at separate hospitals for each eye. Chief executive Helen Jackman said the treatment Lucentis was approved by the NHS in August 2008 and the hospital and primary care trust should have had time to develop their services by now. She said: 'We understand that it is difficult for hospitals in some areas. But it is also very difficult for Mrs Eldridge and we urge the trusts to try to find a more acceptable or imaginative solution that takes into account individual needs.'

Richard Kennedy, medical director at University Hospital, said Mavis was offered the alternative choice of being treated at Selly Oak Hospital to ensure she could get NHS care as soon as possible. He said the decision was made in the patient's best interests because it was vital to treat AMD quickly. Mr Kennedy said there was huge demand for Lucentis as a new drug which was putting hospitals under great pressure.

SOURCE




Obama takes biggest domestic gamble to force though health reforms

Now he's going to add his healthcare bill to the budget

For more than a year President Obama hoped that he could pull off the coup of comprehensive health reform by leaving the details to Congress. Yesterday he admitted that strategy had failed by unveiling a new one: a ten-page, $950 billion “President’s Plan” that could make or break his credentials as a progressive leader in the mould of Presidents Roosevelt and Johnson.

The plan amounts to a last-ditch push for healthcare reform, which conservatives all but torpedoed last year and which Republicans condemned again yesterday as a recipe for a “massive government takeover” of an industry that accounts for more than 17 per cent of the US economy.

Mr Obama claimed that his proposals would help 31 million poorer Americans to afford private insurance, outlaw such practices as denying cover to those with pre-existing conditions, and save US taxpayers $100 billion over the next ten years.

Such arguments have failed to sway independent voters or a single congressional Republican over the past year, and they showed little sign of ending the impasse yesterday. They were posted on the White House website as an “opening bid”, aides said, three days before a crucial healthcare summit convened by Mr Obama at which he has promised to show a new spirit of bipartisanship after losing his 60-vote supermajority in the Senate.

The proposals were swiftly condemned by John Boehner, the minority leader in the House of Representatives, as a resurrection of a Bill that the American people had already rejected. “The President has crippled the credibility of this week’s summit,” Mr Boehner said.

In a Washington that has become fascinated by its own paralysis, the only glimmer of bipartisanship yesterday came from California. Governor Arnold Schwarzenegger, the husband of a powerful lifelong liberal, met privately with Mr Obama after insisting that substantial health reforms were possible if the Administration could only find a “sweet spot” of common ground with its critics.

In his search for such a sweet spot, Mr Obama has taken as his blueprint a healthcare Bill that the Senate passed on Christmas Eve and has set out to appease its critics with carefully targeted adjustments. Under his proposals, a tax on the most expensive insurance policies would not take effect until 2018 and then only above a raised threshold. He has abandoned any hope of a so-called public option, scrapped a hugely controversial subsidy for the state of Nebraska and wooed liberals by eliminating an amendment that would have barred abortion payments for anyone with subsidised insurance.

Share prices for the country’s biggest health insurers were broadly buoyant yesterday, suggesting that Wall Street had either factored the President’s widely leaked plans into its calculations in advance, or that it does not believe they will amount to much. The markets may yet be in for a surprise, but only if Mr Obama can persuade moderate Democrats worried about their re-election prospects later this year to back him. He was helped last Friday by sudden increases of up to 39 per cent in the cost of some Californian health insurance premiums.

A new Newsweek poll suggests that more Americans support the proposals when they read them in detail than when asked to consider them as a whole. Congress is less easily persuaded. Since Scott Brown’s capture of Ted Kennedy’s old Senate seat for the Republicans, the Administration’s hopes of passing health reforms with a full 60-seat majority have vanished.

The White House will almost certainly have to add the entire Bill to the budget instead, where it will need only 51 Senate votes to pass. The process will enrage Republicans but it could just lift Mr Obama into the pantheon of great Democratic reformers. “The President expects an up or down vote on health reform,” one of his spokesmen said, “and he believes the American people deserve one.”

SOURCE




Prospects for health care summit in doubt

The prospect of this week's White House summit on health care sorting out thorny policy decisions and resuscitating the overhaul without wholesale changes are slim. But Democrats and health care advocates believe the televised summit, planned for Thursday, could provide momentum and political cover to President Obama and lawmakers eager to restart the stalled effort.

"I'm not optimistic that this summit will change what appears to be opposition to anything that President Barack Obama supports," National Coalition on Health Care's Ralph Neas said of Republicans. "That doesn't mean that it could not be successful on other levels. The ultimate goal is to get consensus on substantive health care reform."

President Obama announced the bipartisan health summit earlier this month in an attempt to mollify two of the chief criticisms of the health plan - that Democrats didn't listen to Republican ideas and that the negotiating sessions were not televised, a violation of a campaign pledge he made. The top Democrats and Republicans on Capitol Hill and the relevant committees were invited.

Republicans are skeptical that the summit is a real attempt at negotiation and have not said whether they will offer an alternative proposal. But with the White House expected to release a plan it hopes Democrats can support and Republicans firmly opposed to any of the Democrats' proposals, few health policy experts or lawmakers expect the summit to lead to policy compromises.

"Apparently, we're going to be there most of the day and have an opportunity to have a lot of discussion," Senate Minority Leader Mitch McConnell of Kentucky said on "Fox News Sunday." "But if they're going to lay out the plan they want to pass four days in advance, then why are - what are we discussing on Thursday?"

If they show up empty-handed, "that will lead the public to believe that the only views Republicans have on health reform is 'no,'" said Ron Pollack, executive director of Families USA, a liberal health care advocacy group that supports the Democrats' plans. "I believe this will galvanize Democrats on Capitol Hill to move forward."

Republicans have steadfastly opposed a large comprehensive bill and prefer a step-by-step approach that includes proposals such as tort reform and allowing insurers to sell across state lines. They have several small-scale bills.

"For those families and small businesses looking for a sign that Washington is ready to wake up and find common sense on this issue, next week's White House health care summit may not be it," Rep. Dave Camp, Michigan Republican and ranking member of the House Ways and Means Committee, said in this weekend's Republican address. "If the starting point for this summit is more of the same backroom deals and partisan bills, then this meeting will likely be a charade."

Democrats, meanwhile, appear to be pursuing a plan that could be passed through reconciliation, a complicated procedural tool that allows lawmakers to circumvent the chance for a Republican filibuster. The bill would only have to pass with 51 votes, but could not include many of the policy initiatives that don't have to do with the budget.

The White House is expected to release a plan based on negotiations that took place between the House and Senate up until the election of Sen. Scott Brown, Massachusetts Republican, in a special election last month that shook up Capitol Hill.

But Mr. Obama, in his weekly address, asked lawmakers from both sides to come to the meeting with open minds.

"I don't want to see this meeting turn into political theater, with each side simply reciting talking points and trying to score political points," he said. "Instead, I ask members of both parties to seek common ground in an effort to solve a problem that's been with us for generations."

While reconciliation is a controversial tool, advocates of the idea point to it being used to pass welfare reform, the State Children's Health Insurance Program and President Bush's tax cuts.

Under the reconciliation plan, the House would pass the Senate's health bill as it is, and then both chambers would pass another bill to "fix" things lawmakers don't like in the Senate legislation.

The Senate would have to pass its bill through reconciliation because Mr. Brown's surprise win last month stripped Democrats of their 60-vote supermajority needed to block a filibuster.

SOURCE




The Final Straw? Unions counting the cost of health care reform

Turns out that labor leaders have been doing a little cost-benefit analysis behind our backs. Labor leaders balked when they discovered that many unionized employees were eligible for increased taxes in the Senate’s health care bill. At the time, a deal was reached that would make collectively bargained jobs exempt from the tax until 2017; and threshold for family insurance raised from $23,000 to $24,000.

Unions agreed to the whole thing when they thought that the benefits of a comprehensive bill outweighed the potential cost of the excise tax. [Mind you, the labor unions collective "cost" was offset by sweetheart deals, $10 billion to assist unfunded pension liabilities, and exemptions from the excise tax.]

But with a comprehensive bill pretty much off the table, unions see the excise tax in a whole new light–and they are backing off their support. According to The Hill.

“But labor leaders have grown wary that the Obama administration and Congress are scaling back their ambitions for healthcare reform despite the president’s insistence that he has not. Losing union support for the healthcare effort would be a damaging blow. Organized labor has been one of the staunchest proponents of finishing the job on healthcare reform.

“”It appears that the administration and Congress will be taking a much more modest approach to healthcare reform. The cost and value of such reform would not justify using an excise tax,” Larry Cohen, president of the Communications Workers of America, told The New York Times. The communications union has been among the most vocal labor organization in its opposition to the tax.

The story ran in The New York Times, citing union leaders faulting Massachusetts as their canary in a coalmine on the excise tax:

“But as a practical matter, labor leaders said, the excise tax was killed by the election in Massachusetts, where the Republican candidate, Scott Brown, won the Senate seat long held by Edward M. Kennedy. [...] Michael A. Podhorzer, deputy political director of the A.F.L.-C.I.O., said Massachusetts should be a warning to Democrats, like “a canary in a coal mine.”

“Fully 42 percent of voters believed the health care bill would tax employer health benefits, and these voters supported Brown by two to one,” Mr. Podhorzer said.

With comprehensive health care reform–or reform of any type–unlikely, unions have more to gain complaining to Democrats than not. It’s just one more failed thing that labor leaders can torture Democrats with in November, hopefully leveraging their sympathy (and need for campaign money) to push the labor movement’s policy priorities.

SOURCE




Obama to propose federal price controls on insurance

Price controls are the ultimate Leftist idiocy. They just lead to rationing and shortages

President Barack Obama will propose giving federal authorities the power to limit rate hikes by health insurance companies — part of a new health care overhaul plan he will unveil Monday in a last-ditch bid to salvage his signature issue.

The proposal would give the federal Health and Human Services Department — in conjunction with state authorities — the power to deny egregious premium increases, roll them back, or demand rebates for consumers, said a White House official, speaking on condition of anonymity because details have not yet been officially released.

Recent premium hikes of as much as 39 percent sought by Anthem Blue Cross in California have given Obama a new argument for his sweeping health care remake, stalled in Congress since Democrats lost their 60th Senate seat in a special election last month in Massachusetts.

The proposal for tighter oversight of insurers, modeled on legislation proposed by Sen. Dianne Feinstein, D-Calif., will be part of a sweeping overhaul plan which the White House plans to post on its Web site at 10 a.m. Monday, ahead of a health care summit with congressional leaders of both parties on Thursday.

The broader plan, likely to be opposed by the GOP, is expected to require most Americans to carry health insurance coverage, with federal subsidies to help many afford the premiums. Hewing close to a stalled Senate bill, it would bar insurance companies from denying coverage to people with medical problems or charging them more. The expected price tag is around $1 trillion over 10 years.

The summit at Blair House, the White House guest residence, will be televised live on C-SPAN and perhaps on cable news networks. It represents a risky and unusual gamble by the administration that Obama can save his embattled overhaul through persuasion — on live TV.

It was forced on the administration by the Senate special election victory of Massachusetts Republican Scott Brown in January. He captured the seat long held by Democrat Edward M. Kennedy, who died last year. Brown's victory reduced the Democrats' majority in the Senate to 59 votes, one shy of the number needed to knock down Republican delaying tactics.

SOURCE





22 February, 2010

Australia gives another instance of government dental care at work: Desperate senior citizen takes takes pliers to his teeth



WHEN pensioner Baxter O'Brien was told he would have to wait more than a month to see a public health dentist for an aching tooth, he went looking for some pliers. The 75-year-old, from Babinda, south of Cairns, opted to extract the tooth himself, not prepared to go through Christmas and New Year in pain. "It was very, very painful. I couldn't bite on it or chew on it or anything," he said. "I got my bent nose pliers and pulled the tooth out myself. "There was no anaesthetic or anything. How do you describe pain? It was about a nine, I suppose, out of 10."

Mr O'Brien said he took matters into his own hands after being told the public dentist at Innisfail would be unavailable from December 4 to mid-January. "I don't want to make a hero or a brave man out of myself. This is to show how pathetic this bloody health system is," he said.

Figures released by Queensland Health last week revealed that in the last three months of 2009, more than 111,000 people were waiting to see a public dentist. The median wait for a check-up was 712 days and for a toothache so bad it kept you awake at night, such as Mr O'Brien's, it was 31 days.

Australian Dental Association Queensland president Ian Meyers, who resigned as the state's chief dentist late last year, said QH did not have sufficient dentists to meet the huge demand. "You've got about half the Queensland population that's eligible for care in the public sector, which has only about 15 to 20 per cent of the workforce," he said. "Unfortunately, there has been . . . pay inequity over the years and the remuneration that hospital dentists get is not in the same vicinity of the private sector. "There isn't the career path to keep them going."

Dr Meyers said QH had been investigating new models of care designed to reduce public dental waiting lists. "I think the Government is certainly keen and eager. They're ready for reform," he said. But any changes were likely to be delayed in the lead-up to the next federal election, expected later this year. "Obviously, the State Government is not likely to implement a whole lot of new changes just to have them changed again at a national level."

In a report to the Rudd Government seven months ago, the National Health and Hospitals Reform Commission called for a $3.6 billion-a-year Denticare Australia scheme that would offer universal access to dental care. Dr Meyers said Denticare was an "option that should be explored".

SOURCE




Democrats press forward on ObamaCare, reconciliation likely

It looks like the president and Democrats are ready to make a push on ObamaCare, which will likely be forced through Congress using reconciliation:

President Barack Obama is expected to publish his healthcare plan as early as Sunday or Monday, combining features of the two Democratic bills passed by the Senate and House of Representatives, congressional aides and healthcare advocates said on Friday....

The legislation the White House will post on its website is expected to reflect common ground negotiated over the past several weeks by House and Senate Democratic leaders.

Those agreements are likely to be combined as a privileged budget reconciliation bill, which only needs a simple 51-vote majority to pass the 100-member Senate instead of the 60-vote supermajority that has become routine in the Senate and gives Republicans power to block the healthcare bill.

“I believe that’s the path we are going to take,” a senior congressional Democratic aide said.

The government-run health care option is not off the table, according to Senate Majority Leader Harry Reid (D-NV). One thing I’m not clear on is whether this will be a new bill or the House will vote on the Senate’s version and produce a second bill, through reconciliation.

Reconciliation is not a cureall for Democrats’ problems with ObamaCare. As Jeff Davis notes at The New Republic, the process is anything but fast. and the minority can offer an unlimited amount of amendments, each of which must be voted on.

It’s uncertain whether the votes are there in the House to move this through. Remember, there are two vacancies on the Democratic Party’s side of the aisle (Robert Wexler resigned on January 3rd and Jack Murtha died earlier this month) in the House that were present with then they pushed ObamaCare through in November of last year by just three votes. There will be a third vacancy as of February 28th, when Rep. Neil Abercrombie will resign to run for Governor of Hawaii. Also, Rep. Joseph Cao (R-LA) has publicly stated that he will not vote for ObamaCare again.

SOURCE




Another reason to doubt Obamacare’s adequacy

By Hugh Hewitt (Note that the attack on Avandia is a complete crock from a scientific point of view but the politics of it are another matter)

Avandia is a prescription medicine that treats diabetes. According to an Associated Press account of a Senate Finance Committee staff report released Saturday, the drug may have caused up to 83,000 heart attacks from 1999 to 2007. Expect the cable ads to begin airing this week that encourage users of Avandia who suspect they may have been harmed to contact the law firm sponsoring the ad. Lots of them. Even more than those seeking sufferers of mesothelioma. (There is no worse way, really, to hire a law firm than via a television ad, but that’s a column for the future.)

Do a little math on the exposure now associated with Avandia. Imagine that the costs and damage associated with the average heart attack run about $10,000 — a very low estimate. What sort of liability is GlaxoSmithKline looking at when it’s summoned to the roulette table known as mass tort litigation?

Given this headline and the scale of these numbers, it might be useful for the Republicans convening at the so-called Health Care Summit this week to put the looming Avandia avalanche of lawsuits at the center of the table and raise two huge issues illuminated by the controversy.

The GOP might first ask the president how the various schemes put forward by him, or the House or Senate, propose to dispose of the enormous costs associated with this drug — or, for that matter, any drug gone wrong.

GlaxoSmithKline will be absorbing heavy costs if the allegations are remotely true — or, even if untrue, believed by a significant number of juries — and those costs will have to be paid from somewhere.

The left will declare that the shareholders of GlaxoSmithKline ought to pay every cent of every judgment, and they will — at the cost of many jobs, new research and development, and breakthrough treatments — and then only to the limit beyond which bankruptcy lies. How can any proposal that doesn’t deal with such train wrecks purport to be “reform”?

A second and even more important set of questions flowing out of the Avandia report has to do with basic governmental competence. The Senate staff report concludes with an ominous warning about Big Pharma’s record of criminal sanctions in recent years and a demand for increased FDA diligence. If the staff report is correct and Avandia — an approved FDA drug — is crippling tens of thousands of patients, why are we considering giving government regulators more power over the health care system when we cannot even expect the lavishly funded FDA to police the drug industry and spot killer medications?

One answer is that the Senate staff report is a great deal of hyperbole put out in the service of an agenda of demonization of pharmaceutical companies that serves the interests of the mass tort bar. But it issues from the Senate Finance Committee, the same committee that did most of the work on Obamacare. So if we really don’t believe the staff report, why would we believe the same staff’s work on Obamacare?

And if we do believe the staff report, why are we asking a government health care bureaucracy that cannot even prevent mass victimization of the citizenry to take on even more responsibility over the people it so poorly serves?

The Avandia report arrives at exactly the right time to raise again the fundamental doubts about Obamacare just as the left is readying one last push to jam this disaster down our throats. If the federal government cannot spot killer drugs, it ought not be tasked with vastly expanded authority over our lives.

SOURCE





21 February, 2010

Whistleblower being 'hounded out' of evil British public hospital

The senior consultant who warned of "serious failings" at the Great Ormond Street Hospital clinic which sent Baby P home to die is being "hounded out," according to her husband. David Holt said his wife, Kim, a consultant of 25 years' standing, was "in shock" after the world-famous hospital advertised her job recently without even telling her. "She couldn't believe it," he said. "She was speechless. This kind of behaviour completely blows out of the water any belief in the hospital's good faith, or their ability to change the oppressive culture Kim has experienced."

The move is the latest in a string of cases where the NHS's promises to protect whistle-blowers have proved false.

The inquiry into the Stafford hospital scandal has heard how medical staff who tried to warn of fatal failings at the trust were threatened into silence by NHS managers.

This month, a London consultant, Ramon Niekrash, won an employment tribunal case against Queen Elizabeth Hospital, Woolwich, after he was victimised for raising concerns about cost-cutting.

Dr Holt's MP, Lynne Featherstone, has said that colleagues who supported Dr Holt are being "bullied" and "pressured" by the hospital into retracting their statements. However, further staff have come forward to speak of serious problems at Great Ormond Street.

In December, Great Ormond Street promised to reach a "swift and amicable solution" with Dr Holt after a damning NHS London report largely vindicated her criticisms of the child abuse clinic in Haringey, for which Great Ormond Street provided the doctors. Dr Holt has spent the last three years on "special leave" since warning – more than a year before Baby P came to the clinic – that she and other doctors there were dangerously overworked and a child would die unless action was taken.

Tomorrow Dr Sabah al-Zayyat, the temporary locum who replaced Dr Holt after she was forced out of the clinic, goes before the General Medical Council, accused of missing serious injuries to Baby Peter two days before he died.

Great Ormond Street promised to implement the recommendations of the NHS London report, one of which was that Dr Holt had done nothing wrong and should be reinstated. However, more than two months after its publication, said her husband, there has been no movement. "Saying that nothing has happened is almost too positive," said Mr Holt. "What has happened is that they are pushing forward with their plan to drive Kim out of the service."

Dr Holt herself – who first raised her concerns in The Sunday Telegraph – has been warned by the BMA not to speak to the media again for fear that the hospital will use it as a pretext to sack her. But her husband said she had been asked to sign an agreement that was tantamount to a "death warrant." "They called it an independent mediation agreement, but it looked more like an exit agreement," he said. "Kim would have to agree to be bound by it, and the hospital was given the final say over her fate. There is no case for mediation, even if it was genuinely independent, because NHS London has already said Kim should return to her job. This is just another way of disposing of her."

Shortly after the mediation agreement was proposed, Dr Holt opened the British Medical Journal to find that the job she was supposed to return to was being advertised. "That was the most blatant example of the way Great Ormond Street act," said Mr Holt. "They clearly believe they are completely impregnable and beyond the law and they intend to carry on exactly as they always have done."

Mr Holt said that his wife had received "overwhelming support" from fellow staff at the hospital since her Sunday Telegraph interview. "She was approached by a number of other senior individuals in the Trust who feel the same way she does, particularly about the way in which Great Ormond Street is being managed and the oppressive culture there," he said. "Maybe Kim is being treated in the way she is because the management are desperately trying to deter others from going public."

Mr Holt, who is director of finance at the FTSE 100 property giant Land Securities, said: "I have been in the business world for 25 years and I have never seen anything like this. "In most blue-chip organisations people are allowed to express a view without being quashed or targeted."

Mr Holt appealed to potential staff to avoid Great Ormond Street. "Don't believe the hype," he said. "Don't work there. There are clearly major problems at this hospital and my concern is that by ignoring them, they could bring down a great national institution."

A Great Ormond Street spokesman said: "We are committed to resolving the matter with our employee but regard it as a private matter."

SOURCE




Quack medicines being funded on the NHS

While real medicines are often denied to patients

Homoeopathic medicines should not be allowed to make claims they cannot justify and should not be paid for by the taxpayer, MPs will recommend. A report from the Commons science and technology committee is expected to criticise the use of NHS resources to fund the remedies based on the current evidence for them. The committee will also argue that medicines should not be allowed to use phrases like "used to treat" in their marketing, as consumers might think there is clinical evidence that they work.

Latest figures show 54,000 patients are treated each year at four NHS homoeopathic hospitals in London, Glasgow, Bristol and Liverpool, at a cost of £4 million. A fifth hospital in Tunbridge Wells in Kent was forced to close last year when local NHS funders stopped paying for treatments.

Homoeopathy is based on a theory that substances which cause symptoms in a healthy person can, when vastly diluted, cure the same problems in a sick person. Proponents say the resulting "remedy" retains a "memory" of the original ingredient – a concept dismissed by scientists.

During the committee's inquiry, the British Medical Association said the use of homoeopathic medicine could not be justified on the current evidence. The Royal Pharmaceutical Society of Great Britain said there was no possible reason why such treatments, marketed by an industry worth £40 million in this country, could be effective scientifically.

Advocates of homoeopathy say even if the effect of the remedies is to work as a placebo, they are chosen by thousands of people, and do not carry the risks and side effects of many mainstream medicines.

Prince Charles, one of the best known proponents of the concept, which originated in Germany 200 years ago, founded the charity The Prince's Foundation for Integrated Health, which promotes the use of alternative medicines. Dr Michael Dixon, the charity's medical director, urged the Government not to restrict the use of homoeopathy, which he said would mean "abandoning patients". "For all those people with long term conditions for whom there is no evidence-based medicine, it doesn't matter how it works, what matters is whether it helps them get better," he said. A survey carried out at England's NHS homoeopathic hospitals found 70 per cent of [self-selected] patients said they felt some improvement after undergoing treatment.

David Colquhoun, professor of pharmacology at University College London, said: "It really is very simple, there is nothing in the pills. The danger is that people get diverted from the actual medicine which could cure them."

Last year an Australian homoeopath and his wife were found guilty of the manslaughter of their baby daughter because they did not seek conventional medical treatment for the nine-month-old, who died of septicaemia.

Cristal Sumner, chief executive of the British Homeopathic Association, said: "We feel the [select committee] inquiry was too narrow in its remit, there is plenty of evidence to support homoeopathy, with 100 randomised controlled trials, and many more on outcome measures, which reflect how patients say they feel."

SOURCE




What Americans Don't Understand about Obamacare

In his State of the Union speech, President Obama tried to offer a mea culpa of sorts for the unraveling of his health care bill. Calling health care "a complex issue," the president said, "I take my share of the blame for not explaining it more clearly to the American people."

Mr. President, you are correct. We Americans don't understand. However, our lack of understanding is not because we're incapable of deciphering complex issues. Rather, we don't understand how Obamacare itself is supposed to make our health care system any better. Here is a short list of what we specifically don't understand:

* How will our health care system improve by giving a $300-million payoff to Democratic Senator Mary Landrieu in Louisiana in exchange for her vote? Three hundred million was the price tag for Landrieu's "yes" vote on the 3,000-plus-page Obamacare bill. This may improve the health of Senator Landrieu's reelection prospects, but not the health of our nation.

* What is positive about exempting Nebraska from having to pay future Medicare costs but making other states foot the bill? Democratic Senator Ben Nelson was the final Democratic senator holding out support for the bill. After closed-door negotiations, Senator Nelson provided his full support. The reason for Nelson's sudden change of heart? His state was given a special exemption and would not have to pay the projected billions of dollars in additional Medicare costs that Obamacare would create.

* Why are labor unions singled out from all other Americans and given an eight-year pass on paying taxes, while non-union workers have to pick up the tab? In another closed-door negotiation, this time with Big Labor bosses and lobbyists, union members were exempted from paying the dreaded "Cadillac tax" on premium health care plans until 2018. In dollar terms, this would save union workers over $60 billion, while the rest of us have to come up with an additional $90 billion over the same time period.

* Why should taxpayers be forced to pay for elective abortions? After being repeatedly reassured by you, Mr. President, that taxpayer-funded abortions would not be included in your health care bill, why did your Secretary of Health and Human Services brag to the pro-abortion lobby that the Senate version of Obamacare includes taxpayer-funded abortion? How does this improve our health care system?

* How does putting the federal government between Americans and their doctors improve anyone's health? The Senate version of Obamacare would make Americans enroll in a "qualified health care plan" and then dictates that doctors may receive compensation under such plans only if they perform procedures allowed by the federal government.

* How does a closed-door legislative process help us understand the complexities of Obamacare? If health care is a "complex issue" that requires clear explanation to the American people, then how does it help when all of the explaining is being done to lobbyists behind closed doors?

Mr. President, what we don't understand is why a bill that is so good and necessary requires secrecy, bribes, and lies to ensure its passage. Why do you feel the need to hide the bill from us? Why do your biggest supporters need their palms greased before they come on board with your plan? Why do you tell us one thing about the cost of your bill, only for us to find out later that you understated the actual cost by over 300 percent?

In short, Mr. President, why should we believe anything you tell us about health care anymore?

SOURCE




Obama keeps all-Democratic health care option open

The White House signaled Thursday that an aggressive, all-Democratic strategy for overhauling the nation's health care system remains a serious option, even as President Barack Obama invites Republicans to next week's televised summit to seek possible compromises.

The administration's stance could set the stage for a political showdown, with Democrats struggling to enact the president's top domestic priority and Republicans trying to block what many conservatives see as government overreach.

A senior administration official said Democratic congressional leaders have nearly finished efforts to reconcile two health bills, which the House and Senate passed separately last year with practically no Republican help. Obama will use their legislation to expand coverage to some 30 million and require most Americans to carry insurance as the basis for a proposal that the White House will post online by Monday, three days before the Feb. 25 summit, said the official.

He spoke on the condition of anonymity to discuss private negotiations.

Obama says he is open to Republican ideas for changing the health care system. But many Democrats seriously doubt GOP leaders will support compromises that could draw enough lawmakers from both parties to create a bipartisan majority.

If next week's meeting does not break the logjam, congressional Democrats will face a tough choice. They can pass a highly diluted health care bill or nothing at all, which would send them into the November elections with a high-profile failure despite their control of Congress and the White House.

Or they can use an assertive and contentious tactic, known as reconciliation, to pass a far-reaching health care bill in the Senate without having to face GOP delaying tactics. Democrats lost their ability to block filibusters when Massachusetts Republican Scott Brown won a Senate seat last month.

Both parties have used reconciliation rules in the past. But Republicans have practically dared Democrats to do so on health care, citing polls showing significant opposition to the legislation.

It's unclear whether the House or Senate can muster the necessary votes. Democrats, who now hold 255 of the House's 435 seats, drew only one GOP ally when the House passed its health care bill, 220-215, last November. Since then, one Democrat who voted for the bill has resigned, one has died and a third plans to leave office Feb. 28. Moreover, changes meant to meet Senate demands could peel away enough liberals on one end, and party centrists on the other, to cause the revised bill to fail.

In the Senate, Democrats control 59 seats, and reconciliation rules require only a simple majority. But several Democratic senators have expressed discomfort or outright opposition to using the rules to thwart filibusters on health care.

Health and Human Services Secretary Kathleen Sebelius said Thursday that Obama plans to have a health care proposal that "will take some of the best ideas and put them into a framework" ahead of the Feb. 25 summit. The White House has invited Republicans to bring their own proposals, but GOP leaders have treated the event warily at best.

House Republican leader John Boehner of Ohio said Thursday, "a productive, bipartisan conversation on health care starts with a clean sheet of paper." His office labeled next week's meeting the "summit of all fears."

But at least one moderate Republican was optimistic about the session.

Sen. Susan Collins of Maine said if the summit succeeds, a bipartisan bill could be put together and passed within six weeks. "My advice to our Republican leadership is we should view this as a good faith effort and go in there with a consensus list of provisions that we could support and that would make a difference," she said in an interview with The Associated Press.

House Democrats are insisting on several changes to the bill the Senate passed on Christmas Eve, before Brown was elected to succeed the late Sen. Edward M. Kennedy. The changes include reducing or eliminating a proposed tax on generous employer-provider health plans, and eliminating a Medicaid subsidy aimed only at Nebraska.

Also, some House Democrats who oppose legalized abortion are demanding that the Senate's more permissive language on the topic be replaced by the House provisions. It was unclear Thursday how that might be achieved.

The cost of the legislation _ about $1 trillion over 10 years _ would be paid for through Medicare cuts and a series of tax increases. House officials said Democratic leaders are not yet pressing wary colleagues to back a health care bill under the special procedural rules. That could happen soon, however, if next week's summit fails to produce a bipartisan breakthrough.

House congressional aides said they expect leaders such as Speaker Nancy Pelosi, D-Calif., to tell colleagues that using all their parliamentary muscle to pass a health care bill _ even if it triggers withering criticism from the right _ is preferable to facing voters empty-handed this fall.

SOURCE




Australia: Irrational Medicare system delivers inverse health care

(Australians already have a "public option" for all, which they call "Medicare". It delivers cheap visits to private doctors but third-rate hospital care)

By Dr Jeremy Sammut

This week, two health stories from different states point to some fundamental problems with Medicare.

In Victoria, The Age has reported on a convicted conman investigated twice in recent years for suspected Medicare fraud who continues to bill the system for hundreds of thousands of dollars.

Meanwhile, the Daily Telegraph has alleged that the Federal MP for the NSW Central Coast seat of Robertson, Belinda Neal, offered (though she strongly denies it) to have a local Labor Party branch member moved up the waiting list for hip-replacement surgery in return for supporting Neal in a bitter pre-selection contest.

The extent to which Medicare may be being ripped off is unknown. Incredibly, healthcare providers are not obliged to hand over their billing records to investigators, and one in five who are audited refuse to do so.

The federal government spends about $14 billion a year on bulk-billed general practice and other allied health services, or about half the amount state and federal governments spend on Australia’s 750 public hospitals.

Expenditure on this part of the Medicare program (which all governments treat as a political sacred cow) is uncapped and demand-driven. Unquantifiable amounts of health dollars are being wasted due to not only fraud but also overuse of bulk-billed services consumed without upfront charges and co-payments.

By contrast, public hospital budgets are capped and this part of the system is supply-driven. Budget limits determine services levels, and public hospital care is rationed not only by elective waiting lists but also by emergency patients waiting for hours, sometimes days, before a free hospital bed is found.

Australia’s ‘free and universal’ public health system is therefore well-described as an irrational ‘inverse insurance system.’ The worried well can see the doctor for ‘free’ an unlimited number of times although their health needs are mostly minor, leaving taxpayers to pick up the ever-increasing bill. But when medical problems are most serious, an ‘inverse care law’ applies, and patients are forced to queue to receive hospital treatment.

The diminishing numbers of true believers who think Medicare the unblemished jewel in the crown of Australian social democracy are truly deluded. Medicare is not free, let alone universal, and beyond the cost to taxpayers, the highest price is being paid by the truly sick who are routinely denied timely access to essential hospital care.

The above is a press release from the Centre for Independent Studies, dated February 19. Enquiries to cis@cis.org.au. Snail mail: PO Box 92, St Leonards, NSW, Australia 1590.





20 February, 2010

The sorry saga of the NHS and my year undercover in hospitals

By Harriet Sergeant

Sometimes, it's the little things that offer the greatest insights. I was standing in a store cupboard with two outraged nurses. It was dark and stuffy, but the nurses had insisted I inspect the soap. It looked normal enough to me, but that was the problem. 'It's a family sized bar,' said one nurse. 'But we are not dealing with families, we are dealing with individual patients who need a fresh bar every time, so we are throwing away a large bar of soap after every bed bath. It's an appalling waste.'

The answer seemed simple, I said: smaller bars of soap. The nurses shook their heads. 'The NHS dictates who we can buy from,' said the nurse. 'And while the chosen supplier makes so much profit from the large bars, well, they're not going to change, are they?' The two nurses were so upset that they spent their lunchtime - and their own money - buying small bars of soap for their patients.

Those nurses know the NHS spending party is over and that something has to be done about the way we finance our healthcare. Spending has doubled from £51billion in 1999 to £101billion today. Chief executive David Nicholson has said that the NHS must look to save £20billion by 2014.

But how on earth will it cope with the exploding number of elderly patients and the costly new procedures and treatments coming on to the market? The answer, says the health think tank the King's Fund, is to increase productivity in the NHS. But over the past decade, it fell by almost 4 per cent. (Over the same time, it rose by almost 23 per cent in the private sector). So how to push up productivity and get value for the taxpayer?

A possible solution came this week from the Hinchingbrooke Hospital in Cambridgeshire. The hospital has debts of £40million. So from next year it will be run not by the NHS, but by one of five private sector organisations. This is the closest the NHS has come to the privatisation of a leading hospital. It is a radical departure 'born of necessity,' says Stephen Dunn, director of strategy for the East of England Health Authority. 'We need the best provider and this is the only way forward.' Only a private company, he says, will get 'real innovation and efficiency' into the process.

It's a bold and controversial step - but I believe he is right. After a year visiting behind the scenes at hospitals, I have seen at first hand how the biggest problem confronting the NHS is its monolithic bureaucracy. It is not for lack of ideas that our health service has been allowed to stagnate. During my research, I came across plenty of staff - porters, junior doctors, nurses and matrons - with exciting plans for more efficiency and better patient care. (It was surprising how often the two went together). But no one is listening to them.

Instead, initiatives cascade down from the Department of Health (DoH). And there lies the greatest problem in reforming the finances of the NHS.

I had not realised how costly the actual structure of the NHS is until I sat in on a hospital board meeting. Making sure the hospital complied with the latest government initiatives dominated the agenda. We didn't discuss patients, improving care, saving money or any issue relating to the hospital. The focus was on the bureaucratic process. The initiatives did not come cheap. The board has to prove to the DoH it is complying.

So, for nearly every new initiative, the hospital appoints a manager, often on £50,000 to £80,000 a year - not to mention a secretary - to collect the all-important data that must then be submitted to the Department of Health. The hospital is not given any additional money for this. It has to find the funds out of its annual budget, often at the expense of front-line services. Worse, the DoH is not required to calculate the likely cost of any initiative before it is implemented - a situation described as 'astonishing' by the chairman of the Public Administration Select Committee.

The effect of this is clear. One consultant calculated the proportion of managers, administrators and support staff to nurses in the NHS is 41/2 times greater than in private hospitals, which are not subject to the government initiatives.

In the year I spent visiting hospitals, I met only one person who was doing what a good manager in the NHS should be doing - questioning activity and redesigning processes to get the best care and the most efficient use of taxpayers' money. Even finance directors didn't see that as their role. I asked one what he was doing to save money and increase efficiency. He looked at me as if I were mad. He had no time for that. His time was spent reacting to the 'hell of a lot of indicators' pouring out of Whitehall. He told me he was working out the implications 'of a whole new agenda about the way funds flow around the system'. This meant he had little time to look at the finances of his own hospital, let alone work out how to save money.

In fact, what went on in his own hospital was a bit of a mystery to him. He admitted this meant he spent most of his time fire-fighting - rushing from one crisis to another. He was ten minutes late for our interview because his budget deficit had shot up that month. Was it a one-off or a trend? He had no idea. 'The financial position in this hospital is so unstable that if you don't keep an eye on it, it turns around and bites you,' he said.

All this stopped him from doing what he wanted to do and what his hospital and patients needed. As he said: 'At this stage in my career, I should be spending time thinking up intellectual and creative solutions.' Indeed, he should - and his pay should reflect this. But that is not what is happening. Almost all of the 1.6 million NHS staff have their pay increased automatically every year, at a cost of £420million. Pay is not linked to performance, as it is in the private sector, let alone to creative ideas.

The way that our hospitals are funded is surely another bar to finding savings and increasing productivity. I spoke to one non-executive director who has a career in trouble-shooting ailing companies and who was astounded by the attitude of his local hospital. With only a cursory look at the books, he announced he could save £200,000 just by good accounting. The response he got? 'It was as if I was speaking Ancient Greek.' His ideas were dismissed as not applicable in a service funded by the Government.

Worse, the hospital's chief executive feared that an investigation might expose failings and leave him vulnerable to political interference. 'They put up a facade composed of ignorance and fear,' said the non-executive director. Nonetheless, he had a go at the equipment budget, which was 21/2 times over budget in the last financial year. He started from the basics, costing everything from the bottom up. He was startled to discover that this had never been done before. Cascades of money from the top had left managers indifferent to the basic routine of accounting.

Did the trust know what it owned? Was there an inventory? It appeared not. So no one knew how much equipment had simply disappeared. His wife had been given a crutch when she broke her foot. Months later, she is fully recovered, but the crutch is still lying about at home unclaimed and presumably forgotten by the authorities. The taxpayer, of course, has to pay for its replacement.

This financial vagueness was in every area he examined. For example, there was no system or control on what vehicles the trust owned or what they spent on transport. The local energy company had done a free audit of the hospital's heating system and reported that £32,000 a year could be saved by adjusting the boiler controls. But nothing had happened. Instead, managers were spending a fortune attending conferences to learn about the implications of the latest government initiative.

The non-executive director pointed out that, with travelling and a night away, this cost the trust £1,000 a head. 'The chairman and chief executive went to Harrogate last month and that alone cost £4,000,' he said.

The non-executive suggested they save money by not attending any conferences for a year. The amount of money this would save could not be calculated because no one had any idea how much they trust had spent on previous conferences. 'The NHS does not need vast injections of money. It just needs someone on the inside to say how we can save money,' he said.

Yet for all his experience, my source had not grasped the essential feature of NHS accounting. It is not to provide the hospital with the information on how to run itself more efficiently; it is a tool to secure yet more money from central funding. I discovered this while I was shadowing a modern matron. A male nurse in charge of the ward's finances stopped her. He was very upset. Last month, after a lot of juggling, he had managed to reduce spending on agency nurses. It was his best monthly figure ever. So why was he despondent? Surely the least he had got was a pat on the back from the finance department?

On the contrary. They had ticked him off for spending double the amount. I was confused by this. The nurse and the matron looked at me pityingly. In the surreal world of NHS finances, reality had nothing to do with it. What had happened was that the finance department had fiddled the figure to make it look as if he had spent twice the amount - and then had the brass neck to berate the nurse for spending so much. Why had they massaged the figure upwards? Because they wanted to extract more money from the Department of Health. 'They've told me not to do it again,' the nurse said.

The problems with NHS finances are bound up with the problems of the institution itself. It was designed to be state-owned, centrally planned, financed and run. Until we engage with that basic premise, the NHS will continue to be inefficient and expensive. And we'll see more hospitals closed and front-line staff cut.

It is clear to me that we can no longer afford this top-down approach. But where do we go from here? I believe that instead of devising its own solutions to problems, the Government should cease to micro-manage our healthcare. Instead, it should be creating the opportunities for individuals and companies, inside and outside the NHS, to come up with the most efficient and cost-effective solutions, with the Government's role as strictly regulatory.

For a time, it looked as if Labour might be doing just that. They allowed independent providers to compete for business with the NHS and patients could choose where to go for certain treatments, which were still paid for by the Government. This has proved popular and successful. Care UK, which is one of the largest providers of healthcare (and one of the bidders to run Hinchingbrooke Hospital), operates walk-in health centres and GP services, as well as seven hospitals with exceptionally good clinical outcomes and no cases of hospital-acquired MRSA. More than half of its patients come through recommendations from family and friends.

Ali Parsa, the managing director of Circle (another bidder for Hinchingbrooke Hospital), the largest partnership of healthcare professionals in Europe, typifies the new philosophy. He sees the answer to the shortfalls in NHS funding coming from bottom-up innovation rather than top-down edicts. Circle's hospitals and clinics are co-formed and co-run by its clinical staff, who own half the shares. 'We need a system that attracts the best ideas from the greatest number of people,' he said.

Sadly, all this innovation is grinding to a halt under Gordon Brown. Far from giving the public a multiplicity of choice, Andy Burnham, the Secretary of State for Health, recently announced that the NHS should remain our 'preferred provider'. Chillingly, patients will be allowed to go elsewhere only if the under-performance of their local hospital remains 'significant'. So much for Labour putting patient care first.

Paul Corrigan, former special adviser on heath to Tony Blair, has urged NHS trusts to ignore this latest directive. They have a duty to provide the best care and 'this overrides any preference they have for one provider or another'. He said the service 'should not be denied the weapon of competition' to drive up value for money.

That is why what is happening at Hinchingbrooke Hospital is such an exciting departure. Hopefully, the Conservatives are listening. You never know - in the future if you are admitted as an NHS patient, you could even be offered a sensible sized bar of soap.

SOURCE




Children at top British hospital had to wash in buckets

Sick children at a leading hospital were forced to wash in buckets for almost a month after bosses failed to fix the hot water supply. More than 100 youngsters, some of them seriously ill, were left without hot running water over a period of nearly four weeks. Parents were forced to carry hot water in buckets from a single working tap in a sluice room so their children could wash. Youngsters suffering from brain tumours and cystic fibrosis were among those affected.

Despite complaints from patients and staff, bosses at Kings College Hospital, in South London, failed to fix the broken pump - and left half the children's wards without hot water for weeks.

One mother said she saw infants standing in buckets to be washed while parents carried hot water to patients' bedsides in 'sick bowls'. Gemma Dadgostar, whose 18-month-old son Aiden was being treated for Cystic Fibrosis at the hospital, said she was 'shocked' that the hospital failed to solve the problem. 'I thought it was absolutely outrageous,' Mrs Dadgostar, 29, said. 'Hot water is an absolutely basic necessity. 'Aiden was just recovering from surgery and the last thing he needed was to be bathing in lukewarm water. We had to carry hot water to his bedside in cardboard sick bowls. Other parents were washing their children in buckets. 'It was bizarre to see. In a hospital of that size it's unbelievable that they couldn't sort it out.'

Aiden's grandmother Nadine Helsdown said the scene was 'absolutely disgusting' when she visited the hospital last month. 'Other parents with children on the ward were absolutely scandalised the same as we were,' Mrs Helsdown, 51, said. 'The ward manager was disgusted, all the staff were. 'They asked and asked and tried their best to sort it out, but nothing was done.'

King's College is one of 18 hospitals named in a report by the Department of Health this month, for failing to comply with more than 10 orders to prevent people dying from accidents involving drugs, surgery or equipment.

Katherine Murphy, director of the Patients Association, last night demanded a full inquiry into why the hospital did not act sooner. She said: 'This is absolutely appalling and shows a completely cavalier attitude to patient safety. 'A lack of hot water is a serious problem and I don't accept the hospital did everything they could.' Miss Murphy added: 'Staff and parents were both rightly appalled by this and yet the hospital did nothing. I would like to see a full inquiry into how this situation was allowed to continue for as long as it did.'

A spokesman for the hospital said: 'We experienced intermittent problems with the hot water supply on three paediatric wards during January and February. 'The underlying problem was very difficult to trace, but it has now been identified and rectified. 'We would like to apologise to patients and their families who were affected by the problem.'

Earlier this month the same hospital was accused of turning off a grandmother's life support machine before her sons had a chance to say their last goodbyes to save money. The husband of 58-year-old Lai-Mai Pang-Cheung claims doctors told him the life support machine had to be switched off because of 'tight resources' - even though the couple's two sons were rushing to Britain from Hong Kong to see her.

SOURCE




To the ObamaCare Barricades

The 'public option' makes a comeback

Ever since the Massachusetts Senate election that put ObamaCare into critical condition, President Obama has been all for "bipartisanship," even going so far as to claim to take Republican ideas seriously. So how to explain this week's sudden scorched-earth campaign?

Liberals are making a bid to restore the "public option," ObamaCare's most controversial and destructive inspiration. Some 18 Senators as we went to press—led by Colorado's Michael Bennet and growing to include New York's Chuck Schumer on Thursday—have endorsed slipping this government-run insurance entitlement in the reconciliation process that would let Democrats abuse Senate rules to hustle ObamaCare into law with 50 votes. Vehemence among House progressives is also at a fever pitch, though it always is.

Health and Human Services Secretary Kathleen Sebelius joined the mob, telling MSNBC's Rachel Maddow that if the public option is "part of the decision of the Senate leadership to move forward," then the White House is all-aboard. Right on cue, Majority Leader Harry Reid put out a statement that he'll work to "craft a public option that can overcome procedural obstacles."

On that score, the main obstacles to this agenda aren't procedural but moderates in his own party. Rational Democrats killed the public option because it is hated by the insurers that will be driven out of business by its subsidy advantage, by the doctors and hospitals that will be forced to accept its below-market rates, and by the taxpayers who will get stuck with the bill. On the other hand, this new political strategy might fire up the dispirited liberal base—and allow the White House to cast the GOP as obstructionist going into the health summit next week.

It really does seem as if the Democrats are gearing up for Pickett's reconciliation charge. [For non-American readers, "Pickett's charge" was an American civil war disaster. The nearest classical allusion would be a "Pyrrhic victory"] What was that again about "the best ideas from both parties"?

SOURCE




Health costs increase sharply

Consumers are facing budget-busting increases in medical insurance premiums, Health and Human Services Secretary Kathleen Sebelius said Thursday, releasing a report the Obama administration hopes will stoke public outrage and help revive its stalled health care overhaul bill on Capitol Hill. People buying their own insurance in at least six states have seen rate increases from insurers of as much as 56 percent, the report said. Officials said the problem is likely to be more widespread, but data from individual insurers in different states are difficult to obtain. "We think it shines a light on the urgency for health reform," Mrs. Sebelius told reporters.

The Democratic health care bills would lower costs for many consumers by offering government subsidies to most of those buying their own coverage. Premiums would remain high, but insurers would face greater government scrutiny when they try to raise rates.

Proposed premium increases of as much as 39 percent by WellPoint's Anthem Blue Cross in California set off a wave of criticism and forced the company last week to announce a postponement. President Obama seized on Anthem as Exhibit A to make his case for sweeping change before a bipartisan White House health summit next week. California officials said more than 700,000 households face increases averaging 25 percent overall, with such premium hikes of as much as 39 percent.

In a briefing for reporters, WellPoint executives blamed their rate increases on rising medical costs and a pool of customers that is gradually becoming older and sicker, as younger, healthier people drop coverage. They insisted that their competitors are raising rates in much the same way. "We understand this is a hardship," said Brian Sassi, president and CEO of WellPoint's consumer business unit. "This is not something that voluntarily we choose to do."

The HHS report found that the Anthem numbers are in line with increases sought by insurers in other states - at a time of robust profit growth for the companies and a lack of competition in most states. For example, Anthem's subsidiary in Maine was denied an 18.5 percent increase last year and is now requesting that state regulators approve a 23 percent rise. Maine is home to Sens. Olympia J. Snowe and Susan Collins, Republican moderates whose support Mr. Obama would like to have for his health care legislation.

Michigan's Blue Cross/Blue Shield plan requested approval for premium increases of 56 percent in 2009. And in the state of Washington, rates for some individual health plans increased by up to 40 percent until regulators cracked down.

The premium increases affect the most vulnerable part of the health insurance market, policies marketed individually to customers buying their own plans. According to the Census Bureau, only about 9 percent of Americans purchase coverage directly, while nearly 60 percent are covered under employer plans. Family premiums for those with workplace coverage rose 5 percent last year, even as inflation fell 1 percent, but nowhere near the rates seen in the individual market.

SOURCE




Australia: Another triumph of government medicine

Toddler Tarliah O'Connell's tooth agony 'ignored' for days

A TODDLER suffering a mouth infection so severe it later required surgery and teeth removal was given only Panadol while the infection worsened at a hospital. Tarliah O'Connell, from Penrith, NSW, was moaning in pain after four days at Nepean Hospital and the painful infection then spread across her face. After being given only Panadol and Nurofen, a desperately sick Tarliah was transferred to The Children's Hospital, Westmead, last Thursday.

Her mother Raquel said Tarliah was immediately given morphine to control her terrible pain. She said her daughter has been left so traumatised she was now scared of medical staff. Tarliah has undergone serious facial surgery to treat the infection which even spread to her throat.

"Last Thursday they were still keeping her on Panadol," an angry Ms O'Connell said. "She was moaning in pain. "They [Nepean staff] said she needed to go to Westmead. We got to Westmead and they put her straight onto morphine." She said Tarliah may be left with scarring and may need more teeth removed. "She is still at the Westmead hospital and is being fed through a tube."

A NSW Health spokesman conceded Tarliah's pain relief consisted of only intravenously administered Panadol and oral Nurofen. The spokesman said "an apology has been offered" to the O'Connell family for their distress. He said Tarliah was also given antibiotics and IV fluids in a bid to "ease her discomfort". "The patient needed more specialised paediatric treatment and her doctor recommended that she be transferred to Westmead Children's Hospital," the spokesman said.

Opposition health spokeswoman Jillian Skinner said Tarliah's treatment was "appalling".

SOURCE





19 February, 2010

Obama's Health Care Summit Sham

"The proposal to televise a February 25 health-care summit with Republicans grew out of a conclusion by top White House advisers that Obama had bested House GOP leaders during a 90-minute televised discussion in Baltimore last month," according to the Washington Post.

We thought ObamaCare was pronounced dead with the election of Scott Brown, so why are Republicans even discussing it? The American people had won the victory against this key plank in the Obama socialist agenda. Now, weak and unprincipled Republicans, as they have so many times before, may rush in to snatch defeat from the jaws of victory.

Only after it had become abundantly clear that ObamaCare would never pass, after it was pronounced dead by the Massachusetts voters, Barack Obama asked for a do-over, a mulligan, in the form of this supposedly "bi-partisan" televised healthcare summit. Bi-partisan? Poppycock. It does not require a MENSA IQ to figure out that Barack Obama did not call this meeting to listen to Republican ideas. As Rush Limbaugh said, it's a "trap," an attempt to paint Republicans as the "Party of No" and lay the groundwork to bring ObamaCare back from the dead.

That's why the obvious response to Obama's request for a televised healthcare summit should have received an immediate and firm "no," but it's apparently not so obvious to some of our Republicans legislators because, they're falling for the trap.

Someone needs to save these Republicans from themselves. The New York Times called this televised health care summit "a high-profile gambit that will allow Americans to watch as Democrats and Republicans try to break their political impasse." Political impasse? Give me a break. There is no impasse. The American people don't want government-run health care and Barack Obama and the Democrats don't have the votes to pass it. It should be dead. So why are we going to continue the debate? And why are Republicans allowing it, enabling it. There is absolutely nothing Republicans can gain from this meeting.

Obama will use the occasion, with a little help from his spin-doctors at CBS, MSNBC, ABC and CNN, to make Republicans look bad and/or Republicans will actually offer concessions and put ObamaCare back on the table. Both of those outcomes are losing propositions for the American people.

Here's what Republicans should say:

"With all due respect, Mr. President, the American people have already rendered their verdict on ObamaCare. Further discussion would be pointless, fruitless and an insult to the people who elected all of us to public office. Furthermore, Mr. President, we need not remind you that members of your party literally shut Republicans out of the process, wrote the House and Senate versions of ObamaCare during closed-door meetings with liberal special interests, and, in opposition to the will of the American people, pulled every legislative shenanigan in the book to shove ObamaCare down our throats. As such, your offer of bi-partisanship, after having lost, is laughable.

We will not be puppets for your little political theater. If you're really serious about reforming the health care system, meet with members of your own party and tell them to start advancing some ideas that will actually make health care more affordable and more available to the American people such as tort reform and allowing companies to sell health insurance across state lines. We'll support those measures.

If members of your party are unwilling to go down that road, you can still work with us to advance real healthcare reform. We'll simply agree to wait until November, when Republicans have recaptured the majority, and place real healthcare reform legislation on your desk.

That's what they should say. Will they have the courage? All indications look bad.

Greta Van Susteren of Fox News asked House Republican Leader John Boehner, R-Ohio, whether or not he was going to attend the Obama healthcare summit. Boehner tap-danced. He never answered the question. And yet, he did acknowledge the idiocy of the entire exercise. At one point he acknowledged posing the question, "Why are we going to talk about a bill that can't pass?" He also expressed reservations that he might "walk into some trap."

Indeed, Congressman Boehner, this televised healthcare summit is a "trap" and a scam designed to make you and the rest of the Republicans look bad. Since you're going into this trap to "talk about a bill that can't pass," why go?

Moreover, why take the risk that your efforts might actually give new life to ObamaCare and give Obama, Nancy Pelosi and Harry Reid the opportunity to start the whole sordid process over again? Americans have had enough of the secret meetings, the back-room deals, the legislative shenanigans and the repeated attempts to shove ObamaCare down the throats of the American people.

SOURCE




The WellPoint Mugging

The brawl over rate increases is a preview of ObamaCare

Democrats and their media allies have found a new insurance piñata: WellPoint and its recent health-premium price increases in California. This spat deserves more attention, because its real lesson is what will happen to health insurance costs around the country if ObamaCare passes.

WellPoint's California unit, Anthem Blue Cross, recently informed nearly 700,000 individual insurance customers of premium increases of up to 39%. President Obama jumped on the announcement, claiming in a pre-Superbowl TV interview that the hikes were a "portrait of the future if we don't do something now."

Health and Human Services Secretary Kathleen Sebelius quickly piled on by ordering a federal inquiry, claiming a company that made "$2.7 billion in the last quarter of 2009" could not "justify massive increases." Senate Majority Leader Harry Reid ripped WellPoint and other "greedy insurance companies that care more about profits than people." And right on cue, House baron Henry Waxman scheduled a hearing, where he will not blow kisses.

He ought to subpoena California's political class because Wellpoint's rate hikes are the direct result of the Golden State's insurance regulations—the kind that Democrats want to impose on all 50 states. Under federal Cobra rules, the unemployed are allowed to keep their job-related health benefits for 18 to 36 months. California then goes further and bars Anthem from dropping these customers even after they have exhausted Cobra. California also caps what Anthem can charge these post-Cobra customers.

Most other states direct these customers to high-risk pools that are partly subsidized, but California requires the individual market to absorb the customers and their costs. Even as California insurers have had to keep insuring these typically older and sicker patients, the recession has driven many younger, healthier policy holders to drop their insurance—leaving fewer customers to fund a more expensive insurance pool.

This explains why Anthem lost $58 million in California on its post-Cobra customers in 2009. If WellPoint didn't raise premiums amid these losses, it would soon be under assault from its shareholders, if not out of business.

This episode is a preview of the adverse selection that would happen nationwide if ObamaCare passes. The Democratic bills would control what insurers could charge and force them to take all comers, regardless of health status. These burdens were supposed to be made tolerable by requiring all Americans to buy insurance or face a penalty. Yet when this "individual mandate" proved to be unpopular, Congress watered it down so that younger customers would be able to pay the penalty knowing they can wait until they're sick to pay the more expensive premiums. The only way an insurer can make up for these higher costs is to raise premiums.

This is precisely what WellPoint predicted would happen when it released a detailed actuarial study in October showing that insurance costs would soar for millions of Americans under ObamaCare. The White House hasn't forgotten that study, or forgiven WellPoint for releasing it, which may explain the force of its current attacks.

As for WellPoint's profits, $2.2 billion of WellPoint's $2.7 billion fourth-quarter earnings came from the one-time sale of a subsidiary. After one-time items, WellPoint earned $2.92 billion last year, compared with $2.86 billion a year earlier. Anthem's profit margins are in line with its two largest nonprofit competitors in the state; its net income on a per-member-per-month basis in 2008 was $12.62, compared to Blue Shield's $13.22 and Kaiser's $18.45.

Anthem last year hired an independent actuarial firm that found its rates sound and necessary. The company presented its findings to California insurance commissioner Steve Poizner last November, who had a month to review the proposed increases and never objected. But recently amid the White House campaign, Mr. Poizner has joined the chorus claiming to be "skeptical" of the increases and demanding that Anthem postpone them while he conducts a review. Anthem has done so.

Mr. Poizner is a Republican running for governor, which proves that health-care political opportunism can be bipartisan.

SOURCE




Bashing Insurers: Obama's health reform won't do much to stop the premium increases he deplores

Skepticism from a Leftist writer below

The Health and Human Services department has posted online a memo documenting health insurers' insatiable appetite for premium increases. In 2009 BlueCross BlueShield of Maine asked state regulators for a 56 percent increase in nongroup premiums; the state eventually approved a 22 percent increase. Regence BlueCross BlueShield of Oregon asked for 20 percent and got 16 percent. In Washington State Regence hiked some rates as high as 40 percent, prompting the state legislature to approve new regulations limiting future increases....

But there's little reason to believe that, in the still-unlikely event that the health reform bill makes it to Obama's desk, it will do much to curb premiums. The examples cited in the HHS memo underscore this point. Reform, the memo says, will:

1.) "Place additional oversight on health insurance companies to ensure that people get value for the premiums they pay."

Both the House and Senate bills would achieve this by mandating a minimum percentage of the premium dollar that must be spent on health benefits ("medical loss ratio"). In the House bill the requirement is 85 percent; in the Senate bill it's 85 percent for large-group insurance and 80 percent for nongroup and small-group insurance. These are good reforms. There is some evidence of industry abuse: According to the report from Health Care For America Now!, three of the top five health insurers (WellPoint, Humana, and Cigna) decreased their consolidated medical-loss ratios in 2009. But whether a federally-imposed minimum actually lowered premiums would depend a great deal on how the regulations were written; ambiguities exist about which insurer expenses count as health benefits and which count as administrative, and the industry would seek to maximize these. A November letter from the Congressional Budget Office on the Senate bill's likely effect on premiums makes no mention of medical loss ratio.

2.) "End arbitrary limits placed on coverage by insurance companies" and "End Insurance Company Discrimination."

These are references to the bills' abolition of health insurers' lifetime spending limits, their prohibition against insurers denying coverage based on pre-existing conditions, and their limits on how much premiums may vary for different demographic groups. All of these reforms are badly needed, but if they had any combined effect on average premiums at all, it would likely be to raise them, not lower them, since they would impose new costs on insurers. (This increase should be offset, however, by health reform's "individual mandate" requiring everyone to purchase health insurance. Because it's not wildly popular, the HHS memo doesn't mention it.)

3.) "Create competition among insurers with a health insurance exchange."

It's true that for most people, the exchanges would lower the cost of nongroup health insurance. But that's not because the premiums would go down; the CBO projects that by 2016 the Senate health reform bill would actually drive nongroup premiums up 10 to 13 percent. Rather, health reform would lower health insurance costs on the exchanges through government subsidies. For the roughly 60 percent of people purchasing insurance on the exchanges who qualified for the subsidy, the cost of premiums would end up 56 to 59 percent below what they are today, according to CBO. The premium increase would also be mitigated somewhat by the fact that the nongroup insurance purchased through the exchange would tend to cover more than nongroup policies do today. Rock-bottom policies would be available through the exchanges—at prices 14 to 20 percent cheaper than comparable policies today, according to Jonathan Gruber, an MIT economist who's done some contract work related to health reform for HHS—but CBO anticipates that even the unsubsidized exchange customers would usually bypass them.

4.) "Ensure value in our health care system."

This refers to various small reforms, enacted on a mostly experimental basis, aimed at lowering prices at hospitals and in doctors' offices. Everyone agrees that these are worth trying, but nobody expects they will yield significant savings in the short term, and anyway most of them concern Medicare, not private insurance.

5.) "Lower premiums."

This refers to the 14 to 20 percent price drop in rock-bottom policies mentioned above. CBO's main findings were that by 2016 the Senate health reform bill would have virtually no impact on large-group premiums and would raise nongroup premiums 10 to 13 percent. (For more on this see, "Forget The Cost Curve.")

You may have noticed that the HHS memo makes no mention of the Senate bill's 40 percent excise tax on high-value "Cadillac" health insurance, touted hither and yon as health reform's boldest bid to control medical inflation. That's probably because the idea is wildly unpopular—so much so that it had been whittled down considerably even before Republican Scott Brown's election to succeed Ted Kennedy put health reform in peril. Many called this a sellout to Big Labor, but a new study shows that 71 percent of the Cadillac-tax reductions the White House negotiated with labor leaders accrued to nonunion workers. Since then, labor leaders who previously lent the Cadillac tax their reluctant support have reportedly backed away. That's no great loss, since the Cadillac tax was misconceived from the start as a tax on gold-plated health insurance. According to a study published in the January Health Affairs, a health plan's generosity accounts for a mere 3.7 percent of the variation of in the cost of family coverage. What really determines a health plan's "value" are the demographic characteristics of the people it covers.

The HHS memo also fails to mention the House bill's public option. Creating a government health insurance plan that would compete directly with private insurers is the surest way to curb the rise in private health insurance premiums. But in the House the public option had so many restrictions placed on it that CBO ended up concluding it would charge premiums slightly higher than private competitors. The Senate, hampered by its need to muster 60 votes to break a filibuster, jettisoned the public option. Now 18 senators and 119 House members are circulating a letter urging revival of the public option in a "reconciliation" health care bill, should any such emerge. Reconciliation itself—a process that would allow Senate passage of budget-related parts of the bill on a simple majority vote—is looking like a long shot right now, to an amazing (and largely unrecognized) degree because the U.S. Conference of Catholic Bishops is standing in the way. But if divine intercession were to occur once, maybe it would occur twice and restore a muscular version of the public option (or a weak version that might later be strengthened) to health care reform. Without one, I don't see how President Obama can claim his bill would do anything much to address the plague of rising premiums.

SOURCE




GOVERNMENT HEALTHCARE ROUNDUP FROM AUSTRALIA

Three current articles below -- giving hints about what the Obamaclown wants for America

How a corrupt government health bureaucracy blames the media for its problems

By Anthony Morris, QC, who oversaw a review of Queensland Health in 2005

I HOPE that the Courier-Mail is thoroughly ashamed of itself. Thankfully, Heath Minister Paul Lucas has now explained that the essential problem with Queensland Health is not the failure of the Bligh Government, or its predecessors. Rather, as Lucas assured State Parliament last Tuesday (9 February) – quoting selectively from the unpublished report by British health mandarin Sir Liam Donaldson – the blame rests squarely with the CM and other media outlets, for creating a “media climate” which is “very hostile and adversarial”.

It took Donaldson a mere week in Queensland to produce his $40,000 report, but it seems that Queenslanders are not going to enjoy the full benefit of his words of wisdom. Lucas has reserved to himself the right to choose which extracts are officially published. So we must take Lucas’s word that the short extract which he has quoted is fairly representative of the thrust of the report as a whole, and not taken out of context.

One should not be surprised that, after spending a week in Queensland talking to QH bureaucrats in Charlotte Street, Donaldson has been left with the impression that media hostility is the greatest problem facing the healthcare system. Perhaps, if he had been able to spend a little more time here – perhaps long enough to visit some of the regional hospitals, and speak with some of the patients – he would have gained a slightly different impression.

Lucas, however, should know better. For one thing, he should know that, to the extent the “media climate” has become “very hostile and adversarial”, it is QH’s own doing. Perhaps nobody mentioned to Donaldson the fact that Queensland Health employs – at last count – over 60 full-time equivalent spin-doctors. Perhaps nobody saw fit to tell him that the main functions of this legion of propagandists are to manufacture “good news” stories for QH, to downplay and obfuscate anything which reflects poorly on QH, and, above all, to ensure that the media never get access to anything potentially damaging to QH without a fight.

Lucas should also know of the sterling work done by a small team of world-class journalists – especially the likes of Hedley Thomas, Des Houghton and Patrick Lion at the CM – in exposing major problems in our public heath service. With resources which are just a fraction of QH’s public relations machine, these journalists have repeatedly overcome QH’s defence mechanisms to ensure that the truth is revealed. Little wonder that QH bureaucrats find the “media climate” to be “very hostile and adversarial”!

Lucas’s real complaint – echoing the complaint apparently made to Donaldson by the bureaucrats with whom he consulted during his week in Queensland – is that the CM and other media outlets have the unfortunate habit of telling the truth. And that, of course, is the last thing that any QH bureaucrat wants.

I believe that I have read every report relating to QH which has appeared in the CM over the last five years. Not once, to my recollection, has QH’s army of spin-doctors found anything substantially wrong to correct in the CM’s reporting. So if the CM is to be criticised for anything, it is for informing its readers of facts which QH doesn’t want them to know. In just one issue this week – that of Wednesday 17 February – the CM demonstrated why it is so hated by QH bureaucrats.

One story concerned the demotion of former Royal Children’s Hospital chief Doug Brown, for misappropriating $6,500 of charitable donations to buy beauty treatments for nurses. Strangely, though this incident occurred in 2007, nothing happened until the CM blew the whistle. On the contrary, Brown actually received a promotion whilst supposedly “under investigation”!

No doubt QH bureaucrats are right to blame the CM for the fact that one of their senior colleagues has been punished for his wrong-doing. It remains to be explained why: (a) Brown has merely been demoted, rather than sacked and prosecuted through the criminal courts, for his theft of charitable funds; and (b) taxpayers, rather than Brown, are to reimburse the funds which he stole.

Another story concerned the latest tragedy of QH waiting-list figures. At least taxpayers and patients are now being given some approximation of the truth about this issue, compared with the folk-stories and urban myths previously being peddled by QH’s spin-doctors. But the full truth is yet to emerge, with Mr Lucas welshing on his promise to release dental waiting lists.

And so it goes on. The fact that the Health Minister and his department’s bureaucracy feel threatened by the “media climate” proves only one thing: that the CM, and other media outlets, are doing their job very well.

Lucas said in Parliament last week, “I yearn for the day when we can have some maturity in the health debate in this state”. His idea of “maturity” seems to involve the press writing only what he and his top bureaucrats want the public to know. So there is little wonder that he yearns for such a day to arrive. The rest of us can only hope that it never will.

SOURCE

Two years to see a public dentist in Queensland

THE median waiting time for a public dental checkup is two years - and people with toothache so bad it keeps them awake at night face a month-long wait for a Queensland Health dentist.

New figures show that the average wait for someone with bad tooth pain in Queensland is about 30 days to see a publicly-funded dentist. Those with lost fillings or broken teeth have a median wait of 50 days, while most people wanting a dental checkup from a Queensland Health dentist face a two-year wait.

Opposition health spokesman Mark McArdle said the long wait for public dental treatment in Queensland was unacceptable. ``Everybody understands what it's like to have a toothache and the pain that can generate," he said. ``Multiply that over a 30 to 60-day period without any relief's an appalling situation."

SOURCE

Special favours needed to get prompt treatment in a NSW government hospital

Federal MP Belinda Neal was last night embroiled in a new political row as the bitter pre-selection for her marginal seat of Robertson erupted into a war of words over alleged favours for a senior branch member. Last night Ms Neal denied allegations that she had offered to help a 72-year-old senior Labor Party branch figure get her hip-replacement surgery performed earlier if she voted for Ms Neal in the pre-selection.

The allegations have been made by Louisa Sauvage, the acting president and treasurer of the Wamberall/Terrigal branch of the ALP, in Ms Neal's seat of Robertson. Ms Sauvage said Ms Neal visited her home last Friday to ask whether she would sign the MP's preselection nomination form. "She saw me with a walking stick and asked me what was wrong," Ms Sauvage said. "I told her what the problem was and she said, 'I think I might be able to do something for you'. I said that would be nice," Ms Sauvage said. But she said she didn't feel obliged to sign the form at that time. She said she provided her doctor's name and number to Ms Neal.

Ms Sauvage said that on Monday morning Ms Neal called her about 8.30am and told her to promise not to tell anybody "but I think we can organise something for you". "She then told me I had to promise that I would vote for her," Ms Sauvage said.

But last night Ms Neal denied acting improperly. She said: "After I visited Ms Sauvage and requested her support . . . she then raised her pain and her distress at having to wait a long time for an operation. "She asked if I could help. I told her I was happy to try but it was sometimes successful and sometimes not. "Over the next couple of days I investigated and determined it might be possible for her to have her operation earlier if the operation were undertaken by a doctor who might have an earlier available vacancy.

"I rang her on the Monday and told her that I would do a representation on her behalf and that I might have some success if she was prepared to consider another doctor. "She said she would consider that and I said I would go ahead and do a representation. I directed my staff to make this representation and they were sent the morning of the following day."

Ms Sauvage has been on a waiting list with the NSW Health system for three months and was told last week that it would be another 10 months at least before she could expect to have her surgery done. Late yesterday Ms Sauvage said she was phoned unexpectedly by the Wyong Hospital and told that a place had been found for her in April.

Ms Sauvage has been a member of the ALP since 1977. "I don't like to be pushed around," she said. "I felt like a second-class citizen, like she thought I must be stupid."

Ms Neal last night claimed that the allegation that anything was requested in exchange for assistance being provided to a constituent was entirely false. said: "I have made representations on many occasions and am happy to do so for any constituent who needs assistance."

Senior officials in the NSW Labor Party have been made aware of the claims made by Ms Sauvage. Ms Neal is being forced to recontest pre-selection for the seat because fellow Labor Party member Deb O'Neill is challenging her for the Labor endorsement.

SOURCE





18 February, 2010

NHS safety failings 'kill 40,000 a year' as patients pay price of target culture

More than 40,000 deaths a year could be avoided if the NHS improved its safety record, campaigners say. They claim the Health Service is ruled by a 'widespread culture of fear' which puts patients at risk. Managers are more concerned with hitting targets than improving systems known to be flawed, said the centreright think-tank Policy Exchange. NHS funding has nearly tripled from £39.9billion to £102billion in 11 years but there are concerns the cash has failed to raise standards.

Using new data from U.S. and European research, Policy Exchange says 78,400 NHS patients a year die as a result of 'adverse events' - brought on by accidents or caused by medication or treatment. More than half of these deaths - 43,000 - could be prevented if hospitals were inspected more rigorously and recommended safety changes were installed. The figure for deaths is based on ten studies suggesting that 6.6 per cent of hospital admissions each year, around 700,000 patients, suffer adverse events - with 11 per cent of them ending in death.

Policy Exchange used Freedom of Information requests to uncover reports showing that patients became a low priority during a string of organisational reforms. They were prepared in 2008 as the Department of Health undertook a major restructuring of NHS regulation. One report, Quality Oversight In England, by the highly-respected Joint Commission International, identified 'the pervasive culture of fear in the NHS and certain elements of the Department of Health'.

Another, by the Institute of Healthcare Improvement, said the 'NHS has developed a widespread culture more of fear and compliance than of learning, innovation and enthusiastic participation in improvement'.

An NHS worker who was interviewed for the report said: 'The risk of consequences to managers is much greater for not meeting expectations from above than for not meeting the expectations of patients and families.'

The revelations follow high-profile failings at health trusts in Tunbridge Wells, Basildon and Mid-Staffordshire, where managers' obsession with targets was blamed for filthy wards and nurse shortages which led to up to 1,200 deaths at Stafford Hospital.

Henry Featherstone, of Policy Exchange, called for hospital death rates to be made public. He said: 'The reports detail a frightening catalogue of flaws in patient safety procedures. Government has dragged its feet over implementing a robust system of inspection and improvement, even after these flaws have been highlighted in the strongest terms. 'Under a proper system of inspection and oversight, coupled with a continual process of performance improvement, hundreds if not thousands of lives would be saved.'

Tory health spokesman Andrew Lansley said the Tories would fight the 'closed culture' in the NHS. He said: 'Labour's obsession with targets has led to many hospitals being forced to prioritise ticking boxes over caring for patients'.

The Department of Health said: 'England is one of the world leaders in the international drive to improve the safety of healthcare. 'We have set up, and work alongside, the National Patient Safety Agency to encourage medical staff to report and learn from incidents, even when no harm was caused. 'Every death or serious injury due to mistakes in medical care must be investigated and the lessons acted upon.' [Blah! blah!]

SOURCE




Canadian company begins real US health care reform

In 2003, Mr. Baker founded Timely Medical Alternatives. It helps Canadians arrange for medical care in the United States. Though Canadian health care is paid for by taxes, waits are long and the system isn’t concerned with minimizing pain and suffering.

Each year 400 to 500 Canadians contact Mr. Baker for help. Some want a diagnostic test. Others want to save their lives. They have waited so long for care that their health has deteriorated to the point where paying thousands of dollars for U.S. care to escape suffering, death, or permanent debilitation seems like a bargain. Some of the stories of the people helped by Timely Medical Alternatives are available at FreeMarketCure.com.

Christina Woodkey and her husband used all of their retirement savings to pay for surgery in Missoula, Montana to correct her spinal stenosis. They say that they’ll be dependent on welfare for the rest of their old age. Mrs. Woodkey had been disabled and in pain since 2005. After many delays, she was told in June 2009 that she had a September 30th appointment with a specialist. The wait for the actual surgery after that appointment would be 1 to 2 years. She had surgery in September in Missoula, and paid $55,000 for it.

The Canadian government may or may not decide to pay for Mrs. Woodkey’s surgery. Mrs. Woodkey says that regardless of the government’s decision, she’s happy that she took control of her own health care. She would do it again, she says, because money isn’t much good if you are in such pain that you can’t do anything. She says that Canadian doctors don’t care, not because they are horrible people but because under the government controlled system they can’t do anything for you.

Canadian physicians can’t affect waiting lists by working more because the government budget pays them for only a certain amount of work. Hospitals can’t open more beds because the government doesn’t fund them. It is illegal for physicians to accept payment from patients for care that the government is supposed to pay for.

Timely Medical Alternatives depends on Mr. Baker’s ability to find U.S. hospitals and doctors who have good outcomes, treat his patients promptly, and charge fair prices. His newest business, North American Surgery, will help Americans get much lower prices in exchange for cash payment from a network of 22 surgical centers in 13 states.

The differences between the package prices that Mr. Baker negotiates, and the prices charged by providers in most insurance networks, are huge. For example, the standard U.S. price for a hysterectomy is $20,000, while the North American Surgery price is a significantly lower $7,500. A hip/knee replacement that normally costs over $43,000 is much less expensive through Baker’s network at $15,000. And bypass surgery, usually hugely expensive at $100,000, is instead a more reasonable $15,000.

Why do such enormous price differentials exist? At least one of the physicians in Mr. Baker’s network notes that hospitals threaten to withdraw from insurer networks if insurers include lower cost providers in their networks. And insurers don’t have much of an incentive to fight those contract provisions because they can simply pass higher costs along in the form of higher premiums.

Mr. Baker plans to offer his services to people who have high deductible insurance, to people who don’t buy health insurance because they instead prefer to pay cash for care, and to people who just want to pay less for good health care. He and others like him offer the best plan for lowering the cost of American health care and improving its outcomes.

SOURCE




Truth and Reconciliation

The Democrat plan to force health care onto Obama's desk

"Those unversed in the arcana of Congressional procedure should familiarize themselves with 'reconciliation.' It's just another word for nothing left to lose -- that is, it's the tactic Democrats seem increasingly likely to use to bypass the ordinary legislative rules and railroad ObamaCare into law with a bare partisan majority of 50 Senators, plus Vice President Joe Biden.

Speaker Nancy Pelosi announced ... that Democrats 'have set the stage' for reconciliation. 'It's up to us to make sure the public knows that this is not extraordinary,' she said. 'It would be a reflection on us if we could not convince people that this is not an unusual place to go.' Yet the reconciliation gambit really would be unprecedented for social legislation of this cost and scale. And as a matter of procedure, it would also be unusual, to say the least.

As Mrs. Pelosi's senior health adviser, Wendell Primus, explained ... House Democrats would pass a series of 'fixes' to the Senate bill. The Senate would then pass the House reconciliation bill, sending amendments to President Obama to a bill that -- strictly speaking -- didn't exist, because it hadn't yet emerged from the House.

The House would then retroactively pass the Senate bill as is. Democrats say this will all be kosher as long as Mr. Obama signs the Senate bill before he signs the reconciliation bill. 'There's a certain skill, there's a trick,' Mr. Primus conceded, 'but I think we'll get it done.'

So even as Democrats themselves acknowledge that one reason the public hates ObamaCare so much is the corrupt tactics they have used to advance it through Congress, they still plan to try to land this Pelosian triple-handspring-quadruple pole vault to passage."

SOURCE




Poll: Start over on health reform

The American public wants Congress to start the health care debate over from scratch - just as Republicans have been pushing - amid growing talk among Democrats about the need to use a procedural end run to ram through a revised overhaul bill.

A Zogby International poll released Tuesday shows that 57 percent of Americans do not like either of the competing health care bills produced by the Senate and House and say Congress should start over, as a group of bipartisan lawmakers head to a health care summit with President Obama next week.

White House officials say they plan to unveil their revised proposal ahead of the summit, prompting Republicans to question whether the meeting is an attempt at real negotiation or just strong-arming.

Neither Republicans nor Democrats seem to seriously think the event will produce a meaningful negotiation. In fact, four Democrats asked Majority Leader Harry Reid on Tuesday to pursue reconciliation - a complicated procedural move that would allow the Senate to pass a bill with 51 votes and bypass the chance for Republicans to filibuster.

The Democrats - Sens. Michael Bennet of Colorado, Kirsten Gillibrand of New York, Jeff Merkley of Oregon, and Sherrod Brown of Ohio - support the public insurance plan, a government-run health care program that didn't have enough support to get the 60 votes needed to overcome a filibuster in the Senate, even before Republican Sen. Scott Brown's win in Massachusetts chilled support for such a plan on Capitol Hill. "Although we strongly support the important reforms made by the Senate-passed health reform package, including a strong public option would improve both its substance and the public's perception of it," the group said in a letter released Tuesday.

Reconciliation would be complicated, and many of the policy initiatives in a public-option bill or any health bill wouldn't be able to pass using the procedural tool, warned former Senate parliamentarian Robert B. Dove. He called the option an "exhausting process" during a conference call on Tuesday organized by the conservative Galen Institute.

Mr. Obama will review his proposed solution - which is not expected to include a public option - at the televised bipartisan health summit, planned for Feb. 25, White House spokesman Robert Gibbs said Tuesday. He said he expects Republicans to do the same, but minority lawmakers have been skeptical of the summit and haven't formally accepted the invitation.

House Minority Leader John A. Boehner said that after the summit, Democrats would embark "on a legislative course that Democratic congressional aides acknowledge has also been predetermined - a partisan course that relies on parliamentary tricks to circumvent the will of the American people and engineer a predetermined outcome. It doesn't sound much like bipartisanship to me."

Mr. Gibbs said it would be hypocritical for Republicans to turn down the invitation after they chastised Democrats for months for not including them in the health reform conversation. "Not accepting an invitation to do what they'd asked the president to do - if they decide not to, I'll let them leap the chasm that's there and try to explain why they're now opposed to what they said they wanted most to do," Mr. Gibbs said.

The White House's health care bill is expected to include many of the elements that already passed in both the House and the Senate bills, such as insurance industry reforms, requirements for all Americans to purchase insurance and strong incentives or a mandate that employers provide coverage. The sharpest differences among the plans include how to pay for it and how to limit federal funding of abortions.

The Zogby poll found that respondents largely oppose the current shape of the legislation, but a majority say they are more supportive of congressional reform of the health care system than they were a year ago.

Fifty percent of respondents strongly or somewhat oppose the legislation in both the House and Senate plans. But 33 percent of respondents said they were more supportive of reforming the health care system now versus a year ago and 24 percent said they are just as supportive. An ABC News/Washington Post poll released last week has similar findings. It showed that 63 percent of Americans want Congress to pursue a way to reform the health care system.

SOURCE




Australia: Hospital boss dumped for misuse of funds but details kept secret

THE boss of the Royal Children's Hospital has been dumped from the top job as Queensland Health is forced to repay thousands of dollars to the hospital's charity after it was incorrectly spent on luxury beauty treatments for nurses.

RCH chief operations manager Doug Brown has been demoted and will be relocated within the department following the completion of a two-year probe by the Crime and Misconduct Commission. Another unidentified hospital staffer has suffered a pay cut, while two other unnamed officers will undergo retraining in financial management.

Queensland Health will repay $6500 to the RCH Foundation after Mr Brown approved beauty treatments for 65 nurses as part of an alleged pay-off after they missed out on free parking.

The foundation raises money for lifesaving research but, as revealed by The Courier-Mail last year, the funds were instead spent on body polishes, manicures and pedicures at a beauty salon in 2007.

After months of insisting it would comment once the probe was finalised, Queensland Health yesterday refused to release the final report, including the findings, recommendations and exactly why certain staff were disciplined.

The demotion of Mr Brown is an embarrassment for Queensland Health after the department chose him over other candidates to run the RCH last year while he was being investigated.

SOURCE





17 February, 2010

NHS hospitals accused of putting patients' lives at risk

Hospitals have been accused of ignoring NHS orders designed to prevent the deaths of patients from accidents involving drugs, surgery or equipment. According to information released by the Department of Health, hospitals have not introduced safety alerts from the National Patient Safety Agency (NPSA).

Research revealed that a number of trusts have not confirmed they have followed steps set out to improve hygiene, increase the safety of medical procedures and ensure that operations are performed on the correct part of the body. The alerts were designed to ensure that staff were properly trained to use injectable medicines and to force hospitals to have adequate numbers of bed rails to prevent patients falling out of bed and injuring themselves. Another alert was supposed to end practices used to test whether the position of feeding tubes was correct, but which had proved unreliable, such as monitoring for bubbling at the end of the tube. The hospitals' behaviour was criticised as "unacceptable" by the NPSA's chairman, who said their actions could endanger the health of patients.

The figures showed that 104 hospitals and other NHS care providers did not confirm they had taken measures to ensure the safe use of injectable medicines issued in an NPSA alert in 2007. The alert – which was supposed to have been implemented by next month – was issued after 25 patients died and 28 suffered significant harm in an 18-month period.

Twenty five NHS bodies did not confirm they had acted on safer-practice measures to prevent patients from falling out of bed which were introduced after 90 patients fractured their neck or femur rolling out of bed, 11 of whom died.

Eighty one hospitals and NHS care providers were found not to have taken the "required actions" detailed in safety alerts about the use of painkilling medicines, while 10 NHS trusts had not acted on a 2005 alert on nasogastric feeding tubes, which can be wrongly inserted into the lungs and caused 11 deaths before the alert came out.

Lord Patel of Dunkeld, chairman of the NPSA, told The Guardian: "It's not good enough. What's the point of us developing these alerts if they don't pay any attention to them? "Alerts are produced to reduce risk and hopefully avoid many deaths, so not to implement them to me is alarming. If they aren't implemented then they run the risk of harm occurring and the danger will continue."

Peter Walsh, chairman of Action against Medical Accidents, who initiated the research, said: "The fact that so many NHS bodies are failing to act on potentially life-saving alerts from the NPSA is shocking. "It is putting lives at unnecessary risk and adds insult to injury for patients who have been harmed or lost loved ones as a result of NHS lapses in safety."

The Department of Health said it expected all NHS trusts to comply with safety alerts and to record and action them. It will issue the health service with a reminder about the need to update the alerts system reliably and as soon as possible, a spokeswoman said.

SOURCE




Congress’s phony price tags

Legislators have a lousy track record of keeping costs anywhere near their initial projections

Congress says that the health care package it passed at the end of 2009 will cost roughly $900 billion over 10 years—and will somehow end up saving taxpayers money in the long run. If you think that sounds unlikely, you’re right.

With the federal government, massive cost overruns are the rule, not the exception. The $700 billion cost of the war in Iraq dwarfs the $50 billion to $60 billion that Mitch Daniels, then director of the Office of Management and Budget, predicted at the outset. In 1967 long-run forecasts estimated that Medicare would cost about $12 billion by 1990. In reality, it cost more than $98 billion that year. Today it costs $500 billion.

Nor is the problem limited to Washington. In 2002 the Journal of the American Planning Association published one of the most comprehensive studies of cost overruns, looking over the last 70 years at 258 government projects around the world with a combined value of $90 billion. The Danish economists Bent Flyvbjerg, Mette Skamris Holm, and Soren Buhl found that nine out of 10 public works projects had exceeded their initially estimated costs. The Sydney Opera House and the Concorde supersonic airplane were the most spectacular examples, with cost overruns of 1,400 percent and 1,100 percent, respectively. Budget busting occurred throughout the seven decades studied, with the totals spent routinely ranging from 50 to 100 percent more than the original estimate.

How did the United States do? According to the Danish researchers, American cost overruns reached an average of $55 billion per year. The table shows a small sample of these boondoggles. The Big Dig, the unofficial name of the Central Artery/Tunnel Project in Boston, Massachusetts, is the most expensive highway project in the history of the country. By the time the project was completed in 2008, its price tag was a staggering $22 billion. The estimated cost in 1985 was $2.6 billion. The Dig also took seven more years to complete than originally anticipated, and it ran into severe construction quality problems along the way.

The military, too, has a long history of cost overruns. According to Chris Edwards of the Cato Institute, the Pentagon building itself “cost $75 million to build, more than double the originally planned $35 million.” Weapon system overruns are routine. Consider the V-22 Osprey, a tilt-rotor, vertical takeoff and landing aircraft that has been plagued with at least $7.5 billion in cost overruns, mechanical problems, and other failures, including four crashes that took the lives of 23 Marines.

Strangely, lawmakers never seem to anticipate these extra costs even when the excesses take place under their noses. The Capitol Hill Visitor Center, an ambitious three-floor underground facility originally scheduled to open at the end of 2005, was delayed until 2008. The price tag leaped from an estimate of $265 million in 2000 to a final cost of $621 million.

Federal entitlement programs have grown far beyond the original promises of limits or budgets. Medicare hasn’t merely cost far more than originally expected. Data from the Congressional Budget Office (CBO) show how the scoring office’s long-term projections of Medicare spending have steadily increased, even in recent years and over short periods of time. In 2005, for example, CBO projected that Medicare would cost $1.5 trillion in 2050. Two years later, in 2007, the same CBO projected that this cost would reach $2.8 trillion in 2050. And in 2009, it projected that the cost would be $3 trillion instead. In other words, the program’s projected cost doubled in four years.

This upward revision of projected costs comes even in spite of CBO’s allowances for ‘excess cost growth.’ Furthermore, the actual expenditures exceed projections—in 2008, federal outlays for Medicare exceeded most recent projections by $63 billion; in 2009, federal outlays for Medicare exceeded projections by over $148 billion.

According to the Danish study, such inaccuracies aren’t just errors. They reflect widespread, deliberate lying on the part of public officials. “Project promoters routinely ignore, hide, or otherwise leave out important project costs and risks in order to make total costs appear low,” the authors conclude.

At a time of acute political anxiety over government spending and high federal deficits, the politicians behind the latest health care legislation are relying on the same modus operandi. President Barack Obama has repeatedly asserted that he wouldn’t sign a bill that cost more than $900 billion over 10 years, and the CBO has certified that the plan fits this constraint. Yet the true costs for the first 10 years of the Senate bill should be closer to $1.8 trillion. Democratic legislators got the CBO score they wanted by using an old gimmick: They crafted the legislation so that only 1 percent of the first 10 years’ expenses occur in the first four years, backloading costs so the price tag would look smaller than it really is.

Lawmakers thus have essentially estimated the costs for a six-year period, from 2014 through 2019; if the new law basically starts the clock in 2014, the proper end point for estimating its 10-year cost should be 2023. (Also, CBO estimates do not take into account the fact that Congress is unlikely to follow through on the bill’s future Medicare spending cuts. “CBO estimates the effects of proposals as written and does not forecast future legislation,” Director Doug Elmendorf explained.)

It’s hardly surprising that politicians lie so routinely. Voters let them get away with it. When programs go over budget, fail to deliver on their creators’ promises, or simply do not work at all, taxpayers rarely punish those responsible. So lawmakers keep making unreliable promises of low costs, and we keep on accepting those promises at face value. Indeed, voters generally reward legislators who bring more federal funds to their states or districts.

The key to minimizing cost overruns is to return most of the public services to the private sector. Projects such as airports, playgrounds, and entertainment facilities are properly the role of the private sector, not the government.

As far as controlling rising costs within health care goes, a better alternative to the semi-nationalization that the president has in mind would be to increase individual responsibility for medical decisions. When people aren’t exposed to the true cost of their care—even if they pay for it in foregone wages and higher taxes—they consume more. Like lying politicians, we all respond to incentives.

SOURCE




Taxing Medical Plans Loses Luster in Congress

An agreement to tax high-cost, employer-sponsored health insurance plans, announced with fanfare by the White House and labor unions last month, is losing support from labor leaders, who say the proposal is too high a price to pay for the limited health care package they expect to emerge from Congress. But the White House is still urging Congress to adopt the excise tax as a way to help pay for President Obama’s ambitious health care proposals.

With support for the tax eroding, Congressional leaders are searching for alternative sources of revenue. The search has some urgency because Mr. Obama has said he hopes House and Senate Democrats can resolve their differences and come up with a final version of the legislation before he convenes a bipartisan meeting on the issue on Feb. 25.

When the tax agreement was announced on Jan. 14, White House officials described it as a breakthrough that would help clear the way for passage of sweeping health legislation. Besides producing a substantial amount of revenue, they said, the excise tax on the most expensive insurance plans would slow the growth of health costs by giving consumers a powerful incentive to shop for cheaper policies.

Under the agreement, which builds on a provision in the larger health bill passed by the Senate on Dec. 24, the federal government would impose a 40 percent tax on the value of employer-sponsored health coverage exceeding certain thresholds. To win the endorsement of labor leaders, White House officials agreed to changes in the tax that would lessen its impact on workers, including union members with collectively bargained health benefits.

But labor leaders have backed away from the proposal in the wake of the special Senate election in Massachusetts. “I do not believe there will be an excise tax enacted,” said Larry Cohen, president of the Communications Workers of America. “It appears that the administration and Congress will be taking a much more modest approach to health care reform. The cost and value of such reform would not justify using an excise tax.”

A wide range of House Democrats continue to criticize the tax as bad policy, even with the changes negotiated by labor leaders and the White House. Moreover, House Democrats said, the tax is bad politics because it would set the middle class against the poor — people struggling to keep health insurance against people struggling to get it. Revenue raised by the tax would help finance coverage for people who are uninsured.

Reid H. Cherlin, a White House spokesman, said he was not aware of any erosion in support for the tax among administration officials. “The president,” he said, “continues to believe that charging insurance companies a fee for their most expensive polices — an idea that has the support of experts from both parties — will help achieve the core goal of health insurance reform: putting downward pressure on long-term health costs while ensuring that we aren’t placing new burdens on hard-working middle-class families.”

But as a practical matter, labor leaders said, the excise tax was killed by the election in Massachusetts, where the Republican candidate, Scott Brown, won the Senate seat long held by Edward M. Kennedy. In opinion polls and in conversations with lawmakers, Massachusetts voters expressed deep hostility to the excise tax. Members of union households voted for Mr. Brown over his Democratic opponent, Martha Coakley, according to a telephone poll conducted on election night for the A.F.L.-C.I.O. He won 49 percent of the vote from union households, while she got 46 percent, the survey found.

Michael A. Podhorzer, deputy political director of the A.F.L.-C.I.O., said Massachusetts should be a warning to Democrats, like “a canary in a coal mine. “Fully 42 percent of voters believed the health care bill would tax employer health benefits, and these voters supported Brown by two to one,” Mr. Podhorzer said.

Because details of the proposed tax were complex and continually changing, it was difficult for people to know whether they would be affected. Technically, insurers would be responsible for paying the tax, but economists say the cost would be passed on to workers.

Senator Kent Conrad, Democrat of North Dakota, supports the tax but said the outlook for it was “very cloudy.” The House speaker, Nancy Pelosi of California, said, “The excise tax has no support, very little support, in our caucus.”

At meetings of the House Democratic Caucus, lawmakers from Massachusetts, including Representatives Edward J. Markey and Richard E. Neal, said they were struck by the vehemence of opposition to the tax in their districts. Mr. Markey recalled that a constituent had poked him in the chest and said: “Eddie, I’ve voted for you my whole life. But if you think you will tax my benefits and give the money to Ben Nelson in Nebraska, you’re crazy.” Senator Nelson, Democrat of Nebraska, voted for the bill after it was rewritten to provide extra Medicaid money to his state.

SOURCE




Two Fatal Flaws in Health Reform Resuscitation

Salvage efforts are underway for the president's health reform package, put into a stall by the recent surprise election of Republican Sen. Scott Brown in Massachusetts, which disrupted the one-vote margin that would have passed the legislation last month. On the one hand, President Obama seems conciliatory; a proposed televised summit in late February would allow key members from both sides of the aisle to hear from those who have different ideas. On the other, he does not seem willing to scrap the health reform bills that were a year in the making and would radically restructure both the financing and delivery of healthcare. Last week, Secretary of Health and Human Services Kathleen Sebelius delivered the message that the administration would not budge from its comprehensive approach to lowering costs and covering the uninsured, since the "pieces of the puzzle are too closely tied to one another."

She has a point there. The Obama­care puzzle, a centrally driven plan that requires at least a trillion dollars to succeed, counts on a combination of taxation, fines, penalties, and cost savings; a reallocation of major resources within the current health system; and a willingness among doctors and patients to accede to substantial new government controls. Regardless of how workable the administration's grand design appears to be on paper—about 4,000 pages of paper—it will fail if all of these big puzzle pieces are not in place. Most obviously, are the needed resources there for the tapping? There are at least two giant reasons that I think the puzzle is now imploding on its own, and neither has anything to do with political partisanship. And no televised show of hand-holding will make one whit of difference.

The first fatal flaw: leaning on Medicare. Obamacare counts heavily on its ability to drain off money from Medicare—which, by the administration's own accounting, is slated to go into bankruptcy in seven years even as it is. It seems like a heavy dose of voodoo eco­nomics to expect that this program, with its ranks just starting a big swell because of aging baby boomers, has the capacity, no less the will, to cough up half a trillion dollars to pay for half of the cost of health reform. Much has been made of the savings to be found in ending fraud and abuse, but success there would in no way be sufficient to prevent a hike in Medicare payroll taxes on working Americans (who would not be pleased), higher Medicare premiums for beneficiaries, and a big bite out of the medical care our elders now receive.

Health reform proposes to save lots of government money by keeping seriously and chronically ill old folks from being readmitted to the hospital too frequently, a major source of Medicare expenditure. Sounds good, but it is easier said than done, both medically and ethically. Political pundits who would have you think that a hospital admission should cure the disease and that a readmission is a sign of doctor or hospital failure know little about the nature of the formidable degenerative diseases that affect the hearts and lungs, bones and brains, and immune systems of the elderly. Patients who can be tuned up with a few days in the hospital and return home better, even if it's more than once, are not candidates for hospice. Where else are they to turn? Washington is threatening to cut reimbursement to the doctors and hospitals with higher readmission rates, or label them as poor performers, without analyzing the circumstances. It won't work.

Another source of money is slated to come from ending Medicare Advantage, a popular but costlier option that covers 10 million elderly in privately managed healthcare organizations that provide pharmaceuticals and impose small or no copayments. Though the savings here are sure to be realized, they come at the risk of citi­zen discontent. Especially so when some elders, namely Floridians, are exempt. Who was the hero who saved Advantage for the 1 million elderly in the Sunshine State? It was their own Sen. Bill Nelson, who made that loophole the price for his health reform "Aye" vote.

The second seed of destruction: counting on Medicaid. The current plan to cover half of the uninsured by putting them into Medicaid has special appeal to federal budgeteers, since the states would be forced to kick in as much as 50 percent of the expense. But Medicaid is already literally bankrupting many states, which unlike the federal government have no way to print money. This new unfunded federal requirement would inevitably mean higher state income taxes that, yes, would hit the middle class despite the president's promise otherwise.

More here




Australia: Surgery waiting lists grow in Queensland public hospitals

ONE in five Queensland patients are waiting longer than clinically recommended for potentially life-saving elective surgery. Queensland Health's latest quarterly report reveals 6762 of 34,480 elective surgery patients were left languishing on hospital waiting lists too long. The additional 728 patients on the long wait list compared with the previous quarter has been blamed on theatre closures over Christmas.

Health Minister Paul Lucas said that while the number of patients waiting too long increased, the difference was only several days and Queensland hospitals performed more elective surgery during the period. "The overall surgical workload has increased and it has increased significantly greater than the rate of population," he said. But Mr Lucas said he was concerned about a blow-out in the number of urology patients waiting too long and this would be addressed.

Opposition health spokesman Mark McArdle said the number of long waits was "appalling" and a reflection of the Government's failure to plan and invest in infrastructure. Category one patients, those at risk of their conditions deteriorating quickly, were among the worst affected by the Christmas closures.

According to Queensland Health, there were 315 patients left waiting longer than the recommended 30 days at the end of the December quarter compared with 198 in the September quarter and 259 the previous year. There was also a blow-out in long waits for category two patients who should be seen in 90 days because their condition caused pain, dysfunction or disability.

The report found 4183 category two patients were waiting too long, 767 more than the previous quarter and 782 more than the same quarter last year. However, the number of long wait category three patients (conditions that do not require treatment within a set timeframe) improved. Overall, orthopaedic surgery had the most patients waiting too long, followed by general surgery and plastic surgery.

Mr McArdle said the Government was also yet to meet its commitment to release dental waiting lists. "What is the Minister hiding?" he said. "Why are Queenslanders being kept in the dark?"

SOURCE





16 February, 2010

British government uneasy with criticism of health care

I wonder why?

The task of ensuring decent standards in hospitals is being undermined by ministerial sensitivity to criticism, England’s former health regulator has warned. Baroness Young of Old Scone said that her brand of “rugged independence” had collided with the Department of Health’s desire for someone “much more emollient” to scrutinise the NHS and social care system. In her first interview since unexpectedly resigning as chairman of the Care and Quality Commission (CQC) in December, she also said that the health-check ratings system must “change radically” and signalled that dozens of underperforming trusts should face “pretty stringent conditions” when new licences are awarded in April.

Her abrupt departure followed criticism of the CQC for failing to spot significant problems in highly rated hospitals. Senior government sources later claimed that the “volatile and hot-headed” regulator had sent abusive e-mails to colleagues. She told The Times, however, that she had decided to resign as early as September — only five months after the CQC started work as the super-regulator of health and social care.

Lady Young denied that there had been a personality clash with Andy Burnham, the Health Secretary, but suggested that her notion of what was required of an independent regulator sat uneasily with the Department of Health. Describing the vetting before she took up the post, Lady Young said that MPs had emphasised the importance of “not being in the pocket of government” and of being candid.

She added: “It became clear to me, as we went through the whole process, that government knew it should want an independent regulator but in practice didn’t feel very comfortable about that . . . Rugged independence is not what they are looking for, they are looking for something much more emollient and collaborative. “[The CQC] is one of the few fields where the regulator — for saying anything that is unsatisfactory in terms of a service — is actually saying directly that the service being run by a minister is unsatisfactory, and ministers find that quite difficult.”

She suggested that ministers might be braver, particularly in cases where trusts are independent foundations. Instead, in the most controversial cases last year, “it was kick the regulator time — and life is too short. I think the idea that the regulator can prevent every leaf fallen is nonsense.”

Lady Young said that she hoped the vital role of robust, independent regulation would not be compromised by future politicking — which too often turned the identification of problematic hospitals into a blame game with the regulator as the scapegoat.

More here




Sickening corruption at a U.S. community hospital

Have you heard the one about the politician, the preacher and the unemployed single mother of two? No, it’s not the opening line of a stand-up comic’s joke; instead, it’s a story about small-town health care that might turn your stomach.

The story was shared with me recently by a man who identified himself as the former administrator of a small-town community hospital in the Midwest. In order to protect his identity, I’ll call him “Pat” and not disclose the name of the town in which the hospital is located.

Pat approached me in late December, hoping I would help him expose a loophole of sorts he had observed during nearly a decade of work as an executive in the world of taxpayer-funded, small-town health care.

Pat told me about the cases of the elected city official, the preacher and the single mom that came to the attention of the hospital’s five-member board a few years ago as a result of their failure to pay the “responsible portions” of their hospital bills for services received.

At one of the board’s monthly meetings, Pat offered recommendations to board members regarding the disposition of their cases:

* He recommended that the elected city official — who owed in excess of $20,000 and was notorious for not paying her bills at the facility — be sent to a collection agency;

* He recommended that the $5,200 debt compiled by the preacher — who lived in a 5,000-square-foot home and also had a track record of not paying her bills — be turned over to a collection agency; and

* He recommended that the unemployed single mother of two — who had always paid her bills — be given more time to pay her bill of almost $8,000.

Incredibly, members of the unelected board did not follow any of his recommendations. “I was told not to pursue the elected city official or the preacher and that the unemployed single mother of two could be garnished,” Pat explained.

Why did the board vote in such a way? According to Pat, politics and social standing in the community of fewer than 5,000 people played a significant role in the decision-making process. At the time her case came to the attention of the board, the elected city official was well connected, Pat said. In addition to having family members on every kind of board and committee imaginable, she owns two highly-visible businesses in town. Similarly, the preacher is well-connected and holds a prominent place in the community as one of the leaders of a non-denominational church that is one of the town’s largest worship facilities.

While trying to investigate this story by using the state-level equivalent of the Freedom of Information Act, I ran into obstacles presented by the Health Insurance Portability and Accountability Act of 1996, a law often referred to by its acronym, HIPAA (“Hip-Uh”).

In a request made to the current hospital administrator one month ago, I asked for copies of “Documentation of all cases during the calendar years 2006 and 2007 that involved individuals’ with medical bills totaling $5,000 or more that were “written off” and/or deemed not to be collected by a vote of the Board of Trustees.”

Realizing that HIPAA guidelines might restrict the hospital from releasing the information in “as is” condition, I added the following note to my request: “Note: If those minutes contain confidential information, such as the names of patients, please ensure that you redact those names and any personally-identifiable information from the records, per HIPAA guidelines, before sending.”

In explaining why she couldn’t fulfill my request, the current hospital administrator cited HIPAA.

Thinking the obstacle could be overcome, I contacted an attorney who provides counsel to journalists in situations such as mine. Much to my surprise, the attorney confirmed for me what appears to be a glaring loophole in the law: Unelected officials overseeing taxpayer-funded community hospitals can seemingly act with impunity and play “good ol’ boy politics” when it comes to deciding who pays bills or not.

In short, there seems to be little or no oversight of board members’ actions at the community-hospital level. As a result, good ol’ boy politics is allowed to run unchecked.

Pat told me that when he left the hospital more than two years after the above-described meeting took place, the unemployed single mother of two had paid her bill in full. The preacher and now-former city official had not.

SOURCE




Is Health Care Overhaul Doomed to Failure?

Fate of President Obama's Health Care Agenda Hangs in the Balance as Democrats and Republicans Remain Skeptical of Bipartisanship

As Democrats and Republicans sharpen their knives ahead of President Obama's summit on health care, experts are questioning whether the president's health care agenda is doomed to fail just as President Clinton's did in the 1990's.

"If I had to place a bet on it, I would say two to one, it doesn't [pass]," said Dean Baker, co-director of the Center for Economic and Policy Research and a proponent of health care reform. "But it's not an absurd idea. It could happen. Given how much stake President Obama and Democrats have in it, they have to do something. ... They have every reason in the world to pull out all the stops to try and make it happen."

Obama has invited Republicans and Democrats to a televised bipartisan meeting on health care on Feb. 25, but experts are skeptical about whether the open event will be any more than political theater and actually achieve any concrete results in bringing both sides together.

"It could either be a choreographed professional wrestling match or it could be another 'Kumbaya' meeting, and I think both would be totally useless," said Uwe Reinhardt, a professor of political economy at Princeton University. "It should be a frank exchange -- thoughtful, polite, but the way adults should talk to each other."

The president is hoping to thaw the ice on a health care overhaul bill that right now faces grim prospects on Capitol Hill. By bringing both Republicans and Democrats to the table, the White House hopes to resurrect the momentum by energizing wary Democrats and staunchly opposed Republicans.

"Bipartisanship can't be that I agree to all the things that they [Republicans] believe in or want, and they agree to none of the things I believe in and want, and that's the price of bipartisanship," Obama said at an impromptu press conference Tuesday, "but that's sometimes the way it gets presented.

"I'm willing to move off some of the preferences of my party in order to meet them halfway," he said. "But there's got to be some give from their side as well. ... That's what I'm hoping gets accomplished at this summit."

Some health care experts say bringing the debate out in the open when talks haven't even really begun does not bode well for the future of health care overhaul. "I don't think this is the right way to get that kind of dialogue taking place," said Stuart M. Butler, vice president of domestic and economic policy studies at The Heritage Foundation, a conservative think tank. "All this will do is lead to political sound bites and not much else, in my opinion."

The GOP leadership wants Obama to go back to the drawing board. "Why are we going to talk about a bill that can't pass?" House Minority Leader John Boehner, R-Ohio, said Tuesday, after a meeting with Obama on jobs. "It really is time to scrap the bill and start over."

Democrats have been relatively quiet and awaiting direction from Obama. After a whirlwind few months of crafting legislation that would get broad support and pass both the House and Senate, Democrats faced a striking blow when Sen. Scott Brown was elected to fill late Sen. Ted Kennedy's term. Brown vowed to become the 41st GOP senator to vote against the health care bill, deflating any hopes of passing the legislation as the majority party had planned.

Experts say the president made a mistake by stepping away from the debate and leaving it up to lawmakers. He now has to take the lead and play "hardball politics," Baker said. "I think President Obama will have to work very, very aggressively ... [and] be prepared to pull out all the stops. That's the most likely path," Baker said. "If he could basically shame some of the more moderate Republicans such as [Maine Sen.] Olympia Snowe into coming on board in a public session and try to put them on the line, I think that might be a way he gets bipartisanship."

Sen. Judd Gregg, the top Republican on the Senate Budget Committee, has also been billed as another GOP leader who has shows signs of bipartisanship on the health care front. But the senator from New Hampshire is also calling for the administration and lawmakers to start from scratch. "I say, let's step back, let's start with a blank sheet of paper. And let's start putting on that sheet of paper things we can agree about," Gregg said in an MSNBC interview Friday.

Baker said he is "not terribly optimistic" about the summit at the end of this month. However, there are areas where Republicans and Democrats can come together and coalesce on a new bill.

More here




Obama the winter Olympian






Why the House Democrats are about 100 votes short

My colleague Mark Tapscott cites an anonymous quote by a House Democratic leader from a Politico story on why the House Democratic leadership can’t muster the votes needed to pass the Senate health care bill. “‘You just need to twist enough arms to pass the Senate bill.’ You can twist arms if you’ve got a handful of them to twist. You can’t twist over 100 arms. There needs to be some reality check there.” Mark takes that as an indication that House Democrats are short 100 votes of passing the Senate bill.

Clever liberals in the blogosphere are still urging House Democrats to pass the Senate health care bill, with the Senate then making changes through the reconciliation process requiring only 51 votes and the Senate going along. Sounds like a clever idea. But as my Examiner colleague Mark Tapscott writes, an anonymous quote from a House Democratic leader suggests that they are 100 votes short of passing the Senate bill. I wouldn’t take that 100 votes as a precise number, but as an approximation.

Why are House Democratic leaders having such trouble getting the 217 votes needed for a majority (because there are vacancies now in two Democratic-held seats)? Look at it this way. Imagine you’re a Democratic congressman from a not entirely safe district. The leadership comes to you and says, We’d like you to vote for the Senate bill. Oh, and by the way, we can’t change a word in it. You’ve got to vote for the Cornhusker Hustle and the Louisiana Purchase and all that other garbage.

But hey, the leadership guy will go on, there’s no risk, because the Senate will fix everything through the reconciliation process. You will be suspicious of this. You will note that using the reconciliation process requires favorable rulings from the Senate parliamentarian, rulings over which you have no more leverage than you have over phases of the moon. It requires 50 Democratic senators willing to go along with reconciliation, and given the poll numbers that have been coming out lately that’s not a sure thing. And it requires steady leadership from Harry Reid—who just last week, without notice to the White House, the House leadership or the senators involved, yanked a Baucus-Grassely bipartisan “jobs” bill and substituted a much smaller one of his own.

So you, as a Democratic member with potentially serious opposition, do the political caucus. If you vote for the Senate bill, you’re voting for something that has 35% support nationwide and probably a little less than that in your district. You will have voted for the Cornhusker Hustle and the Louisiana Purchase. Your Republican opponent will ask why you voted for something that gave taxpayers in Nebraska and Louisiana better treatment than the people you represent (there are no Democratic House members running for reelection in those two states: Nebraska has only Republican House members and the single Louisiana House Democrat is running for the Senate). The only protection you have against this is the assurance that the Senate parliamentarian and scared incumbent senators will come through for you, and that Harry Reid will pursue a steady course.

So your response to the leadership is either, I gotta think about this, or, Hell no. The House Democratic leadership’s problem is that it cannot credibly promise that the Senate will keep its part of the bargain.

SOURCE





15 February, 2010

Australian conservative leader plans local management boards for public hospitals

This is basically a reversion to the old system -- a system that worked much better than the present constipated bureaucracy. Under the old system doctors and prominent members of the local community ran the hospitals -- with only a fraction of the bureaucracy that is sucking up the health dollars nowadays

LOCAL boards would run major public hospitals under Opposition Leader Tony Abbott's prescription to fix the nation's ailing health system. Mr Abbott yesterday foreshadowed a Northern Territory-style "emergency intervention" for public hospitals under the plan to install local management boards in Queensland and NSW within six months if the Coalition won the next election. The boards would be government-appointed, have control over hospital budgets and discretion to raise money from private patients.

The Rudd Government savaged the plan as "half-baked", while Queensland Health Minister Paul Lucas predicted a disaster.

Flanked by predecessor Malcolm Turnbull, Mr Abbott used the policy to attack Prime Minister Kevin Rudd for failing to meet his promise to improve or take over public hospitals. "All we've had from Kevin Rudd in two years is words ... and I'm telling Kevin Rudd that the only change that will really make a long-term difference is to empower local people ... by establishing local community boards," he said. Mr Abbott said the "systemic malaise" in NSW and Queensland public hospitals meant the Commonwealth should be prepared to intervene.

Health Minister Nicola Roxon said Mr Abbott's ideas were not a comprehensive plan for change. "He was a quick fix, Band-Aid Minister and he wants to be a quick-fix, band-aid Prime Minister," she said. Prime Minister Kevin Rudd said the system needed "urgent surgery" and he made no apology for taking longer than promised to find a solution. Mr Lucas said local communities were not the right people to run hospitals. "Having a local hospital board is a recipe for ... debt being run up by people who do not have the expertise to runthem."

SOURCE




The Obamacare volcano

Americans must ensure it doesn't erupt again

Public support for Obamacare legislation is dismal. According to a Feb. 2 and 3 Fox News-Opinion Dynamics poll, among 900 registered voters surveyed, just 23 percent want it enacted. Fully 70 percent disagree. Among them, 47 percent would start over, and 23 percent would do nothing.

Nonetheless, Obamacare is like a quietly rumbling volcano - dormant but not yet dead. President Obama and Washington Democrats oscillate between tears over their stalled pet project and cheers that "We're moving forward," as Mr. Obama recently chirped. The White House's Feb. 25 "bipartisan" health care summit is a sulfurous puff of smoke that should worry Obamacare opponents. Consequently, those who want to stop this ruinous measure should keep highlighting its shortcomings until this initiative is extinct.

Consider, then, that Obamacare flunks the first test of any potential federal law: It is not constitutional. Obamacare critics deem the individual mandate unconstitutional because Congress lacks the power to force Americans to buy anything, especially health insurance they wisely or foolishly may not want.

Congress' legitimate power to regulate interstate commerce has been stretched like saltwater taffy. "It is one thing, however, for Congress to regulate economic activity in which individuals choose to engage; it is another to require that individuals engage in such activity," observed Sen. Orrin Hatch, Utah Republican; former Ohio Secretary of State J. Kenneth Blackwell; and the American Civil Rights Union's Kenneth A. Klukowski in the Jan. 2 Wall Street Journal. "That is not a difference in degree, but instead a difference in kind."

Beyond this lies another problem. The individual mandate would be enforced by penalizing Americans $495 or 0.5 percent of adjusted gross income, whichever is higher, if they do not acquire health insurance by 2014. Two years later, that fine would rise to 2 percent of AGI, equal to $640 today. Anticipated fines total about $15 billion.

The IRS would collect these payments and require Americans to certify on their tax returns that they carry health coverage. This represents a "direct" tax on U.S. citizens, based solely on the status of living in America. This is not a tax on income. It is not an excise tax, either, because there is no tax on any transaction; if one refuses to purchase insurance, there is no transaction on which to slap an excise tax.

As Sen. John Ensign, Nevada Republican, told his colleagues on the Senate floor: "Anything we have ever done, somebody actually had to have an action before we could tax or regulate it."

"Without precedent, Congress is attempting to punish the nonpurchase of a private product," says Robert Levy, senior fellow for constitutional studies at the Cato Institute, which he chairs. "That would be an intolerable affront to the Constitution and personal autonomy."

Nonetheless, the individual mandate's IRS enforcement scheme operates, in essence, as a tax. The hitch is that Article I, Section 8 of the U.S. Constitution states: "The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises." Section 9 adds, "No Capitation, or other direct, Tax shall be laid, unless in Proportion to the Census or Enumeration herein before directed to be taken."

A penalty collected via the IRS would be a direct tax on individuals, independent of anything reflected in the Census or tied to enumeration of citizens among the states. As such, the individual mandate's enforcement mechanism would fail constitutional scrutiny. And a mandate without enforcement is just a suggestion.

If Obamacare somehow re-erupts into active status, it likely would rely on this ultimately toothless individual suggestion, which many Americans gladly would ignore. Without Washington's capacity to pressure Americans into submission, the number of participants in Obamacare likely would fall well below projections, and this entire, glorious experiment would implode.

One of the most compelling arguments against Obamacare is that it is self-defeatingly unconstitutional. That is yet another reason why this menacing monster must be silenced.

SOURCE




Summit no time to back down

Last week, Washington, D.C. was shut down by two huge snow storms. These rivaled the snow job that President Obama put on in a White House news conference. He scheduled an ObamaCare summit for February 25th to supposedly reanimate his failed health care plan and to demand bipartisanship. The President now wants Republicans to work with him to pass ObamaCare, another stimulus bill and to approve his controversial nominees.

This is no time for conservatives to back down in the name of bipartisanship. “Bipartisanship,” after all, doesn’t mean surrendering to big government. This President is in denial, and he’s showing contempt toward the American people who have repeatedly rejected his big government ideas.

Liberals now need a gimmick to pass ObamaCare, because the usual approach has failed. Senator Scott Brown (R-MA) campaigned on a promise to filibuster and defeat the President’s health care bill, and the people of liberal Massachusetts agreed. Now that the Democrats can’t overcome Republican threats to filibuster a final package of ObamaCare proposals, they have come up with a new plan to force the President’s plan through the House and Senate.

An aide to House Speaker Nancy Pelosi (D-CA) says liberals have crafted a way around the Senate’s filibuster rule, so they hope to get ObamaCare signed into law by Easter. First, the House would pass a reconciliation bill making changes to the Senate-passed bill. With a reconciliation bill, the filibuster rule in the Senate would be set aside, and liberal Democrats could ignore the concerns of moderate Democrats and Republicans. Conservatives call this the “Nuclear Option,” because Senate leaders would be bending the rules of the Senate to avoid any chance of a filibuster.

But a reconciliation bill can only be used to pass spending, revenue and tax bills. So after reconciliation, the House would have to pass the exact Senate-passed version of ObamaCare. This trick would force many liberals to vote for a bill they don’t think goes far enough. But the left understands that this may be its best chance to move America one step closer to a socialist, single-payer health care system

Conservatives should make sure we don’t snatch defeat from the jaws of victory in the name of “bipartisanship.” We must block the President’s flawed health care reform, his big spending approach to stimulus and his left-wing nominees. At some point, Barack Obama may actually listen to the American people. Until then, conservatives must keep working to defend the idea of a limited federal government.

SOURCE





14 February, 2010

NHS managers numbers rise at twice rate of doctors, report finds

Hopefully they do something useful but spending the money on doctors and nurses would surely do a lot more good -- considering the constant stories of insufficient medical personnel -- see the story after this

Numbers of senior managers in the NHS have almost doubled in a decade compared with a 35 per cent increase in doctors and nurses as 'fixation' with the market means health service is bogged down in red tape, a report said.

The British Medical Association highlighted the figures as it launched a campaign to 'Look after our NHS' and end the commercialisation of the health service, with treatments contracted out to independent healthcare providers.

Official data shows that since 1995 the number of senior managers has increased by 91 per cent while the combined numbers of doctors and nurses rose by just 35 per cent. Other 'market driven' health care policies have wasted around £220 million since 2003 as private companies were given contracts to carry out operations on NHS patients which included clauses that they would be paid for a set number of procedures even if they were not carried out....

NHS trusts have been ordered to cut management costs by 30 per cent this year as the health service faces reduced growth funding and is faced with cost savings of £20 billion to find over the next five years. However, Health Service Journal published its own research showing NHS organisations which increased the number of senior managers scored highly on quality scores.

The magazine found that the average trust which received a weak rating on quality of services from the regulator had lost four managerial posts while trusts with an excellent rating gained 12 managers.

Mike O'Brien, the Health Minister, said: "We oppose the privatisation of the NHS. The government is committed to an NHS funded by taxation, with equal access to care, free at the point of use, based on clinical need and not ability to pay. We want to ensure that patients receive the best quality care and tax payers the best value for money. "Independent and third sector organisations were used successfully to get down waiting lists for operations and can make a contribution to this by helping to add capacity and increase patient choice."

SOURCE




Dozens of British children's wards must close

Dozens of children’s wards in Britain will have to close under European rules limiting doctors’ working hours, and because of the need to save money, the President of the Royal College of Paediatrics has said. The combined impact of the European Working Time Directive and the £20billion savings the NHS must make to plug its budget deficit over the next five years mean some children’s in-patient wards will have to close and merge with others, Prof Terence Stephenson told The Daily Telegraph.

He said there was already a shortfall of about 600 consultant paediatricians and 200 top-level trainees before the directive came into force last August, and now the workforce was under “unsustainable pressure”.

Junior doctors are limited under the directive to a 48-hour week, making it harder to ensure proper staffing levels in the wards at all times, Prof Stephenson said. Too many small hospitals provide in-patient children’s services and some of these should close so that doctors can staff the rest round the clock, he added. He also warned that the Department of Health had cut the number of trainees entering hospital specialities by five per cent this year to push more doctors into GP training. The latest figures show that 230 hospitals provide children’s in-patient services.

Michael Summers, vice-chairman of the Patients Association campaign group, said: “Far too many hospital services are closing to save money. It leaves patients having to travel vast distances.”

A Health Department spokesman said a Royal College of Paediatrics and Child Health survey last year indicated more than 100 extra paediatric consultant posts were created as a Working Time Directive solution, adding: “Service levels are constantly under review. Changes should only happen when they deliver quality improvements for patients.”

SOURCE




Could trillion dollar debt kill Obama health care reform?

It seems the President’s spending habits have finally caught up with him, threatening to kill a government overhaul of health care. Though President Obama and congressional Democrats continue to insist that health care reform is on the horizon, the increasing national concern over the rising public debt presents an undeniable obstacle.

James Capretta, a Fellow at the Ethics and Public Policy Center, outlines why this is the case in a recent article for Kaiser Health News. First of all, President Obama is responsible for raising the debt to unprecedented levels. Capretta explains, “From 1789 through 2008, the U.S. government borrowed a total of $5.8 trillion. In 2009, the federal budget deficit exceeded $1.4 trillion. The administration now expects the 2010 deficit to break that record, topping $1.6 trillion. And in 2011, it would only fall to about $1.3 trillion. Thus, in just three years, the debt will have jumped an astonishing $4.2 trillion.”

This outlook will making passing a budget-buster like the Senate health care bill difficult. By 2020, the President’s budget would raise the federal debt to $18.6 trillion. This includes the adoption of a health care bill, which falsely relies on $150 billion in budget deficit reductions between now and 2019. The only problem is that the bill would not reduce the deficit at all—rather, it would add to it substantially. A recent letter from the Congressional Budget Office to Senator Jeff Sessions (R-AL) explains this.

And then there is the question of how President Obama will tackle the nation’s impending fiscal crisis. The President’s plan is to pass health care reform and address deficit spending later through a weak and likely inconsequential bipartisan deficit reduction commission. This commission would present its proposals to Congress for a vote after the 2010 election, meaning voters’ decisions at the polls would not affect the fate of this vital legislation. This is unlikely to satisfy Americans’ concerns over the sustainability of federal spending.

Congress’ last possible plan is to pass the Senate bill in the House, accompanied by a second bill of amendments to appease House members. The Senate would use reconciliation to forego a filibuster which could kill the bill thanks to newly-seated Senator Scott Brown (R-MA). But, as Capretta puts it, “Reconciliation measures are supposed to address budgetary matters. How could amendments to something that is not yet in law change outlays or revenues in any rational way?”

Capretta points out that, in general, the release of a new budget marks the start of a fresh legislative session. It will be difficult for Congress and the President to backtrack to include health care reform in its plans for 2010, as the Congressional Budget Office will have reset its baseline and the congressional budget committees with have already begun to write new budget resolutions.

Because of all this, not to mention the myriad of unintended consequences the Senate bill would unleash on health care, the economy, and every American family, President Obama should wipe the slate clean and start afresh in reforming health care. This time, the President should work with both sides of the aisle and embrace step-by-step reforms that all can agree will have a positive affect on lowering costs and covering the uninsured.

SOURCE




Bend It Like Obama

Can the government control health care inflation through subsidies?

First President Obama said critics of his health care plan had no ideas worth considering. Then he said he never said that. Now he says he is eager to hear those previously unacknowledged ideas.

Taking Obama at his word (always a risky thing to do), is there any realistic prospect that the meeting he plans with legislators from both parties later this month will, as he suggests, produce “some agreements” on how to proceed with health care reform? Not if he continues to ignore the conflict between his approach to expanding medical coverage and the other major goal he says must be addressed by any serious reform proposal: bringing health care spending under control.

Obama wants to cover the uninsured by expanding Medicaid and providing various other subsidies: to small businesses that buy insurance for their employees, to individuals who buy policies from a government-created “insurance exchange,” and to high-risk patients with pre-existing conditions. That last group would be subsidized not only by taxpayers but by younger, healthier policyholders who would be forced to pay higher premiums or to buy insurance they otherwise would have gone without.

The Senate health care bill would spend $1.8 trillion during the first decade after it fully takes effect in 2014 to cover some 30 million people (out of an estimated 46 million without insurance), and that’s leaving aside the unfunded mandates imposed on states, employers, and individuals. Yet in his interview with CBS News anchor Katie Couric on Sunday, Obama said “the package that we've put together” will “start bending the cost curve on health care” and “cut the deficit by a trillion dollars.” How is that possible?

The $1 trillion figure, which Obama misleadingly attributed to the Congressional Budget Office (CBO), is highly speculative. The CBO estimated that the Senate bill would reduce the deficit by $130 billion in the first decade after it was enacted through a combination of higher taxes and Medicare cuts. The CBO also more tentatively projected that if Congress retains its planned reductions in the growth of Medicare payments to providers (instead of rescinding them, as it always has in the past), the savings could amount to between 0.25 and 0.5 percent of gross domestic product in the second decade. Using generous assumptions, the Obama administration converted that highly uncertain estimate into a nice round figure of $1 trillion.

Still, restraining the growth of Medicare, which will swallow a bigger and bigger share of the federal budget as baby boomers retire, will be necessary to avoid crushing payroll taxes and/or sudden, drastic benefit cuts. That’s one possible area of bipartisan agreement, although Republicans have dimmed the prospects by demagogically accusing the Democrats of trying to take away Grandma’s health care.

But note that Obama’s plan to restrain spending has nothing to do with his proposals to expand coverage, which would have the opposite effect, contributing to health care inflation by increasing subsidies. By contrast, market-based reforms that seek to expand coverage by making it more affordable also help to “bend the cost curve.”

Obama has made gestures of support for a couple of these ideas. His proposed excise tax on especially expensive medical benefits is a roundabout, half-hearted attempt to address the tax incentive that encourages employers to offer health coverage in lieu of higher pay, which insulates consumers from prices and retards competition. At the same time, however, Obama would contribute to the problem by requiring employers to provide insurance.

Similarly, Obama says he is open to the idea of fostering interstate competition in the health insurance market. Yet he insists it cannot be allowed to happen without federal coverage mandates that would boost premiums and undermine the benefits of such competition.

Pressing Obama to confront the contradictions in his own proposals—between spending restraint and huge new subsidies, between amplifying and blocking price signals, between promoting choice and impairing competition—might not yield agreement. But it could produce a little clarity.

SOURCE





13 February, 2010

British Parents forced to call emergency number from outside GP surgery 'because doctors were too busy to see dying baby'

A couple whose baby was dying of meningitis were forced to dial 999 for an ambulance from outside their GP surgery - after being told doctors were too busy to see him. Lee Freeman and Shaunna Bent sprinted more than a mile to their local GP surgery with five-month-old Jaydon in their arms after he was struck down with classic meningitis symptoms. But when they arrived, a receptionist told them no doctor was available and they could leave their number so someone could call them back.

Convinced that Jaydon was seriously ill, the couple dialled 999 on their mobile phone from the pavement outside and an ambulance arrived within eight minutes. But the critically ill baby died from meningococcal septicaemia just hours later at Gloucestershire Royal Hospital.

Now father Lee wants to know why there was no doctor available to help his dying son. He said: ‘The surgery rang us back while we were in hospital to ask how he was getting on and I just said he'd passed away and put the phone down. I did not know what to say to them. ‘We want people to know what happened to us so it does not happen again.’

The couple became concerned about little Jaydon on January 25 because he was sick and whimpering. They rushed more than a mile from their house in Littledean, Gloucestershire, to nearby Dockham Road Surgery in Cinderford to try to see a GP but a receptionist told them to leave a contact number because no doctor was available. After they called an ambulance, a doctor rushed out of the surgery to examine Jaydon but could do little to help him.

Shaunna, 19, said: ‘He was really strong and kept fighting but in the end they said it was best to let him go.’

Now the couple cannot bear to go back to the home where they enjoyed such a happy first Christmas with Jaydon. Shaunna added: ‘I was so chuffed when he was born. ‘He was a lovely bubbly baby who was always laughing. He was so happy that he used to wake up smiling.’

The couple are planning to make an official complaint after Jaydon's funeral, which takes place today. Dr Simon Silver, lead doctor at the surgery, said: ‘Meningococcal septicaemia is an absolutely devastating illness. Prompt treatment as in this case can sometimes be powerless. ‘This must surely turn the parents' life upside down and we hope they do not suffer too much in their grief. Our thoughts and sympathies go out to them.’

A spokesman for NHS Gloucestershire said that they would look into the complaint. He said: ‘A child's death is always a terrible tragedy and our hearts go out to the family concerned. ‘We recognise that this must be an extremely distressing time for them. ‘We have a robust complaints process in place and we would urge the family to make contact with us so we can look in to the individual circumstances of this case.'

Asked what prompted the doctor to run outside the practice, both Dockham Road Surgery and NHS Lothian refused to give any more information, before the investigation. The couple were unavailable for further comment today as they were attending the funeral.

SOURCE




Now three MORE female patients kept in British hospital store cupboard surrounded by blood-stained bins

A flagship hospital is facing an investigation as patients told of their nightmare stays in tiny windowless ‘broom cupboard’ treatment rooms. Elderly women described being transferred to 12ft by 16ft store rooms in the middle of the night – where they were surrounded by blood-stained bins, bandages and shelves of medical supplies. Some missed meals because they were not on proper wards while others described sleepless nights as nurses continually entered to collect stores.

It has emerged that Norwich and Norfolk University Hospital has 27 cupboards – labelled ‘treatment rooms’ and regularly used to house patients – attached to wards.

NHS watchdog the Care Quality Commission has launched an investigation into the £229million hospital, built less than a decade ago with private funding, after a flood of complaints. The scandal came to light when 80-year-old Doris McKeown this week told the Daily Mail how she spent two days in one of the rooms as she awaited surgery for compressed nerves in her spine.

Now 85-year-old Rhoda Talbot has told how she was admitted to the hospital last month with a hair line fracture to her spine and was moved into the ‘stock cupboard’ the night before her discharge. Her son Rod said: ‘It was literally a store room. There was shelf racking filled with stuff used to run the ward, green buckets with dirty, bloody needles in them and oxygen cylinders.’

When Mrs Talbot, from Wroxham near Norwich, was collected by her family, she said: ‘I’m absolutely shattered. They [nurses] were in and out all night. Every time they came in they turned the light on.’ Mr Talbot is planning a formal complaint and wants an apology to his mother over her ordeal.

Another woman, Helen Howes, 35, complained to the ward sister after spending the night in a similar windowless room before urgent surgery on an abscess. She was hemmed in by dressing packs, catheter bags and other medical supplies and her handbag was put on a medical waste bin. ‘Even in the night I was having my bed moved across because the nurses needed to get to something on the left-hand side and my bed was too close for them to open the drawers,’ she said.

The mother of one, who lives near Norwich, doesn’t blame nursing staff. ‘They are powerless,’ she added. ‘They knew it was common practice. I wanted to highlight the completely unacceptable manner in which vulnerable patients, who perhaps feel too ill at the time to complain or feel they don’t have a voice to raise these issues, are treated.’

Katherine Murphy, director of the Patients Association, condemned the cupboards. She said: ‘It’s so undignified. Families shouldn’t put up with it.’

Mrs McKeown, of Bungay, near Lowestoft, Suffolk, was moved to a ‘treatment room’ at 2am on October 22 and spent 48 hours there before surgery. The 80-year-old missed out on meals and medication because she wasn’t on a proper ward and described the room as ‘like a broom cupboard’. Her daughter Dr Helen McKeown, a GP, added: ‘My mother needed emergency surgery and she ended up in a cupboard. Where’s the dignity in care?’

Liberal Democrat health spokesman Norman Lamb branded the rooms unacceptable. Norwich and Norfolk University Hospital responded that all its treatment rooms were used strictly on a short-term basis.

Director of nursing Christine Baker said: ‘Our interest is in making sure all our patients get the best possible care and that their dignity and privacy is protected. 'We carefully assess any patient’s needs before they are placed in a ward clinical treatment room.’ Hospital spokesman Andrew Stronach claimed many hospitals followed the same procedure.

SOURCE




Australia: Doctors shut operating theatres in NSW government hospital due to leaky roof

SURGEONS and anaesthetists at the ailing Hornsby Hospital will shut the operating theatres to all but life-saving cases on rainy days after a senior nurse slipped in a puddle from a leaking roof and shattered her arm last week. The snap decision will force some patients to move to Royal North Shore Hospital and others to wait longer for surgery.

Doctors, furious that a leaking air vent in the operating theatres has still not been fixed, say they fear a patient or staff member will die if they do not take action. The chairman of the hospital's medical staff council, Richard Harris, said yesterday that doctors had been left with no option after the Health Minister, Carmel Tebbutt, said on radio during the week that the leaking vent had been fixed in October and a new leak had developed during last weekend's torrential rain.

"How ridiculous. The water is coming from the same place. It has been leaking for 16 years and it has not been fixed. I don't want anyone else getting hurt or killed," Dr Harris said.

The Bureau of Meteorology predicts thunderstorms for Sydney for the next three days. Rain is expected to return on Thursday, which could put staff and patients at risk of electrocution, a senior anaesthetist, David Benson, said.

"If you have water in a roof where there are electrics, by definition you have some potential for safety issues," he said. "It is now time to to force the hand of the state government to to fix this problem." Dr Benson said a cut in the power supply caused by water in the roof could also put patients at risk. "There is a one-second delay before the generator cuts in but that is enough to cause the computerised monitoring systems to shut down and reboot themselves. "So effectively you are without any way of monitoring a patient for about a minute and half, which could be critical."

At present about seven patients a day have elective surgery at the hospital but this rises to about 25 a day later this month.

SOURCE




Bill Clinton, stents, and Demcare

Former President Bill Clinton was rushed to the hospital for a heart condition and has reportedly received a stent. ABC News has details:

Former President Bill Clinton was rushed to a Manhattan hospital late this afternoon, sources tell ABC News. Clinton, 63, was transported to Columbia Presbyterian Hospital in Manhattan for a condition related to his heart.

ABC News’ chief political correspondent [and former Clintonite, ABC News forgets to disclose] George Stephanopoulos reported that sources said he was taken to the hospital “likely for a stent procedure.”

ABC also tells us that Hillary Clinton was spotted leaving the Oval Office a short time ago and “did not seem ‘too concerned’ or ‘in a rush.’” For what it’s worth.

Update: Clinton received two stents.

The former president’s counselor Douglas Band released a statement saying that Clinton is in “good spirits.”

“Today President Bill Clinton was admitted to the Columbia Campus of New York Presbyterian Hospital after feeling discomfort in his chest,” said Band. “Following a visit to his cardiologist, he underwent a procedure to place two stents in one of his coronary arteries.” A stent is a wire mesh tube used to prop open an artery.

Best wishes for the former president’s recovery.

Now, a timely reminder: Stents don’t grow on trees. They were not created, developed, marketed, or sold by government bureaucrats and lawmakers. One of the nation’s top stent manufacturers, Boston Scientific, has weighed in on the Democrats’ proposed massive taxes on medical device makers:

Boston Scientific Corp (BSX.N) warned on Tuesday that a proposed tax in the U.S. health care reform bill that cleared the Senate Finance Committee last week could have serious consequences for the company, including job losses.

“The bill that came out of the committee last week makes absolutely no sense and would be very damaging to Boston Scientific, and the medical device industry as a whole,” Boston Scientific Chief Executive Ray Elliott said during a post-earnings conference call. “In a nutshell, it would raise costs and lead to significant job losses. It does not address the quality of care but the political scorecard of savings.”

Elliott said that the company’s tax liability would be doubled, adding $150 million to $200 million a year, and it would be forced to make substantial cuts in research and development spending, which could result in 1,000 to 2,000 jobs being lost at Boston Scientific…

…In addition to direct fees on device makers, the industry faces a double tax because hospitals, which have agreed to accept $155 billion in cuts in government payments over 10 years, will pass on part of that burden to device makers, said Elliott.

A teachable moment: Taxing innovation in the name of “health care reform” has consequences.

SOURCE




Founders Would Cheer Virginia’s Anti-Obamacare Bill

Virginia is moving towards passing legislation that would make it unlawful to implement federal legislation to compel Virginia residents to buy health insurance, a/k/a, Obamacare. On Monday, February 1st, the Democratic-controlled state senate of Virginia passed a bill that would block the implementation of the individual mandate of Obamacare.

Some have argued that, constitutionally, federal legislation compelling Virginians to buy health insurance is no different than any other economic regulation imposed by Congress. That kind of “that’s the way we’ve always done it” thinking is not only incorrect constitutionally, but may help explain why reckless spending at the federal level has pushed America to the verge of bankruptcy.

It reminds me of an exchange between a reporter and one of the several Democratic committee chairmen in the House that are addressing the health care bill: The reporter asked the chairman “where in the Constitution does it say the federal government can mandate citizens to buy health insurance?” The chairman snapped back: “Where does it say we can’t?!” Sadly, like many of his cohorts, this chairman was blissfully unaware that if the Constitution doesn’t say the federal government can do something, then it can’t do it. And nowhere in the Constitution is the federal government given the authority to mandate citizens to purchase anything.

The bigger-government approach to the healthcare issue is clear cause to reexamine some fundamentals of how our government should operate. Our system of government is a republic. Before the Revolution, the sovereign was England. Following the Revolution, the power of the sovereign devolved to the people of the states, as explicitly noted in both the Declaration of Independence and the Constitution itself.

The states, as sovereign entities, granted express and limited powers to the federal government by way of the United States Constitution. To prevent one branch of the federal government from exceeding its express and limited powers, we have a “horizontal” system of checks and balances – the three branches of the federal government.

However, we also have a “vertical” system of checks and balances between the states and the federal government. This vertical system of checks and balances has been used too infrequently, but Virginia is now using it to declare our own law regarding healthcare freedom as a means to counteract an unconstitutional law (if it passes) at the federal level. This would create a conflict of laws.

But as James Madison wrote in Federalist 51, freedom is best protected when political ambition counteracts political ambition. Virginia is protecting the freedom of its citizens by “checking” the federal leviathan on the matter of healthcare.

The courts would need to resolve the coming conflict. Ultimately, however, the voters will decide: do federal politicians who may vote for Obamacare stand with the people and the Constitution? Virginians are saying “no” on a bi-partisan basis.

Too many people in Washington forget they get their authority – and I’ll add, their only authority – by a grant of express and enumerated powers from the sovereign states. But also as Madison wrote, that power “should be drawn from the same fountain of authority, the people.”

Our Virginia legislation, however, is important for other reasons. It may prove to be a model for other states to combat the reckless, out-of-touch ways of Washington. It has long been apparent that people are frustrated with government, but many people didn’t think they could do something about controlling such a behemoth. Now people are figuring out the way to stop abuses of power which seem to be crippling our economy and eating away our liberty, is by using the Constitution against those who violate it. Leadership in this approach must come from the states. It is the states that were expected to control the federal government, that’s why Madison said that the “different governments will control each other” in Federalist 51. The “different governments” are the state and federal governments. It’s part of our constitutional role as a state.

As attorney general for Virginia, I’m with Madison. The people of Virginia have every reason to expect that when the government violates the law – especially the supreme law of the land, the Constitution – there will be someone to protect them every bit as much as they are protected against violations of law by ordinary criminals. For too long, the federal government has operated as if it granted authority and freedoms to people and the states. It’s time to start returning this system to its proper balance. The system has broken down, and that has real consequences for jobs, the economy, our security and our freedom.

Virginia’s history is steeped in protecting liberty – the foundation of our nation’s greatness. Once again, Virginia is taking the lead in protecting our citizens’ sacred liberty.

SOURCE





12 February, 2010

NHS gives man two left feet

When Patrick Morrison left hospital after having his right foot amputated, he thought the sense of imbalance he felt would vanish once he got used to his newly fitted artificial foot. But it was not until five months later, when he took off the protective socks, that he realised he had been given two left feet.

A prosthetic limb specialist had fitted an artificial left foot to his right leg - and failed to spot his mistake during two further check-ups. The foot was also too big - made to fit a size nine shoe rather than a size eight. The specialist, Malcolm Griffiths, was struck off yesterday after admitting a string of blunders.

Mr Morrison, 76, said: 'The paramedics who brought me home saw that I was leaning too much to one side. 'My wife and daughter noticed that as well. I thought it was just part of the process of getting used to having a false foot. I wasn't concerned.' It was only when Mr Morrison and his wife Alexia decided to change all three protective socks that they realised the mistake. The retired joiner said: 'We both got a big surprise. Thankfully, the hospital got it sorted out as quickly as they could.'

A disciplinary hearing of the Health Professions Council was told Mr Griffiths admitted 16 charges relating to his treatment of 11 patients at Edinburgh's Astley Ainslie Hospital. The prosthetist, who was absent from the hearing, was sacked by NHS Lothian in 2008.

Mr Morrison, from Bathgate, West Lothian, said he bore no ill-will towards Mr Griffiths and always got on well with him.

His ordeal began when an ulcer on his big toe grew worse. Eventually the toe was amputated, but the wound became infected with MRSA and surgeons had to remove the entire foot and part of his lower leg. He was sent to Mr Griffiths to have a prosthetic limb and shoe fitted.

At the disciplinary hearing in Edinburgh, the panel was told that Mr Griffiths not only admitted the charges against him, but had also requested that he be removed from the professional register. Its chairman Colin Allies said: 'The panel is satisfied that it is appropriate and proportionate to make the consent order as requested by the parties.'

As well as the charges relating to Mr Morrison, the prosthetist also admitted that he caused 'unnecessary delay and pain' to another patient by failing to complete work 'within a reasonable time-frame'. He also admitted failing to maintain adequate patient notes.

A spokesman for NHS Lothian said its senior clinical staff had apologised to Mr Morrison. He added: 'As soon as issues regarding this former member of staff's competence were raised, we set procedures in place to provide additional support and training. 'He was dismissed in September 2008 following a failure to engage in our competency supervision processes.'

SOURCE




Australia: Public hospital complaints go unanswered

But the light of publicity suddenly gets some action!

A YOUNG mum who can't hold her baby because of a botched hospital birth is among more than 20 Queenslanders whose complaints have been ignored by the independent patient safety watchdog. The Health Quality and Complaints Commission yesterday admitted that 22 online complaints about public hospital incidents had sat unread for up to five months because of a computer glitch.

The commission, which legally has 90 days to act, issued a receipt to patients but the complaints sat in a computer system until inquiries by The Courier-Mail alerted the HQCC to the problem.

One of the complaints was from Toowoomba mother Dawn Kelly, 20, who nearly died from a flesh-eating infection after having a caesarean. Her family believes the infection was caused by sloppy surgery and poor monitoring. Ms Kelly, who is allergic to latex, was given an epidural with a latex catheter. She has required 14 operations to repair damage to her uterus and abdomen since delivering her first child, Tyler, last April.

Ms Kelly and a neighbour who was visiting her in hospital say the surgeon said: "That's the way the cookie crumbles and this time the crumbs landed on you."

Ms Kelly's mother, Julie Parsons, said she had lost $25,000 in income while taking care of her daughter and Tyler, while Mrs Parson's husband David was working four jobs. "We've been kept in the dark on so many issues. There's nobody taking responsibility for anything," Mrs Parsons said. She had asked the HQCC to investigate in October, but was later told her online complaint was lost.

After being contacted by The Courier-Mail, the HQCC claimed the complaint was one of 22 unopened after being received online. The Courier-Mail understands the HQCC averaged one email every two days before the online complaints were shut down in November. "We apologise for the technical issue and wish to assure these complainants that we will manage their cases as quickly as possible," an HQCC spokeswoman said. The Parsons said their daughter had acute pain several times a week.

Queensland Health acting district chief executive officer Dr Peter Bristow said staff at the hospital "were sorry for the pain and suffering Dawn Kelly has been through. I realise that Ms Kelly's health problems have had a huge impact". Queensland Health said it was arranging an appointment for Ms Kelly to see a pain management specialist at a private hospital and to get surgery to permanently mend her abdomen in the near future.

SOURCE




The Roadmap to Real Health Care Reform

During his State of the Union Address, President Obama declared that “there will be many different opinions and ideas about how to achieve reform, and that is why I’m bringing together businesses and workers, doctors and health care providers, Democrats and Republicans to begin work on this issue next week.” One public servant providing practical solutions is Rep. Paul Ryan (R-WI), who recently introduced his Roadmap for America’s Future Act of 2010. The Ryan bill outlines clear, sound principles to reform entitlement spending and health care. The Roadmap’s health care provisions would bend the cost curve in health spending, make insurance more affordable and accessible, and create a consumer-driven, highly-competitive system. This is how it is done:

1. Changing the Tax Treatment of Health Coverage

Current tax treatment of health insurance gives preference to employer-based coverage by making benefits tax free to the employee and the employer alike. Obviously, this tax policy only benefits those who receive coverage through their employer. It benefits those who also have the biggest benefit packages, usually, but not always, the wealthy. Ryan’s “Roadmap”replaces this inequitable system through creating a system of refundable tax credits of $2,300 for individuals and $5,700 for families for the purchase of health coverage. As Heritage experts have pointed out this will transform the market to respond to patients’ needs, allow portability of insurance between jobs, and further the goal of universal access.

Replacing the tax exclusion with a health care tax credit would not only help the middle class buy insurance and extend coverage to the uninsured; it would also set in place powerful incentives to reduce the rapid growth in health care expenditures…individuals and families will have the ability to choose the health plan they want, own it, and take it with them from job to job. This tax credit would also have the added benefit of allowing individuals and families to decide how much of their compensation comes to them in the form of health insurance

2. Promoting State- Based Reform and Exchanges

The Ryan “Roadmap” would create a Federal-State partnership to help states that wanted to do so create State Health Insurance Exchanges, featuring high-risk pools combined with guaranteed access to care with affordable premiums. A state health insurance exchange can be designed many different ways. The key question is what is the objective of such an exchange. For consumers who want to own and control their health insurance, and take it with them from job to job, a properly designed state exchange, as Heritage’s Robert Moffit argues, can make it easy for employees , especially those in small businesses to compare and buy affordable health plans. It can unleash the free market forces of choice and competition. An exchange designed to restrict health options, as is now being promoted by the Left, is just another regulatory roadblock to personal freedom.

3. Allow Interstate Purchasing of Health Coverage

Congressman Ryan’s proposal would also allow individuals to use their refundable tax credits towards the purchase of health insurance policies in any state. As Moffit explains, interstate competition would lead to broader and more intense competition, greater personal choice and more affordable coverage, and would secure value for consumers’ dollars.

The nonpartisan Congressional Budget Office evaluated Congressman Ryan’s Roadmap favorably, finding that “[The health insurance tax credit] could impose significant downward pressure on… the growth of overall spending on health care.” The Roadmap would also reform Medicare, putting it on more solid fiscal ground and molding it into a more consumer-driven system.

Even the President has kind words to say about the Rep. Ryan’s Roadmap, calling it a “detailed” and “legitimate” plan to tackle our fiscal crisis. The question before the taxpayers is whether the president and the congressional leadership are really serious about pursuing bipartisan reform, or whether they want to continue to push the massive and unpopular House and Senate bills that are so unpopular with the American people.

SOURCE




Health Care Summit the Wrong Approach to Bipartisan Health Care Reform

Later this month, President Obama’s health care summit will aim to highlight input from both Democrats and Republicans. This last ditch effort for bipartisanship appears encouraging on the surface, but many predict it will mean little more than theatrics and sound bites, rather than actual inclusion for the minority in the legislative process.

If the President were serious about moving forward on health care with bipartisan support, he would conduct this meeting in a more serious manner. Rather than create a public illusion of “reaching out”, the President would engage in serious discussions with not only Republicans, but with state and local legislators who also will play a role in enacting reform. Most importantly, the President would ask legislators to start afresh by abandoning current legislation and creating an improved bill from scratch. By bringing both parties to the table to draft the legislation in the first place, lawmakers are more likely to find common ground on how best to proceed. And, as Heritage’s Stuart Butler pointed out in a recent article in the National Journal, there is plenty of common ground to be found. Butler highlights the following areas as those which would address serious problems in our health care system with bipartisan support:

* A firm Republican commitment to achieving affordable coverage for all Americans in annual stages, starting now, in return for a WH agreement to scale the current bills way back.

* A package of insurance reforms, such as extending HIPAA, designed to deal with pre-existing conditions.

* An agreement to provide states funding to address high-risk and chronically ill Americans through high-risk pools. In addition, giving states legislative waivers for left or right ideas to expand coverage — eg through the bipartisan Baldwin-Price House bill.

* An overhaul of the tax treatment of private health coverage to make it efficient and to provide cost-reducing incentives — limiting the tax exclusion by income to finance better tax relief for those who need it to afford coverage.

An effective and bipartisan health care bill is obtainable, but to achieve this, Congress and the President must seek it in a more sincere and productive manner. The President’s summit on health care is the wrong approach.

SOURCE




Pelosi Attempts to Raise ObamaCare from the Dead

Breathing new life into the most unpopular legislative abomination in recent memory, House Speaker Nancy Pelosi is setting the stage for the last stand of ObamaCare. It is an effort that may ultimately fail, but one in which she is clearly unwilling to cede the battlefield.

Speaking at the Academy Health National Health Policy Conference, Pelosi's legislative director Wendell Primus stated that the reconciliation process was "the only way" for Congressional Democrats to pass the ObamaCare monstrosity.

No kidding. The House cannot pass the Senate bill without significant changes, particularly to the abortion funding that flies in the face of the Stupak amendment, named after Congressman Bart Stupak who led the charge with some 39 House Democrats to strip such funding from the House version.

And the Senate cannot pass any modified bill now that Republicans have the 41st vote against cloture on the radical takeover of the nation’s entire health care industry. The election of Senator Scott Brown ensured that.

Which leaves the only scenario left, as outlined by Mr. Primus: “The House would have to take up [the reconciliation bill] first because it would involve revenue changes and then the Senate would pass it and then I think hopefully with the passing of that legislation, the House, only then would take up the Senate bill and pass it… The trick in all of this is that the President would have to sign the Senate bill first and then the reconciliation bill would be signed second and the parts of the reconciliation bill that trump the relevant portions of the first signed bill.”

Only, reconciliation is a process that is supposed to be limited to budget bills, not substantial changes to the laws of the United States that the health care takeover would represent.

The idea here — and the problem — is that House and Senate Democrats want to eliminate the filibuster in the Senate to enact government-run health care, solidifying one-party rule despite the election of Senator Brown in Massachusetts. For, if reconciliation can be invoked to avert the filibuster on this issue, it surely would be used to enact other radical proposes such as caps on carbon emissions, the takeover of the energy industry, the nationalization of the banks, etc.

ObamaCare is a plan that would ration care away from seniors, drive the American people off of private health options and onto the public system, lower quality, increase premiums, and bankrupt the Treasury with over $2.5 trillion in costs over ten years once fully implemented. It would unconstitutionally force the American people to be covered under either a private or public plan.

It, like the rest of the nation’s entitlement spending, is unsustainable, and as ALG News has previously reported, will hasten the nation’s descent into financial Armageddon, as the U.S. would eventually lose its Triple-A credit rating.

Which is why this morbid resurrection of the ObamaCare abomination must be stopped now. The process has become slightly more complicated with the passing of Congressman John Murtha, which may bring the Democrat total votes in the House down to 217.

As reported by the American Spectator, “When the health care bill passed the House the first time around, it did so with 220 votes — giving Pelosi just two votes to spare. With Republican Rep. Joseph Cao no longer willing to vote for the bill given the weaker abortion language and Rep. Robert Wexler having retired in the middle of his term (a special election to replace him won't happen until April [13th])…” plus the death of Murtha, Democrats are conceivably down to 217.

The special election to replace Murtha probably won’t take place until May 18th, according to the Radio Business Report, and with no guarantees that a Democrat will replace him (or Wexler, for that matter), Congressional Democrats have a small window of opportunity to get this done, lest ObamaCare opponents get up to 218. Primus has indicated that the plan would be “very close to being done” by Easter recess, which begins April 3rd.

With 433 currently-filled seats, 217 would give Pelosi the barest of majorities to pass the government takeover of the health system. Coupled with the perversion of the reconciliation process and the elimination of the filibuster, it could be enough.

To review: Congress is planning on using reconciliation to eliminate the controversial abortion funding and pass the changes in the House. Then it would be passed in the Senate. Next, the House would pass the controversial Senate bill.

In the last stage, Obama would sign the Senate bill first, and finally sign the reconciliation bill which modifies the Senate bill. Congressional Democrats have a small window of time to do it, but it could work.

As such, this is a significant threat to the liberty of the American people and the institutions of limited government — and it must be stopped, before the ObamaCare abomination is raised from the dead, and the American people left to deal with the horrid consequences.

SOURCE





11 February, 2010

Elderly British patient was abandoned for two days in hospital store cupboard with little food or medication



Confused and in pain, 80-year-old Doris McKeown is kept in a hospital cupboard while she awaits emergency surgery. The pensioner was stored away for 48 hours in a tiny windowless room, with only shelves of hospital supplies for company. On the door outside was a sign saying 'Dignity in Care'.

But inside the store cupboard - called a 'treatment room' by management but a 'broom cupboard' by Mrs McKeown - she suffered the indignity of being overlooked for medication and meals.

She was taken to Norfolk and Norwich Hospital last October needing an urgent operation for compression of the nerves in her spine, which can lead to paralysis. The mother of two said: 'It was a relief to be in hospital as I knew it was a serious condition, but in the middle of the night I was transferred to a storeroom off the main ward because they hadn't got enough beds. It was like a broom cupboard.'

When she was seen by the consultant, he had to squeeze in with two other doctors and Mrs McKeown's daughter Dr Helena McKeown, a GP who is also chairman of the community care committee at the British Medical Association. ' The consultant didn't seem surprised, it seemed to happen regularly,' said Mrs McKeown, whose late husband Joe was a newspaper photographer. 'I had nurses coming in all the time to pick up the supplies and they were very good, but as I wasn't on the proper ward I missed out on some of the rounds for meals and medication. 'I didn't get put on the ward until after the operation two nights later. 'It's extraordinary that patients have to be looked after in a cupboard because the hospital doesn't have enough beds.'

Dr McKeown said: 'My mother needed emergency surgery and she ended up in a cupboard. Where's the dignity in care?' The family is appalled that patients are routinely housed in such rooms as a result of a controversial scheme using private companies to build NHS hospitals for a profit. They claim the Norfolk and Norwich Hospital not only has fewer proper beds than the old building it replaced but that the public will be paying for it for decades.

Dr McKeown has raised her concerns with the hospitals' watchdog, the Care Quality Commission, and last week gave evidence to MPs. She said the Private Finance Initiative (PFI) scheme that funded the hospital was undermining the NHS. 'The PFI scheme is being used throughout the NHS, which pays private companies for a period of 25 to 30 years,' she said. 'It's like a mortgage with a very high rate of interest and maintenance costs that my four children will be paying for 30 years - and they can't even build a hospital with sufficient space for local patients.'

The £229million Norwich hospital, opened in 2001, pays an annual rent of £40million a year. Figures show the NHS will pay out £63billion for privately financed hospitals - £52billion more than they are worth. The first payments for hospital Private Finance Initiatives began in 1999 and the NHS still owes £58billion on 106 contracts over the next three decades. The BMA will today launch a campaign against the 'commercialisation' of the NHS, which it says is putting profits ahead of patients.

Andrew Stronach, of the Norfolk and Norwich Hospital, said it has 1,010 beds - more than the 952 replaced in two old hospitals. But he admitted that 27 wards had such 'treatment rooms'. He added: 'They are not cupboards, they are treatment rooms. They are normally used for patients who are risk assessed before being discharged.'

SOURCE




Australia: Victoria to ape failed British hospital reform

It leads either to "fudging" the figures or to hasty and inappropriate treatment -- causing death in some instances

WAITING times for patients at Victorian hospital emergency wards would be slashed by half to four hours as part of sweeping health reforms. Victoria is already testing a four-hour target for emergency departments in three Melbourne hospitals. The Brumby Government is closely monitoring the trial before deciding whether to roll out a four-hour benchmark across the state.

South Australian Premier Mike Rann - who faces a tough election fight on March 20 - is leading a national push for the four-hour target. He has been lobbying other premiers and Canberra to back the health plan - with mixed success. NSW is understood to be lukewarm, believing it would require thousands of extra hospital beds, but Victoria and Western Australia are proceeding with the target in a bid to clear emergency wards.

The plan comes as Prime Minister Kevin Rudd is finishing a suite of reforms that he hopes the states will sign in the next few months. It is believed the PM is keen to offer the states extra money to speed up elective surgery waiting lists. He also supports a reform suggested by his Health and Hospitals Reform Commission to pay at least 40 per cent of the "efficient cost" of every public patient admission.

Mr Rudd, who has backed away from a threat to take over the public hospitals, yesterday raised the prospect of introducing hospital boards. This would give local communities greater control over their hospitals - but critics claim it would cost tens of millions of dollars in extra bureaucracy.

The Rudd Government has been working through options with the states ahead of a Council of Australian Governments summit, scheduled for March or April. But the states are far from united on the best way forward for health reform. The plan to introduce a four-hour target for emergency departments highlights the national split. Supporters point to the success of a four-hour target introduced by Britain in 2004. The target, along with extra cash, has produced a big [superficial] improvement at UK emergency departments.

Some concerns have been raised that hospital staff had compromised the level of patient care in order to meet the tougher benchmark. At present, patients who have been rushed to emergency departments have to wait up to eight hours to be treated and either discharged or admitted to a hospital bed.

Canberra appears lukewarm to requests from South Australia for extra money. Health Minister Nicola Roxon said the Rudd Government had increased health and hospital funding by 50 per cent to a record $64 billion.

SOURCE




The Canadian Patients’ Remedy for Health Care: Go to America!

One common assertion among the left is that other industrialized nations, such as Canada, achieved great success in health care within their collectivist framework. This, then, begs the question: why is the head of an east coast Canadian province coming to the United States for medical treatment?

Newfoundland Premier Danny Williams is seeking heart surgery in the United States, drawing criticism from “local bloggers and people calling in to the province’s immensely popular open-line radio shows.” Yet his actions are hardly unusual for world leaders. Saudi Arabian King Abdullah bin Abdulaziz is known to have his checkups at the prestigious Mayo Clinic in Rochester, Minn. Italian Prime Minister Silvio Berlusconi had heart surgery at the Cleveland Clinic in 2006 . Even middle-class Canadians are utilizing their proximity to the United States to seek treatment here.

A study by Steven Katz, Diana Verilli, and Morris Barer in Health Affairs examining the Ontario Health Insurance Plan from 1987 to 1995 found “evidence of cross-border care seeking for cardiovascular and orthopedic procedures, mental health services, and cancer treatments,” although not widespread. Examples include the governments of British Columbia and Quebec sending patients to the United States for coronary artery surgery and cancer treatment. Shona Holmes, a Kingston, Ontario resident in need of an endocrinologist and neurologist, crossed the border when she was told to wait “four months for one specialist and six months for the other.” Karen Jepp delivered identical quadruplets in Montana “because of a shortage of neonatal beds in Canada,” with the Calgary health system picking up the tab.

Perhaps Canadians’ health care migration patterns are a result of their own centralized system of government health care planning and “free care” crashing into the government’s budget constraints. The annual study “Paying More: Getting Less“ produced by the Fraser Institute, a Canadian think tank, found that government-run monopolies established in each province of Canada (simultaneously barring private operators from competing for the delivery of public health services) produce rates of growth in government health care spending that are “not financially sustainable through public means alone.” Each province’s policy of insulating consumers from price signals, such as premiums, co-payments and deductibles, has naturally led to over-consumption of medical treatment. Thus provincial governments, encountering fiscal restraints, must resort to long queues and the rationing of care.

And wait patients must. A hospital survey of five countries (United States, Canada, New Zealand, United Kingdom and Australia), conducted by Robert Blendon and colleagues in Health Affairs found that “waits of six months or more for elective surgeries were reported to occur ‘very often’ or ‘often’ by 26–57 percent of executives in the four non-U.S. countries; only 1 percent of U.S. hospitals reported this. Half of all Canadian hospitals reported an average waiting time of over six months for a 65-year-old male requiring a routine hip replacement; no American hospital administrators reported waits this long.

Perhaps if Canadian provinces adopted a free-market approach to health care, more of their citizens (and politicians) would seek treatment within their borders. This leaves just one question: if the United States adopts government-run health care system, even remotely like that of Canada, with government control of benefits and financing, plus reams of rules specifying what we can and cannot get, which border are we going to cross to get the care we need?

SOURCE




Obama debates straw men

Unlike the jock-sniffers, normal people watching the president's tete-a-tete with the Republicans only wondered why Obama always responds to imaginary arguments no one made, rather than the questions actually being asked. That is Obama's signature move: Invent "people" who are "saying" ridiculous things and then encourage the audience to laugh at these made-up buffoons. Since Obama's reformulations of Republican arguments are always absurd, no further response from him is necessary -- and none is ever forthcoming.

Thus, for example, Obama's description of Republican criticism of his plan to nationalize health care was that "this thing was some Bolshevik plot." No. No one said it was a "plot," Bolshevik or otherwise.

Republicans' objection to national health care could be more accurately portrayed as follows: Obama's plan to nationalize health care was a terrible idea because it would turn over one-sixth of the American economy to Washington bureaucrats, who would run the system as competently as the federal government runs everything else, from airport security to the post office to FEMA.

How about responding to that argument? (And as long as Obama brought it up, can he explain which part of national health care the Bolsheviks would have objected to most strongly?)

This isn't how adults conduct serious political debates; it's how children argue with their parents. Don't have a cow! Liberals hide conservative arguments from the public like teenagers hide contraband from mother under the bed.

Repeatedly positing imaginary attacks by Republicans accusing him of a "plot," Obama said that "the way these issues are being presented by the Republicans is that this is some wild-eyed plot to impose huge government in every aspect of our lives." Again, not a "plot" and certainly not "wild-eyed." The only person accusing anyone of "plotting" here is Obama accusing the GOP of plotting against him. I guess they don't teach irony at Harvard Law School.

If Obama is going to keep imagining others accusing him of "plots," could he provide just one example?

Republicans also did not accuse Obama of trying to "impose huge government in every aspect of our lives." Just the part of it that determines how long we get to live.

Continuing his fantasy battle with imaginary opponents, Obama said, "What you've been telling your constituents is, this guy is doing all kinds of crazy stuff that's going to destroy America." I gather Obama is incapable of responding to his opponents' actual argument, which is that he is proposing all sorts of things that would be very bad for America.

Since he pleads innocence only on the claim that he is doing "crazy stuff that's going to destroy America" -- an argument no one made -- apparently he's guilty as charged on the claim that he's merely doing very bad things to America.

Adopting the pose of limpid nonpartisanship, Obama repeatedly accused Republicans of horrible things using his peculiar straw-man technique. He told Republicans he was "absolutely committed" to working with them, "but it can't just be political assertions that aren't substantiated." Can Obama please name a single "unsubstantiated" political assertion by a Republican before wasting everyone's time by instructing Republicans to stop making them?

I can name a few from Obama! How about the whopper he told about national health care not covering illegal aliens? Or the one about it not covering abortions? Weeks after Obama made those unsubstantiated political assertions before a joint session of Congress, Democrats were in death-match battles with Republicans (and some moderate Democrats) who tried to exclude coverage for illegals and abortion from the very bills Obama said never contained such coverage in the first place.

How about Obama's claim in his State of the Union address last week that a recent Supreme Court ruling would allow "foreign corporations to spend without limit in our elections"? In the case Obama mentioned, the court overruled section 441a of the campaign-finance law, which had banned all corporate spending on elections. The case did not concern, nor did the court address, section 441e, which prohibits foreign corporations from making any "contribution or donation of money or other thing of value ... in connection with a Federal, State or local election."

History will record that these remarks from his State of the Union address were the only case legendary barrister Barack Obama ever argued before the Supreme Court. And he lost.

Even when presented with a short, straightforward, simply stated question by Rep. Mike Pence, Obama couldn't help but to formulate a different question. Pence asked: "Mr. President, will you consider supporting across-the-board tax relief, as President Kennedy did?" The question Obama wanted Pence to ask was: Mr. President, will you join Republicans in cutting taxes of billionaires? Luckily, Obama's reformulation gave him an opening for a killer answer: "What you may consider across-the-board tax cuts could be, for example, greater tax cuts for people who are making a billion dollars. I may not agree to a tax cut for Warren Buffett."

Republicans should take that answer and run like a thief in the night! OK, let's cut taxes on everyone except billionaires. I'd even support a specific tax expressly on Warren Buffett. Now, son, how much will you give us for these magic beans?

If only Republicans could maneuver Obama into answering a question on abortion, we could probably get him to agree to ban all abortions –-- except in the case of teenage girls who have been raped by their fathers. (This is how I assume Obama would rephrase the question.) No conservative argues like this. To the contrary, we're morose that Nexis archives are not more complete, so we can't quote liberals directly more often.

SOURCE




Obama’s Health-Care Summit – Gimmick or Negotiation?

On February 25th, the White House has proposed a bipartisan, half-day televised summit on health care. It is unclear as to whether this is a publicity stunt by the Obama Administration or a good faith effort to negotiate with Republicans to come up with a bipartisan health care reform bill. The Washington Post reports today many Republicans are pushing back and urging the White House to scrap Obamacare as a precondition to any negotiation. House Minority Leader John Boehner (R-OH) and Whip Eric Cantor (R-VA) sent a letter to White House Chief of Staff Rahm Emanuel objecting to the House and Senate versions of Obamacare being the base line bills of the negotiations. Hopefully, this summit meeting is more than the President checking off a campaign promise to have all health care negotiations on C-SPAN.

If this summit is a genuine start to bipartisan negotiations, then a few issues need to be settled before the meeting:

1. Start Over – The American people have rejected Obamacare and they want Congress and the Obama Administration to start over from scratch. The election of Scott Brown as Senator from Massachusetts was a strong message, from a liberal state, that Obamacare is not popular with the American people. An NBC News/Wall Street Journal Poll indicates that 31% think the President’s health care plan is a good idea v. 46% a bad idea. CNN/Opinion Research has the numbers at 38% in favor and 58% opposed. It is clear that a minority in Congress is representing the will of a majority of Americans who think Obamacare is a bad idea and it is time for liberals in Congress and the Obama Administration to start listening to the American people. With the overwhelming weight of polling data and election results in Massachusetts indicating widespread opposition, it is time to start over.

2. Take Reconciliation off the Table – The President needs to state publicly that he will not support partisan efforts in Congress to use reconciliation procedures as a mechanism to railroad through pending versions of Obamacare. Reconciliation, commonly referred to as the Nuclear Option in the Senate, allows the supporters of Obamacare to avoid a filibuster in the Senate and ignore the traditional rules that would allow extended debate and amendment. Using reconciliation and relying on one party’s votes to pass an unpopular approach to health care reform would not translate into a bipartisan solution to comprehensive health care reform.

3. Transparency – Transparency has to be any part of a summit and it does not begin and end with the publicly broadcast meeting. First, what may be necessary is for the Obama Administration, Republican Leaders, Democrat Leaders and Moderate Democrats have a private meeting, before any planned public summit to clear the air. There is nothing wrong with having a private meeting to provide an opportunity for members to speak freely and build some needed trust. Right now, there is no trust and there has been a complete breakdown in communication. Maybe they could sit and discuss the core elements of a true bipartisan plan in private, and then have a public summit to air any agreement over a half day. A meeting and summit does not mitigate the need for public hearings in Congress and other means to transparently consider any new elements of a health care bill. The White House had been actively engaged in closed door negotiations as recently as the first week of this year with lobbyists and congressional leaders in a manner that excluded moderate Democrats, Republicans and the American people. This needs to end. It is reasonable for members of Congress to have informal negotiations at times, yet the work product should be subject to transparent hearings in the House and Senate committees of jurisdiction. Any deal should be vetted with the American people and subject to a transparent process.

The great danger in this process is that the Obama Administration checks off a campaign promise then goes on with business as usual. This summit can’t merely be a gimmick where the President lectures Republicans and Republicans lecture the President, then the President forges forward with the same Obamacare bill that has been rejected by the American people. This summit should be where the President starts the process over and engages in real negotiations with a broad audience.

SOURCE




The ObamaCare Tragedy

Murtha's death is another eerie coincidence

By JAMES TARANTO

Rep. John Murtha--best known in recent years as a onetime Iraq war supporter who abruptly switched sides--has died, CNN reports: "Murtha of Pennsylvania, a longtime fixture on the House subcommittee that oversees Pentagon spending, died after complications from gallbladder surgery, according to his office. He was 77. The Democratic congressman recently underwent scheduled laparoscopic surgery at National Naval Medical Center in Bethesda, Maryland, to remove his gallbladder. The procedure was "routine minimally invasive surgery," but doctors "hit his intestines," a source close to the late congressman told CNN."

May he rest in peace. After paying their respects, political observers wasted no time before speculating about what this means for ObamaCare. If you think the effort is dead anyway, as we guess we still do, the answer of course is nothing. But the president and congressional Democrats are, at least ostensibly, looking for a way to defy the voters and impose this monstrosity, and Murtha did cast an "aye" vote when the House approved its version of ObamaCare in November, 220-215.

The American Spectator's Philip Klein does the math: "The one Republican who voted for it--Joseph Cao--has indicated that he would not support the bill a second time around given the weaker language on abortion in the Senate version. In addition, Florida Rep. Robert Wexler already retired prematurely. Factor in Murtha's death [yesterday], and [Speaker Nancy] Pelosi is down to 217 votes."

With 433 representatives currently seated, 217 is a bare majority. so that Murtha's death does not immediately deprive Pelosi of a needed vote. But the planned Feb. 28 resignation of Rep. Neil Abercrombie (D., Hawaii), who plans to run for governor, would reduce the number of remaining "ayes" to 216 out of 432, not enough for a majority.

What's more, Murtha's seat, to be filled in a special election, likely on May 18, could go Republican. The Cook Political Report rates the district, which John McCain carried in 2008, as a "toss-up." There's even a chance that Abercrombie's heavily Democratic district, which includes Barack Obama's birthplace, could go to the GOP in a special election. As NationalJournal.com notes, the GOP candidate, Charles Djou, is expected to face three Democrats, who could split the vote. A plurality would be sufficient to win.

The fate of ObamaCare is starting to have something of the feel of a Greek tragedy. We are not superstitious, but Murtha's death as the result of medical error at a government-run hospital is certainly an eerie coincidence.

And this follows the demise of Ted Kennedy, who worked all his life for "universal" health care, then perished last year just as the realization of this aspiration seemed inevitable. If ObamaCare dies, it will have been because a Republican senator was elected to Kennedy's seat last month. As the Washington Times reports, some Democrats are so upset they can't keep their metaphors straight: "Many of us thought we were really at the one-inch line, then literally it was like being hit by a freight train with about 10 seconds' warning," said Ken Thorpe, a senior Health and Human Services official during the Clinton-era debate."

What does "literally" even mean when it modifies a simile? Anyway, Scott Brown would not be in the U.S. Senate had Massachusetts Democrats not twice fiddled with the procedure for filling a vacant Senate seat in the expectation of realizing a short-term gain.

In 2004, they took away the governor's appointment power (so that Republican Mitt Romney would not be able to replace the haughty, French-looking then-junior senator, who by the way served in Vietnam, had he been elected president). Under the pre-2004 law, Gov. Deval Patrick would have appointed someone to serve until November. Under the post-2004 law, the seat would have remained vacant until a special election. Instead, the law was changed again so that Patrick could appoint someone in the interim. Result: Dems had 60 votes to push ObamaCare through, and Massachusetts voters had the opportunity to cut that number to 59. So it's really less like being hit by a train than like driving your own car off a bridge.

Post columnist E.J. Dionne, meanwhile, employs a peculiar metaphor to argue that Democrats should force ObamaCare through, the voters be damned:

If President Obama gets to sign a health-reform bill, as I believe he will, one reason may be Rep. Jay Inslee's difficult experience renovating his kitchen. . . .

He recounted all the grief he and his family went through while work on their kitchen renovation dragged on and on and on. "During that time, I had blood lust against my contractor," Inslee said. "Six months went by, and he was still arguing with the plumber. Eight months went by, and there were still wires hanging down everywhere, and he was having trouble with the building inspector."

But eventually, the job got done. "And now I love that kitchen," Inslee recalls saying. "I bake bread in that kitchen. My wife cooks great meals in that kitchen. The contractor's now a buddy of mine, and I've had beers with him in that kitchen." Inslee looked at his colleagues and declared: "We've got to finish the kitchen."

Except that Inslee's kitchen was in his own house! A better analogy to ObamaCare would be if some guy down the street is unhappy because his daughter is having a lot of very bad personal problems, so to take his mind off it, he barges into your house and starts tearing apart your kitchen.

SOURCE





10 February, 2010

Obama looks for a way out of health care jam

Facing long odds and hardening public skepticism, President Obama is pushing forward with health care reform -- with a twist. In a speech to Democratic supporters, Obama laid out a new action plan for reform, calling on both parties in Congress work through existing legislation, then seek public input on what ideas work best. "It's important to have a methodical open process over the next several weeks, then let's go ahead and make a decision," Obama said.

But to a great extent, the public has already spoken on health care reform, with a range of polls showing a majority of Americans oppose the plan -- along with all Republican lawmakers.

Michael Cannon, a health policy expert at the Cato Institute, said Obama's new way forward is designed to fail. "They are not interested in public input because the public has opposed this since July, and they say they are open to Republican ideas but the Republicans' one idea is to kill the bill," Cannon said.

Instead, Obama's new way forward is better designed to appeal to his base -- Democratic Party loyalists disappointed over his handling of health care reform who still want to see it pass. Obama in his first year in office pinned much of his own political fortunes to passing health care reform. Appearing to give up the battle -- and handing Republicans a victory -- could be devastating to the Democratic Party in an election year.

Increasingly, Obama is challenging Republicans to put their ideas forward and be judged. "If Congress decides we're not going to do it, even after all the facts are laid out, all the options are clear, then the American people can make a judgment as to whether this Congress has done the right thing for them or not," Obama said.

But the risk in that for Obama is once again the polls. Having soured public opinion on health care reform, doubling back and winning converts is unlikely. Asking lawmakers to devote more time to an unpopular issue also is not likely to go over well.

Both Obama and Democratic leaders in Congress say they plan to focus on a jobs bill first. House Speaker Nancy Pelosi, who has never fully abandoned health care reform, nevertheless said moving forward will be tough. "I think that all of these things are a very heavy lift," Pelosi said. "Everything good that has been done, whether it is Social Security, Medicare, now health care reform, all have been difficult. It is never easy."

The reform effort was dealt a fatal setback when Scott Brown, a Massachusetts Republican, was elected to the late Sen. Edward M. Kennedy's seat. Brown, who ran against Obama's reform plan, effectively deprived Democrats of their filibuster-proof 60-vote majority in the Senate, which was their only hope for passing comprehensive reform. A subsequent plan to reform health care in smaller, bite-size increments has failed to generate much enthusiasm amid polls showing voters' top concerns are jobs and the economy.

SOURCE




Republicans may opt out of Obama's health-care summit

Leading House Republicans raised the prospect Monday night that they may decline to participate in President Obama's proposed health-care summit if the White House chooses not to scrap the existing reform bills and start over.

In a letter to White House Chief of Staff Rahm Emanuel, House Minority Leader John A. Boehner (Ohio) and Minority Whip Eric Cantor (Va.) expressed frustration about reports that Obama intends to put the Democratic bills on the table for discussion at the summit, which would be held Feb. 25. "If the starting point for this meeting is the job-killing bills the American people have already soundly rejected, Republicans would rightly be reluctant to participate," Boehner and Cantor wrote.

Obama proposed the half-day summit on national television Sunday, but in their letter, the two GOP leaders offer their suspicion that the president is not serious about opening bipartisan negotiations on health-care reform. " 'Bipartisanship' is not writing proposals of your own behind closed doors, then unveiling them and demanding Republican support," Boehner and Cantor wrote. "Bipartisan ends require bipartisan means."

White House press secretary Robert Gibbs responded by saying that Obama has sought Republican input since early last year, and that the president remains interested in hearing ideas that the GOP thinks will advance the reform cause.

But he appeared to give little ground on the idea that Obama might abandon the months of work that produced Democratic bills that passed the House and the Senate late last year. "He's been very clear about his support for the House and Senate bills because of what they achieve for the American people: putting a stop to insurance company abuses, extending coverage to millions of hardworking Americans, getting control of rising premiums and out-of-pocket costs, and reducing the deficit," Gibbs said in a statement.

He added: "The president looks forward to reviewing Republican proposals that meet the goals he laid out at the beginning of this process, and as recently as the State of the Union address. He's open to including any good ideas that stand up to objective scrutiny. What he will not do, however, is walk away from reform and the millions of American families and small businesses counting on it."

SOURCE




Clinton-era health aides push to save Obama's plan

Shock and awe. That's what survivors of the Clinton-era health care collapse are feeling as President Barack Obama's overhaul legislation wobbles in Congress. Aides who shaped Bill and Hillary Rodham Clinton's 1990s plan to cover all Americans, then labored in vain to pass it into law, are adamant that the Democrats can't afford another health care disaster. But they're divided on whether scaling down Obama's plan would be an acceptable solution.

The Clintonistas _ now in think tanks, universities, serving in the Obama administration or lobbying _ are a potent voice in the furious debate within the Democratic Party over how to salvage health care. Listened to because they're the veterans of the last health care policy war, they carry the scars of intense striving reduced to utter futility.

"If Bill Clinton couldn't get it done, and Barack Obama can't do it, no Democrat will ever try again," said economist Len Nichols, health policy director at the New America Foundation. A Clinton White House health budget aide, Nichols has been operating as an unofficial adviser to lawmakers and administration officials wrestling with details of the current legislation.

"History is written by the victors, not the vanquished," said Chris Jennings, congressional liaison for then-first lady Hillary Clinton during the 1990s debate. "Failure would serve as the ultimate judgment as to whether this effort was worth doing." Jennings, now a lobbyist, replaced Ira Magaziner, principal architect of the Clinton plan, as White House health policy adviser.

The former first lady, now secretary of state, says "it's really hard" watching the travails of Obama's plan. Hillary Clinton has been giving advice, as requested, to lawmakers in Congress and administration officials, and says she's still hopeful. "I'm not sure that this last chapter has been written," she told CNN's "State of the Union" on Sunday.

For most of last year, the health care debate was among Democrats. Republicans were left heckling from the sidelines. That changed when Republican Scott Brown pulled off a Senate upset in Massachusetts, winning the seat held by the late Sen. Edward M. Kennedy and depriving Democrats of the 60-vote majority they were counting on in the final push. "Many of us thought we were really at the 1-inch line, then literally it was like being hit by a freight train with about 10 seconds' warning," said Ken Thorpe, a senior Health and Human Services official during the Clinton-era debate. Now a health policy professor at Emory University in Atlanta, Thorpe has proposed a scaled-back alternative in case Obama's plan can't get unstuck.

The mere mention of settling for less is causing consternation among former Clinton aides. Obama's health care plan _ denounced as a government power grab by critics _ is already scaled back from the ambition of the Clinton years.

Clinton would have changed how people covered by large employers got health insurance; Obama does not. Clinton required all employers to contribute significantly to the cost of coverage; Obama exempts small businesses. Clinton aimed at insuring all; Obama's plan reaches around 95 percent of eligible Americans. Today's Senate bill _ supported by Obama _ resembles a plan drafted by a moderate Republican senator in the Clinton years.

"It takes too much work to figure out what 'scaled back' means," said Judy Feder, a former colleague of Thorpe's at human services, now a health policy professor at Georgetown University in Washington. "You can't do insurance reforms alone without expanding coverage, and the expansion costs money. I don't see the politics coming together for scaling back."

The Obama plan focuses on those who have the most trouble getting and keeping health insurance, small businesses and people who buy their own coverage. They would be able to buy private coverage in a new kind of regulated marketplace, with government subsidies for many. Insurers would be prohibited from turning down people with medical problems. Most Americans would be required to carry health insurance. "We are using the private insurance market and private incentives, as opposed to command-and-control," said Nichols. "As a policy matter, we are in the middle."

Thorpe's proposal for scaling down Obama's plan would keep the new insurance marketplace and the ban on excluding people with health problems. It would chop the cost from $1 trillion to $500 billion over 10 years, covering about one-third fewer people than Obama. Thorpe said he hopes if the Democrats can't get Obama's bill, "we don't do like 1994 _ all or nothing."

Obama has sent mixed signals. Early after the Massachusetts defeat, he raised the possibility of scaling back. Then he insisted he still wants a comprehensive approach. Last Thursday, Obama publicly raised the prospect that Congress might not act at all. Sunday, he invited GOP and Democratic leaders to discuss possible compromises in a televised gathering later this month.

The Democrats' reversal "is like a big body blow," said Jennings. "You either stammer and fall down, or you stammer and regain your balance. What Americans respect are those people who can take a punch and come back."

SOURCE




British Leftist hatred of drug companies is very bad for Britons

By Jonathan Waxman, Professor of Oncology at Imperial College London

It wasn’t such a long time ago that we died from what are now considered to be trivial illnesses. Simple infections carried enormous numbers of people to ghastly deaths; cancer wasn’t treatable, and many suffered terribly from chronic diseases.

The advances that have been seen in the lifetime of today’s middle-aged are incredible. Antibiotics only became available during the Second World War, medicines for peptic ulcer appeared in the 1970s and treatment for cancer came into existence just 50 years ago. If Jane Austen had been around today she would have survived tuberculosis, and been up for the Booker, while Mozart would have got over cholera but would not be competing in The X Factor.

Today it is unusual to see people die in the industrialised world from diphtheria or pneumonia, and we are at the edge of developing effective therapies for Alzheimer’s, multiple sclerosis, rheumatoid arthritis and diabetes.

But where do these marvellous advances originate from? Not, as you might imagine, from the golden glades of the University of Arcadia. The universities have elaborated hypotheses and elucidated mechanisms, but it is the profit motive and the market that have been responsible for these life-improving changes. Big Pharma, that boggle-eyed devil in the undergrowth, has brought forward virtually all the drugs that make our lives liveable.

In cancer, for example, perhaps three agents have come from university laboratories — all the rest have been produced by drug companies. And drug development is big business. On average it takes 14 years and costs £1 billion to bring a drug to market. One successful blockbuster drug can make billions in profit and fuels the next generation of research for a new profit-making blockbuster.

The general view is that drug companies are populated by dodgy villains and squint-eyed knaves in sharkskin suits, out to deceive by falsifying clinical evidence, there just to make a buck. This prejudice has perhaps been reinforced by scandals such as the suppression of information about the adverse, possibly fatal, side-effects of Vioxx, which led Merck to fork out damages of $4.8 billion. But that is unusual.

The bottom line does matter to the drug industry — and Britain has created a regulatory environment that makes it harder for them to make money and produce the drugs that we depend upon.

The process for approving drugs in the UK is slow, costly and bureaucratic. A new drug will first be licensed by the EMEA, the European drugs agency. Then, the Department of Health will set a time course for the National Institute for Health and Clinical Excellence to evaluate that new drug. NICE’s evaluation standard is a matter of great despair to patients and clinicians. Why do we despair? Not because we think that there is an unlimited public purse, and not because we think that Pharma profit should be unregulated. Our despair takes its origin from the unscientific and subjective basis for NICE judgments.

NICE evaluations are based on a complex, pseudoscientific formula that attempts to calculate the benefit of a year’s treatment or therapeutic intervention in terms of a year of a patient’s quality-adjusted life or, to use the acronym, QALY. The term QALY casts an illusion of apparent objectivity to NICE’s conclusions.

Here is one of the ways that the QALY is calculated. Imagine that you have ten years left to live. You can choose to live it in your current state or give up some years to live in full health. Mark on the line the number of years in full health that you think is of value to ten years in your current state. If the patient puts that mark at eight years the QALY is 0.8. The formula then takes into account the cost of a whole year of treatment.

But doctors have trouble with this idea of a year’s worth of treatment. For many patients, treatment under a particular drug regime might be just for a couple of months. This is because the drugs might only benefit a third of patients treated; so for unresponsive patients treatment is stopped. That is part of the reason why the QALY calculation is a joke.

At present only 40 per cent of new drugs are considered within the timeframe set as a standard by the Government. During this timeframe, the countdown ticks inexorably towards the expiry of the drug companies’ patent. The UK market is a small fraction of the total market for drug sales — currently about 3.5-4 per cent of global drug sales. Pharma is losing patience with “process”. Many new drugs are not being put up to NICE, and we are in the position now where the UK will be excluded from using new drugs simply because Pharma doesn’t consider us a financially worthwhile market.

This particularly matters at the moment because drug companies are feeling the pinch and having to cut costs. AstraZeneca, which is losing 8,000 jobs worldwide, and GlaxoSmithKline, which is cutting its workforce by 4,000, are both looking at waste-of-time investments.

We mustn’t be a waste-of-time country for the drug company market analysts. That’s why we need to overhaul NICE before the regulator ensures that the British people don’t receive the best medicine on the market.

SOURCE




"High" standards at an Australian public hospital

And a government that refuses to do anything about it

A SENIOR nurse was undergoing emergency surgery last night after slipping in a puddle caused by a leaking vent at the decaying Hornsby hospital. Her fall came two months after orders were given to hide the crumbling, water-damaged ceiling by painting over it.

Last year angry doctors called the rundown hospital "offensive and mediaeval", and complained of possum urine on the walls, dangerous cables across floors, and ceilings collapsing from rain damage. They have run a campaign to have the hospital rebuilt and say they were stunned to see a tradesman painting over the water damage in December.

In the latest incident, Andrea Walters, 54, who said staff had been mopping up water from leaking ceilings in her ward for 16 years, was finishing her shift in the operating theatres on Sunday night when she slid in the puddle. She landed heavily on her side, shattering her right arm. Doctors fear she will need a partial joint reconstruction and a nerve graft. She is expected to be off work for at least three months.

The head of the hospital's medical staff council, Richard Harris, said yesterday: "We are very cranky and upset about this, particularly as the rain marks were painted over … We haven't seen any evidence the state government is taking this issue seriously, and we now demand action."

Dr Harris said the Health Minister, Carmel Tebbutt, was shown several buckets under the vent during a visit in October. They were put in place after Sydney received 27 millimetres of rain in two days. She had asked how staff managed to move patients from the operating theatres to wards through open corridors in bad weather. "She was told it was a nightmare," Dr Harris said, "but nothing was done."

On Sunday two garbage bins and eight towels were put under the vent to catch the rain. They were removed when the leaking subsided, but another downpour about 9pm flooded the floor and caught Ms Walters unaware. "This was totally avoidable," she said. "The [leak] has been placed in the too-hard basket, and it should have been fixed. I haven't got a little bruise, I've got a life-changing injury."

A clinical nurse specialist who has worked at the hospital for 23 years, Ms Walters said she now feared she could lose her house because nurses do not receive penalty rates - which make up a large portion of their income - while on worker's compensation.

A spokesman for the Northern Sydney Central Coast Area Health Service said theatre staff reported the leak on October 26 and the ceiling was repaired two days later. Aesthetic repairs, including painting, were done on December 17. Maintenance staff were working to fix the leak, but there were no plans to replace the roof, she said.

An independent review, the sixth in 30 years, this week found the hospital to be unsafe. The review, part of a redevelopment master plan, found the theatres were a fire risk, surgical and medical wards were cramped and did not allow for effective clinical supervision; and bathrooms, nursing stations and storage areas were too small. It said the hospital needed painting, asbestos removed and its roofs repaired.

SOURCE





9 February, 2010

Health Care Made Simple

I don’t have a home-entertainment system. I buy my clothes off the rack at Macy’s. I drive an ordinary sedan. My dinner table is graced with wine costing less than $10. We shop sales. But my wife and I splurge on health care (as we did on our children’s educations).

Are the values reflected in these choices unusual? I doubt it. But this is the nub of the health care issue at the epicenter of American politics the past year.

We have had a confusing and dishonest debate. Senator Kennedy made this a crusade. Presumably, the reason for crusading was compassion for the uninsured, an estimated 50 million Americans who are not without health care, but who get less of it and of a lower quality. Fair enough. Had Obama had the political courage to ask the rest of us to kick in an extra hundred bucks, or whatever, in taxes so that these folks can get the same care most of us get, I’d have been ready to ante up.

But he didn’t think he could sell that, so he said the urgency of health reform was to save all of us money and reduce the deficit. This is what motivated Teddy’s last crusade: Reducing the deficit? Balancing the budget? Give me a break.

We were told that the reason for Obamacare was that health costs were eating up 17 percent of GDP and rising faster than inflation. Yes, and so are college costs. And for the same reason (i.e. these things are more precious to us), buyers will stint on them less than other things, tilting the market to the sellers’ advantage.

This is the basic engine of rising health costs. It is compounded not, pace Obama, by greedy insurance companies, (they are greedy, of course, but not more so than other companies), but by three factors sacrosanct to Democrats. First, malpractice suits, which add to the cost of practicing medicine and encourage excess treatment. Second, untaxed employer-provided health insurance that further diminishes cost-conscious shopping by health consumers. Third, Medicare and Medicaid, which are worthy programs that I support—but if the government is buying things for people they couldn’t afford themselves, the dynamic of supply-and-demand will drive up the price. Additional government subsidies, as Obama proposes, will increase it further.

Obama’s plan to reduce costs is a Rube Goldberg machine requiring a 2,500-page bill. But the issue can be simplified. Where will the savings come from, especially if 50 million people will now get more and better services? Will the providers get paid less? Then we will have fewer and less talented providers. Can the insurance and drug companies be squeezed? Perhaps some, but they are not earning more than other enterprises. If profit margins are reduced too much, capital will shift to other sectors. In short, the only way to hold down medical costs is by providing less or lower quality medicine.

Is that a goal worthy of a crusade? Why exactly is it bad that health costs are 17 percent of GDP? What percent should they be? So what if they rose to 20 percent? Here’s a question for my fellow aging boomers. Say medical breakthroughs make it possible for us all to live to 100 relatively spry. But the costs are high and will drive medicine to 25 percent of GDP. Would that be a tragedy?

SOURCE




Real Healthcare Reform: Kill the Lawyers

Now that a stake has been driven through the heart of the omnibus healthcare bill proposed and drafted by the Obama-Pelosi-Reid Axis (with an assist from Henry Waxman), we can get down to real reform. The President has stated that he wants to work with Republicans. Then let’s start with the most obvious cost control factor – malpractice/tort reform.

There is some truth to Democratic claims that several of the proposed reforms are interlocking and thus to address one specific issue might be difficult to accomplish. However, this in no way justifies their ridiculous proposal, including its huge growth in the federal government and its invasive government panels.

Unfortunately, the Democrats ignored the biggest opportunity for cost reduction: eliminating spurious lawsuits and getting ambulance-chasing lawyers out of the medical malpractice business. It is also clear that this reform is not interdependent on other reforms.

Doctors spend an enormous amount of time and effort protecting themselves from lawyers and avoiding lawsuits. They order extensive, expensive tests whose only purpose is to protect themselves from lawyers, and pay outrageous malpractice insurance fees just to rid themselves of these predators. Once lawyers get involved, a doctor’s world is always turned upside down.

Consider what happens in these situations. A lawyer takes on a case for someone who has real or imagined harm. The lawyer has no medical training except for the knowledge they have gained from working on other lawsuits. They run up significant costs that they front for the client, and then pursue a legal remedy. Frequently the insurance company settles (makes payment) to the litigant to minimize outlays. If not, the case goes to court in front of a judge (i.e., a lawyer) or jury, neither of whom typically has any medical training. Either way, the lawyer is reimbursed all the up-front costs plus 33-40% of the remaining funds. The person filing the case is often left with less than half of the proceeds.

We need to stop entrusting these issues to unqualified people through a legal system established mostly to enrich the participants as opposed to the truly harmed. Lawyers have no special knowledge or expertise to determine harm in these situations and neither do judges. We have allowed this system to get out of control and we, the American people, must insist that if any change is made to our medical system it starts right here.

Toward that end, I have a proposal. We need to establish a separate forum to handle claims of medical malpractice. We must accept that as dedicated as our medical personnel may be, mistakes are occasionally made due to stress, confusion or just human error, and the people who are harmed should be justly compensated for those mistakes. In addition, there is occasionally a bad apple in the medical field whose care and concern for patients does not meet established standards. Those patients should be compensated for any harm done to them.

The proposal that I suggest is to establish a five-person panel. The panel would consist of two retired judges, two retired doctors and one retired, respected businessperson. There would also be a Medical Advocate’s office – skilled in the issues of medical procedures due to their exclusive focus on medical claims and disputes – that would represent the patient. The advocates would be salaried employees, much like a public defender or district attorney, with no direct financial benefit from winning the case. The accused, be it a doctor or medical facility, would be able to have their own representative to defend themselves against any charges.

Any outcome would be decided by the five-person panel. The panel would not only understand the law, but would actually be able to examine the charges made against the accused and provide an educated medical analysis of any harm done. The businessperson would be able to judge credibility of the business practices used and weigh the economic effects of the decisions being made. The result would be a balanced decision made with analysis of all the ramifications – medical, legal and economic. No longer would lawyers be profiteering on the backs of the medical system and the American people.

I realize that this proposal has little chance of being adopted. After all, the trial lawyers have their hands so deep in the pockets of the Democrats you might assume they were Siamese twins. Despite “reforming” almost all aspects of the medical system in a bill rumored to have ballooned to over 2,600 pages, the Democrats managed to merely “suggest” that the nation might consider a pilot program for malpractice reform.

The Democrats have to decide whether they care more about American people or American lawyers. They have to decide whether they want to truly control the costs of our healthcare system or just launch platitudes. Ultimately the American people will have to choose between their doctors and their attorneys. The two just do not mix, and the national interest is clearly not being served. If they decide for the medical professionals – as they should – the Democrats will need to make real change, or have real change forced upon them: retirement.

SOURCE




The Mirage of Bipartisan Health Care Meetings

With the seating of newly elected Massachusetts Senator Scott Brown, Barack Obama has now agreed to hold televised meetings with Republicans and Democrats on health care reform. This feeble attempt by Obama and the Democrats to look bipartisan is nothing more than calculated damage control trying to prevent the inevitable losses in the coming 2010 mid-term elections.

According to Politico, Barack Obama stated that he wants to “look at the Republican ideas out there.” But the real question is, where was this idea six months ago when Congressional Democrats were having backroom meetings while crafting a bill like a one-party aristocracy?

This shows once again that Barack Obama and his Democratic colleagues in Congress will only listen to the American people when they are forced to. And in this case, it took the special election in Massachusetts.

If this government was truly created “by the people, for the people,” then why was it that the Obama Administration and Congress refused to drop their push for socialized medicine even though the American people were vehemently opposed to it? (Final Health care poll showed 58% opposed the current bill according to Rasmussen Reports)

And before we get all excited about Obama’s newfound ways, let’s remember he has only promised to “look” at Republicans and not to start over with bipartisan input. In fact, at the Obama-GOP Baltimore confab some weeks back, Obama explicitly said that he had “read every Republican bill.” Apparently, that gem now enters the growing repository of Obama “misstatements.”

This paper has repeatedly called for Barack Obama and his Democratic majority in Congress to go back to the drawing boards and take an honest and open look at ways to lower costs in the health care industry.

One major idea that has been ignored by Obama and his cohorts is to allow state-to-state competition. It’s simple, why should someone from North Carolina not be allowed to buy health insurance from South Carolina?

In almost every case, more competition equals lower prices.

Another major idea that has been ignored is tort reform. According to Legal Newsline, “the Congressional Budget Office director, Douglas Elmendorf, has said as much as $54 billion could be saved over the next 10 years if Congress enacts legal reforms including a $250,000 cap on damages for pain and suffering and a $500,000 cap on punitive damages and restricting the statute of limitations on malpractice claims.” And this doesn’t even include the likely savings that will occur based upon a reduction of defensive medicine often practiced by doctors today.

These are just two entirely obvious ideas that have been ignored by the Obama Administration and Congress. They should be included in the mix when Congress goes back to the drawing board. And they should start with a tabula rasa – to be filled in at the will of the American people.

SOURCE




Australia: Queensland Health a bureaucratic mess

ONE of the world's top medical experts has delivered a damning assessment of Queensland Health five years after the Bundaberg Hospital scandal. The unflattering report comes despite billions of dollars in extra funding being poured into the system after the Bundaberg fiasco. The top-level review, conducted by recently retired UK chief medical officer Sir Liam Donaldson, found the department and the independent watchdog set up following the 2005 health inquiries had little idea who was responsible for improving patient safety.

Obtained by The Courier-Mail, the August 2009 report said hospitals had overlapping and unclear safety standards, were too reliant on overseas-trained doctors while staff were burdened with duplication. There was also no strategy for remote and regional areas while the public was given a "weak voice" in the system.

In one of a raft of botched policies, Sir Liam identified an "ambiguity" between the roles of Queensland Health and the Health Quality and Complaints Commission. "(There is) no clear agreement on the respective roles of the (HQCC) and Queensland Health in quality improvement," the report said.

Sir Liam, who visited for a week last year focusing on clinical governance, said Queensland had made a "major commitment" to reform, including an impressive roll-out of programs, strong leadership and accountable services. But he also identified areas where policy was ill-defined or lacking, including unclear and varying reporting standards. "Some standards have strong clinical and managerial credibility, others are not valued," the report said.

Sir Liam, whose bill is expected to hit about $40,000, said recruitment was strengthened but that it took four to five months to hire doctors. "Many areas are still heavily dependent on locums (mainly international medical graduates)," the report said.

It also said that the role of the QH Patient Safety Board needed refocusing. "At the end of every meeting, the board should ask itself: 'Have we concentrated on the most important things?'," Sir Liam said.

Sir Liam noted patient safety was comparable to other countries but the PRIME incident reporting system was overburdening staff. "There is a clear sense of 'implementation fatigue' permeating the current system," Sir Liam said.

Predicting tensions, Sir Liam said QH should own responsibility for quality standards but said the HQCC was "ambitious" and wanted to be proactive in patient safety culture. "On the other hand, it is unlikely that Queensland Health's senior management would accept a wide-ranging quality improvement and cultural change role for the commission," he said.

Centre for Healthcare Improvement boss Tony O'Connell said it was moving in the right direction but admitted more work was required. "This is always a work in progress and we'd never say we'd completed all tasks," he said.

SOURCE





8 February, 2010

Higher pay, shorter hours... but complaints about British GPs soar 12 per cent in ONE year

Complaints against GPs have risen by 12 per cent in just a year. Grievances lodged by patients totalled almost 40,000, official NHS figures show. That means a rise of a quarter in a decade during which GPs have seen their pay increased massively and their workload slashed. Much of the increase in complaints has followed the introduction of a new GP contract in 2004, which sent family doctors’ salaries soaring by 47 per cent to an average of £106,000 a year.

At the same time, more than nine out of ten GPs stopped providing care at evenings and weekends – slashing their workload by an average of seven hours a week in exchange for an annual pay cut of £6,000.

Now figures from the NHS Information Centre indicate that this fall in the amount of work they are carrying out has damaged patient care. Some 7,448 complaints were termed administration errors, including GPs not communicating properly with out-of-hours doctors and, between them, failing to provide proper care. The largest group of complaints – 14,866 – was about clinical care, including failure to diagnose illnesses or refer patients to specialists.

Last week a coroner ruled that failings in NHS out of hours care led to the death of pensioner David Gray at the hands of Dr Daniel Ubani, an exhausted German GP who had just flown in on his first UK shift.

Out of hours care has been the focus of increasing concern since primary care trusts assumed responsibility. A shortage of GPs willing to take up the work means PCTs often employ private companies, many of whom use overseas doctors.

It also emerged recently that medical lawyers have seen the number of complaints about out of hours care shoot up by 50 per cent in two years.

The Daily Mail revealed last week that care is so bad in some parts of the country that you only have a one-in-50 chance of a home visit from an on-call GP.

The latest official figures from the NHS revealed that 48,597 formal concerns were lodged with primary care trusts about GPs and dentists in 2008/09. This was up around 10,000 in a decade – and up more than 5,000 on the 2007/08 total. Dentists accounted for 8,909 of the complaints.

The Patients Association said failings in out-of-hours services and difficulties getting an appointment with a GP were likely to explain the rise in complaints. Claire Rayner, president of the Patients’ Association, called for people unhappy with their GP to complain and do all they can to get onto a rival doctor’s list. She said: ‘Too often people who are ill and frightened are not getting the care they need, especially when they are trying to get care outside normal surgery hours. ‘When people are not happy with their GP, we would urge them to vote with their feet.’

Both major political parties want to see the end of formal boundaries between GP practices, so patients can go to any doctor they choose. But they face a tough battle with the British Medical Association, which would prefer to see them retained.

Tory health spokesman Mark Simmonds called the findings ‘extremely concerning’. He blamed the 2004 change to out of hours arrangements for much of the rise, with family doctors taking the blame when patients could not get adequate help in an emergency in some cases. Other complaints were triggered when out of hours services and GPs failed to share vital information.

Mr Simmonds said the Tories would tear up the 2004 contract and return responsibility for commissioning out of hours care to GPs. He said: ‘I have no doubt that this is in part due to Labour’s failure to put the patients at the heart of the NHS and their changes to the GP out of hours system, which took responsibility for the service away from GPs and gave it to local bureaucrats.’

Dr Laurence Buckman, chairman of the GP committee of the BMA, said that while poor clinical care and bad behaviour could never be excused, it was possible that patients were more likely to complain now than they were ten years ago. He added: ‘Putting this in perspective, there are nearly 300 million consultations every year in general practice and surveys show that, on average, nine out of ten patients are satisfied.’

A league table shows that the London borough of Islington had the highest number of complaints per head of population, followed by Lincolnshire, the London boroughs of Lambeth and Southwark, and Great Yarmouth & Waveney in Norfolk.

The NHS was forced to turn to foreign doctors to plug shortages in hospitals when Labour took office and set targets for cutting waiting times for treatment. Since them, many more Britons have gone through the seven-year training period for doctors and begun work on the wards. But the NHS still has to fly in foreign doctors to cover out of hours shifts since the vast majority of GPs were allowed to opt out of what was a traditional duty of care.

A Department of Health spokesperson said: 'It is important to note this is not representative of the picture across the NHS. The NHS treats millions of people every day and the vast majority of patients experience good quality, safe and effective care - the Care Quality Commission's recent patient experience survey shows that 93 per cent of patients rate their overall care as good or excellent. 'In April last year, we introduced a new, simpler complaints system, which encourages patient feedback and ensures Trusts act on this to make their services more effective, personal and safe.'

SOURCE




Is Obama finally practicing what he preached: Bipartisanship?

Probably just a publicity stunt designed to "prove" that the GOP are obstructionists

In the first major step to revive his health care agenda after his party's loss of a filibuster-proof Senate majority, President Obama on Sunday invited Republican and Democratic leaders to discuss possible compromises in a televised gathering later this month. Obama's move came amid widespread complaints that efforts so far by him and his Democratic allies in Congress have been too partisan and secretive.

The Feb. 25 meeting's prospects for success are far from clear. GOP leaders demanded Sunday that Democrats start from scratch, and White House aides said Obama had no plans to do so. "If we are to reach a bipartisan consensus, the White House can start by shelving the current health spending bill," said Senate Minority Leader Mitch McConnell, R-Ky.

House Republican leader John Boehner of Ohio also threw some jabs while accepting Obama's invitation. He said he was glad the White House "finally seems interested in a real, bipartisan conversation," adding that Americans have rejected "the job-killing, trillion-dollar government takeover of health care bills passed by the House and Senate."

Obama told CBS's Katie Couric that he and the leaders of both parties will "go through systematically all the best ideas that are out there and move it forward." Asked if he was willing to start from square one, the president said he wants "to look at the Republican ideas that are out there. And I want to be very specific. 'How do you guys want to lower costs? How do you guys intend to reform the insurance markets so people with preexisting conditions, for example, can get health care?"' "If we can go step by step through a series of these issues and arrive at some agreements," Obama said, "then procedurally, there's no reason why we can't do it a lot faster than the process took last year."

Congress' Democratic and Republican leaders have differed sharply on most major questions in the long-running health care debate. Only one Republican voted for the House health care bill approved in December, and no Republicans voted for a similar Senate version.

White House officials said Sunday that Obama does not intend to restart the health care legislative process from scratch. Many liberal groups and lawmakers want congressional Democrats to use all the parliamentary muscle they have to enact the measure that the Senate passed on Christmas Eve, employing rules that could bypass GOP filibusters to make changes demanded by House Democrats. The White House has not ruled out such a strategy. But Obama's recent talk of inviting Republican input and extending the debate for several weeks has caused uncertainty about his plans.

SOURCE




Your tax dollars buy TV talking head

MIT economist Jonathan Gruber has no qualms about speaking his mind on ObamaCare. He’s been one of the most outspoken independent voices defending the healthcare proposals. But there’s a catch. He’s not independent at all. As it turns out, the Department of Health and Human Services paid him nearly $400,000 to provide "technical assistance" in evaluating the healthcare proposals.

Funny how he forgot to mention this blatant conflict of interest on the many TV shows in which he’s touted the plan, or in the newspaper articles where he’s been quoted. He even wrote an Op-Ed piece on health reform in the Washington Post, and again declined to mention that he’s getting paid put a positive spin on the plan.

Yup — just one more elite who takes your money to tell you what’s good for you.

For the record, Gruber says it’s all fine because he told anyone who asked, and anyway he was paid to advise the administration — not for his media appearances. To paraphrase an old saying about ducks: If it speaks like a shill and it’s paid like a shill…it’s a shill.

Counting the days until the midterm elections,

SOURCE




A One Page Alternative to "Obamacare"

Seven Real Reforms That Lower Costs, Raise the Number of Insured and be Deficit-Neutral

In the week between Scott Brown's seismic win and the State of the Union address, the Obama administration tried mightily to explain away the verdict of the Bay State voters. Despite the fact that Brown had plainly made the election a referendum on Obamacare, the voters, according to the administration's narrative, had not rejected it.

Rather, they had rejected Martha Coakley. They had been voting on other issues. They hadn't understood the bills in question. They were frustrated that change wasn't coming quickly enough. Indeed, they were simply expressing the same frustration that had swept Barack Obama into office. (In other words, they had apparently decided to stick it to George W. Bush by filling Ted Kennedy's Senate seat with a Republican.)

In the State of the Union, Obama offered another response. The Massachusetts voters had rejected Obama-care, but that didn't mean that he had to abide by their wishes. "I never suggested that change would be easy." "Democracy," he said, "can be noisy and messy." "We can do what's necessary to keep our poll numbers high and get through the next election." Or we can do "what's best for the next generation."

House Democrats seemed a bit stunned by this language, responding with silence rather than applause. They will face the voters in just nine months, and many of them represent Republican-leaning districts. Now, in the wake of Scott Brown's triumph, President Obama wants them to "take another look" at his proposals.

The American people have already taken a long look at Obamacare, and they don't want it. They don't want a government takeover that limits choice and competition, funnels $1 trillion from American taxpayers to insurance companies in its first dozen years (2014 to 2025), cuts Medicare Advantage benefits by an average of $21,000 per enrollee (except in South Florida) in its real first decade, and contains enough shady backroom deals to make Jimmy Hoffa blush.

Most of all, the American people don't want a $2.5 trillion bill that does all of that and still fails to do the one essential thing: lower health care costs.

During his State of the Union address, Obama also said that "if anyone from either party has a better approach ..... let me know." Well, without seeming too presumptuous, Mr. President, here you go!



The small bill offers seven real reforms (the last a combination of smaller reforms) that together would lower costs, significantly increase the number of insured, and be deficit-neutral.

Its proposals are not revolutionary or even particularly novel. They reflect ideas that are widely shared by Republicans in the House and Senate, as well as by many of their Democratic colleagues. The bill incorporates proposals that Tevi Troy and I have previously advanced. And it reflects scoring by the Congressional Budget Office (CBO) of the House Republican bill-the one bill proposed so far that the CBO has said would actually lower health costs. But the small bill would meet the American people's goals for health care reform-while Obamacare wouldn't-and it would do so at only a fraction of the price.

The small bill would cut health costs by roughly as much as the House Republican health bill, which contains very similar cost-cutting provisions. The CBO estimates that by 2016, the House GOP bill would cut insurance premiums by 7 to 10 percent in the small-group market, 5 to 8 percent in the individual market, and up to 3 percent in the large-group market, in relation to current law. Under Obama-care, the CBO says that the average family's premiums in the individual market would rise by $2,100 a year in relation to current law. The small bill would achieve these favorable results despite costing only about $180 billion in its real first decade-just 7 percent as much as Obamacare. And, unlike Obamacare, which would not go into effect in any meaningful way until 2014, the small bill would start next year.

Under the small bill, approximately 10 million additional people would acquire insurance, at a cost of about $18,000 per newly insured person versus about $76,000 under Obamacare. In other words, for every $20 billion spent, Obamacare would result in approximately 260,000 additional people becoming insured, compared with 1.1 million people under the small bill.

When the federal government isn't limiting their ability to do so, Americans know how to shop for value, and they will have no problem identifying the small bill as a far better value than Obamacare. In truth, even the status quo is clearly a better value than Obamacare. But the choice needn't be between those two unpleasant alternatives. Real reform is within our reach.

A recent McLaughlin and Associates poll asked Americans whether they would prefer Obamacare or a bill that took "more modest steps like allowing the purchase of insurance across state lines to improve competition, creating a risk pool to help people with preexisting conditions afford coverage, and curbing lawsuits against doctors." By almost three to one-61 percent to 21 percent-respondents favored the more modest alternative to Obamacare. Among those who felt "strongly," the tally was 31 percent to 9 percent.

Let's start over and give the American people what they want.

SOURCE





7 February, 2010

A senior doctor swore at me for staying with a dying man... THAT'S how bad Britain's out-of-hours crisis has become

(In a classic British government bungle, very few British doctors are prepared to work after hours because the government makes it financial folly for them to do so)

By Dr Ellie Cannon

Since qualifying as a GP I have chosen to work in an out-of-hours co-operative. I am one of a huge number of home-grown GPs to do this for the clinical experience, the skills training and, yes, the financial rewards. Working out-of-hours was a crucial part of my GP training, and for me it remains a fundamental part of being a doctor.

It is time-consuming, tiring and inconvenient. But I never assumed the work of a GP was going to be nine-to-five and I don’t believe I stop being a doctor in the evening when I go home to my children.

I realise this isn’t a view shared by all in my profession. Since 2004, many doctors have opted out of doing work that, I still believe, is a vital part of general practice. They did so because the introduction of a new GP contract has meant surgeries receive just 6 per cent more for providing out-of-hours cover for a lot more work. After costs that means very little difference in salary.

With a swathe of doctors no longer willing to pick up the phone outside surgery times, the out-of-hours co-ops were born. These are GP-run, not-for-profit groups that cover a far larger area than any practice ever would – half of Kent, for example. Many doctors who work in this way are well qualified, sincere and skilled but there is no requirement to be a regularly practising GP.

Nothing could illustrate the risks of the system more clearly than the death of David Gray. The 70-year-old died at the hands of Daniel Ubani – I struggle to refer to him as ‘Dr’ – a locum who had just arrived in Britain. This case may be extreme but it has rightly put the out-of-hours system under scrutiny, something I personally welcome.

Working for an out-of-hours co-op put me in the most harrowing situation I have ever faced as a doctor. One develops a degree of emotional resilience, moulded by years of seeing physical pain and emotional suffering, but there are times when that resilience is tested to the extreme.

I do my out-of-hours work on a Saturday night, when my children are in bed and my husband can babysit. Early last year, I had to visit a 36-year-old man called James, who was dying from terminal cancer. My remit was simply to make him comfortable. At this point he was beyond communication, hours from death and struggling for comfort.

Normally such patients are cared for by district nurses and the wonderful service provided by Marie Curie sitters, who look after patients in their final hours. Unfortunately, in the area this man lived, there were none available and the district nurses had finished for the night. This was a cruel misfortune for a man already dealt such a terrible fate. It is not an understatement to say that the family were devastated, trying to keep their dying son at home in his final hours with no professional care. I remember his mother hugged me on arrival, so relieved was she that someone had appeared.

From the outset it was clear that James needed more medication to ease his agitation. I spoke to the local hospice and started to optimise his drugs with the telephone guidance of one of its doctors. While I waited for the medication to take effect, I discussed with James’s parents what would happen next. I would leave for my next house-visit and, if he was still in pain, they would call the co-op back.

Because guidelines dictate patients are not allowed to call doctors directly, another GP would come to help. I couldn’t guarantee how quickly that might be but I would ask the co-op to prioritise any calls from this house – in general even an urgent call can take two hours to mobilise. That could have been all James had left. Not convinced James had been made any more comfortable, I again tried to optimise his medication. A momentary air of calm prevailed. His family were desperate to have a professional with them, as he was clearly swinging in and out of discomfort.

At this point, I made the clinical and humane judgment that I could not leave James. I firmly believe that most doctors would have done the same. My shift at this point was over and I judged that it was appropriate to stay out of my own time to ensure James was given the death he wanted. It was midnight. I informed my co-op driver and the base team of my decision and continued to monitor James, giving him the necessary medication and comforting his parents.

Within ten minutes I was called by the clinical supervisor from the co-op, an older more senior doctor. I was greeted with a tirade of abuse. Why was I staying wasting co-op time when there were a huge number of visits outstanding? I should call the district nurses, not waste doctor’s time on palliative care. Was I expecting someone to come and replace me? You can’t spend three hours on one visit! When I tried to explain the situation, he swore at me before hanging up. To add insult to injury, James’s father overheard and apologised for the trouble his son’s death was causing.

You see, while my supervisor was supposedly ‘clinical’, his concerns were anything but. The new GP contract is a target-driven concern. Shifts are paid by the hour, calls must be answered within a certain time and, most troubling of all, a certain number of visits must be undertaken in a six-hour shift. These are not measured by the quality of care but by the volume of patients seen. It is an alarmingly similar approach to the targets introduced in accident and emergency wards, where it has become more important that a patient is seen within four hours than by whom or why.

We have moved so far into a target-based system that common sense has been left behind. The clinical supervisor I had to deal with had forgotten his compassion for the dying and his empathy for a distressed colleague. Compassion and sense had been replaced with performance and targets; I believe he had forgotten what it means to be a GP. The out-of-hours services have to prove on paper they are performing well, otherwise the Primary Care Trusts take away their contracts for the next year. This poisonous culture means that they need to fill all shifts with doctors to have any chance of meeting these targets.

Does this mean the recruitment of doctors may be compromised? Clearly it does, as shown in the case of Mr Gray.

I am in no doubt that there should be a return to a more old-fashioned approach because the fragmentation of the current system leaves little chance for continuity of care. GPs should treat patients they know, or at least ones they are aware of. Doctors and patients deserve that. I remained at James’s house, where I continued to monitor him and give him medication. I cried looking at the photos on the lounge wall of a schoolboy with a cheeky smile, who was now dying at just 36. Even thinking about it a year later I can’t stop a lump forming in my throat. I left the house when I felt that he was settled, about five hours after I arrived. He died at 4.30am in bed peacefully, with his family by his side.

Do I regret being involved? Absolutely not. Was I shocked, even as a jaded foot soldier of the NHS, by the reaction I received from my colleague? Absolutely. What could have been more important than making a dying man more comfortable in his final hours?

Meeting the time targets for my shift? Ticking the right boxes to show the co-op was performing well? There were no tick boxes for being a good GP, for compassion, or for helping someone to have a ‘good’ death.

For James, given the circumstances, I did the best I could have done. But his own GP, who would have known his family and had at least spoken to him about his death, would have been better than one who knew him for no more than five hours. The boy in the photographs, the boy with the cheeky smile and his whole life before him, deserved better than that.

SOURCE




A sad example of British government regulations leading to poorer health

DOCTORS have uncovered the first evidence that fathers of test-tube babies may be passing on their infertility to their sons. A new study has found that boys conceived through IVF treatment involving a single sperm being directly injected into a female egg often inherit shorter fingers, a trait known to be associated with infertility. The results raise the prospect of a new and growing generation who may be less likely to have children of their own.

There are now an estimated 1m children across Europe born through IVF treatment. Almost one in 50 British babies is conceived artificially and nearly half the couples having treatment go through a procedure known as ICSI (intracytoplasmic sperm injection). The technique bypasses the normal competition where only the healthiest sperm cell is able to reach the female egg and fertilise it.

Alastair Sutcliffe, a paediatrician at the Institute of Child Health in London, led the Anglo-German study which compared 211 six-year-olds conceived through ICSI with 195 naturally conceived children of the same age. The ICSI group were similar heights to the naturally conceived group, but the boys had significantly shorter fingers. It is known that men with low sperm counts often have ring fingers the same length as their index finger, whereas fertile men are more likely to have a ring finger which is relatively longer than their index finger. The effect is reversed in women, where the most fertile are likely to have index fingers significantly longer than their ring fingers.

Sutcliffe’s findings appeared recently in the journal Reproductive Biomedicine Online. “This is the first study of this kind on these children,” Sutcliffe said. “We don’t yet know the implication of the findings because the children are very young, but we need to inform people [about the possible risks of the ICSI procedure].”

Scientists have long suspected that the test-tube baby boom would bring its own problems. Infertility treatment began as a commercial operation only in the 1990s. The first ICSI baby was born in 1992 and there are now about 3,700 such births a year in Britain.

Finger length is known to be set within the first 14 weeks of pregnancy and is linked to testosterone exposure which is, in turn, governed by a specific group of genes. “This [research] is telling us that we should only use ICSI when it is absolutely necessary,” said John Manning, an evolutionary biologist at Southampton University who has examined the link between finger length and fertility and who is one of the authors of the latest study. “We know the extraordinary depression and pain that childlessness can cause and we have a responsibility to ensure that the focus on the wellbeing of the children born as a result of these techniques is as high as it can be.”

Josephine Quintavalle, from the pressure group Comment on Reproductive Ethics, pointed out that ICSI is becoming the preferred option in infertility treatment because of a shortage of healthy sperm. This occurred after the introduction of legislation requiring donors to agree to be identified to their offspring in adulthood. “Using ICSI is obviously counter-intuitive to good health and this research would demonstrate that may be true,” she said.

Allan Pacey, a senior expert in male infertility at Sheffield University and a spokesman for the British Fertility Society, said ICSI should be used “only when absolutely necessary”.

A spokesman for the Human Fertilisation and Embryology Authority, which regulates private IVF clinics, said doctors are expected to warn couples of the risks of treatment before they are enrolled as patients.

SOURCE




The Public Option Threat Still Buried in the Senate Bill

Most Americans now believe that major health care legislation will not pass this year. But as Heritage Vice President Stuart Butler explains in The New England Journal Medicine one seemingly minor proposal in the Senate health care bill could end up having huge repercussions for our entire health care system:

The Senate legislation contains strong directives to the OPM, requiring it to negotiate medical-loss ratios (the percentage of premiums that insurers actually spend on medical care for enrollees), minimum benefits, profit margins, premiums, and “such other terms and conditions of coverage as are in the interests of enrollees in such plans.” Crucially, the legislation also specifies that the OPM-administered plans would automatically be deemed to meet all the requirements for plans to be offered through the health exchanges created by the legislation.1 This means that OPM-administered plans could in practice operate free of many of the financial regulations that exchanges might impose on other plans, allowing the plans to operate under their own OPM-designed regulations.

How might the health care system evolve if this OPM feature were implemented as part of a modest reform package? Congress rarely gives an agency powers that it does not intend to be used. It also seems reasonable to assume that the people appointed to administer the new bureau within the OPM will be more likely to embrace the adversarial and regulatory philosophy of the leading congressional reformers and the CMS than the traditional “hands-off” culture of the OPM. Managed by such a transformed agency, the private plans that were part of an OPM alternative would probably come, over time, to look more and more like third-party administrators of a federally designed competitor plan, operating under rules significantly different from those governing competing private plans. The result in a few years could be functionally indistinguishable from a public option.

Butler identifies another proposal seen in the House bill that also could spell the death of private health care. Read his whole article here.

SOURCE





6 February, 2010

Death at hands of Nigerian doctor prompts out-of-hours shake-up for Britain

Doctors applying to work as weekend and evening cover for GPs will be put on a national database that will highlight all alerts over their competence, the Government said yesterday. The measure comes as part of a series of tighter controls on out-of-hours services after a coroner ruled that a patient given a fatal overdose by a underqualified locum was unlawfully killed.

The death of David Gray, 70, amounted to gross negligence and manslaughter, William Morris, Cambridgeshire North and East Coroner, said. He added that Daniel Ubani, the stand-in doctor who was carrying out his first GP shift in Britain, was “incompetent and not of an acceptable standard”. Mr Gray died after he was injected with 100mg of diamorphine — ten times the recommended daily dose. He was suffering from severe pain from kidney stones when he was treated by Dr Ubani, a German doctor, at his home in Manea, Cambridgeshire, in 2008.

Mr Morris said: “If he did not know the properties or the size of the drug he was administering he should not have administered it. If he had any doubts or queries I am satisfied he could seek advice. Nonetheless, he went ahead and injected the fatal overdose.” Referring to the standard of out-of-hours services offered to patients, Mr Morris added: “Weaknesses remain in the system.”

Dr Ubani, a specialist in cosmetic medicine based in Witten, Germany, had flown into England the day before and had a few hours’ sleep before starting a 12-hour shift.

Speaking after the coroner’s ruling yesterday, Mike O’Brien, the Health Minister, said that lessons would be learnt from the tragedy. He said that legal requirements for trusts to provide quality care would now be enforced with tougher regulations. These will include a shared database of doctors performing out-of-hours shifts, including alerts on those that have been refused work for failing competency assessments.

Dr Ubani failed a language test with the NHS in Leeds but managed to get on a performers’ list in Cornwall with fewer tests — allowing him to work in Cambridgeshire.

An official review ordered by the Government and published yesterday concluded that patients were being put at risk by out-of-hours services that were poorly monitored, chosen for ease rather than quality and delivered without guidance from local doctors. It said that, while there were robust requirements in place, there was “unacceptable variation” in how these were implemented and monitored.

Mr O’Brien said that all 24 recommendations made by the review, led by David Colin-Thomé, clinical director for primary care at the Department of Health, and Steve Field, chairman of the Royal College of General Practitioners, would be implemented.

More here




Australia: Shortage of public hospital operating theatres means tired surgeons operating late at night

HOSPITALS must stop the dangerous and inefficient practice of squeezing in emergency surgery in the middle of the night due to a lack of theatre space, surgeons say. Describing the situation as a "developing crisis in emergency surgery", the Royal Australasian College of Surgeons has called for hospitals to immediately restructure resources so that emergency surgery can be properly planned. "The current practice of performing cases unnecessarily in the evenings or late at night (simply because theatres become available) must cease," it said.

Patrick Cregan, the chairman of the NSW Surgical Services Taskforce, which recently developed a similar policy for the health department, agreed. Dr Cregan, who is also a surgeon at Nepean Hospital, said this week it was safer for patients if they were operated on in daylight hours rather than at night by fatigued surgeons, who were often junior. There was enough theatre space in NSW hospitals, he said, and it would not necessarily mean delaying elective or semi-urgent surgery.

He said developing an extra emergency surgery operating list, to manage conditions such as fracture repairs or appendix removals, would cost a hospital up to $500,000. "Manage the money, manage the staff, manage the resources so that patients get a safer, more effective outcome," Dr Cregan said. "The patient outcomes is significantly better. It's not money going down the toilet. At some stages we are running two or three theatres in the middle of the night at Nepean. It's crazy stuff."

Dr Cregan said emergency surgery was "the most predictable form of surgery around", and could be easily planned. "There's surges in demand every now and then but overall you know there's going to be 20 fractures a week," he said.

Several hospitals in Sydney, including Prince of Wales and Westmead, were developing acute surgery units but most of NSW has been slow to act.

The college said that unnecessarily operating overnight carried both a human cost - in terms of increased patient errors and fatigued clinicians - and a financial cost to the community from overtime payments of staff. "Regularly health workers face a choice between delaying an emergency surgical patient's treatment, thereby prolonging suffering (a potential for harm), and disrupting elective surgery - which unfairly prolongs the waiting time of a patient who may already have waited weeks."

This meant staff worked through the night on "less time critical emergencies" to clear the backlog of emergencies that could be days overdue.

SOURCE




Obama admits health care overhaul may die on Hill

No, maybe he can't. President Barack Obama, who insisted he would succeed where other presidents had failed to fix the nation's health care system, now concedes the effort may die in Congress.

The president's newly conflicting signals could frustrate Democratic lawmakers who are hungry for guidance from the White House as they try to salvage the effort to extend coverage to millions of uninsured Americans and hold down spiraling medical costs. Obama's comments Thursday night came hours after Republican Scott Brown was sworn in to replace the late Edward M. Kennedy, leaving Democrats without their filibuster-proof majority in the Senate, and Obama's signature health legislation with no clear path forward.

"I think it's very important for us to have a methodical, open process over the next several weeks, and then let's go ahead and make a decision," Obama said at a Democratic National Committee fundraiser. "And it may be that ... if Congress decides we're not going to do it, even after all the facts are laid out, all the options are clear, then the American people can make a judgment as to whether this Congress has done the right thing for them or not," the president said. "And that's how democracy works. There will be elections coming up, and they'll be able to make a determination and register their concerns."

It appeared to be a shift in tone for the issue the "Yes we can" candidate campaigned on and made the centerpiece of his domestic agenda last year. In a speech to a joint session of Congress in September, Obama declared: "I am not the first president to take up this cause, but I am determined to be the last. ... Here and now we will meet history's test."

Sweeping health legislation to extend medical coverage to more than 30 million uninsured Americans passed the House and Senate last year and was on the verge of completion — though there were still disagreements between the two houses — before Brown's upset victory last month in a special election in Massachusetts. Since then it has been in limbo, and Obama has not publicly offered specifics to help lawmakers move forward. Congressional aides felt his remarks Thursday did not clarify matters.

"The next step is what I announced at the State of the Union, which is to call on our Republican friends to present their ideas. What I'd like to do is have a meeting whereby I'm sitting with the Republicans, sitting with the Democrats, sitting with health care experts, and let's just go through these bills. ... And then I think that we've got to go ahead and move forward on a vote," Obama said Thursday shortly after a White House meeting with Democratic congressional leaders that produced no apparent progress on health care. "I think we should be very deliberate, take our time. We're going to be moving a jobs package forward over the next several weeks; that's the thing that's most urgent right now in the minds of Americans all across the country."

White House spokesman Reid Cherlin said the president's position has not changed and he will not walk away from health care reform. "He used his remarks last night to motivate Democrats to come together and get this done, noting that the public will judge their leaders on what they accomplish," Cherlin said.

More here




Has Obamacare Already Won? Existing Government Programs to Take Over Health Care by 2012

For the past several months, Washington has exhausted every possible method to pass a health care bill designed to increase government’s control over health care. They haven’t been successful yet, but that may not matter: even without Obamacare, government health spending is set to increase far faster than private health expenditures, surpassing the private sector as soon as 2012.

Today the Centers for Medicare and Medicaid Services released its projections of national health expenditures for the next ten years. The report shows that spending by the public sector grew much faster in 2009 at 8.7 percent, compared to the private sector which only grew at 3.0 percent. Though public spending was heightened by the recession, as unemployment caused more Americans to lose employer-sponsored coverage and enroll in Medicaid, the trend is expected to continue into the next decade.

What is more, the report bases its projections on current law. In the case of Medicare, this underestimates future spending. Under current law, Medicare is set to reduce physician reimbursement rates by 21.3 percent in 2010. This would lead to growth in Medicare spending of just 1.5 percent in 2010. However, the likelihood of these cuts coming to fruition is slim to none, as every year, Congress votes to suspend them. 2010 will likely be no different. A report by Health Affairs cites that, if physician payment rates are held constant, the more likely growth in Medicare will be 5.1 percent in 2010. Whether or not these physician cuts occur is no small matter—with them, overall health spending growth would be 3.9 percent. Under the more likely scenario, health spending growth would be 4.7 percent.

Thus far, the debate on health care reform has focused on increasing government spending to reduce the number of uninsured. But government spending should be moving in the opposite direction. With government spending growing at a fast clip, rather than overhaul the entire system, lawmakers should channel reform towards high-cost (and largely cost-inefficient) government programs, like Medicare and Medicaid.

Medicare, Medicaid, and Social Security, the three entitlements big spenders, are duly in need of attention from Congress. These programs will be responsible for unsustainable growth in government spending in the years to come, and will quickly become insolvent. By reforming entitlement programs, Congress could kill two birds with one stone: achieve long sought-after health care reform and bend the cost curve in health care spending, all the while addressing the fiscal crisis facing the nation due to out-of-control spending.

Rather than increase government’s role in the health care system, Congress should see the current trend for what it is: a cry for reform of existing government health care programs. Getting public health spending under control would have a monumental effect on overall spending, directly and indirectly reducing costs for all Americans.

SOURCE




Overwhelming Majority Say ObamaCare bills are ‘Unfair’

An overwhelming majority of Americans oppose the “marriage penalty” that currently exists in the House and Senate versions of ObamaCare, according to a new Zogby International poll conducted Jan. 19-21.

The Zogby Poll asked: "Both the House and Senate versions of the health care bill include a new tax whereby married couples making a combined annual income of $50,000, and who do not receive insurance through their employer, would have to pay up to $2,000 more per year for health insurance than an unmarried couple making the same combined income. Supporters say this will help pay for insurance for many that currently do not have it, while opponents say it is a penalty on marriage. Do you think this is fair or not?"

A strong 79 percent majority of American voters say that ObamaCare’s marriage penalty is not fair, while just 12 percent think it is fair. Among Independent voters, 85 percent think ObamaCare’s marriage penalty is unfair, and only 8 percent think it is fair.

A majority of married voters (86 percent) think the ObamaCare marriage penalty is not fair, and just 8 percent think it is fair. Even 65 percent of single voters say the penalty is unfair, while only 18 percent call it fair.

SOURCE





5 February, 2010

Scathing British report rules foreign doctors will have to undertake English tests before becoming out-of-hours GPs

Foreign doctors should face tough English tests before being allowed to become an out of hours GP, a scathing report will rule today. They should receive basic training on how the NHS works and what drugs are commonly used in Britain before they are allowed to practise here. The report will add that some primary care trusts are so bad they are breaking the law and in future they will be ordered to inform all other trusts if they find a doctor does not come up to scratch - something that does not always happen at the moment.

The landmark study - written by leading doctors and commissioned by health minister Mike O'Brien - will lay bare the failings which have led to the creaking out of hours system that puts patients at so much risk. It is expected to say that many health trusts entered into contracts with out of hours providers and did not bother to set minimum quality standards. Often, local GPs play no part in the decision-making - meaning it is left to managers, who have more interest in cost than quality of care, to choose which company to employ.

Mr O'Brien was forced to condemn unacceptable variations in out of hours care after the Daily Mail revealed this week that, in some areas, doctors only make home visits in one in 50 cases.

Last night the Tories demanded wholesale reforms to the out of hours system....

PCTs have been in charge of commissioning private companies to provide out of hours care after the vast majority of GPs opted out of responsibility. Once a company has been taken on, the report will say PCTs are not good at reviewing their performance - so they do not take action if the quality is poor.

One of the biggest criticisms will be that trusts are not doing enough to ensure foreign GPs can speak English properly. Language tests are mandatory for doctors from outside the European Union - but not for doctors within it. The report will say that language tests should be put in place for all foreign GPs, and will call for better training and so they know about how the NHS works, what the area they will be working in is like, and which drugs are used.

The Tories blamed the GP contract of 2004 which allowed doctors to opt out of responsibility to patients in evenings and weekends. Tory health spokesman Mark Simmonds said: 'For too long the out of hours GP service provided by bureaucrats has let families down. For the sake of patients we must return responsibility for out of hours care back to GPs.'

The Department of Health said ministers would accept all of the report's 24 recommendations. A spokesman added: 'The quality of out of hours care for most people is better than it was in 2004, but some PCTs are not meeting their legal obligations. 'The department is determined to tackle this.'

DIAGNOSIS BLUNDER 'KILLED MY WIFE'

Barbara Mizen would be alive today if she had not been wrongly diagnosed by an out of hours doctor, says her husband. Retired Eric Mizen says his 65-year-old wife had severe chest pain - the classic sign of a heart attack - when he called their GP out of hours medical service Thamesdoc. But instead she was diagnosed with a stomach upset by a doctor providing temporary cover for the couple's home area of Haslemere, Surrey. Two days later the retired auxiliary nurse was rushed to hospital, but died later of a heart attack.

Mr Mizen, 73, has won a legal claim for 'tens of thousands' of pounds but says nothing can compensate him for the loss of his wife. He said: 'I have no doubt Barbara would be alive today if the out of ours doctor had picked up on the problems.'

Mr Mizen's solicitors, who won a settlement from the insurers of Thamesdoc's Dr Mukhtar Hussain, said it was achieved without any admission of liability on the part of the doctor or the Medical Protection Society.

SOURCE




NHS kills another oldster

Hospital nurses did not help a dying man after they were given wrong information about whether he should be resuscitated. Peter Clarke, 86, lay for an hour before the error was realised and doctors tried in vain to restart his heart. On Tuesday Derby Hospitals NHS Trust apologised to Mr Clarke’s family and said that stringent measures had been put in place to prevent a repeat.

Mr Clarke, who suffered from heart disease, was a patient at the former Derby City General Hospital in January last year experiencing flu-like symptoms when he suffered cardiac arrest.

Ward staff told an inquest into his death that guidance provided to them in a hand-over note stated that a Do Not Attempt Resuscitation order had been made for clinical reasons.

Ann Proctor, a nurse, said that it was between 45 minutes and one hour before she discovered that there was no mention of such an order in Mr Clarke’s medical records, and that a blank Do Not Resuscitate form, which had been placed in the folder as a matter of routine by clerical staff, had not been filled in.

Dr Paul Webb, who was the first doctor on the scene, told the hearing: “I asked the nurses at the station what time he had collapsed and they said around 9am. “I said ‘do you mean 10am?’ and they said ‘no, 9am’.”

It has not been made public how or why the order was given not to resuscitate Mr Clarke on the hand over note, given that no such order existed on his medical records.

Offering Mr Clarke’s family the hospital’s “sincere apologies,” Alison Fowlie, the Trust’s Medical Director, said: “It was found that the cause of the mistake, for which we're very sorry, was the 'Do Not Attempt Resuscitation' instruction on the nurses' hand-over sheet and that it should not have been there.”

The inquest was told that that Mr Clarke's heart was so badly damaged that he could have suffered cardiac arrest at any time, and that he was in heart failure. Dr Alistair McCance, a heart specialist, told the hearing in Derby that even if staff had tried to resuscitate him immediately, the chances of saving his life would have been "very low".

Mr Clarke’s son, Keith, 57, from Belper, Derbys, said: “They said it was unlikely that he could have been revived but we’ll never know. “I think my dad was badly let down by the NHS.” Adding that it was “too late in the day for my father”, he said he hoped that changes in hospital procedures would protect other patients.

SOURCE




Leftist health reform proving rocky in Australia too

In America, Obamacare seems to have stalled -- JR

AN OPPOSITION'S lot in life is a thankless task; there are the long hours, minimal resources and they spend most of their time hitting brick walls. But sometimes there are small victories. As the Federal Government was taking the wraps off the third Intergenerational Report – a road map to 2050 on the challenges of the ageing population – the Coalition was forcing Labor into a backdown that would help older Australians now.

The win came on cataract surgery, and unless you are waiting to get your eyes fixed and face being out-of-pocket, it might seem like a loose-change victory. But Opposition health spokesman, Queenslander Peter Dutton, was able to force Health Minister Nicola Roxon to limit the cut in rebates for cataract surgery to 12 per cent instead of the proposed 50 per cent.

Dutton points out that for the three months before Roxon and specialists striking a deal, patients who needed their cataracts rectified had to pay hundreds of dollars or go to the public hospital system. Ophthalmology has the longest waiting times of any surgical speciality.

Backdowns from this Government are rare, but the win on cataracts illustrates that Labor has chinks in its armour on health. Dutton is also adept at attacking state governments on their health policies.

Despite all the hot air on climate change in Canberra as federal politicians returned for the unofficial start of the federal election, voters remain concerned about the here and now of improved health and hospital care and getting a decent education for their kids.

Prime Minister Kevin Rudd and Roxon argue they have put money back into the hospitals system. Rudd repeatedly argues the former Howard Government took $1 billion from health and his administration has put $5 billion back in and helped reduced elective surgery waiting lists – but voters cannot actually see new beds with plaques on them or shorter waiting times to visit a GP.

Rudd's bold election promise to fix the nation's ailing hospital system and consider a federal takeover is still in the limbo-land of consultations. He has invested a lot of political capital in the issue, and his pledge that the buck would stop with him resonated with voters. But the Government has found it is far easier to say it will build super-GP clinics than actually get the construction off the ground, and massive reforms to the hospital system means having to navigate around state interests.

Roxon is now facing defeat again on the Government's budget measure to means test the 30 per cent private health insurance rebate. If it goes down a second time in the Senate, it hands the Government another double dissolution trigger.

Rudd argues the Intergenerational Report, prepared by Treasury, showed the Opposition's blocking of the scheme would rip about $100 billion out of the Budget by 2050.

But Dutton's detective skills from his former career as a policeman are still in good working order and he pointed out the figure was not in the actual report. It was instead provided to the Government in some briefing papers. Which brings us back to cataracts.

Dutton has also made mileage out of highlighting seemingly penny-pinching decisions by Rudd and Roxon such as the initial plan, before they reconsidered it, to cap the Medicare Safety Net for people seeking IVF treatment and the postponed proposal to reduce funding for chemotherapy drugs.

The Opposition is making inroads on health but they have a long stretch ahead in the lead-up to the federal election.

SOURCE




How one man killed Obamacare

As most of Americans already know, Republican Scott Brown was elected to take over the “Kennedy seat” in the Senate, dispatching Democrat opponent Martha Coakley handily in Massachusetts’ recent special election. Thus ended Democrats’ filibuster-proof 60-vote majority in the Senate and prospects for ramming Obamacare through on a strictly party-line vote.

Yet had the House and Senate concurred earlier on a health care reform bill agreeable to both Brown’s election wouldn’t have mattered nearly as much. Instead, each body designed legislation to pass their own side and in the end the differences were irreconcilable.

House Speaker Nancy Pelosi finally threw in the towel, saying the one chance Obamacare had – passing the Senate bill as it was in the House – couldn’t draw the required 218 votes. A main sticking point was that the Senate bill lacked the prohibition on the federal government paying directly for abortions. That provision allowed the House to pass their bill with just two votes to spare and gave it the barest bipartisan fig leaf as GOP Rep. Joseph Cao of Louisiana was the lone Republican in favor.

Undeniably, part of Brown’s appeal was the prospect of killing Obamacare by being the 41st Republican vote and denying Democrats their supermajority. In the election’s aftermath, petulant Democrats threw losing candidate Martha Coakley under the bus for running a terrible, gaffe-prone campaign and openly spoke about changing the filibuster rules to allow Democrats to maintain their hammerlock, perhaps needing just 55 votes instead of 60. Decades ago, a compromise measure lowered the limit from a 2/3 majority of 67 Senators to the current 3/5 majority.

Cooler heads prevailed, though, and now the consensus on health care reform is to deliver it in a piecemeal fashion by removing some of the most objectionable portions and focusing on areas where broad agreement exists, such as eliminating the right to deny coverage for preexisting conditions. But gone will be the ability for Democrats to fashion closed-door deals such as the one exempting union workers from a tax on so-called “Cadillac” health insurance plans.

SOURCE




The Hidden Cost of the "Doc Fix"

The convoluted, politicized and hugely expensive issue of the "doc fix" is back in the spotlight after falling by the wayside along with health reform. Unlike health care reform, however, the “doc fix” will likely be passed through Congress without a blink, incurring a $82 billion expense to the U.S. taxpayer. The "doc fix" provides a stopgap to Medicare payments that give doctors less than market value for their services. It doesn't even provide doctors with the full market value; usually, it only covers it to about 80% of what the private sector would pay. But without the doc fix—with Medicare alone—that reimbursement rate would be somewhere near 60%.

Medicare reimburses at a rate that much lower because of 1997 balanced budget legislation, which prohibits medical expenses from rising faster than inflation. However, medical expenses have risen much faster than inflation. So while the standard Medicare reimbursements are kept at the unreasonably low rate, the "fix" bumps them up just enough to make doctors accept them.

What's curious about this year's “fix” is the lack of political attention given to the issue in the wake of vicious political battles over payment options for Obamacare. A version of the "doc fix" was surreptitiously excluded from the health reform bill because lawmakers didn't want to make the bill any pricier. But passing it separately is apparently not a problem for lawmakers, who see a vote against entitlements as political suicide. It's in no party's interest to take on both seniors and the medical lobby.

Michael Cannon, director of health policy studies at the Cato Institute, says he doesn't even like calling the stopgap a "fix" because it's not fixing anything. Instead, it's allowing Congress to continue living in their alternate reality, where medical expenses cost whatever they say they cost. "Because the government's price controls are set in the wrong place, and you're going to put a ‘correction’ in place to fix it? C'mon," said Cannon.

This year, the price will be higher than normal, because Congress is planning on a 5-year "fix" to their problem instead of their usual 1-year fix. The total is estimated at $82 billion, which will prevent doctors from suffering a 21% cut in fees.

The $82 billion 5-year plan is nothing compared with the $200 billion cost of a 10-year plan, or what legislators like to call "permanent." The only reason it's considered “permanent” is because the budget outlook for this issue only extends 10 years into the future.

National Center for Policy Analysis president John Goodman said that there isn't really isn't an end in sight to this issue because of the lack of political will, the inability for Congress to ever effectively address entitlement reforms and the wrong-headed approach that Congress takes to the practice of medicine as a whole. "It never works to have the payers tell the providers how to practice medicine," said Goodman.

SOURCE





4 February, 2010

Congress sacks White House claims of imminent touchdown on health bill

Despite assertions by the White House that Congress remains on the verge of passing health care reform, lawmakers in the House and the Senate have stalled in their efforts to move forward with a bill as they turned their focus to creating jobs. Senate Majority Leader Harry Reid, D-Nev., said he would meet with House Speaker Nancy Pelosi, D-Calif., to discuss how to proceed with health care, and he said congressional and White House staff have already been collaborating on a new plan. But, he warned reporters, "Don't pin me down as to days or number of weeks" before a new proposal emerges.

On Sunday, White House press secretary Robert Gibbs told CNN. "We're still inside the 5-yard line" on health care, in a pronouncement that caught some lawmakers off guard. "I wouldn't think so from a policy and a cost standpoint and what Americans feel about it," Sen. Olympia Snowe, R-Maine, said of Gibbs' remark. "That defines a huge gulf between the reality on Main Street and the reality in Washington, D.C."

Sen. Debbie Stabenow, D-Mich., said Gibbs' use of the 5-yard line analogy "is fine," but senators did not discuss any new health care strategy at their weekly caucus meeting Tuesday afternoon. "There was a lot of discussion obviously on jobs and what's happening with that," she said.

In the House, leaders were vague. House Majority Leader Steny Hoyer, D-Md., promised to disclose a new plan "as soon as a way forward is clear."

Democrats face a logistical and political problem in trying to tackle jobs and health care at once, in part because the health care proposal Democrats favor would raise taxes.

"The Medicare payroll tax is a good example," Snowe said, referring to a provision in the Democratic health care bill that would raise the payroll tax on those with higher incomes. "You can't say on the one hand that everything is OK and we have to work on jobs, then on the other adding to the cost of doing business, because that creates uncertainty."

Democratic leaders in the House and Senate still insist a health care reform bill will pass this year, but even the Senate's more liberal members seem more uncertain of the outcome. "I hope so," said Sen. John Kerry, D-Mass., when asked if he thought health care passage was possible this year.

Kerry said he believed the "best path forward" was for the House to pass the Senate health care plan, after which some changes could be made to the bill in the form of new legislation that the Senate could pass with just 51 votes through a process known as reconciliation. "I don't know if that is achievable," Kerry conceded. "I guess I feel the imperatives of doing nothing are very powerful and therefore I'm hopeful that in the end, common sense is going to win out. But I don't want to put odds on it. This is Washington."

SOURCE




Whistleblower who was harassed when he criticised NHS cost-cutting wins damages

"Shut up!" -- the usual Leftist reply to criticism

A consultant urologist who was suspended after speaking out against cost-cutting at an NHS hospital has won damages at an employment tribunal in a landmark case. Ramon Niekrash, 50, was removed from duty at the hospital and called a "troublemaker" after he questioned the effects of cost-cutting on patients at the Queen Elizabeth Hospital in Woolwich, South London.

A tribunal ruled that he was entitled to damages because he has been acting as a whistle-blower in the public interest when he wrote letters to hospital management raising his concerns about the health of patients. The verdict also placed blame on government targets for raising tensions between management and clinical staff at the NHS hospital.

Mr Niekrash claimed he was the victim of bullying and harassment after he criticised cutbacks at the hospital, which he said included a shortage of senior medical staff and the closure of the specialist urology ward.

At one point a senior doctor at the hospital allegedly said she wished that Mr Niekrash, who was trained in Australia, was "in chains on a plane in Heathrow back to Australia."

Mr Niekrash's lawyers said the case revealed the way in which senior NHS whistle-blowers are punished for speaking out. One case he raised was of a prostate cancer patient who was allegedly not told that he had the disease, nor given treatment for six months after he was diagnosed.

In a letter, he also accused hospital management of behaving like a "plantation owner" towards doctors, The Independent reported.

A 50-page ruling from the tribunal found that Mr Niekrash's suspension from the hospital breached laws put in place to protect whistle-blowers. Judge Burton, sitting at the tribunal, said: "We have no doubt that the exclusion of a consultant, being a rare occurrence, must have an adverse impact on the claimant's reputation," adding that Mr Niekrash had been "hurt" and that his health had suffered.

The judge said tensions had arisen between the claimant's desire to provide health care and "the requirement of management to reduce or limit costs and also comply with varying targets laid down by the Department of Health from time to time."

A hospital spokesman said: "We are considering this judgment very carefully ... There are nearly always lessons to be learned from cases like this, and as soon as we have carefully considered the judgment, we will respond in full."

SOURCE




Australia: Couple sues government hospital over stillborn baby

PARENTS of a baby delivered stillborn at Redcliffe Hospital claim medical staff repeatedly ignored warning signs their unborn baby was distressed. Kym Marie Body and Robert Wayne Body, of Mango Hill in Brisbane's north, are suing the State Government which runs Redcliffe Hospital for nearly $300,000 in negligence and damages. Documents filed to the Supreme Court allege a midwife ignored and turned down the volume of an echocardiogram alarm that sounded for more than three hours while Mrs Body was in labour.

The documents also claim Mrs Body was diagnosed and treated for deep vein thrombosis and thrombophilia (blood clotting) at Redcliffe Hospital after the birth of her first child in 2004. She alleges the hospital ought to have known her medical history and the risks associated and failed to recognise a natural birth "could not be performed safely".

The documents show Mrs Body was admitted to hospital at 8am on February 26, 2007, and was monitored at half-hour intervals between 9.30am and 3pm. Her waters were broken by a doctor about 4pm and at 4.30pm an epidural was administered. It is alleged that at 5.10pm an echocardiogram alarm attached to Mrs Body began making loud noises, but the volume was turned down by a midwife. The documents claim four other times when the alarm sounded, indicating the baby's distress, it was turned down by the same midwife. The echocardiogram alarm continued to sound until 8.20pm but medical staff did not respond to it.

It wasn't until 9.30pm, when Mr Body requested for Mrs Body to have an internal exam that one was performed, court documents claim. By 10.40pm, Mrs Body was told the baby's heart rate was "low" and "we need to get her out now". Paige Hannah Body was delivered by vacuum extraction about 11pm. She was not breathing and could not be revived.

Mr and Mrs Body, who say they suffer anxiety and depression, are suing Redcliffe Hospital for $278,200. The State Government is yet to file a defence.

SOURCE





3 February, 2010

NHS "professionalism" again

Dad delivers own baby when nurse storms off

A FURIOUS father branded a British hospital a disgrace after he was forced to deliver his girlfriend's baby in a maternity ward because the midwife had stormed out. The Sun reported Thomas Howard, 33, frantically called for help when he realised that the birth was imminent, but nobody came to his aid.

By the time the midwife returned, Emily Baron had already given birth to their daughter Madeline.

Baron, who is now recovering at home with Madeline, said, "I was really worried about the bleeding. When Thomas asked if the midwife knew what was wrong and she said 'No', he asked her to find someone who did. "She then just stormed out and you could hear her stomping down the corridor. I think her attitude was unprofessional."

Thomas said his instinct kicked in when it became clear the baby was coming. He delivered the newborn, tapped her on the back to help her breathe, and was cleaning mucous from her mouth when the midwife finally returned. "I was in shock at what had happened but the nurse didn't say anything to me. She just carried on as if it was normal," Howard said.

The couple said they may file a formal complaint against Royal Blackburn Hospital in northern England.

A National Childbirth Trust spokesman said, "Being left alone in labour in hospital is unacceptable. As a civilised society, we must ensure this basic need of women is met. Having a midwife with you when you give birth is vital to ensure there are no complications."

Last month, the Nursing and Midwifery Council said the midwifery profession was "still playing catch up" after a report warned Britain's rising birth rate was leading to a shortage of staff.

SOURCE




Failing out-of-hours care almost killed British baby

In parts of the country one doctor is responsible for 300,000 people at night

It started with a bruise the size of a shrivelled raisin that slowly grew into a magenta plum. It was Sunday evening, our baby was sleepy as we lifted him out of the bath and I noticed the mark under his tummy button. But he’d been running round London Zoo with his brothers and sister and I thought he must have knocked himself as he raced from the gorillas to the flamingos.

I wasn’t concerned as he lay on the bed while the other children bounded around him. He didn’t even have a fever. But I rang the local surgery, which gave an emergency number. I left a message and put the other children to bed. By 9pm no one had replied, so I looked up NHS Direct. An “information handler” answered. When I explained the almost non-existent symptoms, she suggested that I could go to A&E if I was concerned. By now all four children were asleep in bed, and I felt that I was turning a bruise into a drama and was more worried that my 18-month-old would pick up a bug if we queued all night in hospital.

I finally rang a private GP’s surgery when I realised that he had a slight temperature. The doctor on call arrived on her moped in 20 minutes. She lifted our son out of bed, joked with him and asked him to show her his tummy. At that moment she stopped smiling and phoned the consultant paediatrician at the hospital.

“You both need to go to hospital just to be on the safe side,” she said. We drove through dark, empty streets, reassuring ourselves that our baby was still babbling. The consultant laughed when our son started playing with his stethoscope but then he lifted up his pyjama top and began issuing orders. We suggested that it might be a bruise but no one was listening as they inserted drips to pump drugs and fluids into his arms and legs, and started preparing him for a lumbar puncture, The nurse was told to wake him every 15 minutes to prevent him falling into a deep sleep. We finally realised that they thought he might have meningitis.

Our baby screamed, tied to the bed by his tubes, but every time he fell into a fitful sleep he had to be woken. By dawn he was receding into himself, the bruise was vast and pulsating, but he was fading away. The paediatrician with 40 years experience didn’t think it could be meningococcal disease, the surgeon arrived and suggested cutting away the bruise and cleaning out the infected area. It took eight hours to synchronise the anaesthetist’s and surgeon’s timetables. The surgeon was Lebanese, the anaesthetist German and the two nurses were from the Philippines. They were amazing in their dedication. It was only when the anaesthetist said in a mild German accent: “We are going to put your son down now. Do you want to kiss him goodbye,” that I cried.

We sat in the waiting room under the strip lights watching babies tottering past us, not thinking about our son’s first step or his first word until the nurse came back from theatre. As I cuddled my child, the surgeon told my husband that he thought that they had managed to clear the infection. His stomach had been mangled but he looked beautiful as he slept.

It is impossible to draw conclusions from one case, but as our son recuperated over the next two weeks, and we lived our lives in shifts by his side, parents, doctors, nurses and cleaners gave us their views. And I did learn lessons. No one should automatically think that a foreign doctor or nurse is second best. Ours were extraordinary. The hospital wasn’t particularly clean, but we could provide our own pillow cases and food.

Almost everyone in the hospital believed that the NHS out-of-hours service was defective. I kept thinking back to the Sunday night when we nearly left our son to sleep. And I still think about it when I read reports that in parts of the country a single doctor is responsible for more than 300,000 people out-of-hours.

Andy Burnham, the Health Secretary, has finally admitted that this may be “unacceptable” but it has been obvious for several years that Primary Care Trusts who were given responsibility for this in 2004 have, in many areas, failed to provide a safe service, as required by law.

GPs must take back control of their out-of-hours services. This is not because they are greedy professionals who only work from 8.30am to 6pm for average salaries of more than £106,000 a year, or even because one exhausted German locum caused a man’s death through an accidental drugs overdose. They should do it because the current system doesn’t work. A&E departments are overwhelmed because most evening inquiries are directed to them and the emergency services have to mop up much of the rest.

GPs used to act as gatekeepers night and day. Our private GP had seen four children that Sunday, two had colds, but one had croup and ours was the fourth. In our case personal contact was vital. GPs should know who is being sent to treat their patients if it isn’t them and should want to be informed if a patient is suddenly on the critical list.

The Confidential Inquiry into Maternal and Child Health, commissioned by the Department of Health each year, says that one in four child deaths in Britain could be prevented if a parent had realised the child was ill earlier or if a hospital had reacted more rapidly. GPs can help both patients and hospitals to make the right diagnosis whether it’s at 3am or 3pm. At the moment they are the missing link.

SOURCE





2 February, 2010

British GPs 'visit just one in 50 sick patients out of hours' in some areas

Major variations in the quality of out of hours care across the country mean that in the best areas one in four patients will receive a home visit if they call for a doctor at night or over weekends. But elsewhere the proportion is much lower, according to the report by the Primary Care Foundation.

The study, which compares the quality of health services provided by all of England's Primary Care Trusts (PCTs), has disclosed “gaping holes” in the out-of-hours provision. It shows huge variations in the quality of care across the country, although none of the trusts is named. The number of patients receiving home visits varied from 25 per cent in one PCT to 2 per cent in another, the report said. Meanwhile, the number of patients given only a telephone diagnosis also varied between 20 and 70 per cent.

The study also shows that many PCTs are failing to respond quickly enough to urgent calls. Government targets say a GP should visit, or at least telephone within 20 minutes, all patients whose cases are designated urgent. But just two PCTs met this target out of 84 surveyed. The worst achieved the target in only a third of cases. The study also showed large variations in the amount spent on out-of-hours services between PCTs, which ranged from £16 and £3 per person.

An investigation by the Daily Telegraph disclosed yesterday that in the worst areas, there is just one GP covering as many as 650,000 people. Just four GPs are on duty overnight for the 1.1m people living in east, north and west Hertfordshire, while 11 doctors are available to a similar number of people living in east, north and south Birmingham and south Staffordshire.

Katherine Murphy, director of the Patients' Association, called gaps in out of hours provision “scandalous.” "It is such a vital service because it can be very frightening for somebody to get ill in the night, knowing that there's nobody at their doctor's surgery,” she said. "We know from our helpline that this is a national problem. The situation is appalling and it needs to be resolved.”

SOURCE




Virginia Senate votes to nullify Obamacare mandate

If enough States get this through, it would destroy the funding for Obamacare -- because Obamacare needs mandated payments to get the money to pay its costs

The Virginia State Senate voted today 23-17 to add a provision to the Virginia State Code that would exempt Virginians from being forced by the federal government to participate in any health care plan. Furthermore, the provision exempts Virginians from having to pay a fine or fee for not participating.

The text of the legislation sponsored by Jill Holtzman Vogel reads as follows:

No resident of this Commonwealth, regardless of whether he has or is eligible for health insurance coverage under any policy or program provided by or through his employer, or a plan sponsored by the Commonwealth or the federal government, shall be required to obtain or maintain a policy of individual insurance coverage. No provision of this title shall render a resident of this Commonwealth liable for any penalty, assessment, fee, or fine as a result of his failure to procure or obtain health insurance coverage.

This is a big win for Virginians, the 10th Amendment, and liberty. The fight is not over though. I highlight the word “individual” above because it worries me. Does this mean the federal government can mandate family coverage?

Hopefully this ambiguity will be remedied as the bill moves further along in the legislative process.

SOURCE





1 February, 2010

500,000 British hospital patients sent home too soon every year (and 1,500 a day readmitted for emergency care)

More than 500,000 patients every year are readmitted to hospital after apparently being sent home too soon, alarming figures reveal. Labour's waiting-time targets have been blamed for the 50 per cent rise in emergency readmissions of patients within days of them being discharged. Critics said it was a scandal that almost 1,500 a day were apparently being released before they are well enough, harming their recovery. They say the targets put pressure on hospitals to discharge people early to free up beds and have turned the NHS into a 'revolving door'.

Elderly patients are particularly vulnerable if they are sent home too soon, charities warned. There are also fears hospitals are trying to cash in from being paid twice to treat the same patient.

The figures, obtained by the Conservatives, show the numbers readmitted through A&E within 28 days of being sent home from hospital has risen steadily in the past 12 years. In 1998, the figure was 359,719, but it has risen every year since then, reaching 546,354 in 2007-08. A large number of those affected are vulnerable elderly patients, with 159,134 being over the age of 75, up from 94,283 in 1998.

Under Labour's strict target regime, hospitals must ensure no patient waits more than 18 weeks for treatment after being referred by their GP. However, in recent years, the number of NHS beds has been cut by around 20,000, or 10 per cent of the total, meaning many are being discharged too soon from crowded wards to make way for new patients. This is despite a Government pledge to increase beds, as well as a tripling in health spending.

NHS trusts trying to save money have also cut back on community services. As a result a large number of patients do not receive the support they need in their own homes - and often end up back in hospital.

Conservative health spokesman Andrew Lansley said a Tory government intended to change NHS rules so hospitals are not paid for treating patients they have recently discharged. 'It's staggering that there has been such a huge increase in the number of patients having to be readmitted to hospital as emergencies almost as soon as they've been allowed home,' Mr Lansley said. 'It's also a deeply worrying sign that the quality of care in hospitals is being undermined. 'This raises real concerns that patients are routinely being discharged too soon. Hospitals should not have an incentive to discharge patients quickly and then get paid by the taxpayer a second when they have to be readmitted. 'I will ensure that through our payment for results approach, hospitals have to meet any costs arising from emergency readmissions themselves.'

Experts blame a number of factors for emergency readmissions, including early discharge, poor treatment, infections and badly organised rehabilitation and support services.

The figures show hospitals that send patients home more quickly than others - with lower than average lengths of stay for first admission - have higher readmission rates. There is also evidence that patients who have to be readmitted actually stay in hospital longer than after their first admissions.

Patients Association director Katherine Murphy said: 'The pressure on getting beds cleared to meet treatment targets should never be allowed to compromise patient care. It's indefensible that this might be happening and nothing is being done about it.'

A Department of Health spokesman said: 'Patients are only discharged from hospital if the clinicians involved consider it safe and in their best interests. 'Some patients might require readmission if their health deteriorates, but the numbers are small. Only about 5 per cent of patients discharged from hospital are readmitted within seven days of their discharge.'

However, the spokesman added: 'A high rate of emergency readmission after elective surgery is a matter of concern --so we are encouraging hospitals to measure the trends in order to improve the quality of care they provide.'

SOURCE




Australia: Training fails to prepare new doctors

An increased emphasis on "social" education has left less time for teaching such basics as anatomy. Many medical schools also now have a bias against very bright students in the name of "equality"

MEDICAL students are emerging from the nation's universities feeling inadequately prepared to deal with crucial tasks such as calculating safe drug doses and writing prescriptions.

In a challenge to Kevin Rudd's twin promise to improve university education and doctor shortages, a government study has also revealed that medical supervisors feel the abilities of hospital interns fall short of their expectations. The study reveals just 36 per cent of junior doctors think they have been adequately or well-prepared to do wound management. And only 29 per cent of final-year medical students feel they have been adequately prepared to calculate accurate drug doses.

The landmark review of the nation's medical education system was finalised 19 months ago but released only on Friday. Medical leaders warn that the extra influx of students since the Education Department commissioned the research has made the failings it describes even worse.

News of the concerns about medical education comes before today's release of a new Intergenerational Report warning that the nation's ageing population will impose extreme pressure on the health system, including the medical workforce. It also comes as The Australian has learned a Rudd government program aimed at addressing the drastic shortage of nurses in the nation's aged-care facilities has failed, attracting just 138 nurses in two years, against a target of 400.

In the past decade, the quality of medical training has come under increasing scrutiny, particularly since chronic doctor shortages have sparked an increase in medical school intakes and the creation of medical schools in regional universities. In 2007, The Australian revealed that almost three out of four medical students said they were taught too little anatomy during their medical degree, while more than a third questioned their own competence in the workings of the human body.

Such findings led the Howard government to commission the Department of Education, Science and Training to do a two-year study, conducted between 2005 and 2007, to find out how best to train the nation's doctors. The report found medical students feared for their skills in a number of key areas, including knowledge of basic sciences, while hospitals increasingly struggled to make time for effective teaching in the face of packed waiting rooms.

Only 48 per cent of final-year students and 64 per cent of junior doctors thought they were adequately or well prepared to write prescriptions. Interpreting X-rays was a concern for 69 per cent and 77 per cent respectively. And just 44 per cent of medical students and 48 per cent of junior doctors felt they had been properly trained to insert a tube through the nose and down the throat of a patient.

Health Minister Nicola Roxon refused to comment on the detail of the report late yesterday. Instead, she blamed it on Opposition Leader Tony Abbott, a health minister in the Howard government. "Tony Abbott failed to plan for the health workforce needs of Australia and even capped the number of people allowed to train as GPs - a cap that this government has lifted," Ms Roxon said.

The medical community warned that the situation had deteriorated since the report was completed. Australian Medical Association president Andrew Pesce said more needed to be done to properly fund medical training. "Nationally, there will be 2920 domestic graduates from medical schools by 2012, and over 500 international graduates - many of whom will want to stay in Australia," Dr Pesce said. "This will swamp the existing number of intern places - with only 2030 currently available across the country."

The executive director of surgical affairs for the Royal Australasian College of Surgeons, John Quinn, said the report was "a missed opportunity" to demand decisive action. Dr Quinn said the RACS was particularly disappointed, given it had been "vociferous about the dwindling and now inadequate teaching of anatomy" in all medical schools. "This would seem to be a failure to recognise the problem, and to propose some solutions to a problem that has been well-identified previously," Dr Quinn said.

Associate Professor Paul McKenzie, the president of the Royal College of Pathologists of Australasia, said the report was a "disappointment" for failing to recommend improvements to undergraduate science training.

SOURCE




Obama Admits CBO Cost Estimates of ObamaCare Are Incomplete

Yesterday — day #224 of the ObamaCare Cost-Estimate Watch — President Obama told House Republicans: "You can’t structure a bill where suddenly 30 million people have coverage and it costs nothing."

And just like that, the president admitted that the official Congressional Budget Office estimates of his health care plan do not reflect its full costs.

Both the House and Senate versions of ObamaCare would cover millions of uninsured Americans by requiring them to purchase private health insurance. As President Obama notes, even if you force people to spend their own money on health insurance, it still costs something to cover them. And if the government partly subsidizes those premiums, the remaining mandatory premium is still part of the cost of covering them.

Yet Democrats have systematically blocked the CBO from including those costs in its official cost projections. The Senate bill’s estimated price tag of $940 billion, for example, includes only the costs that bill would impose on the federal government. By my count, that’s only 40 percent of total costs. By Mr. Obama’s admission, that’s not the full cost of the bill.

Now that the President of the United States has acknowledged that the CBO’s cost estimates are incomplete, could we maybe get a complete cost estimate? Maybe just for the Senate bill?

SOURCE




Obama’s Not Alone In Thinking We’re Too Dumb To Appreciate Him

The Los Angeles Times reports today that Democrats are conspiring behind closed doors on methods to revive and pass health reform. You may be forgive for thinking the LAT didn’t put it quite that way, but I don’t believe I’ve mischaracterized their report. You decide:

President Obama’s campaign to overhaul the nation’s healthcare system is officially on the back burner as Democrats turn to the task of stimulating job growth, but behind the scenes party leaders have nearly settled on a strategy to salvage the massive legislation.

They are meeting almost daily to plot legislative moves while gently persuading skittish rank-and-file lawmakers to back a sweeping bill.

This effort is deliberately being undertaken quietly as Democrats work to focus attention on more-popular initiatives to bring down unemployment, which the president said was a priority in his State of the Union address on Wednesday.

And what of the often-promised but now forgotten “transparency that was supposed to accompany health reform? Again, Obama is not the only one who’s forgotten it.

In a 24-hour news cycle, with the Internet and bloggers and cable news, sometimes a lot more can be accomplished, especially with healthcare, when it happens behind closed doors,” said Drew Altman, a healthcare policy expert who heads the nonprofit Henry J. Kaiser Family Foundation.

Among those plotters behind closed doors is Arkansas Sen. Mark Pryor, described by the LAT as “a conservative Democrat who was among a group of centrist Democrats from the House and Senate” who’ve been meeting. “Formerly conservative” or “a Senator who would like to be thought of by his constituents as conservative” might be more accurate, but whatever his political coloration at the moment Pryor believes he has plumbed the depths of human nature, and he’s discovered that people, or at least voters, are not as smart as he is.

“A little bit of time and quiet could help,” he said.

“Human nature being what it is, it's always easier to be against something than to be for it. And if you create any uncertainty with change, opponents can jump on that and just try to scare people. . . . That has been hard to overcome politically,” Pryor said. “Maybe over time, people will have a chance to understand what is in the legislation.”

In other words, we were too dumb to understand what Obama explained to us in 29 (or was it 39?) speeches and endless snippets from them on TV. But maybe if they just keep quiet about it for a while and bring it up later, we will have forgotten that we don’t like it.

Democratic leaders do not reserve their condescending scorn for voters who disagree with them; they have similar contempt for many of their own skittish followers (or not) in Congress who were, for some reason, “rattled by Brown’s winning campaign in Massachusetts.”

House Speaker Nancy Pelosi (D-San Francisco) and Senate Majority Leader Harry Reid (D-Nev.) particularly want to give members time to recover from the shock of Republican Scott Brown’s victory in the Massachusetts Senate race two weeks ago. The election cost Democrats their filibuster-proof Senate majority.

But in the coming weeks, Pelosi and Reid hope to rally House Democrats behind the healthcare bill passed by the Senate while simultaneously trying persuade Senate Democrats to approve a series of changes to the legislation using budget procedures that bar filibusters.

But why should they recover from the shock? Will the threat to Democrats intent on passing unpopular legislation implicit in the message of Brown’s election lessen over time?

The Dem leaders thus assume not only that voters are too dumb to appreciate the wisdom of the Dems’ health reform but also that they are so dim they will forget their opposition, thus allowing the “rattled” Democrats in Congress to recover from their Brown-induced “shock” and stick by their former willingness to impose massively unpopular legislation on a forgetful public.

SOURCE







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


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


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


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


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


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


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


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

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