More Britons die as lone NHS GPs cover thousands after hours
SOME parts of Britain are relying on just one out-of-hours GP at night to serve more than 240,000 residents. An investigation by The Sunday Times into the inadequacy of round-the-clock cover has established two further deaths, including that of a three-year-old boy, after failures in the system.
Brighton, Bolton and Wigan are among the areas where a lone doctor is responsible for dealing with late-night emergencies. The news follows revelations last weekend that just two GPs provide cover for Suffolk and its 600,000-strong population on some nights.
Mark Simmonds, the Tory health spokesman, said repeated warnings about out-of-hours cover had gone unheeded by ministers: “It’s disgraceful that the government hasn’t taken action over this before.”
Brighton and Hove primary care trust (PCT) has one GP to cover an area with 248,000 residents on most nights. It claimed the doctor can receive as few as 10 calls each evening. However, in one case involving the trust, a three-year-old boy from Hove died from blood poisoning after the failure of the out-of-hours service. The frantic parents of Joseph Seevaraj phoned the duty doctor at 11pm on a Sunday and asked whether they should take their son to hospital because he was vomiting and suffering from diarrhoea. Joseph was already taking antibiotics for tonsillitis and the doctor advised his parents, Jean and Nicola, to wait for those to take effect. They watched over the toddler closely, but he died a few hours later.
A consultant in paediatric intensive care later said she believed the child would have survived if his parents had received proper advice from the out-of-hours service. “He needed basic medical attention,” said Veronica Hamilton-Deeley, the coroner, at the inquest. “The failure to provide it was gross failure.” South East Health, which provides round-the-clock services for Brighton and Hove PCT, said it had learnt from the incident in January 2008.
This weekend it emerged that only one GP serves 310,000 residents in the Wigan area on most nights, while 270,000 residents in the Bolton area also have to routinely rely on a single out-of-hours doctor. In North Somerset there is just one GP for 200,000 residents on a week night. Cambridgeshire has three GPs at night, Norfolk has four and Cumbria has six.
Such skeleton cover was introduced when GPs negotiated new contracts in 2004, boosting their average salary to more than £100,000 and allowing them to opt out of providing round-the-clock care.
This week a coroner is expected to conclude the inquest into the death of David Gray, a 70-year-old from Manea, Cambridgeshire. Gray died in February 2008 after being given a massive overdose of diamorphine by Daniel Ubani, a locum doctor from Germany who had flown in for his first out-of-hours shift.
While some PCTs say that just one or two GPs can adequately cover a population of more than 250,000, others have more doctors available for home visits. Under South Birmingham PCT there are 11 doctors on overnight duty, each covering an average population of about 35,000. Hampshire has 13 GPs on duty at night and Devon has eight, working at medical centres across the county.
Patients are often unaware if their local service is in crisis because most trusts do not publish performance reports. NHS Bristol said last week that a report on the quality of its out-of-hours GPs’ service was “confidential” and “commercially sensitive”.
Most round-the-clock services struggle to fill shifts with local GPs. Instead they use doctors from other parts of the country or foreign GPs who fly in for their shifts. A parliamentary debate was told last week of a case in Cornwall in which a patient had been confronted with a foreign doctor who used “an electronic word converter” to communicate. Other patients have complained of waiting eight hours for a doctor to arrive.
There have also been complaints that out-of-hours GPs do not have access to patient notes and sometimes fail to diagnose serious conditions. In one case, a doctor working as a duty GP in West Yorkshire was suspended from the General Medical Council register after he failed to examine an elderly patient properly. She died the next day. Dr Krzysztof Robak, 62, commuted more than 175 miles from Surrey, where he worked for a diet clinic, to his Yorkshire employer, Local Care Direct. When he visited the 86-year-old patient, he failed to check her blood pressure or take her temperature and did not consider her seriously ill.
Robak said yesterday that he had drunk two bottles of wine four days earlier and was suffering from the medication he took for his gout. He told the family of the woman: “Look what two bottles of wine can do to you” — a comment they considered inappropriate. Robak said he had told his employer he had been feeling unwell. “I felt guilty because I failed this woman,” said Robak. “I did not refer her to the hospital because she appeared to be over the crisis.”
He said he felt he had been treated harshly over the mistake and plans to appeal against his suspension. Local Care Direct, a nonprofit organisation which provides out-of-hours care services for 2.5m people in Yorkshire, said it had vetted Robak rigorously before employing him. It said it did not consider that he had contributed to the patient’s death in July 2007, but it had raised concerns about his conduct.
Australia: Patients in Queensland government hospitals malnourished
Just like government hospitals in Britain. And the solution is very British too: More bureaucracy. That it's more nurses that are needed to help feed the elderly is beyond their tramtrack socialist comprehension
ONE in three patients in Queensland public hospitals is suffering from malnutrition, according to a State Government report. The Queensland Health briefing paper says malnutrition is "highly prevalent" in hospital patients and residents in aged care facilities. It said malnutrition could be costing Queensland more than $13 million a year. It was blamed for extended hospital stays, causing illness and disease, and exposed the department to legal action.
Liberal National Party health spokesman Mark McArdle said he was concerned that the Government had slashed health budgets by cutting patient food services. Health sources said hot meals in some hospitals had been reduced from three to one per day. "This is Third World . . . this is seriously affecting patients' recovery and ultimately tying up desperately needed hospital beds," Mr McArdle said.
In documents obtained by the Opposition under Right to Information laws, it was revealed that Queensland Health first examined the problem in 2003, but did nothing about it until 2008. A July 2009 report for Director-General Mick Reid warned of the dangers of malnutrition. "Due to the emphasis placed on the high and increasing prevalence of obesity and related disorders, there is little awareness of the existence and extent of the other extreme, malnutrition," the report said.
Queensland Health's Patient Safety Centre conducted a six-month investigation in 2008. It found that 30 per cent of hospital patients and 50 per cent of aged care facility residents suffered from malnutrition. It was estimated to have cost taxpayers $13 million in 2002-03.
The centre recommended the establishment of a malnutrition prevention manager within Queensland Health, to be paid $120,000 a year.
Congress’ New Secret Plan to Pass ObamaCare – The Nuclear Option
Leaders in the House and Senate have a new secret plan to pass President Barack Obama’s sweeping health care plan using strong arm tactics and no transparency.
I wrote back in September that Congress had a plan to ram through ObamaCare by the end of the year, but the American people stopped that plan. Public outrage was amplified by Rush Limbaugh and others in the media who took up the cause to educate Americans about Congress’ plan to railroad the unpopular bill through Congress with little debate and no opportunity for dissent. Cooler heads prevailed and Congress stopped efforts to sneak the bill through Congress.
On January 19, the proponents of ObamaCare suffered a big setback. When little-known State Senator Scott Brown scored a shocking upset in a special election for Senate in Massachusetts campaigning as an opponent to ObamaCare, moderates in the Senate and House put the brakes on ObamaCare. The left had to retool their strategy, because there was no will in the Senate to take up and pass ObamaCare again. The only way proponents of Obamacare can win now is if they change the way the game is played, and liberals seem to be prepared to change the traditional rules of the Senate by triggering a legislative Nuclear Option in an effort to pass Obamacare by the end of February.
This is a Nuclear Option, because the left is preparing a strategy to obliterate the filibuster rule — the rule that requires 60 votes to shut off debate on legislation, for the purposes of passing multiple pieces of legislation that add up to ObamaCare. They will either use reconciliation to pull an end around the filibuster rule or they may be bold enough to merely use a simple majority of Senators to exterminate the filibuster rule from the Senate rule book.
Sources on Capitol Hill tell me that liberals in the House and Senate are a handful of votes away from a scenario where they can get ObamaCare to the President’s desk by the end of February. Here is the way it works. According to The Hill, “House Democrats are readying a series of smaller ‘sidebar’ healthcare provisions to introduce by mid-February even as they push for using reconciliation rules to move a broader healthcare package, according to leadership aides.” So the plan is to try to pass a few smaller issues and to prepare a so called “reconciliation measure” to make changes to the Senate passed ObamaCare bill awaiting action in the House.
The reconciliation plan would be done by “using budget reconciliation rules to pass parts of the healthcare package (and) would require only 51 votes in the Senate. But those rules can only be used to move provisions affecting the federal budget.” If they can pass smaller portions of ObamaCare with Republican support, then they jam a reconciliation measure through the Senate with only 51 votes containing ObamaCare tax provisions. Next the House would take up and pass the Senate passed 2,700 page ObamaCare monstrosity. If that happens, then the game is over and the will of the American people will be ignored again.
President Obama declared at the State of the Union, “here’s what I ask Congress, though: Don’t walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people. Let’s get it done. Let’s get it done.” This is a message from the President to Congressional liberals that he will support their efforts to ram through ObamaCare with all means at their disposal. The President showed his complete disconnect from the feelings of average Americans when he called for Congress to pass his health care proposal that has been rejected by the voters of liberal Massachusetts. Real Clear Politics has the President’s plan with the approval of an average of 37.4% and an opposition of 54.4% – that is an average poll deficit of 17% for ObamaCare, yet the President forges forward.
Liberals can use the Nuclear Option to pass at least some part of ObamaCare and it allows them to deal with the tax or revenue aspects of health care reform. Then they will pull the trigger and force the House to pass the 2,700 page ObamaCare bill which is one House floor vote away from a Presidential signing ceremony. This is a multi-bill strategy. The reason why House members may vote for the Senate ObamaCare bill is because they may have their concerns addressed with the small bills and reconciliation measures that will have passed before this historic vote. This scenario also provides cover for moderate Democrats in the Senate who can vote against the reconciliation measure and claim to constituents that they were, in the end, against ObamaCare.
This procedure is an indication that Congress understands that even the people of liberal Massachusetts hate ObamaCare, so they need to pass this bill as fast as possible and with little transparency to try to minimize the participation of the American people in this process. A rational politician would see the terrible polling numbers for ObamaCare and the results in Massachusetts as a sign that the bill should be scrapped. The problem today is that the American people are dealing with an elite class of politicians in Washington that don’t care what the American people think about ObamaCare.
These elites make fun of people who participate in Tea Parties. They have distain for those that show up at Town Halls to voice opposition to the bill. They denigrate protesters who come to Washington, D.C. to demonstrate against a government takeover of health care. They laugh at all the poll numbers that indicate they are going in the wrong direction. They are ignoring the voters and their own constituents to further the cause of President Obama’s vision of a de facto government run health care system.
This is one of those unique moments in history where a minority number of Members of Congress are protecting the will of a majority of the American people – the big question is who will win?
SOCIALIZED MEDICINE IN BRITAIN -- WHAT SCOTT BROWN SAVED AMERICANS FROM
Four current horror stories from Britain below
Is this the worst diagnosis and treatment of all time? NHS told dying woman she was lying and locked her up in a mental hospital!
I had chronic fatigue syndrome once but luckily I have a very good immune system and it only lasted a month. It was a very real debility, though -- JR
As Criona Wilson knelt beside her dying daughter’s bedside, she promised her that her death would not be in vain. Before the frail body of 32-year-old Sophia finally succumbed to the medical complications and ravages of ME, she replied in a whisper: “Then it’s all worth it.” In the years that followed, Mrs Wilson, 66, a former midwife, dedicated her life to proving that her daughter’s condition was not a figment of imagination, nor one that merited her youngest child’s incarceration in a mental hospital.
Her battle saw her take on the medical profession and accepted thinking about the diagnosis and treatment of ME, also known as chronic fatigue syndrome. Eventually, in 2006, a coroner ruled that Sophia’s death was the result of myalgic encephalomyelitis — the first such ruling at an English inquest.
The fierce debate over ME has been highlighted once again by the case of Kay Gilderdale, who admitted assisting her daughter, Lynn, to kill herself after suffering from ME for 17 years. When she walked free from Lewes Crown Court on Monday, having been cleared of murder, Mrs Wilson was among those cheering her from the public gallery. “I had to be there,” said Mrs Wilson yesterday. “It was such an important case. And the verdict was a vote for common sense in a trial that highlighted what people suffering ME and their carers have to face.”
Her daughter, Sophia Mirza, was a talented and popular arts graduate living with her mother in Brighton in 1999 when she contracted ME at the age of 25. She became confined to her bedroom and, just as Miss Gilderdale had, needed round-the-clock care. In 2003 she was visited by a psychiatrist, even though Miss Mirza complained only of physical discomfort. The psychiatrist told her that she was making up her symptoms and if she continued to pretend to be ill he would section her under the Mental Health Act. Mrs Wilson said: “I knew my daughter. There was no way she was mentally ill or pretending.”
When the dread knock on her door finally came in 2003, there was little she could do. A policeman forced the door open and the psychiatrist and a social worker locked themselves into Miss Mirza’s room to prepare her for her trip to a psychiatric ward. Her condition took a dramatic turn for the worse. After 13 days she was released and taken back to the care of her mother. “That spell in a mental hospital set her back terribly. We lost all faith in medical professionals. We were alone,” said Mrs Wilson.
In 2005 Miss Mirza could barely muster the energy to speak, eat or drink. She and her mother had already agreed that no doctors should be called in case she would be sectioned again. On November 25, 2005, Miss Mirza died in her bed at home.
Wiping tears from her eyes, Mrs Wilson said: “We did everything we could.” Determined to get to the bottom of why her daughter’s treatment had been so bad, she got hold of her medical records. After being contacted by the 25 Per Cent ME Group, which campaigns for those with the most acute form of ME, she agreed to her daughter’s body being examined.
At the inquest the next year a neuropathologist told the court that Miss Mirza’s spinal cord was inflamed and three quarters of her sensory cells had abnormalities. It was, the court heard, a clear physical manifestation of ME. The coroner ruled that she had died from “acute renal failures as a result of chronic fatigue syndrome”.
A year later, the National Institute of Clinical Excellence (NICE) issued its first guidelines on the diagnosis and treatment of the illness, describing it as “relatively common”, affecting up to 193,000 people in Britain. At the heart of that guidance is the need to take into account the opinions of the patients. Mrs Wilson is campaigning to get the Government to fund research into ME. “It’s not over yet.”
A doctor who prescribed “potentially hazardous” levels of painkillers to elderly patients who died has escaped being struck off the medical register. Jane Barton will be allowed to continue working as a doctor, despite being found guilty of serious professional misconduct, a fitness to practise panel ruled.
She was accused of a series of serious failings in her care of 12 elderly patients at Gosport War Memorial Hospital, in Hampshire, in the 1990s. These included prescribing prescription drugs at “excessive” and “inappropriate” levels, a hearing at the General Medical Council (GMC) was told.
The fitness to practise panel found that Dr Barton was guilty of putting patients at risk of premature death at the hospital between January 1996 and November 1999. She was found to have prescribed diamorphine, the opiate painkiller, at varying levels “and created a situation whereby drugs could be administered which were excessive to the patients’ needs” the panel found. However, it said that it had taken into account her ten years of safe practice as a GP in Gosport and 200 letters of support and ruled that she could continue working under certain conditions.
Relatives of the patients who had died reacted furiously to the verdict and walked out of the hearing in central London today. Iain Wilson, the son of Robert Wilson, one of the patients who died, shouted at the panel: “You should hang your head in shame.”
The GMC, which regulates the work of 150,000 doctors in Britain, had recommended that Dr Barton be struck off and also criticised the decision. Niall Dickson, the council’s chief executive, said: “We are surprised by the decision to apply conditions in this case. “Our view was the doctor’s name should have been erased from the medical register following the panel’s finding of serious professional misconduct. “We will be carefully reviewing the decision before deciding what further action, if any, may be necessary.”
The case will now be reviewed by the Council for Healthcare Regulatory Excellence, an ombudsman of misconduct cases. If found to be unduly lenient the decision could be referred to the High Court and possibly overturned.
In April last year a jury inquest at Portsmouth Coroner’s Court ruled that at least five elderly patients who died at a hospital in Hampshire were overprescribed strong painkillers that hastened their deaths.
In the cases of patients Robert Wilson, 74, Geoffrey Packman, 66, and Elsie Devine, 88, the use of painkillers was found to have been inappropriate for their conditions. Arthur Cunningham, 79, and Elsie Lavender, 83, were prescribed medication appropriate for their condition but in doses that contributed to their deaths, the jury found.
Dr Barton, who worked as a clinical assistant at the hospital, was the only individual to be investigated by police in connection with the deaths but was not charged with any offence.
Grandmother disgusted at filthy NHS hospital nursed and bathed other patients on her ward
A grandmother was so disgusted by the filthy conditions and neglect on a hospital ward that she bathed and cared for the patients herself. Janet Halsall, 74, was admitted to Hinchingbrooke Hospital in Huntingdon, Cambridgeshire, for three days to have a scan on her liver, when she was shocked to see staff repeatedly ignore pleas for help and leave fellow elderly patients to ‘fend for themselves’. The kind-hearted pensioner was so appalled by the conditions in the hospital that she bathed, washed and tucked in the frail elderly patients herself.
The grandmother-of-seven said fellow patients were distressed after being left without water, and when she went to the pantry to clean their glasses, she found it in a ‘disgusting state’. When one elderly lady got no help after repeatedly complaining to staff she was cold, Mrs Halsall was moved to search a store cupboard for a blanket. The former hairdresser even washed and bathed one lady who needed help to clean herself and took another pensioner to the toilet after staff continually ignored her requests because they were ‘too busy’. When she was discharged on Monday afternoon, her fellow patients cheered and clapped her - branding her their 'guardian angel'.
Speaking from her home in Little Staughton, Beds., she said: ‘I was absolutely disgusted when I entered the ward. ‘At 7pm I arrived in the ward and was appalled to find the bed was unmade and the water jug and glass were on the floor. ‘There was no locker or table to put my things on or bag to dispose of rubbish. ‘The patient in the next bed to me kept asking staff if she could go to the bathroom to have a wash and clean her teeth before breakfast. The reply was always “in a minute”. ‘She was really upset so I found her a bowl and washed her from head to toe and made her feel better. She was so grateful.
‘Never before have I seen so many people rushing around, working so hard but achieving nothing.’
Mrs Halsall, whose partner Eric died five years ago, blames the shoddy treatment on a shortage of staff. She added: ‘There simply weren't enough staff looking after the ward. People were asking for help and it was falling on deaf ears. ‘The poor nurse was running around and didn't have time to help everyone. I couldn't just sit there and watch so, being quite agile, I got up and helped them myself. ‘When I left the ward on Monday they all cheered me out and said I was their guardian angel.’
Mrs Halsall was referred to the Hinchingbrooke Hospital at around 11am on Friday amid fears she was suffering a liver complaint. She was told she could not have the scan until Monday and was later transferred to the Appletree Ward for the weekend. But within minutes of arriving, she became angry after spotting a number of patients who were not being cared for. Pensioner Joyce Bates, who was also on the Appletree Ward as she underwent physiotherapy for rheumatoid arthritis in her legs, hailed Janet a 'heroine'. Widower Mrs Bates, from March, Cambs., said: ‘I don't know what we would have done without Janet. The place was an absolute disgrace and our treatment was even worse. ‘I've stayed in hospital 38 times and I've never watched as a patient is forced to give another a bed bath because the nurses won't. ‘She truly was magnificent in what was a nightmare situation.’
Director of the Patients Association Katherine Murphy said: ‘Unfortunately we hear far too many examples of the kinds of things described by Janet Halsall. ‘It is completely unacceptable for patients not to be treated with dignity and respect and not to receive the help they need with things like personal hygiene. ‘That should be fundamental to NHS care-whenever it's not it's an appalling indictment of our treatment of some of the most vulnerable users of our health services.’
A spokesman for Hinchingbrooke said: ‘Hinchingbrooke Health Care NHS Trust takes all complaints extremely seriously. ‘We would ask Mrs Halsall to contact us directly so that a full investigation can be conducted into her experience on the ward. ‘Until we can look into these incidents in more detail it would be inappropriate to comment further at this time.’ [Blah, blah, blah!]
Don't fall sick out of hours in Britain: GPs refusing to work nights and weekends claimed boy's life
Like so many proud parents, Jean and Nicola Seevaraj meticulously recorded the milestones in the life of their first child, Joseph. He smiled when he was a month old, stood up on his own four days before his first birthday and loved the movie Madagascar. And there was so much more to look forward to - his first day at school, learning to read and to ride a bike. Instead, at the age of three years, one month and 19 days, Joseph was dead. 'I remember checking on him around 4am,' says Mr Seevaraj, 33, a church minister from Hove, East Sussex.
'I went back to bed and the next thing I knew it was 7.30am and my wife was screaming. She was absolutely frantic and I knew something terrible had happened. She was next to Joseph's bed. His eyes were open, but he wasn't responding to anything she did or said. 'It was the worst moment of my life. We called 999 and they told us to try to resuscitate him, but I knew inside myself that it was too late. He'd already passed away. 'The paramedics arrived and rushed him to hospital, but it was hopeless. And that was the beginning of our nightmare.'
It was a nightmare that would be made all the more ghastly because of the fact that Joseph's death had been avoidable. His parents had sought medical help for their son, who had tonsillitis. Joseph was prescribed antibiotics, but when he started to vomit and had diarrhoea, Mr Seevaraj phoned for further help. Because it was a Sunday, he could not talk to the family doctor. Instead, he was connected to the out-of-hours service and was put through to a German-trained medic. The locum doctor, who Mr Seevaraj claims struggled to understand what was being said to him, told him there was nothing to worry about and that, no, it wasn't necessary to bring in the child for further treatment.
Mr Seevaraj followed that advice - and the following morning woke to find that his son was dead. An inquest would later hear that had Joseph been taken to hospital, then the septicaemia that claimed his life could have been treated. 'He needed basic medical attention,' the coroner said, ruling that neglect had contributed to Joseph's death. 'The failure to provide it was gross failure.'
Mr Seevaraj says: 'If we had been able to speak to our family GP that weekend, I believe Joseph would still be alive. There are lots of holes in the out-of-hours system - it needs to be sorted out.'
And he is not alone in that view. New figures show that serious complaints about out-of-hours care have shot up by 50 per cent in just two years. The Medical Defence Union, the leading insurance company that covers most GPs, reported a sharp rise in the number of grievances against doctors following deaths, misdiagnoses and negligence. In 2007 and 2008, there were 517 complaints related to consultations at evenings and weekends - up from 337 over the previous two years. Seventeen insurance claims followed the deaths of patients.
And then there is the shocking case of David Gray, a 70-year-old kidney patient, who died in February 2008 after being injected accidentally with ten times the maximum recommended dose of morphine. It was administered by Dr Daniel Ubani, a locum who had travelled to Britain from Germany and had slept for just three hours before going on his first out-of-hours weekend shift in Cambridgeshire. As well as giving the fatal injection to Mr Gray, an 86-year-old woman died of a heart attack after the Nigerian-born Dr Ubani failed to send her to hospital.
While the deaths of Mr Gray and young Joseph may differ in their circumstances, both serve to shine a spotlight on the growing scandal of British doctors' refusal to work nights and weekends, with their places too often being filled by doctors from abroad, some of whom speak poor English.
All this, of course, is the result of one of the Government's most disastrous pieces of meddling, which allowed British doctors to opt out of out- of-hours duties - and meant they were no longer responsible for the care of their patients 24 hours a day, seven days a week.
That's why, six years on, Suffolk - a county of 600,000 people - has just two British doctors on call overnight and at weekends. Similarly poor coverage is offered elsewhere, as sick patients are fobbed off with telephone assessments or forced to make their own way to overloaded Accident & Emergency hospital departments.
Before the introduction of the new contracts in 2004, GPs were responsible for providing out-of-hours care to their patients. Since then, however, the responsibility for in-hours and out-of-hours care was split, so that primary care trusts took on responsibility for patients at nights and on weekends. As a result, despite the fact that British GPs are the highest-paid in the developed world - average earnings are £106,000 - they earn their crust during office hours.
Under pressure to return profits and cut costs, primary care trusts introduced ways of dealing with patients that reduced the need for time- consuming home visits while looking for 'cheaper' doctors from elsewhere. Though precise figures are not available, research by the Daily Mail suggests that a third of primary care trusts are flying in GPs to fill these posts. The doctors come from as far away as Lithuania, Poland, Germany, Hungary, Italy and Switzerland, and are attracted by the comparatively good rates of pay.
While the NHS has a long history of employing foreign doctors, their presence on the front-line of healthcare has raised specific concerns. Top of these are question marks over the foreign medics' qualifications and language skills.
It's something that 66-year- old Renee Forrow discovered when her husband Derek died at their Suffolk home two years ago after a longterm illness. It was a Saturday evening and, with her GP surgery closed, she called the out-of-hours service - Suffolk Doctors on Call (Sufdoc) - to request that a doctor be sent to certify the death. But what should have been a dignified process quickly degenerated into what Mrs Forrow describes as a 'Monty Python farce'. First, the Polish doctor and his driver could not find the house and took two hours to arrive.
When he did arrive, there were no sympathetic words. Instead, the doctor asked the stunned widow to fill in a form with her husband's name, address and other details. 'When he came in, he didn't say anything to anybody,' she says. 'He just scuttled in, pointed at my husband on the bed and said: "Accident?" 'He then examined him, gave me a form and said: "You say, you do. You fill in. I don't understand." I felt it was wrong that I had to fill in the details myself, but it was impossible to have a proper conversation with him. He simply could not converse in English adequately.'
As if that was not distressing enough, the doctor then pointed at her husband's morphine pills and asked: 'How many you give him?' Mrs Forrow said: 'It sounded insensitive because it almost suggested that he could have overdosed. It was almost as if I had done my husband in.' Just minutes after his arrival, the Polish doctor left. Shocked by what had happened, Mrs Forrow decided to speak out. She is concerned by what might have happened had the doctor been called to treat a complicated case.
'Suppose he visited an ill, old lady and was trying to pick up the nuances of what she was saying,' she says. 'Communication is half of diagnosis and he was like a little scared rabbit caught in the headlights.' A letter of apology subsequently arrived from Sufdoc. It stated: 'There is no question about his (the doctor's) competence as a clinician. It is just an issue about communication.'
It is these twin issues - competence and communication - that are at the heart of concerns over the role being played by foreign doctors in the out-of-hours service. While concerns over the competency of foreign doctors are pressing-there is a growing belief that the way to address them is by a fundamental overhaul of the outofhours system that would make their presence unnecessary.
This would be achieved by handing back responsibility for roundthe- clock care to family GPs. In this way, continuity of care between patient and doctor would be ensured, as would direct accountability. Perhaps unsurprisingly, doctors' leaders oppose these suggestions, saying that it would be 'unsafe' to make GPs work longer hours.
It is not an argument that cuts much ice with the likes of Dr Frank Newton, who worked as a GP for 25 years in rural Northamptonshire before retiring in 1989. 'When I started, there were two of us and we covered 200 square miles with about 4,500 patients,' the 80-year-old told me. 'I worked every hour the other guy didn't work. We took it in turns during the week for the nights, and in turns for the weekends. 'We took a fortnight's holiday each, so if the other guy was away you would be on for two weeks in his absence and he would do the same when you took your fortnight. 'I can tell you that we weren't on our knees with exhaustion and we were not unsafe - we were used to it. We wanted to be involved because we were part of the community and that is what the job was about. 'I find it very sad the way things have gone today, because I think that the people who are missing out are the practitioners themselves as well as the patients. What pleasure can you get from doing only half a job?'
So, should GPs be involved in arranging out-of-hours care for their own patients? As providers or commissioners of this care, they would not necessarily be obliged to return to outofhours work themselves, but they would be obliged to organise it (experts predict that if this happened, more local doctors and nurses would get involved). Even the NHS Alliance - an independent body that represents NHS professionals working outside hospitals, including some GPs - is calling for doctors to take back at least some of the responsibilities they cast off in 2004.
Many patients who have experienced the shortcomings of the system - such as negotiating complex phone systems or being forced to take a sick child to a dropin centre in the middle of the night - would go further and demand that, in return for their increased salaries, doctors would be available when they were most needed.
As Katherine Murphy, director of the Patients Association, points out, ill-health can strike at any time. 'There should be no less emphasis put on the out-of-hours care than there is on the care on offer between 9am and 6pm,' she says. 'No one decides when they get ill, so the same importance should be given to the provision of care whatever the time of day.'
Democratic leaders on Thursday shelved plans to push through a major health care overhaul, casting aside President Obama's top legislative goal, which has bedeviled congressional Democrats for more than a year.
Senate Democrats put a positive spin on it, arguing that they're sidelining it until later this year - possibly until the summer - so they could deal immediately with Mr. Obama's State of the Union call to address the economy and job creation. But House Speaker Nancy Pelosi, who said a comprehensive bill is still a priority, already has plans to pursue small, targeted health bills, such as a repeal of insurance companies' antitrust protection.
Rank-and-file Democrats aren't optimistic about the fate of a comprehensive overhaul. Sen. Mary L. Landrieu, Louisiana Democrat, classified the legislation as on "life-support" and with a pulse, but warned that resuscitating the legislation would take a lot of work. "Can we come out of the dugout in the second half and fight and come back and win in the second half of the game?" she said. "Yes. But it's going to take some serious strategic excellence ... and absolutely extraordinary communication and coordination to do that."
Mr. Obama said Wednesday that he still wanted a health care reform bill - an uphill legislative effort that headlined his first year in office - but suggested that lawmakers take a step back before renewing their work. "As temperatures cool, I want everyone to take another look at the plan we've proposed," Mr. Obama said in his address. "But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. Here's what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close."
But Democrats on Capitol Hill, eager to prove to voters that they're listening to their concerns about the hobbled economy and the job market, are ready to move a jobs bill. "The president made it clear that our No. 1 focus this year is putting Americans back to work," said Senate Majority Leader Harry Reid, Nevada Democrat. "And we couldn't agree more."
Democrats plan to release a jobs package, possibly next week, that could include a mix of funding for infrastructure projects, targeted tax cuts and small-business loans. The plan could include a "cash for caulkers" program or even forgiving some payroll taxes for companies that hire unemployed workers, said Sen. Richard J. Durbin, Illinois Democrat and majority whip.
Leaders stressed that health care reform legislation is still important and is still going to get done. "We're going to do health care reform this year," Mr. Reid said. "The question is, at this stage procedurally, how do we get where we need to go."
The yearlong effort to push reform legislation through five congressional committees and both chambers of Congress dominated Mr. Obama's first year in office. Presidents had tried for decades to pursue a universal health bill, but never got nearly as far as Democrats did last year.
The debate over a public insurance plan, federal funding of abortion, costs and other issues divided the public. Mr. Obama said Wednesday that he holds himself responsible for never clearly explaining what he wanted the bill to do. Republicans seized on the opportunity to label the plan over the summer, telling voters that the bill would lead to a government takeover of the health care system, tax hikes and even at one point to the infamous "death panels."
The public's distrust of the effort came to a head in Massachusetts when Republican state Sen. Scott Brown on Jan. 19 won the seat long held by Sen. Edward M. Kennedy, shocking Democrats and giving Republicans enough votes to sustain a filibuster of the bill. Mr. Brown won in the traditionally blue state by promising to vote against it.
Mrs. Pelosi is already planning on pursuing small pieces of the Democrats' health bill - an indication that House Democrats are anxious to take action and declare a small victory. She said she would and wait to see how the Senate pursues obtaining a comprehensive bill now that Democrats no longer have a supermajority. Legislation to repeal insurance companies' antitrust protections could be introduced as soon as next week. "We will move on many fronts, any front we can," she said. "But we are going to get health care reform passed for the American people for their own personal health and economic security and for the important role that it will play in reducing the deficit."
Why do British politicians think that their National Health System is so wonderful? Braving the snow and icy conditions one recent afternoon on Christmas holidays in London, I visited a doctor’s surgery near my sister’s home to make an appointment for her newborn baby. Rather than being a simple endeavour of securing the next available timeslot, it was an annoyingly bureaucratic experience.
It began with a stern lecture from the receptionist for not following the rules. The NHS requires patients to be formally registered with the practice before the doctor sees them. Appointments must be made in the morning for the same day only. In addition, you cannot make phone appointments but must visit the surgery in person. This particular rule appears to have been established by the practice itself to sidestep confusion with the Appointments Line – an NHS telephone booking system so complicated that it requires an 18-page user guide!
The complexity of NHS regulations means that everyone is confused about procedure – patients and practices alike. And although many British surgeries are over-burdened, the NHS prevents patients from visiting GPs outside their designated catchment zone. In effect, the NHS would rather keep you in a crowded waiting room than let you see an available doctor.
In the world of the NHS, the patient is treated like an errant child whose punishment is to wade through a quagmire of bureaucracy to receive treatment. Fortunately in my case, the receptionist decided that given my colonial ignorance and argumentativeness, it was easier for her to break the rules ‘just this once, mind’ and give my little niece an appointment that very evening. A cherished victory of common sense over bureaucracy.
In an increasingly authoritarian Britain, the ill-functioning NHS is just one example of the difficulties imposed on the lives of citizens by too much regulation and government involvement.
At the forthcoming UK elections, Conservative Party leader David Cameron looks set to oust embattled Prime Minister Gordon Brown from 10 Downing Street. But don’t hold your breath for a Conservative victory to loosen the state’s bureaucratic grip over the country. Although Cameron has occasionally mused on leading Britain into a new ‘post-bureaucratic age,’ this supposed big government sceptic has just plastered Britain with campaign posters promising: ‘I’ll cut the deficit, not the NHS.’
Any British child could tell him that there is plenty of NHS red tape waiting to be cut.
The above is a press release from the Centre for Independent Studies, dated January 29. Enquiries to cis@cis.org.au. Snail mail: PO Box 92, St Leonards, NSW, Australia 1590.
Last week, the voters sent a message to Washington. Last night, Obama made clear he will not listen
The key passage in the State of the Union Address last night was this:
So, no, I will not give up on trying to change the tone of our politics. I know it's an election year. And after last week, it's clear that campaign fever has come even earlier than usual. But we still need to govern.
To Democrats, I would remind you that we still have the largest majority in decades, and the people expect us to solve problems, not run for the hills. And if the Republican leadership is going to insist that 60 votes in the Senate are required to do any business at all in this town--a supermajority--then the responsibility to govern is now yours as well. Just saying no to everything may be good short-term politics, but it's not leadership. We were sent here to serve our citizens, not our ambitions. So let's show the American people that we can do it together.
The nub of it was the statement explaining away the election result by analogy to a disease: "After last week, it's clear that campaign fever has come even earlier than usual." If the voters of Massachusetts sent a message, President Obama refuses to listen.
In a moment of faux humility, he said of ObamaCare's failure: "I take my share of the blame for not explaining it more clearly to the American people." He will not listen to us; he expects us to listen to him as he explains this monstrosity again, "more clearly" this time, he promises.
On his personal blog, Robert George of the New York Post offers an astute and somewhat charitable analysis:
I didn't have time to pour [pore?] through all SOTUs given, but I can't remember when a POTUS explicitly reminded his side of the size of its majority and the other side the price that comes with asserting that 60 votes are necessary for passage of major bills.
He was, at that moment warning that Democrats risked being labeled cowards and Republicans obstructionists if his agenda wasn't pushed through. Was that serious ass-covering ("If this all falls apart, it's your fault, not mine!")? Maybe, but it's not a completely unfair reading of the current political reality. . . .
Barack Obama is daring Democrats to walk away from him on health care--now that each chamber has passed a bill. A party legislative dream of decades is tantalizingly close. November may prove that Massachusetts was the warning sign that Republicans and many independents believe it to be. But Obama has put down the gauntlet to declare that he deserves to have half his first term play out before the post-mortems of his presidency are carved in stone--regardless of how unpopular health care is at this moment.
In short, Obama is faced with the perpetual tug in politics--does an elected leader stick to the inner compass or does he follow what the polls (and one special election) tell him?
Obama seems willing to bet his congressional majority on the former. That's why this was a give-no-inch political speech.
This seems unlikely to work as an electoral strategy--which is to say that many Democrats seem likely to lose their seats if they follow Obama's urging and support widely hated initiatives like ObamaCare. That would seem to be the clear political message of Massachusetts, and surely enough Democrats received it to make Obama's approach unlikely to succeed as a legislative strategy.
Putting together the slim House majority and Senate supermajority for ObamaCare was an arduous enough task for Harry Pelosi and Nancy Reid. The results of their work were thrown into disarray by the election in Massachusetts, and reassembling the majorities (or even just the House majority) will be even harder than assembling them in the first place. Rather than study the "legal implications of Einstein's theory of relativity," Obama should have examined the political implications of the second law of thermodynamics.
Obama did not deliver what many observers expected: a show of humility, and a scaling back of his vast ideological ambitions, à la Bill Clinton after the 1994 elections. George argues that this expectation was unreasonable:
Huh!!! Really?
Losing Ted Kennedy's Senate seat is the political equivalent of losing both chambers of Congress--including the Democratic House for the first time in 40 years! Conservatives really want to make that comparison? Obama appears to be making the bet that a president gets two years before the inevitable midterm correction delivered by the voters. To toss aside all plans now would be the mark of someone with absolutely NO backbone.
We look at it differently. The special election in Massachusetts was a gift for Obama and the Democrats--an early warning that the country strongly rejects their priorities. By plowing ahead with those priorities anyway, Obama is squandering an opportunity to bring his ambitions into line with the views of the electorate--a chance President Clinton did not have until his party had already lost its majority.
Our surmise is that Obama's approach reflects a defect of character more than a carefully wrought strategy. We may be proved wrong about this--the real test will come in 2011 and 2012, assuming the Republicans do make big gains this November--but our preliminary reading is that the president combines the worst traits of his two predecessors. He is ideologically overambitious, to an even greater extent than Clinton was in his first term. And he is as arrogant and inflexible as George W. Bush's harshest critics accused him of being.
The American people simply do not matter to Barack Obama. He said so himself last night as he attempted his first State of the Union Address, declaring, "[W]hen I ran for president, I promised I wouldn't just do what was popular -- I would do what was necessary." This was a nice way of saying he had heard the overwhelming opposition to his Big Government agenda — and he has decided to plow ahead anyway.
"I will not walk away" from the government health care takeover, he said, and "neither should the people in this chamber." This, in spite of devastating resistance to the scheme that would ration care, raise premiums, drive people off of their insurance, cut benefits, and bankrupt the treasury with over $1.5 trillion in costs over ten years once fully implemented.
All told, 58 percent oppose the plan in Scott Rasmussen's last weekly poll on the subject. His tracking has been way ahead of the curve on opposition to the health care takeover. While apologists were claiming majority support for plans like the "public option," Rasmussen has polled clear opposition for most of 2009.
Barack Obama doesn't care. With only an occasional glance at the glaring reality that the American people really are not in favor of his plans, Obama's State of the Union was mostly a "stay the course" campaign rally, coupled with blind assertions as to the correctness of his position. Not to mention his bull-headed insistence that the Democrats get it done and "not run for the hills."
For example, he came close to prevaricating (to put it kindly) about losses from the Troubled Asset Relief Program: "[W]e have recovered most of the money we spent on the banks. To recover the rest, I have proposed a fee on the biggest banks." Only, the biggest banks are the ones who have paid TARP back in full, with interest.
Most of the $120 billion in losses have arisen under loans to AIG (not a bank), GM (not a bank), and Chrysler (not a bank). It was Obama's own Treasury secretary, Timothy Geithner who testified to Congress, "There is a significant likelihood that we will not be repaid for the full value of our investments in AIG, GM and Chrysler."
But not to worry, Obama says, "I am not interested in punishing banks." Only, he is. He asserted that "Our most urgent task upon taking office was to shore up the same banks that helped cause this crisis." By that, he means, take over, regulate, and monopolize. You know, punish.
Despite all of his bald distortions, Barack Obama's greatest transgression in this speech was more a sin of omission than commission in his historical account of what actually happened. In fact, the only entities Obama is not interested in targeting are those most directly responsible for the mess.
Obama had positively nothing to say about Fannie Mae, Freddie Mac, and the Federal Reserve (government-created entities all), whose errant policies of loose lending and easy money coupled together to incentivize borrowing on an unprecedented level, inflate the housing bubble, sell worthless securities worldwide, and bring the economy to brink of ruin. Not one word.
Even as George Bush was attempting to justify the unprecedented bailouts his Administration ushered in, he at least acknowledged the role played by, for example, too-low interest rates. Instead, Obama presented a bizarre, disjointed address that was almost completely disconnected from reality, save for the touch of icy indifference to the express will of the American people not to proceed on this course.
But then, by now, that is what the American people have come to expect from the imperial, impervious president.
The Scott Brown political earthquake has had more far-reaching implications than anyone anticipated. With the public admission of Nancy Pelosi that she does not have the votes in the House to pass the Senate health bill, President Obama's government takeover of health care appears to have stalled out, at least for now.
What this means is that Republicans and conservatives now have the first real opportunity to be heard on alternative health reform ideas. To prevent the return of socialized medicine to center stage, we should move aggressively with reforms that will solve what the public is really concerned about.
Cover the Uninsured
The well-kept secret of health policy over the past year is that the uninsured can be covered for little additional net cost, without the government takeover of health care, rationing, new health care bureaucracies, or any of the other central components of Obamacare.
No one wants to see anyone suffer or worse because they can't get essential health care. The lack of a clear safety net for the uninsured is what gives Democrats the political lift to keep coming back for socialized medicine. Reform now should focus on the modest changes necessary to establish a true safety net that will ensure that no one will be denied essential health care. Only that will permanently protect the health care of the American people from government takeover and control.
Real health reform should begin with Medicaid, which already spends over $400 billion a year providing substandard health care coverage for 50 million poor Americans. Congress should transform Medicaid to provide assistance to purchase private health insurance for all those who otherwise could not afford coverage, ideally with health insurance vouchers. This one step would enormously benefit the poor already on Medicaid. The program today pays doctors and hospitals only 60% of costs for their health care services for the poor. As a result, close to half of all doctors and hospitals won't take Medicaid patients. This is already a form of rationing, as Medicaid patients find obtaining health care increasingly difficult, and studies show they suffer worse health outcomes as a result. Health insurance vouchers would free the poor from this Medicaid ghetto, enabling them to obtain the same health care as the middle class, because they would be able to buy the same health insurance in the market.
Ideally this would be done by reforming Medicaid financing to provide the federal assistance to the states for the program through finite block grants, which do not vary by matching increased state Medicaid spending as under the current system. With finite block grants, states that innovate to reduce costs can keep the savings. States that operate programs with continued runaway costs would pay those additional costs themselves. Such reforms worked spectacularly to stop the runaway costs of the old AFDC program when Congress adopted welfare reform in 1996.
Give states the incentive to embrace such reform with a block grant formula that would provide states with increased funding sufficient to provide assistance to all those who truly cannot afford health insurance, counting continued state Medicaid funding, along with broad flexibility to redesign their Medicaid programs. The voters of each state can then decide how much assistance for the purchase of health insurance to provide each family at different income levels. This would rightly vary with the different income and cost levels of each state.
This would not cost much because only about 12 million Americans arguably cannot afford health insurance without some public assistance. Out of the 47 million uninsured we keep hearing about, 9.7 million are already eligible for current government programs like Medicaid or SCHIP but haven't signed up. Another 6 million are eligible for employer sponsored insurance but have not signed up for that either. Another 9 million are in families earning more than $75,000 per year. Another 10.2 million are immigrants, legal or illegal, and not U.S. citizens.
Just give the assistance necessary, counting what they can reasonably pay based on their income, to that 12 million to buy private health insurance. That is the key to avoiding a multitrillion-dollar new entitlement involving government rationing, which would trash the best health care in the world the American people now enjoy. With broader welfare reforms involving positive incentives, we could end up with less total government spending than today.
Completing the Safety Net
But a second step is necessary as well to ensure a complete safety net. Federal funding should also be provided to help each state set up an uninsurable risk pool. Those uninsured who become too sick to purchase health insurance in the market for the first time, perhaps because they have contracted cancer or heart disease, for example, would be assured of guaranteed coverage through the risk pool. They would be charged a premium for this coverage based on their ability to pay, ensuring that they will not be asked to pay more than they could afford. Federal and state funding would cover remaining costs.
Such risk pools already exist in over 30 states, and for the most part they work well at relatively little cost to the taxpayers because few people actually become truly uninsurable. This works far better than forcing insurers to cover everyone regardless of pre-existing conditions, or regulation such as guaranteed issue (forcing insurers to cover everyone who applies regardless of health condition) or community rating (forcing insurers to charge the same or nearly the same to all regardless of health condition). Such regulation has been proven beyond dispute to cause health insurance premiums to soar. That is because it is like requiring insurers to provide fire insurance for houses that are already on fire. With the above reforms, those cost increases are completely avoided, while ensuring that everyone has someplace to go to get essential coverage and care.
The law already provides that insurers cannot cut off already existing policyholders, or impose discriminatory rate increases, because they become sick while covered. That would be like allowing fire insurers to cut off coverage for houses once they catch on fire. If this law needs to be modernized, it should be.
With these reforms, those who have insurance can keep it, those who can't afford it are given help to buy it, and those who nevertheless remain uninsured and then become too sick to buy it have a back up safety net in the risk pools. Notice that this completely solves the problem of the uninsured without any individual or employer mandate, which are unnecessary gateways to enormous trouble. Once the government adopts such mandates, it is inexorably led down the path to socialized medicine.
Controlling Costs
A few, simple, additional reforms would help greatly to reduce health costs as well. Insurers should be allowed to sell health policies nationwide across state lines, subject to the regulation of their home states. This would reduce costs through increased competition, as well as greatly expand consumer choice.
Medical malpractice reform would also reduce costs. Non-economic damages, such as compensation for pain and suffering, should be sharply limited. Punitive damages should apply only in criminal proceedings, not in civil trials. Traditional tort standards for medical liability should be strictly enforced. Doctors and hospitals should be responsible only for damages for which they were the proximate cause.
Health Savings Accounts (HSAs) involve health insurance with high deductibles in the range of $2,000 to $6,000 per year, which reduces the cost of such insurance by 25% to 40%. These cost savings are kept in the HSA to pay health expenses below the deductible, growing beyond the deductible amount in a year or so. This gives patients incentives to control costs, as they keep unspent funds in their accounts for future uses, such as health care, retirement income, or others. With this new patient interest in controlling costs, which they don't have with traditional health insurance that pays for almost everything, doctors and hospitals would increasingly compete to control costs in serving patients.
The American Academy of Actuaries released a report last year on experience with consumer driven health care plans, such as HSAs or the quite similar Health Reimbursement Arrangements (HRAs). It showed that these are the only plans that are controlling and even reducing health care costs, and that patients with such coverage are using more chronic and preventive care. That's why employers and health insurers are increasingly turning to these products.
Greg Scandlen provides more detail in a new study from the Heartland Institute, "Ten Ways Consumer-Driven Health Care Is a Proven Success." He reports that experience with HSAs and HRAs shows:
Once people have control of their own money and are able to make their own choices, they suddenly become very interested in seeking out information about costs and quality. They are more likely to listen to their doctor and look for ways to lower their own costs. They are more likely to change their lifestyles because it is their money on the line, not an insurance company's.
He adds that those covered with these plans choose lower cost health options, sharply reduce visits to hospital emergency rooms, and are more likely to participate in wellness programs and to use preventative services.
Scandlen further reports the powerful effect of the incentives in such plans in slashing the growth of costs, saying:
The Mercer Company found that the annual rate of increase for consumer-driven health plans was about half that for PPOs and HMOs. Wellpoint looked at the experience of 8,000 of its group accounts in 2008, and found that PPO and HMO rates rose between 7 percent and 10 percent from the previous year while rates for its consumer-driven plans actually dropped from 2007 to 2008….[S]imilar programs offered by the Postal Workers Union and the Government Employees Health Association had no increase in premiums for four years running.
Finally, Scandlen explains that these plans provide patients with more power and control over their own health care, saying:
Traditional health insurance means the insurance company picks and chooses what providers it will recognize. These providers may be very good for the insurance company, by accepting lower fees, but not so good for the patient. With a consumer-driven plan, and especially with an HSA, patients may go to any health provider they choose so long as the provider is duly licensed and providing a service recognized as a health care expense by the IRS.
Federal and state governments should consequently promote such HSAs as much as possible. HSA options should be allowed for the above Medicaid vouchers. Seniors should be allowed an HSA option in Medicare Advantage. And consumers should be allowed to contribute at least as much to their HSA savings account each year as the deductible on their health insurance.
The Medicaid vouchers discussed above would also reduce the cost of health insurance by transferring Medicaid patients to the private insurance market, ending the cost-shifting to private insurance that currently results from the steep underpayment of doctors and hospitals under Medicaid. In other words, you will see your health insurance premiums go down under such reform because part of what you are paying today is being used to cover the services provided to Medicaid patients, which the government is not paying for despite its promises.
No Rationing
Republicans should move quickly to join together behind this common sense reform package, and communicate it to the public. They should aggressively seek to join with moderate Democrats who want to solve problems rather than promote government power. Conservative and grassroots activists should support such Republicans and Democrats in truly bipartisan collaboration, and help to communicate the message of real, constructive reform.
But Republicans and these new Democrat reformers must stay away from any reform component of any kind providing for health care rationing. These include fixed health care budgets, accountable care organizations, pay for performance, comparative effectiveness dictates, or "cost effectiveness" regulations, among others. This was the main source of grassroots revolt over health reform, and any new reform proposals will be closely monitored by grassroots watchdogs to raise a new angry revolt if they continue to be included. Republicans in particular are vulnerable to third party challengers if they cross the grassroots over this.
Instead, government policy should seek to maximize incentives for investment to maintain the most advanced, cutting edge, high-tech health care system in the world. Americans rightly want access to the latest possible miracle cure drugs and medical technology. Policymakers should tend carefully to maximizing incentives for health care innovation and breakthroughs, taking maximum advantage of rapidly advancing modern medical science. This is a central component of the high standard of living Americans expect, and demand.
The California Senate approved creating a government-run health care system for the nation's most populous state on Thursday, ignoring a veto threat from Gov. Arnold Schwarzenegger. Supporters said it is time for state legislatures to take up the debate as the Obama Administration's national health care proposal falters in Congress. "If it's not to be done at the national level, let us take the lead," said state Sen. Christine Kehoe, D-San Diego.
The move in California comes after Massachusetts voters changed the calculus in Congress by electing a Republican to the Senate who opposes the pending plan.
Democrats are the majority in both houses of the California Legislature. The 40-member state Senate passed the single-payer plan on a 22-14 vote, sending it to the Assembly. One Democrat voted against the measure.
Schwarzenegger promised to veto the proposal, as he has two similar plans that previously reached his desk. Spokeswoman Rachel Arrezola cited the state's massive budget cuts and looming $20 billion deficit in arguing the state cannot afford to shift to a single-payer health care system. "Any elected official who thinks it's a good idea to strap the state with tens of billions of dollars from a government-run health care system is clearly not in touch with what voters need and deserve," Arrezola said.
The proposal by Sen. Mark Leno, D-San Francisco, authorizes $1 million to establish a commission that would decide how to pay for the system. The funding plan would ultimately have to be approved by voters. Leno argued the state-run plan would replace the $200 billion Californians already pay for their health care while eliminating insurance companies' share. He previously said the system could use existing state and federal money and a payroll tax, coupled with increased efficiencies from a government-run system. "We are spending $200 billion currently," Leno said. "It is the same $200 billion used in a more efficient, cost-effective fashion."
Republicans derided the timing of the vote, saying Democrats are ignoring the lesson in Massachusetts at their political peril. "This plan is to the left and radical of what couldn't get out of Washington," said Sen. George Runner, R-Lancaster.
Senate President Pro Tem Darrell Steinberg said Republicans refused to support even a $14.7 billion health care reform bill that Schwarzenegger, a Republican, negotiated with Democratic leaders two years ago. "Not a single Republican vote — so what are you for?" asked Steinberg, a Democrat from Sacramento who usually strikes a conciliatory bipartisan tone. "The demagoguery needs to be answered and addressed."
Schwarzenegger's proposal actually was undone by Democrat Don Perata, Steinberg's predecessor in the Senate, when he ordered a financial review that found the plan would be billions of dollars out of balance within a few years.
Australian public health spending on course to disaster
KEVIN Rudd has declared 2010 a year of "major health reform", warning that health spending alone will outstrip state tax revenues within two decades. In the latest in a series of speeches in the lead-up to Australia Day, the Prime Minister yesterday warned that Australia faced the choice of cutting pensions, health services and aged care; running massive deficits; or, his preferred option, boosting productivity as the population aged to help lift tax revenues.
Mr Rudd told a reception in Sydney that the states' health spending was already growing at 11 per cent a year compared with revenue growth of 3 to 4 per cent a year. "Rapidly rising health costs create a real risk (that), absent major policy change, state governments will be overwhelmed by their rising health-spending obligations," he warned. "If current spending and revenue trends continue, Treasury projects that the total health spending of all states will exceed 100 per cent of their tax revenues, excluding the GST, by around 2045-46, and possibly earlier in some states. That is why 2010 must be and will be a year of major health reform."
The big-ticket item remains a new carve-up of commonwealth and state responsibilities to fund and run the nation's public hospitals, with pressure on the federal government to act at next month's Council of Australian Governments meeting. The Rudd government promised during the last election campaign to take over hospitals if the states failed to lift their game by this year. The Prime Minister must now decide whether to embrace a single-funder model for hospitals, with the commonwealth to fund health facilities, but the states to run them.
Mr Rudd said growing health-spending pressures would account for two-thirds of the total projected increase in government spending over the next 40 years. "Forty years ago, Australian government spending on health equated to 1.2 per cent of gross domestic product," Mr Rudd said. "In 2010, Australian government health spending equates to 4 per cent of GDP. And the Intergenerational Report projects that it will rise to 7.1 per cent in 2050. "In dollar terms, that's an increase of over $200 billion by 2050 and equates to an increase in average Australian government health spending per person in real terms from $2290 today to $7210 in 2050."
Australian Medical Association president Andrew Pesce said a single funder would help stop some of the blame game between the states and the commonwealth. "When things go wrong, the states blame the commonwealth," Dr Pesce said. "If there's a single funder, at least you know who is responsible for the money. The commonwealth would be the insurer or purchaser of healthcare and the states would run hospitals."
Mr Rudd surprised and angered health groups by failing to deliver a new agenda on health reform at last month's COAG meeting in Brisbane, but the issue is expected to take centrestage when premiers hold their next meeting, next month. Beyond the central issue of who funds and runs public hospitals, other items to be discussed include primary care and who, other than doctors, should have access to Medicare payments -- such as nurses. There is also a push by aged- care providers again to introduce some form of high-care nursing home bonds and reforms to help fund new infrastructure needs as the population ages.
Health groups have recently complained their patience is wearing thin as the government fails to act on promised reform. But senior Rudd government sources argue the Prime Minister was deliberately taking his time to get the policy right.
In the short term, the rising costs will make for another tough budget for Health Minister Nicola Roxon, who must deliver new spending cuts after targeting private health insurance rebates, IVF and cataract surgery in the last budget.
British centrist party calls for tighter rules on foreign doctors
The Liberal Democrats have launched new proposals to tighten rules on the employment of foreign doctors after the death of a 70-year-old man treated by a doctor from Germany. Norman Lamb, the party's health spokesman, called for a series of reforms including a national language and competency test for every doctor wishing to work in Britain.
The demand comes after David Gray, from Manea, Cambridgeshire, died after he was given more than 10 times the recommended daily dose of diamorphine by Daniel Ubani, a locum doctor from Germany. Dr Ubani, 67, had been on his first shift working for an out-of-hours medical service when the overdose was administered on February 16, 2008, an inquest into Mr Gray's death has heard.
The Liberal Democrats said the reforms should include making sure that a suspension in one country is effective across the European Economic Area - covering the European Union, Iceland, Liechtenstein and Norway.
There should also be a criminal offence created for a primary care trust to allow a doctor to operate without ensuring compliance with regulations, the Liberal Democrats said. Mr Lamb said: "The tragic death of David Gray raises serious concerns about the safety of out-of-hours care in this country. "We cannot allow a situation to continue where we are reliant on tired, overworked foreign doctors to cover out-of-hours care.
"Patients' lives are being put at risk because standards across Europe are not uniformly good and foreign doctors can practice in the NHS without a test of competence and language. "Ministers have known for some time that the safeguards in place were not adequate but they have completely failed to take action. "These proposals will ensure that every doctor working in this country can speak English, is familiar with our health service and is well trained."
The General Medical Council (GMC) currently applies a test for English language proficiency and clinical skills to doctors from outside the European Economic Area before granting registration to work in the UK. But it cannot apply the same set of tests to doctors from within the EEA - a situation described as "profoundly unsatisfactory" by Niall Dickson, chief executive of the GMC.
In the wake of Scott Brown's astounding win last week in Massachusetts, President Obama has been backpedaling faster than Darrelle Revis on health-care reform, telling reporters that Congress should "move quickly to coalesce around" parts of the health-care bill that both parties can agree on, "core elements" such as insurance reform. That might be more popular politically, but it still won't work.
Take one "core element": prohibiting insurers from turning down customers with "pre-existing conditions" or charging more to customers who become sick. A bill to simply ban such practices might attract support from such GOP moderates as Maine's Olympia Snowe and Susan Collins. But the "reform" would wind up pushing millions of people off the insurance rolls — and New York state provides the proof.
The term "pre-existing condition" simply means people who are already sick. But if you can wait to buy insurance after you get sick, who'd ever buy insurance while they're healthy?
Requiring insurers to charge the same premiums to the sick and the healthy compounds the problem: Premiums would fall for older and sicker customers — but rise for the young and the healthy. Knowing that they could always buy a policy after falling ill, many young people would drop out of the insurance market. (Indeed, these "young invincibles" already make up the largest part of the uninsured.)
New York provides an object lesson: It enacted precisely these "reforms" in 1993. The next year, roughly 500,000 people canceled their insurance, according to a study by the actuarial firm of Milliman & Robertson.
With the young and healthy dropping out of the insurance pool, premiums will have to rise to cover the now-sicker insured population. That, in turn, will encourage more healthy people to drop out, raising premiums still further — and so on, in what's known as the "adverse-selection death spiral." The only solution would be to mandate that everyone buy insurance. But, as the last year's debate has shown, that creates all sorts of problems:
* To mandate that people buy insurance, the government has to define what insurance is. (I'm pretty sure my policy with the $1 million deductible won't qualify.) This opens the door to all manner of special interests demanding to be part of the required benefits. People would be unable to keep their current plans, but would have to buy new, probably more expensive, policies that met government specifications.
* If the government is going to force people to buy insurance, it'll have to subsidize insurance for those who can't afford it. Covering those costs means new or higher taxes for someone. And subsidies without cost controls will break the bank (as they're doing now in Massachusetts) — so the government will have to impose price controls or restrictions on care.
Before you know it, "mini-me" ObamaCare has morphed back into the full-blown version.
Democrats have boxed themselves into a corner. The public has rejected their plans for a government takeover of the health-care system — but giving up would mean admitting that they just wasted a year on a bill that didn't even pass. They'll be tempted to try to pass something — anything.
Alas, "anything" so far doesn't include the type of free-market reforms that could actually solve some of these problems. For example, if Democrats really wanted to deal with the problem of pre-existing conditions, they'd support expanded state high-risk pools. Better yet, they'd offer the same tax break to people who buy their own insurance as we give to employer-provided insurance. Moving to personal, portable insurance means that people who lose their jobs would no longer automatically lose their insurance — so pre-existing conditions would be far less of an issue.
And, if Democrats want to create an incentive for the young and healthy to buy insurance, they could eliminate costly mandated benefits that makes insurance a poor deal for the young.
But Democrats seem determined to prolong the agony — trying to force through some version of their top-down, command and control, government-directed approach no matter how often Americans say "No!" We can only hope that sooner or later they'll get the message — and start over with something that will actually work.
This is the sound of President Obama's health-care reform bill crashing to earth: Senate Majority Leader Harry Reid on Tuesday: "We're not on health care now. We talked a lot about it in the past." Democratic Sen. Dianne Feinstein: "It's a time out."
The bill's advocates can't believe this is happening. They elected a popular and charismatic Democratic president. With him came a filibuster-proof congressional majority. Done deal. Write the bill, vote it into everlasting life, and burn votive candles to Franklin Roosevelt's unfinished national entitlement legacy.
After seven nonstop months ObamaCare is failing, just as ClintonCare failed after a year's effort in 1994. It's clear there is something inherently wrong in what the Democrats have been trying to do here. What is it? The answer lies in the often-repeated phrase that they are trying to reform "16% of the American economy." Why would anyone think it possible in 2010—as politics, economics or mere practical feasibility—to reorder 16% of a $14 trillion economy of 300 million people living in 50 separate states whose geography is 16 times larger than France?
The Obama reformers are driven by the idea that their bill would fulfill a dream running back 70 years to 1939, when FDR failed to win passage of a universal health-care bill. But this isn't 1939. It's not even 1994. American health care, whatever its defects, is today unimaginably complex. What the Democrats are trying to do isn't just difficult. It's impossible.
According to data compiled by Hoover's business research from the U.S. Census, the health-care industry consists of 340,650 separate establishments employing 5,508,926 people. I leave it to a mathematician to calculate the number of possible economic relationships this would produce every day, much less annually . We have 512,000 physicians and surgeons, 2.2 million registered nurses and a galaxy of different jobs orbiting around them. Some 36% of these are in individual physicians' offices.
One of the jewels of this collection of professionals, which the politicians say is "failing" us, is the U.S. medical-device industry. It has come a long way since the days of "The Clinic of Dr. Gross" in Thomas Eakins's famous painting. There are 8,616 separate medical-device companies in the U.S., employing 359,065 people. Within the device industry, its two largest categories are electronic and precision equipment and surgical appliances. These are the wizards of American medicine.
The president says the special interests oppose his bill. But to pay for the bill, Congress would levy a $2 billion annual tax on the medical-device industry, which ardently opposes the legislation. Let's pick a state. How about suddenly famous Massachusetts. The Massachusetts Medical Device Industry Council lists more than 220 companies as primary members. They have weird names like Aeris, ExtruMed, Bioxcell and WunderThink. Yet the Democrats are agog that Massachusetts voted Scott Brown into the Senate.
Harvard Medical School Dean Jeffrey Flier said of the health-care bill in these pages recently that "our capacity to innovate and develop new therapies would suffer most of all." And that's the high-minded criticism of the bill. Down at the level of simple retail politics what you see are tens of thousands of separate health and medical interests that understandably are in motion because of this bill's determination to change everything in American health care.
The president and his health-care advisers are giving philosopher kings a bad name. Only people who have reduced American health care to rows and columns of data in academic studies would think it possible to remake this incredibly sophisticated organism as easily as rebooting a spreadsheet. You can't do it.
Meanwhile, press reports this week also noted that Mr. Obama's "comprehensive climate bill" is being down-sized to something that can pass Congress. Same problem.
Barack Obama is 48 years old, a "young" president. But in a sense, he is an old 48-year-old. The House leadership, the committee chairmen leading his agenda, are old guys from the 1960s and '70s. The so-called progressive Democrats who make up his core base are essentially a labor movement stuck in a one-size-fits everything industrial model from the 1930s.
It is a revealing irony that the other big story this week is the phenomenal steady success of Apple's iPhone, the result of a basic platform opening itself to a zillion application companies. Probably 90% of those tiny app firms voted for Barack Obama, whose idea of how the world actually works could not be less like their own.
Senate Minority Leader Mitch McConnell's suggestion that Mr. Obama start over is better advice than he knows. Refashioning America's terrific health-care industry from basic platforms might even be exciting. That won't happen. The Democrats will ride their, and Mr. Obama's, 70-year-old national-entitlement dream straight to November, and over the cliff.
Can we have “universal” medical care without coercion?
The recent loss of what supposedly was a “secure” U.S. Senate seat by Democrats in Massachusetts has triggered a firestorm of speculation about the future of the Democrats’ “health care” bill. For the current legislative season, so-called ObamaCare looks to be dead or at least dormant.
“Politically dead” is a temporal term, however, and there is no doubt that President Obama and his congressional allies are going to formulate an alternative strategy and then try once again to ram “universal care” through the legislative process. In this piece, I don’t deal with the politics of universal care, but rather with the larger collectivist and coercive reasoning that accompanies its implementation.
Ever since the Progressive Era, Americans have been told that there is a difference between “good government” and “bad government.” “Good government” provides all sorts of services that poor people cannot afford, such as medical care, transportation, housing, education, and even food. (“Bad government” arrests, imprisons, and generally acts like an occupier.)
Obviously, “universal care” falls under the “good government” label, and when conservatives or libertarians complain about “government on our backs,” the “Progressives” are quick to reply that government “gives” us all sorts of goodies that we never would have unless there were intervention by the State. While this sounds good, I remind readers that government provides nothing without coercion, so when someone speaks of “good government,” that person really is claiming there is “good coercion.”
What comprises “good coercion”? It is the application of force that supposedly serves a “greater public good,” the “greater good” being medical insurance for those who did not have insurance before. Clearly, a philosophical issue is before us. Should government force someone not only to pay for health insurance for someone else (through taxation), but also to purchase a government-approved health insurance policy for himself?
Advocates of such coercive measures are quick to accuse private enterprise of being “exploitative and oppressive.” (Listen to a speech by Ralph Nader or read the latest issue of The Nation or the editorial page of the New York Times.) Something does not quite make sense, however.
No one has forced me to purchase the vast amount of things that I own and use. Instead, I choose to purchase them, and that includes health insurance. (I would prefer that the health system not be dominated at all by third-party payments, so I could purchase insurance for potential catastrophic events, but nonetheless I do purchase my insurance voluntarily.)
Contrast what I just have described to the purchase of government-produced goods. As a taxpayer I am forced to pay (on pain of arrest and imprisonment) for products that other people use, from roads (which, at least, I use myself), public schools, Social Security and Medicare, and, of course, “national defense.” It does not matter if I wish to use those products or support them; I have no choice but to help pay for them.
Thus it is with “universal” medical care. The plan is for the government to force everyone to purchase an “insurance plan” and pay for others to purchase such plans as well. No one is permitted to opt out (unless one is part of an old-order Amish sect).
Proponents of such a policy claim that unless everyone is forced to participate, the system will not provide “equal care,” and therein is the lynchpin of the whole system. From taxation of “Cadillac” plans to forcing everyone, regardless of health, to purchase policies, the government is attempting to enforce an egalitarianism that is in the best interests of no one but the political classes.
There is no way that the plan can make everyone better off. Instead, like so many other tax-and-spend schemes, it seeks to make some people better off by making a lot of other people worse off, and such a plan can be put into place only with brute force. It is a truism in economics that people won’t deliberately and knowingly make themselves worse off. The political classes know it, and perhaps maybe others are beginning to understand.
The Left-leaning writer below is not buying the Democrat excuses for failure
"Communications failure" is the phrase being used by the White House and assorted commentators to explain the collapse of health care reform and other parts of President Obama's agenda. According to this reasoning, Obama hasn't pursued the wrong goals. He has simply failed to articulate them. And tonight's State of the Union could somehow change that.
There are two problems with this theory. First, it's not as if the administration has failed to articulate its message. Second, even if it has, it's unlikely the State of the Union will make a difference.
Obama himself seems to subscribe to the notion that no one is listening. "What I haven't always been successful at doing is breaking through the noise and speaking directly to the American people in a way that during the campaign you could do," Obama told ABC's George Stephanopoulos after Republican Scott Brown's win in Massachusetts last week. Spokesman Robert Gibbs, meanwhile, argued on Tuesday that the administration was out-communicated by its opponents. Health care reform "became a caricature of its component parts," Gibbs said.
In one sense Gibbs is right: Ever since the inauguration, and especially since the health care debate began in earnest in the fall, the Obama administration has done nothing but communicate. Between the town halls, the weekly presidential addresses on YouTube, the prime-time speech on health care to a joint session of Congress, and the constant hawking of the administration's line on cable news—all of which drew charges that Obama was "overexposed"—it's hard to say that the White House hasn't done enough talking. Yet certain memes—"death panels," anyone?—took hold despite the administration's efforts.
So "communications failure" seems too pat an explanation for the collapse of the administration's plans for health care reform. It's an easy political fall-back. When something doesn't go your way, it's not because of a flaw in the policy. It's not because you failed to organize your supporters. It's because you failed to articulate your goals and why they're important. In the spectrum of political failings, it's the least blameworthy, since it leaves open the possibility that people just don't get it.
There are more plausible—and just as easy!—explanations. One of the best is that the administration has simply been battered by a series of unfortunate events. If Ted Kennedy had not died when he did, there would be no talk right now of a "communications failure." Same if Martha Coakley had run a better campaign. Or if Senate Democrats had not spent so long trying to court Republican votes that never materialized. If these events hadn't played out the way they did, we'd be talking about Obama's patience, Rahm Emanuel's diplomacy, and the White House's shrewd communications strategy.
What must be frustrating to the administration is that its talking points are hardly unique. Most independent experts, including the Congressional Budget Office, say that both the House and Senate versions of health care reform would reduce the deficit. The White House has repeated this numerous times. Yet 68 percent of Americans believe it would increase the deficit. The CBO says that reform would be fully paid for, be it through taxes on the wealthy or a tax on so-called "Cadillac" plans. Obama mentions this often. Yet more than 75 percent of Americans think it would lead to higher taxes for the middle class. Perhaps the most telling contradiction is that while many Americans believe that reform would improve care, costs, and access for the country as a whole, they think it would hurt them personally—a logical conundrum, if not an impossibility. The White House may be suffering from a communications failure, but it's not for lack of talking.
An alternate theory, of course, is that Americans hear quite well what Obama is saying, thank you—they just don't believe him. If that's the case, then he may need more than a single speech to turn sentiment around.
Congressional leaders are taking health care legislation off the fast track as rank-and-file Democrats, wary of unhappy midterm election voters, look to President Barack Obama for guidance in his State of the Union address. House and Senate leaders said Tuesday they need time to determine the best way forward on health care in the wake of last week's special election loss in Massachusetts, which cost Democrats their filibuster-proof Senate majority.
Obama is not expected to offer a specific prescription in Wednesday night's speech, but Democrats want to hear him renew his commitment to the health care overhaul he's spent the past year promoting as his top domestic priority. It is now badly adrift, and lawmakers want to stop talking about the divisive topic and move on to jobs and the economy, the issues they say preoccupy their constituents.
"The president effectively will hit the reset button (Wednesday) night, after which we'll have a matter of weeks, not months to get this right," said Rep. Anthony Weiner, D-N.Y. "We're reaching the point where our momentum is clearly stopped already," Weiner said. "If we're going to do this, I think we have to do this soon."
Not so, according to Senate Majority Leader Harry Reid, D-Nev. "We're going to find out how to proceed," Reid told reporters Tuesday. "But there is no rush."
The House and Senate separately passed 10-year, nearly $1 trillion bills last year to remake the nation's medical system with new requirements for nearly everyone to carry health insurance and new regulations on insurers' practices. Negotiators were in the final stages of reconciling the differences between the two measures before last week's GOP upset in the race for the Senate seat long held by the late Edward M. Kennedy. Democrats acknowledge that opposition to the health care remake in Washington helped spark the Massachusetts revolution.
Democrats now have four options for moving forward, said House Majority Leader Steny Hoyer: no bill; a scaled-back measure designed to attract some Republican support; the House passing the Senate bill; or the House passing the Senate bill, with both chambers making changes to bridge their differences.
House Speaker Nancy Pelosi has ruled out passing the Senate bill with no changes, and no Democrats are publicly advocating abandoning the effort altogether, though Rep. Stephanie Herseth Sandlin of South Dakota, a leader of conservative House Democrats, said some conservative Democrats would prefer to do just that.
The option attracting the most attention is for the House to pass the Senate bill with changes. Rep. Jim Clyburn of South Carolina, the No. 3 Democrat, told reporters Tuesday he thinks the House could do so if lawmakers get rid of provisions like special Medicaid deals for Louisiana and Nebraska and dial back a tax on high-cost insurance plans opposed by labor unions.
But two centrist senators threw up a roadblock to the approach, because it would require using a special budget-related procedure to go around Republican opponents in the Senate, a calculated risk sure to inflame critics on the political right. Sens. Evan Bayh, D-Ind., and Blanche Lincoln, D-Ark., who both face re-election this year in Republican-leaning states, said they would oppose taking that step.
The strategy requires only 51 votes to advance, but Senate leaders may not be able to round up the support. Even if they do, final action could stretch into late next month or beyond. And a number of Democrats sounded Tuesday like health care was the last thing they wanted to be dealing with. "If someone's losing their house, lost their job, the last thing they care about is their next door neighbor's health care," said Rep. Shelley Berkley, D-Nev. "Health care isn't the No. 1 issue on their minds. If it's not the No. 1 issue on my constituents' minds, it's not the No. 1 issue on my mind."
I’ve long said that the magic number to kill Obamacare was %35. But with the election in Massachusetts, I think %38 will do. From the story:
Only three in ten Americans say they want Congress to pass legislation similar to the health care reform bills that have already been approved by the House and Senate, according to a new national poll. A CNN/Opinion Research Corporation survey also indicates that nearly half the public, 48 percent, would like federal lawmakers to start work on an entirely new bill, and 21 percent feel Congress should stop working an any bills that would change the country’s health care system.
Devastating. What a debacle. Why? Because they made the same stupid blunder as Hillary Clinton did in 1993. Unbelievable.
For the good of the country, it is time for President Obama, Speaker Pelosi, and Leader Reid to pull the plug on this monstrosity and start anew with a more targeted reform. Or, they can tear the country apart–and destroy their own political fortunes–by forging arrogantly ahead in total disregard of public opinion. Politically, I’d rather they did the latter. But too many people need help, so I am rooting that they finally gain wisdom and pursue the former course.
Whereas the Obamans want us to have less health care, the movie “Extraordinary Measures” wants us to have more medicine, more cures
Here’s a paradox of liberalism: Hollywood hurts the Obama health care plan more than it helps. Hurts it a lot more. But how could that be, one might ask, when everyone knows that studio moguls, as well as actors and writers, are solidly “blue” in their politics--and in their campaign contributions? The answer is this: Yes, Hollywoodites think liberal, but when it comes to making movies, they think a bit more conservatively. More precisely, they think in terms of what real people will want to see, and that pushes in a center-right direction, which is where the country is.
Oh sure, they might give a few thousand dollars to chic liberal Democrats every couple of years, but when it comes to spending tens of millions on a movie--in hopes of making a lot more than that in return--they are a good deal more, well, conservative. A case in point is the new film, “Extraordinary Measures,” starring Brendan Fraser and Harrison Ford. The movie is an out-and-out tribute to science, family values, and, yes, entrepreneurial capitalism. Obamacare, with its emphasis on bureaucratic rationing and government control, is nowhere to be seen.
If the Obamans had stopped to think about the implications of such a movie being made in 2010--released by CBS Films, no less--they would have realized that their fundamental approach to healthcare is wrongheaded, at odds with the way that Americans think about health issues. Whereas the Obamans want us to have less health care, “Extraordinary Measures” wants us to have more medicine, more cures.
“Measures” tells the mostly true story of John Crowley, a business executive whose two children were diagnosed with Pompe Disease, a degenerative neuromuscular disease that paralyzes, then kills, its victims, usually before their 10th birthday. In other words, it is a horrible disease, fully worthy of a massive effort to cure it; “I wish we had a drug to treat Pompe,” one character says early on--“but we don’t.” And so the issue of health insurance, while important, is not as important as the issue of cures. If there’s no cure for Pompe Disease, children die a painful death--and an expensive death, involving lots of time in hospitals, lots of expensive therapy equipment. But if here is a cure, the children can grow up to become productive citizens.
As for John Crowley, he did something truly daring and capitalistically heroic--right out of an Ayn Rand novel. Starting with $100,000 of his own money, he quit his job and started a company to make the cure for Pompe and so save his children. And it worked--let’s hear it for capitalism and freedom. Fictional composites aside, this is basically a true story, as recorded by a Wall Street Journal reporter, Geeta Anand, in her 2006 book, "The Cure: How a Father Raised $100 Million--And Bucked the Medical Establishment--In a Quest to Save His Children."
And so yes, it’s an inspiring story of family love and duty--although, of course, Hollywood has made many movies in the past out of similar stories. “Magnificent Obsession,” about a man who goes to medical school to restore the sight of the woman he loves, has been made and remade--although, to be sure, most medical dramas coming out of Hollywood go to TV, where for half a century, dramas ranging from “Dr. Kildare” to “Marcus Welby” to “ER” to “House” have emphasized heroic doctors, practicing heroic medicine. Indeed, the currently running “House,” about a crazy-brilliant doctor who breaks all the rules in his determination to cure his patients, is rated as the most popular television show in the world.
So if people love medical drama, focusing on cures, then Hollywood loves medical drama, focusing on cures. Show business is, after all, a business.
But politics is a business, too, and so one would think that politicians would know what they are doing. But maybe not. Obamacare, like Clintoncare before it, is bureaucratic and boring. And that’s on a good day. Last August, The Nation’s Chris Hayes, a liberal-leftist supporter of Obama, perfectly described what the Obamans had done to the health care issue:
In its health care messaging, the White House has taken an issue more intimate and immediate than perhaps any other in a voter’s life and transformed it into an abstract, technical argument about long-term actuarial projections. It’s a peculiar kind of reverse political alchemy: transforming gold into lead.
Turning gold into lead--not at all what Hollywood is about. If there’s one thing Hollywood prides itself on, it’s getting bottoms into seats, and eyeballs onto screens. And if that takes drama and excitement, so be it: The show must go on.
One might think that at one of those posh L.A. fundraisers, some Tinseltown type would have taken Obama aside and said, “Look, your whole campaign is about ‘hope.’ Hollywood movies are about hope; 98 percent of the time, the picture ends happily. So enough with the bureaucrats and the ‘death panels’--give the folks some reason to hope! Talk about cures! A cure for breast cancer. A cure for Alzheimer’s. For Parkinson’s. A cure for spinal cord injuries and paralysis--that would play with families of war veterans. Pick one of those; trust me, it’ll play well in Peoria, especially if we get Michael J. Fox involved. And then, once you have the trust and confidence of the folks, you can pile on with the rationers and price controls!” In other words, the mogul might have said, turn Obamacare into a movie with a happy ending--not a sorry and scary show starring Kafka-esque bureaucrats.
But if anything like that conversation occurred, the Obamans didn’t listen. Like the Clintonites two decades ago, they charged ahead with a health care plan that bombed.
Now as it happens, “Extraordinary Measures” has received mostly weak critical reviews, and is not doing particular well at the box office. Perhaps the disease, Pompe, is too obscure. Perhaps, as noted, TV has absorbed the huge market for “true med” stories. So there might not ever be a sequel to “Measures.” But here’s a safe bet: No matter how much they might love Obama, Hollywood execs will never greenlight “Obamacare: The Movie.”
In the days since the Massachusetts vote, liberal columnists and bloggers urge Democrats to fight one last battle to save Obamacare. In his Friday column, economist Paul Krugman writes in the New York Times that House Democrats must recognize their “moment of truth.” He implores them to vote for the Senate healthcare bill and “do the right thing.”
47 health policy experts endorsed this position, writing an open letter to the President. In The New Republic, Prof. Harold Pollack of the University of Chicago, one of the letter signers, notes that: “we are so close to enacting a historic reform.”
Former Democratic speechwriter Michael Cohen, writing in the New York Daily News, implores Democrats to act now. He recognizes that they will need to “swallow their pride and vote for the health-care bill that passed the Senate without much change” but suggests it’s all worth it.
These arguments have been echoed across the blogosphere.
As I noted last Tuesday, there are still options on paper to pass Obamacare this year. The most plausible one: to get the House to drop conference negotiations with the Senate, and simply pass the Senate bill. Krugman, Pollock, and Cohen all endorse this approach. It seems that the White House is at least flirting with a variant of the idea. The reality, however, is that the war is over. Obamacare was lost the moment that the Democrats managed to lose even Massachusetts.
Democrats are still in a state of shock. They shouldn’t be. They spent 2009 crafting bad legislation.
The White House’s determination to swiftly pass health reform, and to pass it along partisan lines, meant that all meaningful policies were abandoned in the process. Health reform was supposed to be about reducing premiums for working Americans; every CBO estimate has suggested that premiums would in fact rise with the proposed legislation. President Obama has spoken time and again about the need to “bend the curve of rising health costs.” The White House half-heartedly embraced ideas that would rein in rising health costs, and then quietly negotiated away these provisions in the different drafts before Congress. Even a federal agency estimated that costs would increase under Obamacare. The promises of greater competition? By the time the Senate finally got around to passing its bill, the national health insurance exchange (modeled after the health benefits enjoyed by members of Congress) was whittled down to 50 unworkable state exchanges.
It should never have gotten to this point. The surprise wasn’t that the people of Massachusetts rejected this problematic legislation – it’s that the White House didn’t put the brakes on the process earlier.
In the coming days, we can expect Democrats to do little. They will blame others for their loss in Massachusetts; they will scheme about the possibility of passing some legislation this year; they will fantasize about a shift in public opinion. Ultimately, the White House will need to make a decision. Either they abandon all efforts or they reach across the aisle.
In 2009, the President worked with Democrats in order to craft popular and needed legislation to reform American healthcare. By this January, he couldn’t even persuade the people of Massachusetts as to the value of his efforts – in a state where registered Democrats outnumber Republicans 3.5 to 1, in a state that he himself won by more than 26% just over a year ago. In other words, while working with his allies, he didn’t achieve anything close to success.
A bipartisan effort, however, won’t give him everything he wants, but it may give him some sensible legislation. On Wednesday, when he delivers his State of the Union address, we’ll get a first taste of the post-January 19 presidency. Will he be feisty but irrelevant? Or will we enter into a period of post-partisanship, as he’s promised before?
Regulations will jack up costs and the number of uninsured
Democrats are in turmoil. In the wake of last week's Republican Senate victory in liberal Massachusetts, there's no agreement about what to do with the government health care bill. A dazed Speaker Nancy Pelosi admitted she didn't have the votes to pass it in the House, but House Majority Leader Steny Hoyer and Senate Majority Whip Dick Durbin still seem determined to ram it through.
President Obama and some other Democrats are putting out sounders about scaled-down health regulations. Striking his new populist pose, Mr. Obama told ABC News, "We know that we need insurance reform, that the health insurance companies are taking advantage of people." The problem with the president's anti-business stance is that if enacted into law, it will destroy private health insurance.
You don't have to take our word for it. Liberals like New York Times columnist Paul Krugman are warning about the president's suggestion. Regarding the regulation to forbid insurance companies from taking into account preexisting health conditions, Mr. Krugman wrote, "healthy people [will] choose to go uninsured until they get sick, leading to a poor risk pool, leading to high premiums, leading even more healthy people dropping out." In other words, proposed regulations would produce more uninsured Americans and higher insurance costs.
To illustrate how bad this idea is, imagine if motorists could buy automobile insurance right after an accident and then were allowed to drop it once the car was fixed. Without revenue from regular premiums, insurance companies couldn't cover all the claims and would go under.
In the current Senate bill, people who didn't buy insurance would be fined on an escalating scale that would start at $200 in 2014 and peak at $750 by 2017. In 2008, the average price of an insurance policy was $4,704 for individuals and $12,682 for a family of four. It's not hard to see how quickly private insurance companies would go bankrupt with those numbers.
Some Republicans are tempted to support this faux reform. If they do, they will share the blame with Democrats for the impending insurance collapse.
Democrats look different these days. They look thinner. Last week, they lost their sixtieth vote in the Senate to Massachusetts Senator-elect Scott Brown. But Brown’s victory is only the latest bruise. Three weeks ago, North Dakota Senator Byron Dorgan and Connecticut Senator Chris Dodd announced their retirements. And last month, Alabama Congressman Parker Griffith switched parties.
True, more Republicans are planning to retire from Congress than Democrats—for now. But conservative Democrats who voted for Obamacare look pale for some reason. Maybe they’re sweating the fact that in Rasmussen Reports’ exit polls from last week’s election, 56 percent of voters said that health care was the most important factor in their decisions, and 51 percent opposed the Democrats’ plan—in Massachusetts.
Democrats’ troubles stem from their handling of health care, an issue on which their arrogance is patent. The Democrats’ proposal arrogates to themselves control of a sixth of our economy. They demand that insurers disregard preexisting conditions but that insurers distinguish between the sick and the healthy because the former are more expensive. If insurers cannot charge different prices, they’ll charge the healthy more to cover the difference. And if plans prove too pricey, the healthy will drop them, sucking money from the pool and raising premiums for the sick. So Democrats want everyone to buy coverage or face a fine, yet the fine they’ve prescribed is too low to deter dropouts. A higher fine, they fear, would provoke outrage.
On top of this morass, Democrats assert that their plan, which subsidizes about 30 million people so that they can afford coverage, will lower the deficit. Fears of higher taxes and bigger deficits, they sneer, are unfounded. Their reasoning? The Congressional Budget Office (CBO) says so. But they raise taxes to pay for the subsidies—a surcharge on the rich in the House of Representatives, a tax on “Cadillac plans” in the Senate—taxes that could have gone exclusively to reducing the deficit. And the CBO warns that the deficit will lessen only if Congress cuts billions from Medicare. Yeah right.
Yet Democrats scoff at critics. Republicans, they say, offer criticism but no solutions. What about Arizona Congressman John Shadegg’s proposal to allow people to buy insurance across state lines? Or Wisconsin Congressman Paul Ryan’s offer to tax employer-provided insurance and provide tax credits for individual coverage? Or Arizona Senator John McCain’s push for caps on exorbitant lawsuits against medical malpractice? Or former Massachusetts Governor Mitt Romney’s suggestion that states lift their mandates on insurers that force them to cover particular services—like in vitro fertilization?
“Please, Republicans are tools of Big Business,” they counter. Really? Pharmaceutical Research and Manufacturers of America (PhRMA) authorized its lobbyists to spend $150 million on television commercials in support of President Barack Obama’s plan. Democrats had to bribe Louisiana Senator Mary Landrieu and Nebraska Senator Ben Nelson with millions of dollars in funding to their states for their votes. And President Obama had to break his pledge to broadcast negotiations on C-SPAN, because the more people learn about his plan, the more they dislike it.
Besides their unworkable policies and their weak counterarguments, Democrats demonstrate arrogance with their flabby campaigning. “Republicans are culture warriors,” Democrats used to tell us, “who attack candidates’ personal lives to avoid discussing issues.” Yet Virginia State Senator Creigh Deeds, the Democrats’ failed gubernatorial candidate, aired television ads attacking his Republican opponent, Virginia Governor Bob McDonnell, on his graduate thesis. President Obama, when he campaigned in Massachusetts for the Democrats’ failed senatorial candidate, Massachusetts Attorney General Martha Coakley, ridiculed Brown’s pickup truck. Coakley herself stressed Brown’s party label, believing his association alone could sink him. This year, Democrats are the culture warriors.
After these candidates flopped, Democrats patronizingly blamed their misfortunes on voters’ “anger.” “People are angry, and they’re frustrated,” Obama told George Stephanpoulos, “not just because of what’s happened in the last year or two years, but what’s happened over the last eight years.” This tactic smells stale. In 1994, Peter Jennings, then-host of ABC Nightly News, said voters threw a “temper tantrum” after Republicans won control of Congress. And Time magazine declared on its cover that Newt Gingrich had “perfected the politics of anger.” Democrats dismiss disagreement as mere emotion.
So here’s my plea for humility. President Obama should drop his plans for health care and focus on the economy, which remains Americans’ main concern. Democrats have spent months trying to fool people into believing that expanding government is fiscally responsible and have failed. The current floundering is only trying people’s patience.
Most damning is their attempt to pooh-pooh their defeats as the result of voter anger against incumbents. People have legitimate objections to Obamacare, and no amount of spin can change that. For Democrats to try, they make themselves look ridiculous—and desperate.
As the Massachusetts blame game unfolds, the president’s unpopular health bill leads the list. But the substantive provisions of the bill were just part of the problem. Perhaps more important, voters were appalled by how the deal unfolded.
Consider the pre-election giveaway to the labor unions. Negotiators agreed to exempt union contracts until 2018 from the tax on so-called Cadillac health-insurance plans. That backroom bargain not only outraged the voters, it also violated the Fifth Amendment to the Constitution, requiring the federal government to extend equal protection of the laws to all U.S. persons. Of course, not all voters understood the constitutional nuances, but they sensed that something was very wrong; and they reacted.
For the record, here's the constitutional framework: If government were to discriminate against a specially protected class (racial, religious, or by nationality), its laws would be rigorously scrutinized by the courts. So too if government infringed on a "fundamental" right (such as speech, press, religion). But enrollees in non-union Cadillac health plans are not a specially protected class, and the right to an untaxed Cadillac plan is not deemed fundamental. That means the tax would be reviewed by the courts under a more relaxed standard. Essentially, courts would give great deference to the legislature, which could do pretty much anything that's reasonable. Rarely would a court override the judgment of our elected representatives. But “rarely” is not the same as “never.” Congress may not classify groups for differential treatment based on a criterion that bears no plausible relationship to the asserted goals of the legislation. The justification for discriminatory regulation must be legitimate – not simply a payoff to get the bill passed.
Yes, tax legislation often discriminates among parties. But discriminatory taxes are typically tied to social costs (e.g., cigarette taxes offset public expenditures for smoking-related illnesses), or regulatory objectives (e.g., alcohol taxes discourage excessive liquor consumption), or reciprocal benefits (e.g., gasoline excises pay for highways), or income redistribution (e.g., taxes on Cadillac health plans subsidize policies for the uninsured). By contrast, the tax on non-union plans was tied to none of those. Non-union plans do not impose higher social costs than union plans. There are no regulatory reasons that would justify unequal taxes. No benefits are extended to enrollees in non-union plans that are denied to enrollees in union plans. Nor is income redistribution from non-union to union workers a rational goal of health care reform.
Pure and simple, the tax on Cadillac plans was designed to generate revenue for Obamacare. That goal might have been reasonable; but the revenue could just as well have been generated by taxing all such plans or even selecting plans at random. Singling out non-union plans was merely a sop to the unions – a naked bribe to buy their support. Paradoxically, the bribe would make it tougher to raise sufficient revenue. Indeed, the Obama-union pact produced a $59 billion reduction in estimated tax receipts over ten years. And “bending the health care cost curve,” which might justify taxing Cadillac plans, did not justify taxing only non-union Cadillac plans.
Behind the scenes, the dispute over Cadillac plans threatened to drive a wedge between the White House and its union supporters, who played a major role in Obama’s 2008 campaign. The internecine warfare was so intense that AFL-CIO president Richard Trumka tipped off his Democratic friends they might not get union support in the upcoming election. One union even warned it would no longer endorse the health bill. So, unless Congress revised the tax on Cadillac plans, the President’s top legislative priority might be jeopardized and unions might sit on the sidelines while Republicans recapture the House.
This sordid episode, piled on top of Sen. Ben Nelson’s special Medicaid exemption for Nebraska, bred more voter cynicism about a political process that had gotten out of hand. A few men and women, behind closed doors, negotiating in secret, kowtowed to politically connected special interests. The losers weren’t represented at the bargaining table. Predictably, they were left holding the bag – penalized for not having a union-sponsored medical plan. As the health bill evolved, its victims couldn’t see or identify the negotiating parties, couldn’t hear the negotiations, and couldn’t protest their victimization. Take it for granted, they were told, that one political party would promote the welfare of all Americans. It just wasn’t so.
Another rogue overseas doctor in an Australian public hosital
Helen Kerner trusted her "nice, clean-cut" neurosurgeon when he said he had performed the delicate spinal operation she required 1500 times before. The 60-year-old was confused when she woke up incontinent, still in pain, with no feeling in her legs or pelvis, and upset when he tried to discharge her from hospital two days into recovery.
But when Suresh Surendranath Nair confessed that his "drill slipped" during the procedure, severing several nerves in her spine, Ms Kerner said she felt sorry for the doctor, who was then 38. "I felt like 'my goodness me, he must be feeling awful for what he's done'," Ms Kerner said. "But not now, not now, I'm pretty angry now."
The Health Care Complaints Commission is reportedly reviewing all surgery performed at Nepean Public Hospital under the direction of Dr Nair, 41, who faces drugs charges following the death in November of a 22-year-old student in his $1.7 million apartment. Sydney West Area Health Service has admitted a breach of duty of care in Ms Kerner's case.
Another neurosurgeon described the procedure, performed in 2006, as a standard operation and said Dr Nair's mistake was "usually so rare as to be virtually unheard of". The Malaysian-born, Australian-trained surgeon's registration had been suspended in 2004, after an appearance before the NSW Medical Board's Impaired Registrants Panel. He was suspended again in 2008 and on November 26 last year, following his arrest.
Ms Kerner, a former relief manager at Anglicare second-hand shops, said she did not know Dr Nair had been suspended when she was referred to him in 2006. "I had very bad back pain, sciatic pain, and all the doctor had to do was remove a bone spur away from the nerve, just grind it away from the nerve," Ms Kerner said. "The drill slipped … and my life changed, completely changed."
Sydney West Area Health Service would not comment. Dr Nair's solicitor, Mitchell Cavanagh, said he was not aware of the case and had not yet been able to discuss it with his client.
Ms Kerner, formerly a keen dancer and gardener, now uses walking sticks because she cannot feel her left leg and her foot is deformed. She is bowel and bladder incontinent, has lost all sexual function and lives with constant, severe pain in her legs and feet, according to a statement of claim filed in the NSW Supreme Court. "I'm very depressed. I wake up in the morning crying sometimes … I'm very embarrassed to go out because of things that happen," she said. "That's my life now. I don't have one."
Ms Kerner said she knew something was wrong as soon as she woke up. "I spoke to Dr Nair the next morning and he didn't tell me he slipped with the drill … He told me [he] stretched one of the nerves and it had to be repaired," she said. "He said within three months it should heal itself and I believed him because he's my doctor." Her confusion was compounded when Dr Nair tried to have her discharged from hospital two days after the procedure, before she had been seen by an continence adviser or physiotherapist.
It was not until Ms Kerner noticed the word "severed" written on her observation chart that she pressed for answers. At a meeting Ms Kerner said she attended with her then partner, the hospital's nursing manager and a clinical liaison officer, Dr Nair confessed his mistake. "I said, 'But you didn't tell me that before' and he said, 'Yes I did' … " she said.
At a second meeting attended, according to Ms Kerner, by her continence adviser and a friend, two hospital administrators told her she could sue for negligence. Legal proceedings began in November 2008 and Sydney West Area Health Services wrote to Ms Kerner's solicitor on November 3 last year, admitting a breach of duty of care.
"As far as I'm concerned the hospital should have got rid of him at the start, in 2004," Ms Kerner said. "If he was gone I wouldn't be like this."
Dr Nair has been in police custody since January 9 after he breached his bail conditions, which prohibited him from hiring prostitutes or taking illicit drugs. He is due in court on March 1. The State Coroner is also investigating the death of an escort, Victoria McIntyre, whose body was found in Dr Nair's apartment last February.
A NSW Supreme Court hearing in July will determine what compensation and damages NSW Health must pay Ms Kerner.
There is already sufficient evidence from Massachusetts to suggest that poorer working families in the old factory towns there - frugal households in Fitchburg, Gardner or Peabody who have purchased private health insurance at considerable costs to their style of life - are disinclined to donate their tax dollars to further subsidising the healthcare costs of those who don't appear able to budget as tightly as they do. No doubt this shows a regrettable diminution of the impulses of universal humanity and sympathy on their part. And yet who among us truly knows, if we fell upon genuinely hard times, how well our own impulses of universal benevolence would hold up?
In recent decades the historic role of the Democratic Party's "base" (that most over-invoked and self-glamorised of entities) has been to adopt the interests of non-white ethnic minorities and the very poor, along with the grand ideals and more pragmatic career-aspirations of the highly educated, but to neglect or reject the concerns of the majority of Americans between those two social extremes, seen for these purposes as morally uninteresting.
And yet, since the 1960s the greater purpose of every serious Democratic president has been to show themselves capable of taking to their hearts the troubles of poor white folks and poor black folks, migrants and old-timers, the struggling and the striving alike, against all the snobbish instincts and the noblesse oblige pretensions of the Democratic Party's so-called base. Obama's trouble now is that he appears to lack the moral and rhetorical resources to fulfil that role. In its absence the would-be Robespierres of the Democratic Party - the posturers, the self-glamorisers and the selective empathisers alike - are having a field day.
Poll shows majority wants Congress to suspend work on ObamaCare, Democrats weigh options
A new Gallup poll shows that a majority now favor suspending work on ObamaCare, showing a 56% of independent voters holding that opinion as well:
The USA Today/Gallup poll was conducted Jan. 20 to gauge initial reaction from Americans to Brown’s victory in the special election to fill the remainder of the late Sen. Edward Kennedy’s term. Massachusetts voters elected a Republican to the Senate for the first time since 1972. Americans widely agree that the election result has national political implications — 72% say it reflects many Americans’ frustrations, which the president and members of Congress should pay attention to, while 18% believe it is a reflection of political conditions in Massachusetts.
[…]
According to the poll, most self-identified Democrats (67%) want Congress to continue working toward passage of the bill. However, an even larger majority of Republicans (87%) call for suspension of Congress’ current work on the bill. The majority of political independents, whose support has been crucial to recent Republican election victories in Massachusetts, Virginia, and New Jersey, would also prefer to see the reform efforts put on hold rather than moved forward.
According to the poll, 65% believe that Congress should focus on other issues first or believe that health care should not be a major priority.
This isn’t stopping Democrats from trying to get something on health care passed. As I pointed out the night that Scott Brown beat Martha Coakley in Massachusetts, they may try reconciliation, which would bypass the filibuster but still could result in non-revenue producing measure being stripped from the bill if a point of order is raised.
Some news outlets are reporting today that Democrats may try to pass a list of changes to the health care bill as a separate piece of legislation as a way to get something moved through Congress this year. That could still meet a Republican filibuster in the Senate, assuming Senate Majority Leader Harry Reid (D-NV) can’t win over one of the two Senators from Maine.
ObamaCare isn’t dead, but it is on life support and with each passing day comes the reality that the president’s domestic agenda was defeated in Massachusetts on January 19th.
Highly informed sources on Capitol Hill have revealed to me details of the Democratic plan to sneak through Congress Obamacare, despite collapsing public approval for healthcare "reform" and disintegrating Congressional support in the wake of Republican Scott Brown's victory in Massachusetts. President Obama, House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid have all agreed to the basic framework of the plan.
Their plan is clever but can be stopped if opponents of radical healthcare reform act quickly and focus on a core group of 23 Democratic Congressman. If just a few of these 23 Democrats are "flipped" and decide to oppose the bill, the whole Obama-Pelosi-Reid stratagem falls apart.
Here's what I learned top Democrats are planning to implement. Senate Democrats will go to the House with a two-part deal. First, the House will pass the Senate's Obamacare bill that passed the Senate in December. The House leadership will vote on the Senate bill, and Pelosi will allow no amendments or modifications to the Senate bill.
How will Pelosi's deal fly with rambunctious liberal members of her majority that don't like the Senate bill, especially its failure to include a public option, put heavy fines on those who don't get insurance and offering no income tax surcharge on the "rich"? That's where the second part of the Pelosi-deal comes in.
Behind closed doors Reid and Pelosi have agreed in principle that changes to the Senate bill will be made to satisfy liberal House members -- but only after the Senate bill is passed and signed into law by Obama. This deal will be secured by a pledge from Reid and the Senate's Democratic caucus that they will make "fixes" to the Senate bill after it becomes law with Obama's John Hancock.
But you may ask what about the fact that without Republican Scott Brown and independent Democrats like Joe Lieberman, Reid simply doesn't have the 60 votes in the Senate to overcome a Republican filibuster that typically can stop major legislation? According to my source, Reid will provide to Pelosi a letter signed by 52 Democratic Senators indicating they will pass the major changes, or "fixes", the House Democrats are demanding. Again, these fixes will be approved by the Senate only after Obama signs the Senate bill into law.
Reid has also agreed to bypass Senate cloture and filibuster rules and claim that these modifications fall under "reconciliation" and don't require 60 Senate votes. To pass the fixes, he won't need one Republican, he won't even need Joe Lieberman or wavering Democrats like Jim Webb of Virginia. His 52 pledged Senators give him a simple majority to pass any changes they want, which will later be rubberstamped by Pelosi's House and signed by Obama.
This plan, of course, is a total subversion of the legislative process. Typically, the Senate and House pass their own unique legislation and then both bills go to a conference committee. In conference the leadership of both Democrat-dominated houses wheel and deal and iron out differences. The final compromise bill is then sent back to the full Senate and full House for a vote and has to pass both to go to the President. In the House a simple majority passes the legislation. But under Senate rules, major legislation requires 60 votes to end a filibuster.
As it stands, the House bill and Senate bill have major discrepancies. Reid does not have 60 votes to pass a compromise bill that would no doubt include some of the radical provisions House members have been demanding. But if the House passes the exact Senate bill that passed by a 60-39 Senate vote last month, there is no need for a conference on the bill. It will go directly to the President's desk.
There is a rub to all of this. This secret plan being hatched by Pelosi and Reid requires not only a pledge by 52 Democratic Senators to vote later for the House modifications. House liberals must actually believe these Senators will live up to their pledge and pass the fixes at some future date. A Senate source cautions: “Senators more than House members and both more than ordinary people, lie.”
Still, my Senate source and others in Washington believe that the liberals in the House, grasping at straws after the stunning Massachusetts defeat, will go along with the Reid-Pelosi plan to bypass a conference bill and and will ultimately vote for the Senate version without changes.
Among the key "fixes" House liberals are demanding the Senate pass in reconciliation at some later date include a “carve out” for unions from the “Cadillac policy” insurance tax. The Senate plan funds their health care plan by heavy taxes on so-called "Cadillac" insurance plans that provide those insured with exceptionally good coverage including almost unlimited health access with little or no co-payments. The Senate's view was that rich people have such plans and should be taxed for them to pay the less fortunate.
But many unions have "Cadillac' plans for their members, and they are furious their members will be hit with the Senate tax. The unions have told their minions in the House to oppose the Senate Cadillac plan tax. House liberals are also requiring a fix that increases fines for those who flout the law and don't buy health insurance (the Pelosi passed plan includes criminal penalties, including possible jail time if a person doesn't purchase insurance). Another fix will raise subsidies for low-income families seeking to buy insurance.
In the original House bill that passed, healthcare expansion costs would have been paid for by an income tax surcharge on the "rich." House liberals are pushing for that fix as well.
So what is the counter-move? How do opponents of Obamacare stop this? Opponents cannot rely on liberal Democrats in the House who might balk at passing the Senate bill with just a "pledge" from 52 Senators. I have no doubt House liberals, despite their skepticism, will fade under pressure from Pelosi and Obama. They will do their duty and pass the Senate bill, whatever their current posturing.
Instead, the key to stopping the Pelosi-Reid plan lies with conservative or “moderate” Democrats who voted for the health care bill the first time. There are 23 of these conservative-leaning Democratic House members who voted for Pelosi's Obamacare back in November, which passed by just five votes, with 39 Democrats defecting to vote against the bill. All 23 of these Congressman who did vote for the Pelosi bill are extremely vulnerable.
Opponents of Obamacare need to climb all over these 23 Congressmen with TV ads and advocacy campaigns in their districts to get them to change their vote this time, to vote "no" to the Senate bill when it comes before the House. Voters need to say, "You voted for Obamacare the first time. But your district opposes it by 2 to 1. Now it is coming up for a vote again. Listen to your constituents and vote no. We don’t want Medicare cuts or premium increases or rationing of medical care. Don’t monkey with our health care. Vote no this time.”
Since the House healthcare bill passed by five votes, much has happened and the political landscape has changed dramatically. The Massachusetts election of a Republican to Ted Kennedy's Senate seat has sent shock waves through Washington. Every one of these 23 Democrats knows they will face an angry backlash in their districts if they vote for the Senate bill and go along with Pelosi-Reid plan to ram through Obamacare. I believe now is the time to act for opponents to act. The truth is that Obamacare is hanging by a thread. Opponents, if they move now, can drive a stake through its heart.
Once these Congressmen hear from their aroused constituents, they won’t be able to back Obamacare. As I mentioned, the Pelosi health bill passed the House by only 220-215. Nancy Pelosi knows she has no margin for error. If only a handful of these 23 Congressman change their vote under public pressure, the Pelosi-Reid plan is stopped and Obamacare is dead.
Fertility regulators are allowing doctors to screen out embryos that could lead full lives despite having a genetic condition
FERTILITY regulators have triggered a new row over designer babies by allowing doctors to destroy embryos affected by more than 100 genetic conditions, including many illnesses that are not life-threatening. The genetic “defects” that can now be routinely screened out include conditions carried by a number of leading figures, such as Pete Sampras, the tennis champion, and Sergei Rachmaninoff, the Russian concert pianist and composer. In some cases it will mean the elimination of an embryo that has been identified as carrying genetic material inherited from a stricken grandparent, but which may not necessarily develop the same illness.
The Human Fertilisation and Embryology Authority (HFEA), has published a list of 116 inherited conditions that fertility clinics can screen out without requiring special permission. Although many of the conditions can cause gross deformity, protracted pain and premature death, the list also includes illnesses, including cancer and blindness, which can strike late in life after a victim has enjoyed decades of good health.
A number of the conditions are not life-threatening or can be readily treated because of advances in medicine. The disorders include Marfan syndrome, a congenital weakness of connective tissue that can lead to abnormal growth. Among the people thought to have suffered from the illness are Rachmaninoff, who was noted for his large hands, Charles de Gaulle, the French leader, and Abraham Lincoln, the American president.
Another condition that the HFEA allows to be screened out is the blood disorder thalassemia. Sampras, who won 14 Grand Slam singles titles during his career, has a version of the trait that can cause mild anaemia.
Sion Simon, the minister for creative industries, suffers from choroideremia, an inherited form of progressive blindness that is also on the HFEA list. Simon, 41, rarely speaks about the condition, but writing in The Spectator eight years ago, he said: “Being approximately half-blind now, I know perfectly well that the diurnal exigencies of deteriorating vision are no fun. They are tedious. And yet going blind carries a certain prestige that other losses of faculty do not. There are many much worse things.”
The HFEA said it takes into account the age of onset and the variability of physical and intellectual impairment when deciding which genetic conditions can be screened. The unpleasantness of medical treatment available for a given condition is also considered when deciding whether an affected individual will have a worthwhile life.
However, David King, director of Human Genetics Alert, a pressure group, said he was concerned about the use of selection for non-fatal conditions. “It contributes to a social climate in which even minor deviations from ‘normality’ are seen as unacceptable,” he said.
The established procedure for identifying inherited genetic abnormality is to remove one or two cells from an eight-cell embryo three days after fertilisation. The cells are then put through pre-implantation genetic diagnosis (PGD), a search for one or more defective characteristics. Abnormal embryos are discarded, while healthy ones are kept for implantation into the mother’s womb.
The HFEA is now considering adding a further 24 inherited disorders to its list of genetic conditions. Decisions on eight of them are expected this week. They include porphyria, a potentially painful condition caused by overproduction of red blood cell pigment that was linked to the “madness” of George III. Karen Harris, of the British Porphyria Association, said: “I have porphyria, so does one of my three children and so does his child.” Although Harris said she would not have used PGD to select her own children, she would not condemn its use by other families. “If you have lived with someone unable to function and on constant morphine because of the pain, you would take a different view.”
Joyce Harper, co-founder of the PGD centre at University College London, said the selection procedure is expensive and seldom available on the NHS. However, she has agreed to use the technique for a couple who want to ensure their child is not affected by a family gene causing deafness. She admitted: “It’s controversial and it’s going to get more controversial.”
No diagnostic tests when the baby was first seen of course. Tests are expensive -- and babies are expendable, apparently!
One of England’s biggest counties has only two GPs on call on some nights to cover a population of more than 600,000. Doctors admit the out-of-hours service in Suffolk is so stretched that it is threatening patient safety. On some occasions, residents have resorted to summoning an ambulance after failing to get hold of a GP.
In one case, a couple whose baby was seriously ill were told to wait up to four hours for a telephone call from a doctor. The nine-month-old boy, who was in fact suffering from meningitis, died later that night.
The GP skeleton service from 11.30pm to 8am is provided by Take Care Now (TCN), a private company that uses foreign doctors to cover some shifts. Three doctors are supposed to provide cover, but one is sometimes replaced by a nurse.
The situation in Suffolk is reflected across rural England, with the number of doctors on call plummeting in the past five years. The pressures on the service are revealed in a new report by the Primary Care Foundation, an independent body, which found that only 16 of the 80 primary care trusts it examined met the target of clinically assessing 90% of urgent calls within 20 minutes.
TCN has been under scrutiny since the death of David Gray, 70, from Manea, Cambridgeshire, in February 2008. Gray died after being given a huge overdose of diamorphine by Daniel Ubani, a German-based doctor who was on his first shift for the company.
TCN won the contract to provide out-of-hours services for NHS Suffolk, the primary care trust, in 2004 after GPs were permitted to opt out of providing round-the-clock care. The NHS trust covers the entire county, apart from one surgery that did not opt out and the Waveney district, which is covered by a separate trust.
Other out-of-hours providers in England also provide a skeleton night staff compared with the 1990s. However, GPs have written to the trust, complaining that patient safety could be at risk. Dr Claire Giles, chairwoman of Suffolk’s Local Medical Committee, which represents GPs, said: “The patches covered by these doctors have got bigger and bigger as the funding has been cut.”
TCN says most people are satisfied with its services and it hits all the NHS’s out-of-hours targets. But residents say the targets fail to reflect the delays in the system.
One couple, Mark and Jennifer Smith, from Kesgrave, Ipswich, lost their nine-month-old son to meningitis after being told they faced a wait of up to four hours to speak to an out-of-hours doctor. The couple visited an out-of-hours clinic at the Riverside centre in Ipswich at about 6pm on Saturday, March 14, last year with their sick baby, Taylor. The doctor there told them he was suffering from a bug.
When Taylor awoke at 2am that night with a bright rash, the couple telephoned NHS Direct and were told they would have to wait up to four hours for the doctor to call back. At 5am, the out-of-hours doctor rang and the Smiths explained the symptoms. Clearly concerned, the doctor advised the couple to check the baby. It was too late, however — their son had died of the blood poisoning that accompanies meningitis. “Our beautiful little boy had gone,” said Mark Smith.
He said the family had been failed by the NHS during the night. “It should not take four hours to get a call back from a doctor when you have a sick baby.”
Other residents say they have been forced to call ambulances rather than wait for an out-of-hours GP.
TCN, which is being investigated by the Care Quality Commission, had its contract with NHS Cambridgeshire terminated last November. It is also being replaced by a new out-of-hours service in Suffolk in April. The company is, however, defended by some GPs who say it is underfunded and that its problems are shared by similar providers.
NHS Suffolk said: “We are continually monitoring patient safety and experience and will continue to do so.” [Blah! blah!]
President Barack Obama and Democratic leaders insist they will push ahead with efforts to overhaul the U.S. health care system despite losing undisputed control of the Senate. They just haven't decided what it will look like or how they will pass it. In fact, they aren't explaining much.
A senior Democratic aide said Saturday that House and Senate leaders are considering changes to the health care bill passed by the Senate that could make it acceptable to the House. Under one scenario, Democratic senators would make the agreed-upon fixes using a special budget procedure that requires only 51 votes to overcome Republican delaying tactics. The House would then pass the Senate bill, sending it to Obama for his signature and allowing the health care remake to become law.
But the aide, who described the discussions on condition of anonymity because of the sensitivity of the issue, said no decisions have been made. The strategy would be politically risky because it would enrage Republicans, and the legislation itself lacks strong public support.
Obama acknowledges running into a "bit of a buzz saw" of opposition. A top Democrat suggested that Congress slow down on health care, a sign of eroding political will in the wake of a Republican's upset victory in the Massachusetts Senate race Tuesday.
Democratic Sen. Chris Dodd of Connecticut, who got health legislation through the Senate's health committee last year after the death of his friend, Sen. Edward M. Kennedy, said Obama and lawmakers could "maybe take a breather for a month, six weeks."
Just a week ago the health legislation had appeared on the cusp of passage after Obama threw himself into marathon negotiations with congressional leaders to work out differences between the separate health care reform bills passed by the House and Senate. "There are things that have to get done. This is our best chance to do it. We can't keep on putting this off," Obama said Friday at a town hall meeting in Elyria, Ohio. "I am not going to walk away just because it's hard," the president said.
Obama seemed to pull back from a suggestion he made Wednesday that lawmakers unite behind the elements of the legislation everyone can agree on. Obama said scaling back health care presented problems because some of the popular ideas, such as banning denial of coverage to people with medical problems, can't be done unless most Americans are insured. "A lot of these insurance reforms are connected to some other things we have to do to make sure that everybody has some access to coverage," he said. For example, insurers wouldn't be able to end the practice of denying coverage to people with health conditions unless more people were covered. Otherwise people could wait until they got sick to buy insurance and premiums could skyrocket.
Obama has used immense political capital to advance the health care overhaul and remake a system that has frustrated past administrations, most recently Democrat Bill Clinton's in 1994. Whether he can succeed where others have failed is now unclear. "Here's the good news. We've gotten pretty far down the road, but I have to admit, we had a little bit of a buzz saw this week," the president said.
Despite Dodd's suggestion that Democrats take a breather, both House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid insist the health care legislation will go forward. They just haven't said how.
The changes under discussion to the Senate bill would reflect agreements leaders of both chambers made during negotiations at the White House two weeks ago. That includes weakening the Senate bill's tax on high-cost insurance plans, opposed by labor unions and considered a nonstarter in the House. Closing gaps in prescription drug coverage for the elderly is also under consideration.
One potential approach could allow the Senate to act with a simple majority instead of the 60-vote total Democrats now lack with the election of Republican Scott Brown in Massachusetts. A supermajority of 60 votes is needed to overcome Republican filibusters -- a legislative procedure that blocks measures from coming up for a final vote.
But House Republican leader John Boehner said the election of Scott Brown in Massachusetts has sent a loud warning to Democrats -- cease and desist on health care overhaul. "For the better part of those nine months, Democrats in Washington have been focused on this government takeover of health care that working families just can't afford and want nothing to do with," Boehner said in his party's radio and Internet address Saturday.
Obama has made fixing a broken health care system the top domestic policy priority of his first term, but has faced solid opposition from the Republican minority. Despite assurances from Obama and his administration, opposition to his plans have grown among people who bought into allegations of higher taxes, unbearable government deficits and serious government meddling in health care.
The United States is the only industrialized country without a version of universal health care. Americans get their health insurance mainly through their employers, with government programs to cover mainly retirees, military veterans and members of Native American tribes. Forty million to 50 million Americans are uninsured and get medical care largely through hospital emergency rooms.
The vote looming in the Senate to raise the debt limit should serve as a wake-up call that federal spending is out of control. Instead, Democratic leadership has tried to convince Americans that passing costly health care legislation is not only sensible, but requisite, and must be done now.
Neither is true. The bills use weak spending limits, weak tax provisions, and even weaker cuts to current spending to pay for reform. Democrats claim these provisions mean that the massive health bill will not only be paid for, but will decrease the federal deficit. In a recent testimony to the House Budget Committee, health care expert James Capretta outlines why this is contrary to Obamacare’s more likely fiscal future.
Weak Cost Control on New Entitlements. Both bills increase coverage by expanding Medicaid or offering subsidies to purchase insurance on the exchange. Lavish subsidies will be available to those who do not qualify for Medicaid but make under 400 percent the Federal Poverty Level. While 127 million Americans fall in this category, only 18 million are projected to receive the subsidy, due to a “firewall” to prevent those who are offered employer-sponsored coverage from receiving it. This creates gross inequity within income brackets. As is the way with Congress, lawmakers will likely give in to taxpayer pressure down the road to extend the subsidies and eliminate the inequity. Expanding this entitlement will cost billions, adding to the deficit.
The bills create another new entitlement via the CLASS Act, which provides community living assistance. Beneficiaries would pay premiums but would not receive benefits until years later, thus creating one-time savings at the programs onset. Obviously, years down the road this spending cushion would deteriorate, and the program would become insolvent. This is not accounted for in ten year cost projections.
Weak and Unpopular New Taxes. The Senate bill is paid for with a 40 percent excise tax on high-cost insurance plans. This provision is to deter Americans from purchasing unnecessarily extravagant health plans, but it is also responsible for about half of the revenue used to pay for the bill. This tax is widely unpopular, and Washington has already begun and will likely continue to carve out favored constituencies who balk at this tax. Union members have already been exempt through 2017, which eliminates 40 percent of expected revenue from this tax.
Presumed Cuts to Medicare. Finally, both bills are largely paid for by cuts to Medicare of approximately half a trillion dollars. These cuts will presumably be made to payment rates for certain care providers by decreasing inflation updates. The expectation that this will actually occur is almost laughable. At the same time that lawmakers are proposing to pay for health care form using cuts to Medicare, they are trying to pass the “doc fix” legislation to end cuts to Medicare that were enacted to—you guessed it—contain costs. Every year, Congress is supposed to decrease physician payment rates in order to control Medicare spending. And every year, Congress votes to suspend the doctors’ payment decrease due to pressure from the industry. The House recently passed legislation that would get rid of the payment cuts for good. And yet without blinking an eye, they propose to use the same failed method to pay for health care reform.
These cuts to Medicare are even more unlikely considering their full impact. As Capretta points out, “The Chief Actuary of the Medicare program has warned that these arbitrary reductions could have serious consequences for beneficiaries’ access to care, as [they] would push about one out of every five hospital facilities into insolvency.”
The House and Senate bills received positive cost estimates by the Congressional Budget Office based on these weak spending controls and the fact that the CBO analysis looks at the first ten year window, which for both bills, includes ten years of raising revenue, but only six years of spending. The country is facing a fiscal crisis as the population faces a demographic transformation of 30 million citizens entering old age within the next twenty years, Capretta points out. Lawmakers need to acknowledge the precariousness of America’s fiscal future and be honest about the true cost of Obamacare.
The loss of their 60th Senate seat on Tuesday night in Massachusetts struck fear into Democrats. The president, who two weeks ago was driving deals to settle disagreements among House and Senate Democrats, sent mixed signals this past week that betrayed a lack of certainty about his intentions. Old divisions resurfaced, leaving Democrats confused and frustrated.
Obama on Friday sought to recover his equilibrium. "I didn't take this on to score political points," a defiant Obama told workers in recession-weary Ohio. "And I'm not going to walk away just because it's hard. We're going to keep on working to get this done _ with Democrats, I hope with Republicans _ anybody who's willing to step up."
Step up. That's what some Democratic lawmakers are saying Obama needs to do. "I think he has got to get even more deeply involved," said Rep. Elijah Cummings, D-Md. "He's a key factor and we have to see exactly to what degree he wants to play that role." "He has the ability to bring us all together," said Sen. Christopher Dodd, D-Conn., one of the negotiators in recent White House talks. "He did that ... to try to resolve the differences between the House and Senate. Again, it's going to take that kind of leadership." ....
Lawmakers came to work Wednesday morning facing a new reality. Democrats no longer had the votes in the Senate to keep Republicans from blocking the health care bill, and the rest of Obama's agenda. With the loss of Kennedy's seat, Obama seemed to retreat _ and stumble. In an interview with ABC News, the president who only days before had been functioning as nightshift foreman of the health care talks said it wasn't his role to delve into the details of legislative strategy. He suggested lawmakers might want to regroup around a smaller package of popular measures.
With House Speaker Nancy Pelosi, D-Calif., trying to gauge support for passing the Senate's bill, Obama's candor unnerved White House aides, who scrambled to reinterpret their boss' remarks. It was no use. After meeting with Democratic lawmakers Thursday morning, Pelosi delivered the news that she didn't have the votes to pass the Senate bill.
Suddenly every Democrat had his or her own idea about what to do next. Some wanted to move on, noting that jobs and the economy are more important to voters than health care. Many called for scaling back the bills to more manageable and understandable dimensions. Some demanded a heroic attempt to enact comprehensive changes.
Not two weeks ago, Pelosi was close to a final handshake with Senate Majority Leader Harry Reid, D-Nev. By Thursday, she dismissed the Senate bill as a nonstarter tainted by backroom deals. Reid complained that the House doesn't listen to him. Pelosi huffed that the House, unlike the Senate, doesn't have surprise elections.
By Friday, Obama was back to arguing that comprehensive health care legislation remains the best route for the nation.
Democrats are now in a self-imposed cooling off period of uncertain duration. No decisions have been made on how to salvage health care.
British woman sent to a maternity unit with no doctor despite 'disastrous' family history of birthing problems
A girl who suffered brain damage at birth after her mother was sent to a maternity unit with no doctor despite a “disastrous” family history of birthing problems has been awarded more than a million pounds. Colchester Hospital University Trust, in Essex, who have not admitted liability, have agreed to pay the child £1.25m in damages. The trust will also make annual inflation–linked payments currently set at between £96,000 and £130,000 to the girl, now aged five and named only as X.
Her mother, aged 21 when she gave birth, had a family history of troubled labours, including stillbirths and haemorrhages. She insists that she was not told about the lack of medical facilities at Clacton Hospital, which is staffed only by midwives and not doctors.
The birth was difficult and X was eventually delivered "blue and floppy" in the back of an ambulance as her mother was being rushed to Colchester General, 16 miles away, on May 5, 2004. She suffered brain damage at birth, is severely physically disabled, cannot see or talk and will require 24-hour care for the rest of her life.
A spokesman for the Trust said: “There remain significant differences between the parties, but the Trust acknowledges some failings for which it apologises and, as a consequence, made improvements. “We are sorry that this girl sustained a brain injury at birth and wish her and her family best wishes for the future."
Approving the settlement in the High Court, Mrs Justice Slade praised the child’s parents, describing them as "devoted". Late last year the chairman of the trust was fired after a health watchdog found that it was failing patients and had mortality rates 12 per cent above the national average.
British doctors repeatedly treat a healthy boy just on his mother's say-so
They clearly were not mentally involved -- just bureaucrats filling in their hours
A "SADISTIC" mother has been jailed in England for subjecting her healthy son to "24 hour-a-day torture" by pretending he was severely ill to gain publicity and cash. Lisa Hayden-Johnson, from Brixham, Devon, was said to have "reveled" in the national attention her young son received. The mother-of-two conned charities out of dream holidays and donations and secured meetings with royalty, celebrities and former UK prime minister Tony Blair. She even successfully lobbied for her son - who she falsely claimed suffered from cerebral palsy, cystic fibrosis and dysphagia among a litany of illnesses - to receive a Child of Courage Award in 2005.
The 35-year-old was jailed for three years and three months at Exeter Crown Court, having previously admitted child cruelty and perverting the course of justice.
Prosecutor Andrew Macfarlane said Hayden-Johnson "organised, orchestrated and ensured a regime of medical, physiological and psychological mistreatment amounting to 24 hour-a-day torture that touched on every aspect of his young vulnerable life".
She frequently described her son "as the most ill child in Britain", the lawyer told the court. He continued: "As a result of her sadistic fabrication of non-existent symptoms, the defendant achieved much publicity and national attention, including an encounter with royalty and the then prime minister."
Hayden-Johnson subjected the child to a total of 325 medical encounters, during which he was subjected to a series of "physical intrusions and interventions", Mr Macfarlane said. These included blood tests, intravenous treatments and a gastrostomy, and he was fed through a tube and confined to a wheelchair. He still believed he was seriously ill, more than two years after his ordeal ended, Mr Macfarlane said.
Negligent British health bureaucracy: Nigerian doctor who killed British patient 'avoided English test'
A German doctor who gave a patient a fatal overdose of drugs had failed an English test at one NHS health care trust before being accepted to work by another, an inquest heard.
Dr Daniel Ubani was told he had not passed the language exam in June 2007, but a month later successfully applied to a different trust for formal registration as a GP. The Cornwall and the Isles of Scilly PCT did not enforce the test because he was an EU doctor and subsequently placed him on the nationwide performance register. This meant Dr Ubani could work anywhere in England and Wales and never worked in the south west, accepting his first job in Cambridgeshire, the hearing was told.
On his first out of hours NHS shift on February 16, 2008, he gave 70-year-old David Gray up to 20 times the recommended dose of diamorphine, killing him within hours.
It emerged yesterday that the out of hours’ company which used Dr Ubani’s services told him to return to Germany that day after he killed Mr Gray, who had suffered from kidney stones. Dr Ubani, 67, has since been suspended by the General Medical Council in the UK but continues to practice in Germany.
At the inquest into Mr Gray’s death, held at Wisbech Magistrates Court in East Cambridgeshire, the different level of medical scrutiny between NHS trusts across the country was exposed. Dr Ubani was accepted on the GMC register in October 2006 because he held a Certificate of Good Standing in Germany. Shortly afterwards, the Nigerian-born doctor, who specialises in cosmetic surgery, applied for a place as a GP on the performance register at Leeds PCT.
Without registration, he would not be allowed to practice medicine in the UK, the hearing was told. He was asked to take part in the International English Language Testing System (IELTS) through the West Yorkshire NHS Central Services Agency. On the form, Dr Ubani stated that his first language was Igbo, a Nigerian language, but later told officials that he had been taught in English at school. In May 2007, his results showed that he got 4.5 for his listening, 4.5 for his reading, seven for his writing and seven for his speech. This gave him an overall mark of six, but Leeds PCT demanded a pass mark of seven, the inquest heard.
Concerns were also raised about his references, one of which was from a medical professional who had never worked with him. Dr Ubani was told that his application would not be successful and so he withdrew his form on July 2.
He immediately applied for registration with the Cornwall and Isle of Scilly PCT and 16 days later, on July 18, 2007, his application was accepted. Adrian Tyas, the former director of Cornwall and Isles of Scilly Primary Care Support Agency, was responsible for placing doctors on the performance list. He said the PCT was not aware that Dr Ubani had failed a language test because he had withdrawn his application from the Leeds PCT and therefore had not been formally rejected. “The PCT did not carry out test on the competency of English for EU nationals,” he said.
David Locke, representing the Cambridgeshire PCT, responded: “But Mr Tyas, if you cannot speak English, you cannot function as a doctor in England, can you?” “That is correct,” he conceded. “Do you think you should have at checked at the least that a doctor could speak English?” Mr Tyas replied: “I think the PCT has a responsibility, but so do the people employing someone as a locum doctor.”
The inquest heard that Dr Ubani was paid by the company Cimarron, which supplied his services to Take Care Now, an out of hours’ company subcontracted to the Cambridgshire PCT.
Mr Tyas admitted that Dr Ubani had not given any detail about his experience as a GP. “You had no idea if he treated children, had any experience in palliative care, you had no idea if he had three patients or 3,000?” asked Mr Lock. “No,” replied Mr Tyas.
Sharon Brooks, from Cimarron, said Dr Ubani was told to return to Germany the day after he killed Mr Gray. She said Dr Christopher Browning, clinical governance lead at TCN, had advised the doctor to go home. Mrs Brooks told the inquest: “I got a phone call from Dr Ubani telling me that he had spoken to Dr Browning at TCN who told him it was best to go back to Germany. “I told him that if Dr Browning had told him to go home, that is what he should do.”
Mrs Brooks, who does not have a medical background, said Dr Ubani was registered with the GMC and the NHS performers' register before they employed him. However, she conceded that his specialisation in cosmetic surgery including botox, was in no way relevant to his job as a GP.
Congressional Democrats are abandoning their massive health care package in the face of strong public resistance manifested in the election of Republican Scott Brown of Massachusetts to the Senate. Brown's victory Tuesday halted the intense backroom negotiations aimed at merging competing House and Senate versions of President Obama's health plan.
The bills, developed over more than a year of legislative work, would have expanded coverage for the poor, created a national health insurance plan and paid for it with increased taxes and Medicare cuts.
"Both of those bills, as they stand now, are dead," said Rep. Bill Pascrell, D-N.J., after a caucus meeting with panicked House Democrats, who characterized Brown's win and the message it sent as their party's Hurricane Katrina. "I got the sense that people want to move on and not look back at the House or Senate bill."
Democrats pulled the plug two days after Brown's shocking victory over Democrat Martha Coakley to fill the Senate seat long held by liberal icon Ted Kennedy. Brown campaigned on the pledge to be the Republicans' 41st vote in the Senate, enabling the GOP to block the president's health plan.
House Speaker Nancy Pelosi, D-Calif., confirmed Thursday that there is not enough support in the House to pass the less expensive Senate version of the Obama plan. The Senate bill does not include a government-run insurance program but would have forced all Americans to buy insurance and levied a hefty tax on expensive insurance coverage. "I don't see the votes for it at this time," Pelosi said.
Pelosi insisted that health care reform will move forward in some way, but she may have difficulty passing anything as ambitious as the now-discarded House or Senate bills. "The worst position for a politician to be in is to say to the public, 'Open wide and swallow, this is good for you,' " said Rep. Gerry Connolly, D-Va., who is president of the House's politically vulnerable freshman class. "I don't want to be in this situation and my colleagues don't either."
Democrats are now considering a drastically scaled-back plan that could be passed in smaller, separate pieces. It would not include a public option, mandatory insurance or the creation of any new entitlement programs.
Pascrell said he is proposing a plan that would address insurance malpractice reform, increase insurance competition and bring reforms to the insurance industry. The bill could be passed in pieces over the course of several weeks and would allow the House to turn its attention to job creation. "It has appeal to a lot of people," Connolly said of the idea.
Leadership aides confirmed that Pelosi is considering the piecemeal approach, but there is no agreement on what it should include. Brown's election, one top leadership aide said, "has changed the dynamic completely and now we have to regroup and choose the best way forward."
Republicans are touting their own bill, which would forbid insurance companies to deny coverage because of pre-existing conditions and place limits on medical malpractice lawsuits. "Republicans are not going to work off of this monstrosity," Minority Leader John Boehner, R-Ohio, said of the proposal to retool the president's plan. "There's just not enough common ground."
The Snare of Incremental Heath Care “Reform”. Perilous days lie ahead
Opponents of (more) government control of health care and health insurance are breathing a sigh of relief after Tuesday’s upset senatorial election in Massachusetts. But now that the celebrations are subsiding, I feel compelled to warn that the most perilous days may lie ahead. How can that be, when Sen. Edward Kennedy’s seat is about to be assumed by a man who campaigned on a promise to vote against Obamacare, depriving the ruling majority of its critical 60th vote?
It’s simple: In place of 2,000-page omnibus monstrosities, we are likely to see a series of micro “reforms” — that is, government interventions — that may well garner bipartisan support. The new buzzword on Capitol Hill is “incrementalism.” This is a strategy to break the big House and Senate bills into several small ones — to slice the salami into manageable portions. Instead of one 2,000-page piece of legislation, we might see ten 200-pagers, or perhaps 100 20-pagers.
Will that make a difference substantively? Most likely not, because those micro bills are unlikely to be the needed repeals of the government’s impediments to free competition, such as the ban on interstate insurance commerce, the Food and Drug Administration, the patent system, and the tax-code bias toward employer-purchased insurance.
Instead we’ll probably see bills that embody most of the elements of President Obama’s, Speaker Pelosi’s, and Majority Leader Reid’s proposals. But since the series of small bills won’t look like an overambitious program to reinvent 16 percent of the U.S. economy in one unreadable fell swoop, much of the congressional opposition could be defused. Its previous talking points and photo ops regarding legislation that stacks three feet high will be useless.
Furthermore, individual elements in Obamacare have populist appeal. Many people (rightly) feel abused by big insurance companies, and being ignorant of both economics and the intricacies of current policy, they could be attracted to what appear to be modest consumer protections. (See this.) With the House of Representatives and a third of the Senate up for election this year, a preponderance of members may fear alienating those voters.
In other words, the incremental approach may be to the omnibus approach what (as the old folk warning has it) slowly cooking a frog is to tossing it into boiling water. (For the record, frogs will jump out of gradually heated water if they can.)
The majority party may kick itself for not thinking of this strategy sooner. One big bill is easy to scare people with — a bunch of smaller, less intimidating bills is not.
What might the series consist of? It seems certain that a bill will be introduced to require insurance companies to cover people who are already sick; that is, an end to the preexisting condition exclusion. Other bills will require guaranteed renewal, community rating (uniform premiums for all members of a group regardless of health status), and a limit on the difference between premiums for younger and older policyholders. (Today the premium for an older person can be six or seven times that of a young person, which is not surprising because older people tend to consume more medical services. Yet the pending legislation would permit only a two- or threefold difference. See Prateik Dalmia’s analysis here.)
Will members of the minority party go for the proposals? All indications up to now say yes. For example, as Sam Stein of the Huffington Post pointed out last November, “Many of the most respected health care voices in the GOP have historically treated the idea of eliminating pre-existing condition exclusions as an obvious plank in any reform effort…. Even deeply conservative figures like Senator Tom Coburn (R-Okl) insisted as recently as August that ‘everyone agrees’ that legislation should ‘eliminate pre-existing conditions’ as an excuse for denying coverage…. Another Senate Republican who was heavily involved in negotiating health care reform, Chuck Grassley of Iowa, has unequivocally declared that the government has ‘to prohibit insurers from denying coverage to people with preexisting medical conditions and charging higher premiums to people who are sick.’”
This, to say the least, is ominous. (And see Sen.-elect Scott Brown’s comments here.) For one thing, it won’t be enough to compel insurers to accept people who are already sick. In all likelihood, insurers would also be prohibited from charging sick customers more than well ones. (There’s no political point otherwise.) If the minority party will go for this, what won’t they go for? New taxes perhaps?
As I’ve pointed out before, coverage for an existing illness at someone else’s expense is not insurance. It is charity, or if forced through the state, subsidy and welfare. Once that intervention is enacted, others will follow.
Which brings us to the individual insurance mandate. Proponents justify the mandate on grounds that, to protect the viability of the insurance market, young healthy people must be forced to buy insurance when the companies are obliged to cover sick people at actuarially unsound premiums. From the beginning of the discussion in 2009, the majority party has insisted on the mandate (and one on employers too). It’s is an obvious violation of individual liberty, but where was the minority party’s protest? If one of the incremental bills calls for a mandate, as is most likely, will it pass the Senate? Let’s hope not, but we’ll have to wait and see.
British hospitals must cut services to stay afloat, watchdog warns
Hospitals will have to reduce services, sell off buildings and move into smaller premises to cope with financial pressures in the next few years, the head of the foundation trusts’ regulatory body has warned. William Moyes, who steps down from his role as executive chairman of Monitor after six years next week, told The Times that too many hospitals were not grasping the economic challenges ahead. While political parties have promised to protect NHS funding and avoid service cuts, Mr Moyes said it was inevitable that some hospitals would have to reduce services and sell off assets to keep afloat.
Any hospital department that was treating too few patients to cover its costs risked compromising the quality of care, he said. Some maternity and paediatric units, which are very costly to run, might be merged or relocated, while A&E departments could be downgraded to minor injury units if they had a small number of serious cases that could be sent elsewhere. “People need to know where they are making money or losing money. If you find a service where the income can’t cover the cost, you may eventually have to question whether the income is ever going to be sufficient, and whether this is in fact the wrong activity for the hospital. “In quite a lot of places the number of births is too small to support the cost of giving a high-quality service. You have three choices: increase the flow of patients, move the service elsewhere or stay as you are and risk compromising the care.”
Mr Moyes, who oversees the regulation of finances and governance of England’s 125 flagship foundation trusts, said that as well as focusing on core departments, trusts would need to consider stripping out “uneconomic” facilities such as pathology laboratories and scanning units in some hospitals that were being used for very small numbers of patients. “There may be surplus assets — buildings, land, equipment, stuff they think they might need in years to come under their development plans — and in some cases working in a much smaller physical space and disposing of all the hospital penumbra that can be brought into the main building.”
Mr Moyes said he had requested that foundation trust chief executives resubmit a “downside assessment” — stripping back their budgets — to get a more realistic grasp of the funding pressures they faced. He said that he was disappointed when, on being asked to revise their financial predictions in September, a number of trusts had resubmitted even more rosetinted forecasts of growth. “You can’t assume everything will go well and if a problem arises the Department of Health will bail you out,” he said.
His warnings were echoed yesterday by Sir David Nicholson, the chief executive of the NHS, who described the coming years as “extremely challenging”. Giving evidence to the Commons Health Select Committee, Sir David warned of pay cuts and service reorganisation. “It is going to be very tough,” he said, adding that tighter budgets would mean the 1 per cent pay cap demanded by the Treasury would be treated by NHS managers as a maximum rise, not an entitlement. His comments came a day after inflation hit 2.9 per cent when unions are already angry over a pay freeze on council workers. “There is essentially a trade-off between pay and numbers of jobs,” he told the committee. “In a cash-limited system, that is the big unknown for us. We need to talk through with the trade unions and staff associations about what that trade-off is.”
Sir David has previously warned that the NHS would have to find productivity and efficiency savings of between £15 billion and £20 billion over the three years 2011-12 to 2013-14.
The head of the Audit Commission added to the debate, saying that political pledges to safeguard spending on health and education were “insane”. Steve Bundred told the Commons public administration committee that billions would have to be saved. “It seems to me absurd to imagine that the only services where no efficiencies can be found are those that have been the most generously funded for ten years,” he said.
Mr Moyes said he thought that an “unintended benefit” of future economic turbulence would be to heighten hospitals’ understanding that they had to operate with a robust business model. “A lot of hospitals, even the very good ones, are at the stage of learning how to think long-term,” he said. “We are good at strong visions, big pictures, but we need to learn to be very good at pessimism and what will happen if things are not going to turn out well.”
A record 10,000 British public hospital patients hit by malnutrition IN HOSPITAL
At least 10,000 patients left hospital last year after becoming malnourished while under NHS care - the highest number on record. Official NHS figures show that in 2008/09 175,003 patients were victims of malnutrition or another nutritional difficulty when they were admitted to hospital. But 185,446 were suffering the same conditions when they were discharged. The difference between the figures, obtained by the Tories, is 10,443, a 27 per cent rise on the previous year's 8,229.
Critics said it was almost unbelievable that hospitals were routinely sending people home in a worse condition than when they arrived. In 1997/98, Labour's first year in power, just 75,431 patients were discharged in a malnourished state, of whom only 4,773 had become malnourished while in NHS care. The total of 185,446 patients discharged in a malnourished state last year is 18 per cent more than the 157,175 the year before. This is the sharpest rise on record, largely because the number of patients admitted with nutritional difficulties was itself 17 per cent higher.
The continuing problems come despite years of Labour promises to improve hospital food. The Daily Mail's Dignity for the Elderly campaign has highlighted the scandal of old people not being fed properly in hospital. The food is often so unappetising that patients do not eat, and sometimes placed out of their reach and taken away untouched.
Nurses often claim they are too busy to help patients eat. Age Concern says 60 per cent of older patients, who occupy two thirds of hospital beds, are at risk of worsening health or becoming malnourished.
Andrew Harrop, head of policy, said: 'It's scandalous to see that malnutrition is still a huge problem. 'Nutritious food and help with eating are an essential part of basic care which must be recognised by all staff. 'Despite a commitment from the Government, many NHS trusts are yet to introduce protected mealtimes and one in three haven't introduced red-tray systems to identify those who need help. 'Until nutrition is given top priority in every ward, older people will continue to be needlessly malnourished, putting their health at risk.'
Tory health spokesman Stephen O'Brien said: 'These figures are of serious concern. 'It has been a growing problem for a number of years and yet Labour has done very little to protect these vulnerable people. 'Nutrition is important for people who aren't ill: how much more for those recovering from serious illnesses and operations? 'It is scandalous that people come out of hospital in a worse state than when they go in, particularly due to something as basic as being given decent food.'
The Department of Health said last night: 'It is misleading to suggest that an increase in patients discharged with malnutrition is due to poor care or the quality of food. 'Many patients who are admitted to hospital are already malnourished. Malnutrition can be a consequence of serious illness or medication. 'Many patients who have malnutrition and are discharged from hospital continue their care through primary care and social care. 'In 2009 a survey found that 94.5 per cent of NHS hospitals achieved an excellent or good rating for quality, choice and availability of food.'
Australian health bureaucrats think they know better than the doctors
EXCESSIVELY strict interpretation of rules governing the prescription of human growth hormone is compromising the care of children with medical conditions that make them abnormally short, specialists say.
The doctors say officials are rejecting legitimate applications to put children on the program, and restricting others to doses too low to be effective, after changes at the Department of Health and Ageing that have made new staff reluctant to continue a tradition of informal agreement over who should qualify and instead insist on the letter of the rules.
They want the department to update its regulations based on new research showing larger doses should be given early in a child's treatment for maximum effectiveness, and to consider research suggesting it is useful in a wider range of disorders.
But the department has made a submission to the independent Pharmaceutical Benefits Advisory Committee, which sets rules for subsidised treatment, arguing for more tightly defined eligibility and dosage criteria.
The Australian Paediatric Endocrine Group had made a submission arguing for more liberal prescribing, its president, Andrew Cotterill, said.
Dr Cotterill said he understood the department's dilemma, but he wanted "to work … to develop a process that is gentler around the hard edges". The prescribing system had previously worked as a "gentlemen's agreement" in which public servants usually accepted specialists' advice that patients needed the drug if they fell marginally outside the criteria. But the approach had toughened and more applications were being rejected. "The current medical literature is pointing towards the first year of treatment [offering] the best chance of a response," Dr Cotterill said, meaning children should be moved quickly towards the maximum dose if they did not respond to lower doses. But the rules say the dose should be increased slowly.
Growth hormone is prescribed to about 1500 children a year, costing typically $5000 to $10,000 a patient. More than half goes to those whose failure to grow has no known cause - but only if they are in the lowest 1 per cent of the expected height range based on their parents' statures. Other reasons include the genetic Turner syndrome, which affects only girls, cancer radiotherapy to the head, and kidney failure, along with hormone deficiency resulting from biochemical imbalance.
A Sydney endocrinologist, Maria Craig, said officials were "reading the guidelines very literally and overriding clinical experience … So much has to be taken in the context of a child's age, ethnic background, bone age, and [stage of puberty]. To have guidelines that are overly prescriptive just doesn't make sense." Dr Craig said the official dosing regime when a child started on the hormone was already conservative, offering "one of the lowest doses by global standards".
The chairman of the Pharmaceutical Benefits Advisory Committee, Lloyd Sansom, said a special meeting in December had discussed how the hormone might be used to treat chromosomal abnormalities and other disorders and "certain issues about dose escalation". He said the process was intended to set general terms for public subsidy and recommendations had been sent to the federal Health Minister, Nicola Roxon. A separate committee of specialised doctors could advise government on individual cases, but it was the Health Department's prerogative to make the final funding decision. "There is a limited health dollar, and decisions have to be made that can sometimes seem draconian," Professor Sansom said.
Obama rediscovers bipartisanship -- when he is forced to
He talked the talk. Now he might have to walk the walk
President Obama signaled on Wednesday that he might be willing to scale back his proposed health care overhaul to a version that could attract bipartisan support, as the White House and Congressional Democrats grappled with a political landscape transformed by the Republican victory in the Massachusetts Senate race. “I would advise that we try to move quickly to coalesce around those elements of the package that people agree on,” Mr. Obama said in an interview on ABC News, notably leaving near-universal insurance coverage off his list of core goals.
But it was not clear that even a stripped-down bill could get through Congress anytime soon. Throughout the day, White House officials and Democratic Congressional leaders struggled to find a viable way forward for the health care bill and to digest the reality that much of their agenda, including an energy measure and an overhaul of banking regulations, had been derailed by the outcome in Massachusetts.
Inside the White House, top aides to the president said Mr. Obama had made no decision on how to proceed, and insisted that his preference was still to win passage of a far-reaching health care measure, like the House and Senate bills, which would extend coverage to more than 30 million people by 2019.
On Capitol Hill, Democratic leaders said they were weighing several options. But some lawmakers in both parties began calling for a scaled-back bill that could be adopted quickly with bipartisan support, and Mr. Obama seemed to suggest that if he could not pass an ambitious health care bill, he would be willing to settle for what he could get. In the interview with ABC, he cited two specific goals: cracking down on insurance industry practices that hurt consumers and reining in health costs.
“We know that we need insurance reform, that the health insurance companies are taking advantage of people,” Mr. Obama said. “We know that we have to have some form of cost containment because if we don’t, then our budgets are going to blow up, and we know that small businesses are going to need help so that they can provide health insurance to their families. Those are the core, some of the core elements to this bill.”
Republican Congressional aides said a compromise bill could include new insurance industry regulations, including a ban on denying coverage based on pre-existing medical conditions, as well as aid for small businesses for health costs and possible steps to restrict malpractice lawsuits. But as Mr. Obama noted on ABC, a pared-down package imposing restrictions on insurers might make coverage unaffordable, which is one reason he prefers a broad overhaul.
As the full Congress returned to Washington to start a new legislative year on the first anniversary of Mr. Obama’s inauguration options were limited and there were signs of a divide between the White House and Democrats on Capitol Hill. House leaders signaled that they had effectively ruled out the idea of adopting the Senate bill, which would send it directly to the president for his signature. Yet close advisers to the president said such a move was still on the table.
Mr. Brown’s victory in Massachusetts on Tuesday denies Democrats the 60th vote that they need to surmount filibusters and advance a revised health measure. Senate leaders said they would not risk antagonizing voters by trying to rush a bill through before Mr. Brown could be sworn in, and Mr. Obama agreed. “People in Massachusetts spoke,” the president told ABC. “He’s got to be part of that process.”
Another option considered by Democrats would be to use the procedural maneuver known as reconciliation to pass chunks of the health care bill attached to a budget measure, which requires only a simple majority. But there appeared to be little appetite for such a move on Capitol Hill...
At a news conference at the Capitol, the Senate majority leader, Harry Reid of Nevada, sought to minimize health care as compared with jobs and the economy. But he made clear that Democrats did not see a clear path forward...
Senior Republicans showed little new willingness to collaborate with the Democrats. Asked where he might be willing to work across the aisle, the Senate Republican leader, Mitch McConnell of Kentucky, offered praise for Mr. Obama’s strategy in Afghanistan but not a single example on domestic policy. Mr. McConnell was asked if the health care bill was dead. “I sure hope so,” he said....
When the majority of voters in the bluest of blue states elects a candidate opposed to Obamacare to fill the Senate seat previously held by the man who was that proposal's most prominent supporter, there is a clear message: You lost because of what you've been doing for the past year, so stop doing it.
Incredibly, President Obama's political brain trusts and his most powerful allies on Capitol Hill don't understand this reality. Witness Obama adviser David Axelrod saying of Republican Scott Brown's victory in Tuesday's special election: "I think that it would a terrible mistake to walk away now. If we don't pass the bill, all we have is the stigma of a caricature that was put on it. That would be the worst result for everybody who has supported this bill."
Robert Gibbs, Obama's White House press secretary, saw nothing in the Massachusetts results but reasons to keep on keeping on, "not that we somehow abandon our pursuit on things that are important to the middle class." Similarly, even before all the votes in Massachusetts were counted, House Speaker Nancy Pelosi was vowing to reporters she will plunge ahead to pass Obamacare: "We will get the job done. I am confident of that."
The same refusal to see what everybody else sees was reflected in commentary by the president's most vigorous supporters on the nation's editorial pages. The Boston Globe, for example, saw nothing in Brown's win to "negate the resounding mandate that President Obama and Democrats in Congress received in 2008 to address escalating health costs." The Globe encouraged Obama and House Speaker Nancy Pelosi to "bring the legislative process to a close by pushing House members to pass the Senate version."
Then there are Obama's supporters in academe like Yale's Jacob S. Hacker and Georgetown's Daniel Hopkins, political scientists both, who even before they knew the outcome of Tuesday's election confidently explained in The Washington Post that "running from reform" would be the wrong message for Democrats to glean from the Massachusetts contest. Hacker and Hopkins thus provide a sterling illustration of minds being made up before becoming confused by the facts.
Obama and Democratic leaders would do well to listen to these words of wisdom from one of their own, Rep. Anthony Weiner of New York: "If there isn't any recognition that we got the message and we are trying to recalibrate and do things differently, we are not only going to risk looking ignorant but arrogant." Translation: If voters are so angry that Republicans can get Ted Kennedy's Senate seat, there isn't a safe Democratic incumbent anywhere in the country.
Obama health plan in doubt as Dems reject fast fix
Though reeling from a political body blow, House Democrats rejected the quickest fix to their health care dilemma Thursday and signaled that any agreement on President Barack Obama's signature issue will come slowly, if at all. Democrats weighed a handful of difficult options as they continued to absorb Republican Scott Brown's election to the Massachusetts Senate seat long held by Edward M. Kennedy. Several said Obama must forcefully help them find a way to avoid the humiliation of enacting no bill, and they urged him to do so quickly, to put the painful process behind them.
House leaders said they could not pass a Senate-approved bill, standing by itself, because of objections from liberals and moderates alike. Such a move could have settled the matter, because it would not have required further Senate action. Brown's stunning victory restored the GOP's power to block bills with Senate filibusters.
Democratic leaders weighed two main options, both problematic. The first would require congressional Democrats to muscle their way past stiff GOP objections despite warning signs from Massachusetts voters and worries about next November's elections. The other would pare down the original health care legislation in hopes of gaining some Republican support. But the compromise process is more difficult than many lawmakers suggest.
Democrats' hopes of settling on a strategy by the weekend seemed to fade, as lawmakers struggled to comprehend the drawbacks of every option. "We have to get a bill passed," said House Speaker Nancy Pelosi, D-Calif., because her party would have no excuse for failing to revamp health care when it controls Congress and the White House.
Some lawmakers said it will take time for congressional Democrats, who huddled repeatedly Thursday, to realize how limited their options are. "People are at various levels of the seven stages of grief," said Rep. Anthony Weiner, D-N.Y.
The first chief option would require House Democrats to approve the Senate-passed bill along with a guarantee that the Senate would make several simultaneous changes to health law desired by the House. Senate Democrats presumably would do so with a tactic called "budget reconciliation." It requires only a simple-majority vote for certain budget-related matters, but it cannot be used for every issue. Both parties have used the tactic at times.
When Brown is sworn in, Democrats will control 59 of the Senate's 100 seats. They need 60 to block GOP filibusters.
The second option calls for drafting a new, compromise bill more palatable to moderates, including some Republicans. But numerous officials said it's far easier said than done. For instance, a widely popular goal is to bar health insurers from refusing coverage to people already suffering medical problems. But without requiring most people to buy coverage, millions might wait until they have a serious problem before buying a policy, driving coverage costs to unsustainable levels. Moreover, "individual mandates" to buy insurance would almost certainly require government subsidies for low-income people. And that in turn would require new government revenues, such as taxes.
Many of these interconnected features drew strong objections, especially from Republicans, when the House and Senate passed competing versions of health care revisions last month.
Pelosi cited the dilemma Thursday. "I don't think anybody disagrees with 'Let's pass the popular part of the bill,'" she told reporters. "But some of the popular parts of the bill is the engine that drives some of the rest of it," which is far less popular, she said.
Outside groups were more blunt. "You can't do it," said Ron Pollack of the liberal-leaning Families USA. Enacting popular "insurance reforms" won't work without the more controversial and expensive steps of expanding coverage to the uninsured, he said.
Some lawmakers talked of placing partial limits on insurance companies' ability to deny coverage to those with pre-existing medical conditions. Companies might be required to cover sick children, or to keep covering customers who become sick and failed to disclose every detail of their medical histories when first buying their policies. Such compromises could leave Obama well short of the universal coverage he touted during his 2008 campaign.
House Democrats cite many objections to the Senate-passed bill, which make them wary of adopting it without some type of ironclad guarantee of improvements by the newly configured Senate. But budget reconciliation is one of Congress's most complex and controversial exercises, and it's not clear how many House objections can be remedied with the process.
A widely criticized feature of the Senate bill made special Medicaid concessions to Nebraska, demanded by Democratic Sen. Ben Nelson. Senators promised to expand the help to all 50 states, but Brown's election cut that negotiation process short. Congressional budget referees said Thursday it would cost $35 billion over 10 years to extend the so-called "Cornhusker Kickback" to every state.
Some Democrats said Obama must lead his dispirited party to a resolution. "He has got to bring the Senate and the House together," said Rep. Elijah Cummings, D-Md. "He has got to help all of us pave a way to get it done." White House spokesman Robert Gibbs said Obama thinks the best path is "giving this some time, by letting the dust settle, if you will, and looking for the best path forward." He said Obama does not believe a major health care revision is dead.
Asked what is next for the legislation, Sen. Debbie Stabenow, D-Mich., shaped her hand like a gun and pointed to her head. "We're looking to see what there's support to do," she said.
THE HUGELY WASTEFUL AND STULTIFYING BUREAUCRACY OF AUSTRALIA'S SOCIALIZED MEDICINE SYSTEM
Two current articles below -- from two different Australian States
Doctors highlight a cancerous medical bureaucracy in Queensland
Medicos wage war on billions wasted on bureaucrat jobs
AUSTRALIA'S peak medical group will demand Queensland Health stop hiring bureaucrats as part of a new name and shame campaign targeting the hundreds of millions of dollars it claims are being wasted in hospitals. The Australian Medical Association will today unveil a "War on Waste" campaign in a bid to highlight problems in the beleaguered health system, ahead of proposed reform by the Rudd Government later this year.
AMA Queensland president Mason Stevenson last night told The Courier-Mail the campaign would attempt to pressure both the state and federal governments to act on health reform, given an estimated $4 billion was being wasted nationwide. The group claims, for example, one in 10 surgery patients is admitted to hospital and prepared for surgery but discharged before their operation because of a lack of theatres. "The wastage is widespread and is costing lives," Dr Stevenson said.
The move comes amid a heated debate over a proposed federal takeover of hospitals, with the Rudd Government still considering recommendations from a top-level report.
But the Bligh Government last night produced a letter written last year by Queensland Health director-general Mick Reid asking to consult with the AMA about red tape. It claimed that request has been met with silence from the AMA.
The AMA campaign includes a list of questions Queensland Health will be asked to answer within two weeks, including how much extra hospital floor space bureaucrats have been given in the past decade. The AMA has also called for a moratorium on hiring bureaucrats, saying department figures showed the number of administration jobs had swollen from 5060 to 13,645 positions since 1995. Doctor jobs, meanwhile, had risen from 3095 to 6715 positions.
But Health Minister Paul Lucas defended the administration staff, saying they were crucial to taking paperwork from doctors and nurses who had been hired in record numbers. He instead accused the AMA of trying to introduce its own red tape and waste. "The AMA criticises Surgery Connect now but this is just sour grapes from an organisation that in 2006 supported the initiative and wanted to charge the State Government a $1.7 million 'management' fee to administer the program," he said. "Every hour of paperwork taken out of doctors' hands by booking clerks and patient liaison officers is an extra hour spent treating patients."
But Dr Stevenson said a moratorium was necessary to stop wastage.
Over the past 18 months I have spent an inordinate amount of time in public hospitals in NSW, not as a patient but as a witness to the ordeals of family members. There were multiple trips to the emergency department - where elderly people were piled up in corridors - and wards in which four very sick people crammed in one room managed to be pleasant to each other while overstretched nurses remained cheerful and the doctors adept.
There was the hand clinic with an inexplicable waiting time every week of four to six hours, but with world-class doctors fixing broken fingers for free, and the deserted endocrinology clinic, which a specialist opens by himself on Saturdays so his sickest patients don't have to wait.
I walked along deserted corridors at night and marvelled at how such a massive, ingenuity-sapping bureaucratic institution somehow still manages to save lives and bring out the best in people who work there. Two things were notable: first, the professionalism, expertise and good humour of most doctors and nurses; and second, the extent to which they must work around a government bureaucracy of Soviet-style ineptitude. Their successes are in spite of the system, about which they are openly scathing.
How did our hospitals become so remote from the needs of patients and the good sense of medical professionals? Two doctors with a combined total of more than 80 years in the NSW public hospital system, and a passion for public service, are speaking out about their experience of the "chaos, tragedy and sometimes downright farce" they have encountered in the second half of their careers.
Dr John Graham, the chairman of the Department of Medicine at Sydney Hospital and Sydney Eye Hospital, and Dr X, a staff specialist physician at a large hospital in the Northern Tablelands, (who cannot give his name for fear of being sacked) say the problem is not a lack of funding but the dead hand of bureaucracy. They have prescribed the remedy to restore public hospitals to their former place among the most trusted and well run institutions in the country: to reinstate local autonomy, with independent hospital boards taking full control of the budget.
Dr X, who is also a senior officer in the army reserve who served in Rwanda, Afghanistan and Banda Aceh after the tsunami, knows a thing or two about organising medical teams. "I have an appreciation of organisations, of command and control, of man management and of assessing clinical priorities and planning for them," he says. "In criticising the Department of Health, I am not an anarchist or privateer; I believe in our public institutions."
He says the amalgamation in 2004 of the Hunter and New England Health services into one giant administration was "an absolute disaster". "I can honestly say that in my three decades here I have never seen the system more dysfunctional. It just gets more and more bloody difficult."
His hospital is so stretched for doctors he has been without a day off and on call every second night since November. In an impassioned letter written on New Year's Eve while he was on call, he stated: "At the moment I have no resident medical officer, no registrar or secretary. I am expected to be all of these. "Meanwhile, in hospital I have patients waiting for investigations and treatment which will not be available for several weeks [due to holiday closures]. I am being pressured to discharge patients before they are ready, and to not admit patients who should be admitted.
"I am supposed to compromise patient care in order to save the hides of non-clinical incompetents who make irresponsible decisions without any consultation or consideration of the likely consequences. "Such a situation would never have occurred when communities had 'ownership' of their local hospitals and governed them though their local hospital boards . . . "And it is not as though the Hunter-New England Area Health Service is short of money; with a budget of $1 billion dollars, you could be forgiven for thinking that the staffing of its hospitals with appropriately experience doctors would be a priority."
Like Dr X, Dr Graham traces the rot back to the 1980s and 1990s when local hospital boards were replaced with area health services. In a policy paper for the Centre for Independent Studies in October, he argued that "the disastrous reorganisation of public hospital administration over the past 25 years needs to be reversed". Decision-making in hospitals used to be quick and effective, but now "funding is not spent optimally and trust, co-operation, morale and institutional loyalty has been sapped . . . Resource misallocation involving extraordinary growth in the size and cost of the bureaucracy has led to a massive waste of taxpayer's money."
The bimonthly department meetings that he attends at Sydney Hospital show how dysfunctional the system has become. "The department's time is mainly occupied in dealing with centralised directives issued by the South Eastern Sydney and Illawarra Area Health Service and NSW Health . . . Doctors and nurses these days are forever wasting time and energy complying with the new sets of orders issued by an intrusive, arbitrary, and seemingly unaccountable bureaucracy." For instance, there are new rules issued to medical staff every day about everything from handwashing to how to write a blood test request or talk to the grieving relatives of a patient. "They're constantly telling you your business," Dr Graham says.
And if you buck the system, "there is a lot of heavy-handed pressure brought to bear, especially on younger doctors and nurses. NSW is really like what it would have been in Moscow 20 years ago." Dr Graham, who is semi-retired, says that he is able to speak out because he is in the "lucky situation where they can't hurt me".
In an indication that the deteriorating state of our hospitals will be a major election issue, the Australian Medical Association this week called for wide-scale health reform in its submission to the 2010 budget. It's about time someone listened to the doctors.
Barack Obama will attempt to push through health care reform despite the shock loss of a previously safe Democrat senate seat in Massachusetts, aides have said. Advisers said tactics would have to be rethought but the president remained determined to stick to his political agenda.
Little-known Republican Scott Brown triumphed in one of the most liberal states in the country, which had delivered landslides to the late Edward Kennedy for 47 years.
On what was a grim first anniversary of Mr Obama's inauguration, Democrat leaders in Congress held urgent meetings to assess how they could salvage health legislation. The election defeat cost them their 60-vote majority in the Senate which was needed to see off Republican threats to filibuster the bill.
David Axelrod, a senior adviser in the White House, said: "We'll have to think through this next year from the standpoint of tactics but in substance the mission can't change. It's not an option simply to walk away from a problem that's only going to get worse."
David Plouffe, the president's former campaign manager, said that passing what was meant to be the cornerstone of the administration's domestic agenda would demonstrate strong leadership. "We have a good health care plan," he said on ABC. "We need to pass that. We have to lead and then explain it. We can't cut and run, it would be devastating for the country."
Republican leaders in Congress called for a reworking of the bill, which would provide near universal coverage and aimed to bring down long-term costs. But Nancy Pelosi, the Democratic House Speaker, argued that because Massachusetts already had near-universal health coverage under a state law, the vote should not be seen as a referendum on the issue. "We don't say a state that already has health care should determine whether the rest of the country should. We will get the job done. I'm very confident," she said.
Others in the party fear that their own seats are now at risk in November's midterm elections, and are convinced that the message from Massachusetts, a state Mr Obama won by 26 points in 2008, is that they must go back to the drawing board on health care.
At a raucous victory rally on Tuesday night Mr Brown said: "We won because of a shared conviction with voters that the people do not want a trillion dollar health care plan that's being forced on the American people. "The bill hasn't been debated openly and it will raise taxes and destroy jobs and drive the country deeper into debt. We need to start afresh and work together to do the job better."
Jubilant supporters at a Boston hotel ballroom compared his victory to the uprising against the British in the same city in 1773. "The revolution started here 230-something years ago, the same thing is happening tonight. Last time it was George III, now it's Washington we're going for," said Dave Knight, who volunteered for the Brown campaign.
With the Democrats' filibuster-proof majority gone, plans to introduce a cap and trade system for carbon emissions are also now at risk. A bill passed the House of Representatives but has been stuck in the senate for months.
The trial of five September 11 suspects at criminal court may also be in jeopardy. The proposal to move them from Guantanamo to the mainland for trial needs approval by Congress and Senator-elect Brown is fervently opposed to the notion. "Giving new rights to terrorists is wrong for our country," he said. "Our tax dollars should be spent on weapons to attack them, not lawyers to defend them."
Mitch McConnell, the Republican leader in the Senate, said the result should encourage Mr Obama to be more accommodating. "If he turns to govern in the middle we would be happy to meet him there," he said. But given a near complete breakdown in either side's ability to work with the other, observers said that seemed an unlikely scenario.
The Republican beat his Democratic rival and Massachusetts attorney general Martha Coakley by 52 per cent to 47 per cent.
Did the Dems secret deals on health care elect Brown?
During this morning's press conference, newly elected Massachusetts Senator Scott Brown discussed what he had heard from voters driving while driving around Massachusetts. He said that voters were tired of "business as usual," and he specifically cited anger over Nebraska Senator Ben Nelson's shady "cornhusker kickback" in the health care legislation as an example of why Massachusetts voters produced a stunning upset by voting for him the previous evening.
Brown isn't the only one who thinks that the populist backlash against these secret deals on health care reform is major reason why Democrats are in big trouble right now. In a memo yesterday that losing Democrat Martha Coakley gave to the press, her campaign blamed Washington Democrats for losing. The memo observed that Coakley declined steadily in the polls immediately following the Christmas eve passage of the health care bill. Further, the Coakley campaign's internal polls showed Brown's argument that the health care legislation and cap-and-trade were effectively tax increases were the most effective arguments with voters.
"We Democrats had to explain to Massachusetts voters and other Americans why non-Nebraskans and nonunion members have to pay more taxes, while Nebraskans and union members get to pay less. Those two deals seem to have alienated most people across the political spectrum. That’s not easy," wrote former Clinton Special Counsel Lanny Davis in the Wall Street Journal this morning.
And yesterday, The New York Times quoted one Massachusetts voter saying, "I'm just devastated by what Obama’s doing. I don’t think he cares enough about anything other than his own personal agenda or this foolish health care bill." The same voter also specifically cited the unfairness of the union tax exemption the health care bill as unfairly punishing her daughter and her husband who worked at a non-unionized business. It's also worth noting that Massachusetts has the highest average health care premiums in the country at almost $14,000 annually per family -- as such, the "cadillac" tax that unions received their exemption from would unduly hit Massachusetts residents. The unfairness of the union deal was likely not lost on them.
With new GOP strength in Senate, will Obamacare die in House?
Throughout the Massachusetts Senate race, we heard the number "41" repeated over and over -- as in Scott Brown would become the 41st Republican senator, whose presence would deprive Democrats of a filibuster-proof majority and stop President Obama's national health care plan. But now that Brown actually is the 41st GOP senator, the most important number in politics is 218 -- as in, can House Speaker Nancy Pelosi amass a majority of 218 votes for House Democrats to pass the health care bill already approved by the Senate, thus sending it to Obama's desk to be signed into law.
That is the essence of what's known as Plan B. The Senate is out of the game, now that Democrats no longer have their 60-vote majority. Any new version of a bill combining elements of the House and Senate versions won't be able to get through a Senate with 41 Republicans united against it. So the only course of action available to Democrats is to have the House pass the Senate bill verbatim, and then promise to quickly make changes to satisfy the objections of lawmakers in both houses.
But to do that, House Speaker Nancy Pelosi will need 218 votes to pass the Senate bill. And all across the House, Democrats and Republicans are doing the math.
When the House passed its version of the health care bill last November, the margin was 220 to 215. But the House has changed since then. First, Democratic Rep. Robert Wexler, a strong supporter of national health care, has quit to become president of a Washington-based think tank. That leaves Democrats with 219 votes. Then Republican Rep. Joseph Cao, the only GOP lawmaker to vote for the bill, announced that he would vote against it the next time, leaving Democrats with 218 -- the bare majority needed to pass the health care bill.
In addition, the House Republican leadership calculates that 11 Democrats who voted for the health care bill will likely vote against the Senate version because it lacks the House bill's tighter language on the subject of abortion. These are Democrats who voted for the so-called Stupak amendment and then voted for final passage of the health care bill because it contained the Stupak amendment language. If 11 of them do indeed defect, Democrats will be down to 207 votes -- 11 short of the number needed for passage.
How to close that gap? Well, three Democrats who voted against the bill -- Reps. Brian Baird, Dennis Moore, and John Tanner -- have decided to retire. No longer facing voter wrath over health care, they might be convinced to change their votes. If they all changed their position, Democrats would get to 210. But after that, what? Pelosi would still need eight more votes.
It is widely believed that the Speaker held some votes in reserve when the House passed the health care bill last November. That is, there were some Democrats who really wanted to vote against the bill but could have been arm-twisted to vote for it if it were absolutely necessary. Since Pelosi had the votes needed for passage, she let those lawmakers vote against the bill. Now, she could lean on them to change their vote.
That will surely happen -- but the question is, will it happen at least eight times? No one knows. But Republicans expect the Speaker to pull out every stop, to make every deal, to go to any length to pass the bill. "They have so much riding on this, I think they'd do almost anything to pass it," says a highly-placed House GOP source. "If it failed, Pelosi would have to acknowledge that they were wrong, and we've seen no indications that they believe that anything they've done on this health care bill is wrong."
Look for Democrats to enter into intense negotiations in coming days. They might not move immediately -- and they don't have to, because the Senate bill has already been passed, giving the House the freedom to vote on it tomorrow, next week, or six months from now. But it's likely that the President's Day recess, scheduled for the week of February 15, will emerge as a self-imposed deadline for a deal. "Their natural break is President's Day," says the GOP source. "If you go home for a week and you haven't finished this, it gets even harder."
Does Mass. Health Law Cover Fewer People Than Believed?
More dubious statistics
As Massachusetts held a de facto referendum Tuesday on Democrats' national health plans, a new study says the state's own health overhaul law hasn't been as successful as its backers claim. Republican Scott Brown has vowed to be the 41st vote to block a health care overhaul if elected to the U.S. Senate. But as a state senator, he voted for landmark legislation in 2006 seeking to cover virtually all residents.
In 2006 the Census Bureau reported that 10% of Massachusetts residents were uninsured. In 2008, it had fallen to 3.8% . But that understates the uninsured by at least 45%, according to Michael Cannon, director of health policy studies at the libertarian Cato Institute. "The official estimates overstate the health coverage gains in Massachusetts in part because residents are concealing their coverage status," said Cannon, who co-authored a study with Aaron Yelowitz, an economics professor at the University of Kentucky.
The law's supporters accuse Cato of "sloppy research." "Cato has a far-right libertarian point of view, and they opposed reform even before it passed," said Brian Rosman, research director of Health Care For All, a liberal advocacy group in Massachusetts.
The state requires people to buy insurance or pay a fine. That may affect how people answer Census questions about their insurance status, Cannon argues.
Nondenial Denials? Some respondents don't answer questions on insurance status. The Census tries to correct for that by comparing them with people with similar characteristics who did answer the question. "We find evidence that these imputations rose in Massachusetts, not just after the law passed but relative to other New England states," said Cannon. "Using those other states as controls, it shows that nonresponse to the health insurance question is growing in Massachusetts for some reason that is unique to the Bay State."
Cannon and Yelowitz find that the uninsured rate could be closer to 5.1% vs. the official 3.8%. "And that's only one strategy for concealing your health insurance status from the government pollster," said Cannon. "You can refuse to participate in the survey or you can lie."
Rosman isn't buying any of it. "When confronted with numbers that don't support their conclusion, Cato makes up a reason why people are lying," he said. "No one goes to jail here for not having insurance. It's no different than other issues on your taxes." He adds that reports looking at people — not samples — are "completely consistent with each other."
Children’s lives 'being put at risk by high rate of prescription errors in British hospitals'
Children’s lives are being put at risk in hospitals across the country, according to a new study which found mistakes in one in eight drug prescriptions. Experts warned that although many of the errors would not have caused serious harm, some could have proved fatal. Much more needs to be done to improve prescribing, especially when children are involved, they said.
The study is the largest to look at errors in prescriptions given to children in British hospitals. One in 10 of the mistakes uncovered involved youngsters being given either too much or too little of a drug. “Some of these errors could have ended up being fatal,” said Dr Maisoon Ghaleb, from the University of Hertfordshire, who led the study, carried out in five London hospitals.
In one case the researchers found that a six-month-old had been prescribed 5mg of the powerful painkiller morphine, more than 50 times the 96mcg dose that should have been prescribed. The mistake was picked up by the nurse administering the drug. “The nurse intervened and questioned the prescription, but if she had not it could have been fatal,” said Dr Ghaleb.
The researchers also found cases where doctors had forgotten to write down how much of a drug a child should be given, or whether it should be administered as a pill or as an intravenous drip.
Giving drugs to young people often involves complex calculations based on a child’s weight and their medical condition. By contrast, many adult patients are given standard doses.
Overall, mistakes were made in 13 per cent of prescriptions given to children, the study found. However, on one hospital ward the rate of errors was much higher, 32 per cent or almost one in three. Most of the errors, 41 per cent, involved incomplete prescriptions, including those where no dosage was given. In almost one in four cases of errors, 24 per cent, doctors used an abbreviation, the research also found, while 11 per cent of mistakes involved the wrong dose.
The study also found that mistakes were commonly made when the drugs were being given to the children. These included errors in how the drugs were prepared or the rate at which they were given intravenously. Overall there was some kind of mistake in 19 per cent of cases, the study found. On five occasions the researchers intervened to prevent the patient suffering harm.
During the study pharmacists reviewed almost 3,000 prescriptions written on children’s wards in the hospitals, which agreed to take part on the condition of anonymity, over a two-week period. Trained observers on the wards also watched how 1,554 doses of medicine were given to children, mainly by nurses. In all the study, carried out in 2005, picked up 391 prescription errors and 429 administration errors. Of these only one mistake was reported to the hospital’s risk management department, in charge of preventing errors.
The research team, which also included experts from the University of London School of Pharmacy believe that their findings show a general picture across Britain. They called for a system of electronic prescribing to be introduced in hospitals, which could pick up signs of mistakes being made, as well as better education for doctors on how to prescribe drugs.
The hospitals which took part included one specialist children’s hospital, three general teaching hospitals, and one non-teaching general hospital.
The study suggests that errors are more common when drugs are given to children than adults. A study last year by the General Medical Council warned that almost one in ten prescriptions for hospital patients contained mistakes.
Norman Lamb, the Liberal Democrat health spokesman, said that the study raised “serious concerns” about the safety of children in hospitals. “Everyone understands that occasional mistakes will be made but the scale of errors reported here is very worrying," he said. “Many parents will now fear that proper safeguards have not been put in place to ensure the safety of their children in hospital.”
National Health ID for Australia: Risks acknowledged from the outset
THE same people who claim a new national health identity system will be safe from fraud will be able to get fake ID to keep their own records secret. While every Australian will soon be assigned a 16-digit health ID number, politicians and other "well-known personalities" will be able to take advantage of false identities to stop their records falling into the wrong hands.
The 16-digit health number is a "building block" towards national electronic health records, which will be eventually shared among health professionals. The federal agency responsible for the rollout yesterday conceded the safeguards would be built into the system to "mitigate against the potential risks of exposure to this information". But access to the extra level of protection offered by the false IDs, known by the federally funded National E-Health Transaction Authority as "pseudonymisation", will not be widespread. "Pseudonymisation is not intended to be a generally available option," a spokeswoman for NEHTA said.
She said there was a "need to provide special protection for vulnerable people such as "well-known personalities" and victims of domestic violence. "With the universal allocation of individual healthcare identifiers to all Australian residents, there is a need to provide some form of special protection for vulnerable individuals to mitigate against the potential risks of exposure of this information," the spokeswoman said. The numbers, called "individual healthcare identifiers", or IHIs, will store only names and dates of birth and will not contain clinical information. The numbers will "tag" medical results such as blood tests and X-rays. The process is designed to ensure the right results are about the right patient.
Someone with one of the false IDs would be given a token which they could use the same way as they would their own identifying number. Although every Australian will be issued with an IHI number, they can choose not to use it. But people who did want an IHI number with an alternative identity would have to make a special application.
Despite the concession that an extra level of protection would be given to some, the NEHTA says the system is secure. NEHTA clinical head Mukesh Haikerwal said the system would include an audit trail, which would mean any individual would know where someone had accessed their records. Dr Haikerwal, a former president of the Australian Medical Association, said: "You will never satisfy everyone in regards to privacy, but I have far more confidence in the future of e-health and the security of its records than I do in the current system. "If confidentiality of the doctor-patient relationship is in any way compromised, I would have no part in it." [Haikerawal is a fine man so he is no doubt sincere. Whether he underestimates the crooks is another matter, however]
Currently, Australians can access anonymous medical care by simply not using their Medicare card. Health Minister Nicola Roxon did not comment yesterday but has previously said e-health would have strict, legislative protocols to protect patients' medical histories.
With Scott Brown's victory in Massachusetts, the hill that health reformers were storming got a lot steeper
Republican Scott Brown's improbable victory Tuesday in the Massachusetts special election to fill Ted Kennedy's Senate seat is more than a shot in the arm for opponents of ObamaCare. It's more like a successful triple bypass, plus new hips, knees and a facelift. What looked like an inevitable legislative victory now looks sketchy, after Brown campaigned against Democrat Martha Coakley promising to be the 41st vote against ObamaCare and beat her by about five percentage points.
On Christmas Eve, the Senate overcame a Republican filibuster and passed the $871 billion health overhaul bill 60 to 40. With one of those blue seats turning red, the Democrats face tough choices. Several of the "yea" voters, including Nebraska's Ben Nelson and Connecticut's Joe Lieberman, are already threatening to pull back their support if the combined House-Senate bill that is scheduled to be voted on later this month ends up being more liberal than the Senate version.
Sen. Al Franken promised Tuesday that the legislation will pass "one way or another." Here are some of the different scenarios: Find a Republican Vote in the Senate: Not likely--the Democrats haven't had any support from the other side of the aisle since mid-October, when Sen. Olympia Snowe of Maine voted for an earlier version of the bill in the Senate Finance Committee.
Refill the Tank: The Democrats could take a break and, as New York Times columnist David Brooks recommends, "spend the next year showing how government can serve a humble, helpful and supportive role." Then, with renewed humility and political capital, they could try again. The problem with this is that failure could mean a loss of momentum, the appearance of impotence and even the loss of seats during this year's midterm elections.
Rahm it Through: Obama's chief of staff, Rahm Emanuel, has always hinted that the Democrats could pass the bill through the Senate with only 51 votes by passing a compromise version through the House and then simply voting on it not as new legislation but as a budget reconciliation in the Senate. Such a move would avoid a filibuster. But using a shortcut to pass such a controversial bill could cause problems politically, not to mention set a bad precedent the next time Democrats are in the minority. In the past, reconciliation has mostly been used to pass tax bills.
Keep The Senate Bill: Franken mentioned that one option would be to have the House vote on the Senate bill without modifying it. That would avoid the need for a second Senate vote. This is the most intriguing option, but will the House pass a bill that it didn't help write? Especially after witnessing other Democrats lose seats?
Congress can pass a federal health care bill and President Obama can sign it, but that doesn't mean the states plan to abide by it
Lawmakers in 30 states are pressing for constitutional amendments to exempt individuals from the requirement to purchase health care, a pivotal piece of the legislation under debate in Congress. In Colorado, organizers of a proposed ballot measure filed language with the state elections office Friday. They would like the state legislature to place the amendment on the ballot, but given that both houses are controlled by Democrats, that's unlikely. "I want Colorado to become a sanctuary state for good health care," said Jon Caldara, president of the Independence Institute, who is leading the ballot effort. "People are angry, and rightfully so. If the legislature's not going to step up and do something, then we're going to have to."
Mr. Caldara's group plans to kick off its ballot campaign with a rally Tuesday outside the state Capitol. His group drafted its own language, but many states are using versions of legislation developed by the American Legislative Exchange Council.
Nineteen states have filed or pre-filed legislation using the organization's legislative language, known as the Freedom of Choice in Health Care Act, said Christie Herrera, ALEC's director of health and human services task force. Ten others have announced their intent to introduce similar bills this session. "It's all about preserving the right of people to choose health care for themselves," said Ms. Herrera.
Opponents of the opt-out movement argue that it shows no regard for the uninsured. They also question the motives of state lawmakers, accusing them of being more interested in embarrassing the president and weakening the Democratic Party's chances in 2010 midterm elections than in true reform. "This is a classic case of 'follow the special interests.' If you look at the people orchestrating this effort, it's exactly the same people who were behind the tea parties and who organized rallies against the stimulus and cap-and-trade," said Michael Huttner, chief executive officer of ProgressNow, a liberal advocacy group.
"These people have nothing better to do than hammer this administration and everything they do," he said. "This is just the issue that's been in the news. If it were some other issue like energy, this entire campaign would be on a completely different thing."
Why Dems' Health Reform Hopes Are 'Hanging by a Thread'
As the New Year unfolds and congressional Democrats meet with the President behind closed doors trying to reconcile the differences between the House and Senate versions, they also appear to have lost a good deal of the optimism they had just a few weeks ago about health reform's prospects. Sen. Chris Dodd (D-Conn.) recently said that healthcare reform was "hanging by a thread." And on the other side of the Capitol, Rep. Charlie Rangel (D-N.Y.) said, "We've got a problem . . . A serious problem." Negotiations over a final bill may well drag into February.
This discord within the Democrats' ranks offers Americans a renewed opportunity to learn about the sweeping changes augured by the congressional reform package. What they'll discover is a bill that hikes taxes to pay for "reform," making health care more expensive and less responsive to patients' needs.
New insurance regulations form the core of the reform plan. Paramount among these new rules is an individual mandate, which would require all Americans to maintain coverage. Proponents of the idea claim that it will bring healthy, previously uninsured young people into the insurance pool. Premiums from these folks would help lower the premiums of older, sicker Americans -- or so the thinking goes.
Unfortunately, these regulations would make both the uninsured and the majority of the middle class worse off. Most uninsured Americans go without coverage not because they want to but because they can't afford it. The Democrats' reform package does nothing to address this problem. In fact, health insurance costs would grow faster under the Senate bill than they would without reform.
People who refuse to buy insurance would be fined anywhere from $95 to $2,250 a year. By the time the fines are fully implemented, a typical individual insurance policy is expected to cost about $5,000, according to the Congressional Budget Office (CBO). Americans faced with the choice of forking over thousands of dollars a year for unaffordable coverage or paying a fine will likely opt for the latter. Other proposed regulations on insurance policies make such an outcome even more likely. Case in point: the reform plan's requirement that insurers accept all applicants, regardless of their health status or medical history.
That may sound fair, but such a provision encourages people to go without insurance until they actually need it. Why put out $5,000 on coverage you may never use if you can just pay $95 and pick up a policy down the line if you become ill?
These and other new insurance rules would increase the price of coverage for everyone -- not just the uninsured. Consider a 25-year old male living in Richmond, Virginia, for instance. Research using actual enrollee data from WellPoint, a large insurer, revealed that the major health insurance reforms under consideration would cause this hypothetical man's premiums to increase by 155 percent.
His peers in other states would experience similar increases. A healthy young man in Indianapolis, Indiana, would be saddled with a 178-percent premium hike. And a similarly situated man in Los Angeles, California, would see his premiums go up 106 percent. Families with children would also get hit with higher insurance bills. The same series of studies found that a two-child family living in Milwaukee, Wisconsin, would see its insurance tab more than double. A family with two kids in Richmond would face an insurance bill that's 82 percent higher. Other portions of the reform package would send health costs even higher. Medical device makers are being slapped with $20 billion in new taxes, and pharmaceutical companies are expected to kick in $80 billion to fund reform. These firms will undoubtedly raise their prices in order to offset the cost of these new government levies. And if insurers face steeper charges for their beneficiaries' drugs or medical devices, it's only natural that premiums will go up too.
Last week union leaders met with President Obama to complain about the Senate bill's 40 percent excise tax on "Cadillac" plans and how that would negatively affect their members. Now it appears that a tentative deal has been reached which would exempt unions' collective bargaining agreements from this tax. In order for the plan to be deficit neutral, revenue will have to be raised from other sources. A likely target will be the Medicare payroll tax, which was already going to be increased by 0.9 percent to 2.35 percent in order to fund the previously raised exemption. If accepted, the Medicare payroll tax will have to be raised even higher to cover the lost funding.
The give-and-take of the legislative process rarely produces perfect results, but the health reforms offered by congressional Democrats aren't just less-than-perfect -- they're worse than the status quo. Americans should hope that the thread from which the Democrats' reform package is hanging snaps soon.
A Cadillac Exemption From a Cadillac Tax From an Edsel Administration
This past Sunday marked the first time President Barack Obama graced a Washington, D.C., church with his presence since Oct. 11, but apparently it was not to sit in a pew and worship. Instead, he was doing the sermonizing and politicking -- gloriously intermingling church and state as only liberals are allowed to do in this country.
Don't get me wrong; I'm no scold when it comes to the church-state separation mania, which I think has been grossly expanded by liberals not to preserve the constitutional protection of religious liberty, but to selectively suppress it. But here I am digressing before I've even gotten started on the main focus of today's rant.
Instead of quibbling over the propriety of Obama's turning the church service into a political rally for health care, let's focus on the outrageous substance of his message.
He told the congregants at Vermont Avenue Baptist Church that Obamacare would help more than 30 million Americans -- "men and women and children, mothers and fathers" -- to get health insurance. "This will be a victory not for Democrats," he said. (He's got that one right.) "This'll be a victory for the United States of America." (Yes, once he and his party get thrown out on their ears for this monstrosity.)
But it's another one of his statements that really sticks in the craw: "This'll be a victory for dignity and decency, for our common humanity." Oh? How dignified is it for Obama to cram this extraordinarily unpopular scheme, replete with backroom deals and political payoffs, down Americans' throats? How decent of him is it to have made (and broken) an insincere pledge to televise these health care negotiations on C-SPAN, only to have his arrogant press secretary, Robert Gibbs, glibly duck all questions about it?
How common does Obama think our humanity is, when he's always abusing the power of his office to select certain categories of that humanity as winners and others as losers?
Does he think union members are more common, say, than nonunion members? Or are some workers, in the words of George Orwell's "Animal Farm" -- a fitting analogy for this socialist administration -- more equal than others? I think that goes without saying, but I'll say it anyway, because some people remain too stubborn to hear.
Obama first proposed a "Cadillac tax" on health plans whose benefits were more generous than he, in his dictatorial discretion, could tolerate. This tax was un-American enough in its own right, as well as a breach of his promise not to interfere with patient choice and the quality of health care, because it would use the tax code to encourage uniform coverage and prevent employers and individuals from operating in a free market.
But even this good socialist couldn't apply his principle of equal treatment for the entire proletariat. It seems the other Marxist imperative of glorifying union workers had to trump the principle of equality.
Just outside the reach of C-SPAN's video cameras, Obama agreed to exempt union workers from this Cadillac tax until at least 2018 -- at the estimated cost of $60 billion. What possible justification does he offer for this unjustifiable act? None; he doesn't have to justify himself. He is the flawless post-partisan, post-racial, post-George W. Bush president.
It's a good thing for him that he has exempted himself from scrutiny just as he is exempting unions from his Cadillac tax. For there is no rationale to set unions aside for special beneficial treatment any more than there was for the bribes to Sen. Ben Nelson of Nebraska and Sen. Mary Landrieu of Louisiana -- other than that Obama is in bed with unions and wants to reward them and swell their ranks with our money.
How's he going to make up for that $60 billion shortfall? No problem. Just applying his "common humanity" principle again, he'll extend the 2.9 percent Medicare payroll tax to capital gains, and according to The Washington Times, he'll extract $15 billion more from hospitals and $10 billion more from pharmaceuticals. There must be no rush in the world that compares with transferring billions from certain groups to others with a flick of the presidential pen.
To borrow another word from the Obama vernacular, can you imagine the audacity of this guy's lecturing us about decency, dignity, common humanity and health coverage for the "uninsured," when he has turned this entire health care issue into a poster child for Chicago-style political corruption and payoffs? Oh, the sweet irony of an overdue comeuppance courtesy of the Commonwealth of Massachusetts.
Patients in England and Wales denied powerful drug available in Scotland
Patients in England and Wales are being denied a powerful new arthritis drug on the NHS despite a decision by Scottish health authorities to provide it to sufferers for free. The Government’s drugs rationing body, the National Institute for Health and Clinical Excellence (Nice), has provisionally said that it does not intend to recommend the use of the drug, called Tocilizumab, or Roactemra. Nice claims that the £9,000 a year drug, for rheumatoid arthritis, has not proved that it is cost effective.
But patients in Scotland are to receive the treatment after it was recommended by the body which regulates drugs on the Scottish NHS, the Scottish Medicines Consortium (SMC). The move will reopen accusations of medical ‘apartheid’ within Britain. It follows an outcry after patients in Scotland were given access to expensive cancer drugs denied on the NHS in England and Wales.
Roactemra has been described as a “life changing” drug because it can be taken after other medications have failed, a common problem in the treatment of rheumatoid arthritis. Patients groups last night said that denying the medication to tens of thousands of patients with the crippling condition in one part of the country was “cruel”. Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society (NRAS), said: “I have heard patients stories that would make you weep. “People are virtually suicidal because they have nowhere else to go and yet they know that there are other drugs out there that they could have access to but cannot because of Nice.” She added that it was “ludicrous” that the drug would be available in Scotland “and yet two miles on over the border you can’t get it.”
The drug - the first new arthritis treatment for a decade - is already used in most other European countries, including France and Germany. It offers another option for patients for whom other treatments have failed or no longer work and is used in combination with a standard anti-inflammatory drug, called methotrexate. Currently many rheumatoid arthritis patients receive methotrexate as a first-line treatment to ease their symptoms. In later years they are offered another class of drugs, called anti-TNFs, together with methotrexate, but even combined the effects of the drugs can wear off.
In combination Roactemra has been found to improve the rates of remission of the illness sixfold in comparison with just methotrexate alone.
The SMC - set up in the aftermath of devolution to make decisions about drugs north of the border - has agreed that the drug can be used for patients suffering from moderate to severe forms of the disease for whom other medications no longer work.
Prof John Isaacs, from Newcastle University, said: “This is fantastic news for people in Scotland who suffer from this disabling, lifelong disease. “However, it also highlights the disparities in accessing treatments between Scotland and the rest of the UK. “Because Roactemra works in a completely different way to the existing drugs it is likely to be effective in some patients where the other drugs don’t work or have stopped working, providing an extremely important option for these individuals.” ...
Obama and Coakley afraid to make the Mass. Senate race a referendum on Obamacare
President Obama and Senate Democrats have pledged to make the 2010 midterm elections a referendum on Obamacare. "If Republicans want to campaign against what we have done by standing up for the status quo and for insurance companies over American families and businesses, that is a fight I want to have," Obama said Thursday. But during Sunday's rally for Democratic Senate candidate Martha Coakley at Northeastern University--Obama's first campaign appearance of 2010--he tried to keep the spotlight off of the health care legislation that Massachusetts voters could kill on Tuesday.
Obama mentioned "Wall Street" five times while talking about his proposal to tax banks. He mentioned taxes more than a dozen times. But when it came to health care, the president could muster only a few oblique references to health care reform in general. Talking about the letters he reads from average citizens, Obama said, "Sometimes it's young children who are writing: ... Mr. President, can you help, my brother is sick and we don't have health insurance."
Obama also said that Ted Kennedy waged a "personal battle" for "seniors who are living on fixed incomes, for families struggling to get health coverage for their children, for students who dream of a college education." Health care reform, which Kennedy called "the cause of my life," is just one issue on a laundry list of others--no mention that Kennedy's legislation hangs in the balance on Tuesday.
"Understand what's at stake here, Massachusetts," Obama said toward the end of his speech before talking about abstract ideas of progress rather than a concrete legislative agenda. "It's whether we're going forward or backwards. It's whether we're going to have a future where everybody gets a shot in this society or just the privileged few. If you were fired up in the last election, I need you more fired up in this election."
Coakley too didn't mention the health care legislation in Congress. At one point, she told a story about a couple named "Jim and Karen," who had health care and insurance problems, and said: "They know I will go to Washington and fight for them." But she couldn't bring herself to say, I'm going to go vote for a health care bill to fix these problems.
The reason for this shiftiness is obvious: Massachusetts voters oppose Obamacare. In fact, they oppose "President Obama's health care plan" 48% to 40%, according to the new PPP poll. Those polling numbers also explain why Brown is so confident in attacking the health care bill head on.
Hoping It Won’t Be Needed, Democrats Ponder a Backup Plan on Health Care Bill
With the Massachusetts special election for United States Senate increasingly unpredictable, Democrats in Washington are contemplating a fall-back plan to advance far-reaching health care legislation, even if a Republican victory on Tuesday deprives Senate Democrats of the crucial 60th vote they need to overcome filibusters.
For the moment, at least, the preferred Plan B would be to try to persuade House Democrats to approve the health care bill that the Senate adopted on Christmas Eve, obviating the need for an additional Senate vote and sending the measure directly to President Obama for his signature, administration officials and Congressional aides said on Sunday.
House Democrats have expressed complaints about the Senate legislation, and Congressional leaders and top White House officials, including Mr. Obama, worked last week to negotiate various compromises. Over all, however, the bills are similar, if not identical, on a vast majority of issues. For supporters of the health care overhaul, the complaints with the Senate bill may seem minor compared with the prospect of outright defeat of the legislation, the president’s top domestic initiative, and the thought of Republicans’ using a health care failure to clobber Democrats in this fall’s midterm elections.
Aides said that the Democrats could move forward with the Senate-passed bill and then push through a raft of changes during the upcoming federal budget process.
If rank-and-file House Democrats balk, party leaders have other options. They could try to pass a revised health care bill in the Senate before the new Massachusetts senator is sworn in. Or they could try to use a procedural tactic known as budget reconciliation that would require only 51 votes. But there is little appeal in those choices. Rushing a bill through the Senate would prompt howls from Republicans and accusations of foul play. And budget reconciliation would most likely require scaling back the scope of the health care changes.
From a political and public relations standpoint, officials said it seemed better for House Democrats to step forward and make the case that approving the Senate bill would be better than having no health care bill.
A House Democratic aide said the House view of the Senate bill had not changed. “We are working toward a compromise bill,” the aide said.
The Republican Senate leader, Mitch McConnell of Kentucky, appearing on “Fox News Sunday,” warned that health care would be a political weapon under any circumstances. “I think the politics are toxic for the Democrats either way,” Mr. McConnell said.
Health Care Reform Loads the Deck Against Specialists
Scarcely does a week roll by without a human interest story appearing somewhere in the news about a child with an unusual and rare ailment being flown to the United States to see a medical specialist. Often the story features a prominent person or even a government official of his or her particular homeland making a medical pilgrimage here to take advantage of medical expertise that can be found nowhere else.
Our free market health care system furnishes an environment within which medical specialists can flourish. It rewards their unique and rare levels of skill and expertise handsomely via the law of supply and demand. As these sorts of highly qualified specialists are in short supply relative to the demand for their services, those services when performed reap high monetary rewards.
Unfortunately, not everyone esteems these specialized services. And, hence, they have come up with other ways of setting the value of a medical service or procedure besides those of the free market.
Medicare (and Medicaid) has for years used such an alternative method and, shocking though it may be to some, critics charge that this method is nothing more than a revival of the old “Labor Theory of Value” championed most notably by Karl Marx. In fact, a Harvard team in the 1980s set out to study and discern the “value” of a physician’s “work” and subsequently created a fee schedule based on this theory, which has governed Medicare payments to physicians since January 1, 1992.
Quite simply, the centralized planners of Medicare — as Robert Emmet Moffit puts it in his insightful Heritage Foundation study “Back to the Future” — wished to use Medicare not only to provide health services to the elderly, but also as “a powerful engine of income redistribution and social justice among American physicians.”
They developed their “relative value scale” as a means of leveling the compensation playing field between what they deemed to be overvalued and overpriced surgeons and other specialists and allegedly undervalued and underpriced general and family practitioners.
A prime feature of the Labor Theory of Value is that it values a product or service according to the amount of labor that went into it, independent of market forces. Accordingly, Medicare and Medicaid’s relative value scale pays for a procedure based on how hard it is—i.e., based on the amount of labor that went into it—not based on the level of skill and knowledge needed to perform it.
So less highly skilled procedures performed by primary care physicians or general practitioners, if deemed to require the same amount of work as more intricate services that can only be competently performed by highly skilled specialists, will—in theory—be rewarded with equivalent compensation by the relative value scale. Note how this decidedly goes against trends in the free market which value rarer, more highly skilled work by specialists over the simple hard work of family physicians.
What is the relevance of this for current health care “reform” legislation? In an early white paper giving the essentials of what became the Senate health care bill; its architects remarked that they spent much time focusing on Medicare “because of its unique ability to lead the way for system-wide changes.” Their conclusion: “Increasing the supply of primary care practitioners and redefining their role in the health system — by using Federal reimbursement systems and other means to improve the value placed on their work — is a necessary step toward meaningful reform.”
Given that proposals in the Senate version of the bill are likely to be given preference in any final compromise version of the legislation, it is wise that we take this claim to heart as showing the direction in which the Democrats would like the health care system in the coming years. It is a direction that does not bode well for medical specialists – nor for their patients, few of whom, one assumes will travel from afar to seek highly specialized treatment from government-spawned general practitioners.
Barack Obama has now handed Big Labor the ultimate prize in its decades-long push to force workers into unwanted unions: the power to bludgeon employees with government taxes.
That is real purpose behind the backroom deal conjured up between the president and the union bosses late last week. They want to require non-union workers to foot the bill for a massive 40% excise tax increase on health care benefits. Union workers need not pay. And the only way union workers can escape the onerous tax is to meekly cave in to union demands.
Obama and the union bosses call it a “Cadillac Tax.” A “Right to Work Death Tax” would be more accurate – because its ultimate goal is to gut the 22 state Right to Work laws and turn those sovereign states into union serfdoms.
Now, all that is standing between the union bosses and the targeted workers are the 44 U.S. Senators and 167 members of the House from states protected by the highly popular Right to Work laws. Thirteen of those Senators and 73 of those House members are Democrats.
For them, it is a time for choosing: they can either side with Barack Obama and the union bosses, or they can stand up for the right of their constituents to continue working free of union coercion. It is one or the other. They can’t have it both ways.
If they vote for the Obama government health care takeover with the “Right to Work Death Tax” included, they will have betrayed the trust of more than 90 percent of their constituents who have chosen to remain independent. They will have condemned their states to the same union thuggery that has destroyed the economies of non-Right to Work states throughout the once prosperous Northeast. And they will have consigned the industries within their states to the same fate as America’s now-defunct auto industry.
If, on the other hand, they stand up for workers rights – if they say a resounding “No!” to the Obama-union boss attempt to force their workers to pay thousands of dollars more for benefits union employees get free – they will have put the people of their state before party dictates. And they will have earned the lasting gratitude of tens of millions of workers who want only to work free of government oppression and union coercion.
It seems like an easy choice – for those who put principle before politics. And, so, this paper echoes the words of the prophet Joshua to say, “Choose ye this day whom ye shall serve.”
If you must get ill in Britain, make sure it’s before 6pm
As GPs reap the rewards of their 2004 pay deal, patients are dying. It’s time to rethink our contemptible out-of-hours cover
Warm, fuzzy escapism is one honourable role of popular fiction, so Friday’s Coronation Street was justified in offering us a heart-warming medical vignette. A child had a fever; anxious divorced parents called their GP, who shortly turned up in their home, smiling, familiar, articulate and reassuring. At no point did anyone have to explain themselves repeatedly to NHS Direct “information handlers” on the phone, or wait four hours for an outsourced “provider” to send round a jetlagged foreign doctor they couldn’t understand. Nobody had to bundle the shaking child into the car to A&E, after scrabbling down the back of the sofa for change for the hospital car park.
Bless the warm nostalgia of it! Leave gritty realism to the newspapers, with the grimly unsurprising inquest reports about the day David Gray, a retired engineer, was killed by a tenfold overdose of diamorphine. It was administered by Dr Daniel Ubani, fresh in from Germany for his first dawn shift on the disgraceful, wasteful gravy train of British bought-in care. Now serving a nine-month suspended sentence back home, he freely admits that when he answered Mr Gray’s call he was in a state of “tremendous stress”, after only three hours’ sleep. Moreover, Ubani had never actually used diamorphine (his own clinic in Westphalia advertises “anti-ageing” and cosmetic services).
But you have to feel a bit sorry for the chap, as for all those who can’t resist golden temptations. UK primary care trusts, saddled with responsibility for “out-of-hours” services formerly provided by GPs, have been known to pay £800 per shift. One foreign doctor observed that he earns more in a couple of nights in the UK than in a whole month back home. European law means that a doctor certified in any EU country — even the newest and least familiar — must be automatically accepted as fit to practice here (the rest of the world is, at least, tested). Locum agencies need not make certain that the incoming doctor speaks English properly, or has had any sleep. Evidence has been given that the UK doctor who “inducted” and signed off Ubani wrote on his form that he was too busy to give him a proper assessment.
Mr Gray’s tragedy is an extreme, like the earlier death of a 41-year-old mother from undiagnosed septicaemia after six phone calls and two locum examinations. But the problem is far wider, and not confined to foreign doctors. Only 6 per cent of trusts hit the official target for prompt attention to urgent cases, and tales of incompetence abound. Try our own extended family: one serious injury to a teenager, bone exposed, met hours of indifferent delay and finally a trip to hospital (lucky they had a car. Plenty don’t). Another relative, with a nursing background, caught an incomprehensible foreign locum injecting her with a wholly inappropriate drug as a “painkiller”. Personally I can just offer one serious, basic misdiagnosis of a small post-op problem (English doctor this time, but clearly rubbish). The entry-level crassness of what he told me visibly shocked the real consultant when, after a terrified weekend, I got to a proper clinic.
Meanwhile, among the very elderly — such as my late mother — after 2004 it became axiomatic never to try for a doctor at weekends. You struggle on with your breathing problems or worsening pain until Monday, when you can see someone who speaks English, and knows you.
And so it goes on. Why? Because, in 2004 the Government blithely signed a new contract with family doctors — admittedly an undervalued service before. It boosted their pay by 30 per cent (with extra bunce for paperwork, such as making lists of fat patients) while crucially allowing them — by losing a small increment — to opt out of any responsibility for their patients outside surgery hours. Most GPs jumped at the chance. primary care trusts had to find cover: profit-seeking locum providers, such as Take Care Now which hired Ubani, mushroomed, undercut each other, and used the vast expansion of the EU and the ban on vetting or testing to keep things speedy and cheap, even with high shift fees. As to UK doctors who choose agency work, even their professional websites carry warnings that “lack of continuity and follow-up can be vocationally barren in the long run and could contribute to disillusionment and burn-out”. In other words, it’s a dehumanising and impersonal way to practice medicine. Which doesn’t bode well for the patients, either.
It has been a disaster, a thoughtless, formulaic governmental incompetence that ignored the daily realities of citizens’ lives (as does the still chronic shortage of NHS dentists, another contractual foul-up). Its effect has been condemned by Action Against Medical Accidents and the Care Quality Commission; even the Royal College of General Practitioners is uneasy. It has certainly put extra pressure on the 999 service and A&E departments. The Tories say they will reverse the contracts and make GPs collectively responsible for organising reliable care: heaven knows whether they can achieve this against BMA resistance.
And yes, doctor, I know that before the change you were often persecuted by stupid, selfish, unnecessary night calls. Yes, we do live in a society where some people dial 999 because their cat is annoying them, or ring the GP at 3am because their eyebrow tickles. But there were other ways to tackle those idiots, if only governments were not so terrified of offending voters and tabloids by bringing in sharp penalties or charges. Instead, by stealth and without much thought about consequences, they inflicted on us all a degraded and degrading service, and the BMA did nothing to stop it. The fact is that normal, considerate, responsible people do sometimes get ill and afraid after 5pm and at weekends. They deserve better than the cavalier, dangerous contempt they are currently offered.
Know the TRUTH about the Government Health Care Bill H.R.3200 - Key Points
Beware ObamaCare fine print
“No matter how we reform health care, we will keep this promise,” President Obama told the American Medical Association last June. “If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”
Obama’s pledge is hollow, mainly because most Americans do not own their health plans, unlike their auto or home insurance, which is their private property.
Some 159 million non-elderly Americans have employer-controlled group coverage, according to the Kaiser Family Foundation’s annual Employer Health Benefits survey. Employees may prefer to keep their current medical insurance, but their bosses can change that coverage the moment they become disenchanted, just as easily as companies switch from Coke to Pepsi in office vending machines. Employers also can drop coverage altogether.
“ObamaCare” would forbid insurers from basing rates on the individual health of their customers in any community. It also would force issuers to cover people who refuse to buy insurance until they get sick. These and “ObamaCare’s” other complexities would make insurance pricier. Thus, some employers would save money by paying fines after de-insuring their employees. Workers who cherish their health plans then would find themselves dumped into the government-run Health Insurance Exchange.
“Some smaller employers would be inclined to terminate their existing coverage,” said a recent memorandum by Medicare’s chief actuary, Richard Foster. He added: “The per-worker penalties assessed on non-participating employers are very low compared to prevailing health insurance costs. As a result, the penalties would not be a significant deterrent to dropping or foregoing coverage. We estimate such actions would collectively reduce the number of people with employer-sponsored health coverage by about 17 million.”
Also, ObamaCare would require employers to provide federally approved coverage “meaningful” coverage. “Obama’s definition of ‘meaningful’ coverage could eliminate the health plans that now cover as many as half of the 159 million Americans with employer-sponsored insurance, plus more than half of the roughly 18 million Americans in the individual market,” says Cato Institute analyst Michael Cannon. “This could compel close to 90 million Americans to switch to more comprehensive health plans with higher premiums, whether they value the added coverage or not.”
Meanwhile, Medicare Advantage covers some 11 million seniors. ObamaCare would siphon $118 billion from Medicare Advantage through 2019 and funnel it into a massive, new entitlement — even as Medicare wheezes toward bankruptcy in 2017.
The ObamaCare fine print elsewhere — particularly, the baffling prose on pages 114 to 118 of the Senate’s ObamaCare bill — seems to limit Health Savings Accounts to the individual market, and only for those under age 30. The 9.5 million workers who now enjoy Health Savings Account plans — and self-insured individuals over 30— apparently would lose catastrophic coverage and tumble into the governmnent insurance exchange. Can we Americans lose health coverage under ‘ObamaCare’? Yes we can!
If the bill passes, the U.S. health care system will face chronic political warfare
"I am not the first president to take up this cause [of health care reform], but I am determined to be the last one," President Barack Obama declared in September. But history will force the president to eat his smooth bravado if he signs anything resembling what's on the table right now.
Far from settling the issue once and for all, the bill will usher even fiercer confrontations--not only on health care but on constitutional matters of governance as well--that will make the current battle look like the political equivalent of a spit-ball fight.
The Senate and the House begin reconciling their versions of health care "reform" this week. But everyone--barring die-hard Obama supporters--now believes that the outcome is going to be more botched than Michael Jackson's nose. There is a growing consensus in both the right and the left that the individual mandate provision, which is almost certain to be part of the final bill, represents a kind of neo-feudalism. Liberty-lovers (like myself) hate it because it will mean that for the first time ever, Americans will be forced to buy a service as a condition of lawful residence in this country. Americans will lose control over their money without the government even having the decency to formally call for a tax increase.
Progressives are offended too--not because the mandate involves a new leap in state power, but because this power would be unevenly wielded. They would be fine with the mandate if it were accompanied with an outright ban on insurance company profits or at least a public option to drive these profits down. Absent that, all it will do, they argue not without plausibility, is deliver a captive audience to insurance companies.
Since the odds at this stage that the final bill will include their beloved public option are next to zero, the left's next big battle will involve reinstating it while Obama is still in office. The biggest impediment to their ambition--as the current health care battle has made clear--isn't going to be evil Republicans or the venal insurance industry, but America's system of checks and balances. In particular, the Senate filibuster rules.
These rules are what gave blue dog Senate Democrats the power to stand up to their party bosses and derail the public option even though Democrats control the White House, the House and have a near supermajority in the Senate. And so long as these rules exist, enacting this option will only get harder when Democrats lose their overwhelming political advantage as is likely to happen this November. Hence it is no surprise that the liberal punditocracy is demanding the annulment of the filibuster--even though, ironically enough, it was a Democratic-controlled Senate that reinstated it in 1975 after a long hiatus.
Filibuster is not a beautiful thing, but it is a long established tool for checking overweening political ambition--and it can't be abolished without a bruising political battle. To the extent that most laws involve an expansion of government power, scrapping it will inevitably empower the government against its citizens. What's more, a president--a minority of one--will be able to override Congress with a stroke of his pen. But even 49 senators won't be able to stop him from ramming his agenda through their chamber.
This will shift the balance-of-power away from Congress and toward the president, diminishing his incentive to court political opponents, further polarizing the country. If the Tea Party disgust with government expansion is approaching revolutionary fervor now, imagine what will happen if a serious attempt is made to mess with a basic internal check on government power to shove a public option down the country's throat.
But with or without the public option, both the Senate and House bills involve a de facto nationalization of health care. The government already pays for half of the health care consumed in this country through Medicare, Medicaid and the veteran's administration. Another trillion dollars-plus of health care subsidies will give the government a majority stake.
And there is no sign that it plans to be a hands-off stakeholder. The panoply of mandates and regulations that Democrats are proposing--guaranteed coverage of pre-existing conditions; money back to policy holders if insurance companies' administrative costs exceed 10% of their revenues, etc.--will put the government squarely in the driver's seat. No less than the Congressional Budget Office has concluded that "this further expansion of the federal government's role in the health insurance market [that the Senate bill entails] would make such insurance an essentially governmental program."
The upshot of all this won't be unlimited, top-notch health care for everyone, as the Democratic establishment is promising. To the contrary, with individual patients losing even nominal control of their medical dollars, the health care system will be powered less by patient needs, and more by collective social goals dictated by politicians driven by powerful lobbies adept at political marketing.
Nationalized health care systems always and everywhere face a contest between competing interests trying to capture scarce medical dollars. If, say, women with breast cancer shame political authorities into approving expensive cancer-fighting drugs, men launch their own campaign to shift medical dollars to prostate cancer treatment. Patients who lack political savvy or represent disfavored causes--obesity, smokers, homosexuality--inevitably get relegated to second class medical status. If money poses an unfair obstacle for patients in a market-based system as progressives allege, can they with a straight face claim that the political establishment doesn't pose a far bigger obstacle in a government-run system?
But it is not just patients who are pitted against each other; providers are too. Unlike in a market where competition and innovation is always expanding the medical pie, in a nationalized system providers are engaged in a zero-sum game. Every dollar that goes for reduction of infant mortality to a pediatrician is one that doesn't go to a neurologist for Parkinson's treatment.
Since there is no equitable formula to deal with all these competing claims, politicians under nationalized health care are constantly tinkering and experimenting to fashion the system after their own pet causes. Even basic questions as to whether a health care system should be more cost-effective or more accessible become subject to political whim. For instance, England's Labor government some years ago repealed the internal market reforms put in place by the previous Conservative government to bring some cost discipline to the country's government-run National Health Service--only to reinstate these reforms after costs started exploding once again.
In short, if ObamaCare passes next month, America's health care system won't be revolutionized so much as thrown into a state of permanent revolution. Hence, its opponents can either redouble their efforts to strangle this monster in its crib now--or prepare for endless political warfare later.
Toddler dies after NHS doctors dismiss meningitis signs
Meningitis is so dangerous that it should always be treated as likely
A TODDLER died of meningitis after doctors dismissed a temperature and rash as an ear infection and sent her home from hospital. Within hours of being turned away from A&E, 17-month-old Kyra Davies developed bruise-like rashes in her eyes and on her head that did not vanish under a glass – a classic meningitis symptom.
Her parents dialled 999 and she was rushed back to Pinderfields Hospital in Wakefield, West Yorkshire. But by the time she arrived she was covered in black bruises and her body was swelling up. She died of meningitis and septicaemia just four hours after being transferred to another hospital.
Now Kyra’s parents, Shelley Budby and Mark Davies, are suing hospital bosses and say she would still be alive if they had not sent them away with a bottle of infant paracetamol. Mr Davies said: ‘I’m so angry. I feel like I’ve been ripped in half.’
Mid Yorkshire Health Trust expressed sympathies and is investigating.
Busy British maternity units turn away hundreds of women in labour
Women in labour are being turned away from overstretched maternity units amid Britain’s continuing baby boom
Hospitals across the country closed their doors to expectant mothers on more than 350 occasions last year because they could not cope with demand, sending women to other units to give birth. Reasons for the temporary closure or suspension of services included shortages of midwives or beds, despite government pledges to improve staffing levels and choice for women giving birth. Maternity wards in at least six out of ten regions in England closed at some point in 2008-09, figures reported to the Nursing and Midwifery Council (NMC), the independent regulator, showed yesterday.
The NMC warned that staffing levels of midwives were “still playing catch-up” with the rising birthrate, now higher than it has been for more than 36 years. Increasing numbers of complicated births, because of problems such as obesity, substance abuse, domestic violence or mothers not speaking English as a first language also placed a strain on services, the watchdog said.
The Government promised in 2007 that all pregnant women in England would have a choice of where to give birth. Campaigners said that in many cases this choice could not be guaranteed and that it could be terrifying for women to be turned away at the last minute by a hospital or maternity unit.
Reports submitted to the NMC by Local Supervising Authorities, which oversee the work of all registered midwives, found that units in the North West of England closed on more than 219 occasions last year. There were also 60 closures or suspensions in the East of England, 46 suspensions or attempted suspensions in London, 15 in the South East and 13 in the East Midlands.
Jay Francis, of the National Childbirth Trust, said that the Government’s choice guarantees were “clearly not being met”. “It is terrifying for a woman to go into her chosen unit in labour and to find the doors are closed,” she said. “While temporary closures may occasionally be necessary on the grounds of safety these should be rare events. Women rely on maternity services being open for them 24 hours a day, seven days a week.”
Anne Milton, the Conservative health spokeswoman, said: “The Government have not adequately planned for the rising birthrate. The Government claims it has increased maternity funding yet it appears that more units are closing.”
The Department of Health said that funding for maternity services had almost doubled since 1997 to just under £2 billion and that it had set a goal to recruit an extra 4,000 midwives by 2012.
Case Study
When Kate Goode, 31, went into labour at 35 weeks at 10pm on July 3, 2006, her husband Jack took her to The Grange Birth Centre in Petersfield.
The couple knew that the centre was due to close the following day, but it was officially still open. Nurses advised them to go home and relax but when Mrs Goode returned five hours later, 7cm to 8cm dilated, she was turned away.
Because she was a first-time mother, they were told to drive 20 miles to St Mary’s Hospital, Portsmouth, where her son Jacob was born three hours later. The Grange reopened in 2007 but was too understaffed to be the choice when her daughter, Maisie, was born a year later.
A health tax that hits everyone except the Democratic base
Democrats seem impervious to embarrassment as they buy votes for ObamaCare, but their latest move makes even Nebraska's Ben Nelson look cheap: The 87% of Americans who don't belong to a union will now foot the bill for a $60 billion giveaway to those who do.
The Senate bill was financed in part by a 40% excise tax on high-cost insurance coverage. The White House backs this "Cadillac tax" as one of the few remaining cost-control tokens. But Big Labor abhors the tax because union benefits tend to be far more generous than average, and labor leaders and House Democrats have been throwing a political tantrum for weeks.
So emerging from their backrooms, Democrats have agreed to extend a special exemption from the Cadillac tax to any health plan that is part of a collective-bargaining agreement, plus state and local workers, many of whom are unionized. Everyone else with a higher-end plan will start to be taxed in 2013, but union members will get a free pass until 2018.
Ponder that one for a moment. Two workers who are identical in every respect—wages, job, health plan—will be treated differently by the tax system, based solely on union membership.
Richard Trumka of the AFL-CIO says this and other concessions mean the excise tax will raise some $60 billion less than the original Senate version. Democrats are probably going to charge investors for this political perk, by extending the 2.9% Medicare payroll tax to capital gains for the first time ever—on top of all the other taxes. Just what the economic recovery needs.
Meanwhile, the extra five-year dispensation gives labor lobbyists plenty of time to negotiate a permanent extension for the Democratic union base, even as labor is being armed with an important new organizational tool: Eliminating the secret ballot in union elections might be unnecessary when unions have an exclusive tax privilege at their political disposal. Right-to-work states will also be punished because they are less unionized.
The payoff shows that no one is doing a better job of rebutting the White House's technocratic cost-control claims than its own party. How exactly is the excise tax going to drive down premiums when a good part of the most expensive plans is exempted? The new union deal follows a similar one with Harry Reid that exempted the 17 states in which health costs are highest, plus longshoremen, construction workers, some farmers and sundry other liberal allies.
Amid the Beltway panic over Tuesday's special Senate election in Massachusetts and deepening public revulsion about sweetheart deals like Mr. Nelson's "Cornhusker kickback," it's more than a little surprising that the White House would be so tone-deaf to even contemplate a demand that is so contrary to basic fairness. But somehow Democrats have convinced themselves that the only tourniquet that will stop the political bleeding is to pass a bill that even President Obama admitted on Thursday is deeply unpopular.
Democrats wouldn't have to pay these partisan bribes had they chosen to write a less radical bill that could attract Republican votes. But then they would have had to pass something other than this destructive and unaffordable exercise in entitlement politics.
For healthcare bill, a frantic ride in the final days
Like a roller-coaster ride on its last twisting turns, President Barack Obama's campaign to remake health care is barreling into final days of breathless suspense and headlong momentum. Democrats, led by Obama himself, are deploying this weekend to salvage an unpredictable Senate race in Massachusetts, while senior White House and congressional staffers in Washington hurry to finish work on cost and coverage options at the heart of the sweeping legislation.
A Republican victory in the race to fill the late Sen. Edward M. Kennedy's seat would deprive Democrats of the 60-vote majority needed to pass the bill in the Senate. Obama and Democratic congressional leaders would have a political window of perhaps days only to try to ram the bill through _ at considerable risk of incurring public wrath.
Democrats put on a bold public face Friday, while working behind the scenes with grim determination. Negotiators are "pretty close," Senate Majority Leader Harry Reid said at the end of a week of marathon negotiations to reconcile House- and Senate-passed versions.
A White House statement said there are "no final agreements and no overall package." But no further meetings were scheduled, and Rep. Jim Clyburn, D-S.C., the third-ranking House Democrat, said, "Something should be going to CBO very soon," indicating that aides were drafting the decisions made around the table in the White House Cabinet Room. The Congressional Budget Office is the official arbiter of the cost and extent of coverage that any legislation would provide. No details were immediately available, and congressional aides stressed the decisions made at the White House had not yet been fully shared with the Democratic rank and file.
One key obstacle appeared on its way to a resolution when Sen. Ben Nelson, D-Neb., requested the elimination of an intensely controversial, one-of-a-kind federal subsidy to cover the entire cost of a Medicaid expansion in his home state. That provision in the Senate-passed measure has drawn criticism from governors and others in both political parties from the moment it was disclosed, and even former President Bill Clinton urged that it be jettisoned. In its place, officials said Obama and lawmakers decided to increase federal money for Medicaid in all 50 states, although it was not clear if there would be enough to cover the expansion completely.
The increase in the Medicaid program is a key element in the bill's overall goal of expanding health coverage to millions who lack it. The bill also envisions creation of new insurance exchanges, federally regulated marketplaces where consumers can shop for coverage. Individuals and families at lower incomes would receive federal subsidies to defray the cost.
The legislation would curb insurance industry practices such as denial of coverage because of medical problems and charging higher premiums to people in poor health.
At the White House, spokesman Robert Gibbs was unequivocal that Obama's effort would prove successful. "As you heard the president say yesterday, we're going to get health care done," he said.
Not everyone was quite so certain, particularly given poll results from Massachusetts that showed Republican Scott Brown within reach of an upset over Democrat Martha Coakley in a three-way race. "If Scott Brown wins, it'll kill the health bill," said Rep. Barney Frank, D-Mass, reflecting that the Republican would provide opponents of the health care bill a decisive 41st vote to uphold a filibuster and block passage in the Senate. Frank predicted Coakley would ultimately prevail and thus preserve the essential 60-vote Senate majority. Obama hurriedly scheduled a weekend campaign trip to the state. Even so, Frank's remark sent shudders through the ranks of Democrats.
The president called on Congress in his inaugural address a year ago to send him legislation that would remake the health care system, including expansion of coverage, new regulations on industry and unprecedented measures to slow the rise in health care costs generally. Obama has made an unusual commitment in time and energy to the negotiations at the White House, essentially serving as a referee on key issues that the House and Senate leaders could not resolve.
Beyond that, he was willing to reopen issues where the two bills were identical. One example involved the patent protection that drugmakers would receive for their biotech drugs from generic competitors. The president wants to give generic makers quicker entry into the marketplace, and the pharmaceutical industry's top lobbyist, former Rep. W.J. Tauzin, sent an e-mail threatening to oppose the legislation if that happened. Even with an agreement on cost and coverage issues, Obama and congressional Democrats would have to resolve controversy over abortion, coverage of immigrants and other issues before sealing a final compromise.
The US Senate recently passed their altered version of the House's healthcare reform bill. Among hundreds of other economically harmful proposals, the Senate bill, HR 3590, will create several onerous new taxes on the producers of health goods and services.
The Tax on Insurers
In Title IX, Section 9010 of the bill, the Senate proposes a new direct tax on health-insurance providers in dense and esoteric language. The annual amount of the new tax for any insurer is defined as the sum that when divided by $6.7 billion yields the same result as
(The firm's net premiums for all US health risks insured + 200% of third-party administration fees received by the firm)
Divided by
(Aggregate premiums received by all private insurers + 200% of all third-party administration fees received by all firms)
Simple mathematical understanding reveals that the structure of this ratio ensures that the tax will fall most heavily on those insurers whose total premiums constitute the largest share of the total market for health insurance. Politically, this tax is an attempt by Congress to award itself a certain measure of backdoor authority over the execution of antitrust law.
Economically, this tax is a draconian attack on the largest health insurers in America. While Austrian analysis advocates against attacks on firms of an arbitrary size or market share in all cases, this conclusion is especially important when considering the market for health insurance.Download PDF
Insurance companies profit by separating their clients into "risk pools" and charging monthly premiums that reflect the collective financial risks of those pools. If both the timing and the cost of consumers' future health outlays were known by insurers in advance, insurers would enjoy guaranteed profits by selling insurance to each consumer at a price just above his future health outlays.
In reality, however, health insurers must constantly collect new data on maladies and their methods of treatment, hedge against the financial risks of unknown future costs, and account for the possibility of losses due to fraud and errors in calculation, all while optimizing the timing of their cash flows.
With such monumental challenges in mind, it is clear that insurance is a market that favors large firms with diverse clienteles. The addition of new customers, rather than indicating some sort of unfair monopolization or "bloating," is a natural and necessary outcome of the provision of insurance. Increases in size will occur until a firm's management is no longer able to handle additional growth.
Large firm size benefits both clients and insurers, and should not be penalized with a new progressive tax. This tax will result in a smaller-than-efficient typical firm size and therefore smaller-than-efficient risk pools, which will create unnecessary and unwanted financial risks that must be mitigated by higher premiums.
The ratio also includes 200% of all fees received by a firm for managing another insurer's health risks, which is a harsh disincentive for those insurance firms who manage other firms' health benefits packages. By making such contracts much more expensive for the insurance firm, the tax makes any "outsourcing" of benefits management by a large employer much more expensive.
As a result, large firms that now provide employee health insurance will either deduct more for their benefits packages or attempt to manage the plan internally. Firms that outsource plan management to insurers, by the very act of doing so, demonstrate that their managers do not believe themselves competent to manage the plans.
Therefore, this tax will lead to poorer management of employer-provided health insurance plans that, by government fiat, can no longer be inexpensively outsourced. For employees, this will mean more expensive premiums and more erratic claims-payment practices, both of which undermine the benefits to employees of having insurance in the first place.
The Tax on Capital Production
Section 9009 of Title IX establishes a new tax, or as the bill calls it, an "annual fee," on all producers and importers of medical devices. This tax is calculated similarly to the tax analyzed above, the tax to each individual producer being defined as that sum which, divided by $2 billion, is equal to the producer's percentage share of the market.
The implications of this tax are similar to those of the tax on insurers; it is an attack on the utilization of economies of scale in the production of medical capital goods. However, the analysis of a tax on producers of medical devices must take into consideration another dimension, namely that of economies of scope. "Economies of scope" refers to the profitability of diversifying rather than specializing.
For example, a firm specializing in artificial hearts may enjoy economies of scope in the production of vascular-care equipment due to the firm's access to dually useful knowledge. The same firm, however, will likely face diseconomies of scope in the production of prosthetic arms, due to the need to maintain an entirely separate stock of capital goods.
Just as with firm size, a firm's optimal scope would be determined by the profit-and-loss mechanism on the market. This tax, then, will discourage expansions of firm scope along the margins.
In more concrete terms, this means that medical-goods companies will be less likely to produce medical devices that have complementary relationships with their main products, or to produce different devices that enable the treatment of similar afflictions. To the health-services consumer, this implies higher risks of device failure and fewer available treatment methods for any given malady.
This tax on the capital supply also implies that hospitals and clinics will face higher costs to replace their capital stocks, which of course are composed almost entirely of medical devices that will be made scarcer by the tax. Thus, institutions will likely continue to use their medical devices beyond the point of degradation at which they would now be deemed unsafe for medical use.
Conclusion
The so-called "Patient Protection and Affordable Care Act" in fact will make access to health insurance more expensive and less useful, and will also render the care provided by insurance less effective, more risky, and more expensive by taxing the production of new capital goods. The taxation approach taken by Senate Democrats is a purely foolish method of funding regulations that are themselves horrible.
Australia: Health bureaucrats send police after a "disobedient" pregnant mother
A rough public hospital adds insult to injury. The same hospital killed a pregnant mother a couple of years ago. Their attitudes have obviously not changed
A HOSPITAL that wants a mother to have her baby induced sent police to her home after she failed to keep an appointment yesterday. Rochelle Allan, who is reluctant to be induced even though her baby is 12 days overdue, was told by the hospital they intended to go ahead with the procedure when she came in.
But after speaking to her midwife following a visit to the hospital the day before, and being assured her baby was fine, she decided not to attend the hospital the next day.
Now Ms Allan is furious after the two police officers arrived on her doorstep after they were called by Bathurst Hospital. Wanting a home birth, Ms Allan, 24, has been under the care of a private midwife and had been attending the hospital daily to monitor the baby's health. "I couldn't believe it when I saw the police officers at my door," Ms Allan said. "They told me they had been asked by the hospital to check on my welfare because I had not attended. "The hospital knew I did not want to be induced and they gave me no medical reason why I should be." Throughout her pregnancy, Ms Allan and her partner Daniel Jones have been regularly attending the hospital's antenatal clinic for mandatory tests and scans to monitor the baby's progress.
A hospital spokeswoman confirmed police were sent to Ms Allan's house to conduct a "welfare check". The spokeswoman said doctors were worried about the mother as she had previously complied with all appointments.
Ms Allan said that she had decided on having a home birth after a "horrific experience" at the same hospital two years ago when their son Bailey was born. "I was induced and I spent 48 hours in labour," she said. "I don't want to go through with that again."
Ms Allan is not against medical intervention and said she would not hesitate to deliver at the hospital if her baby's life was threatened. "If they had told me that my baby was in danger then I would have the baby in hospital," she said. "But they could give me no reason and all the tests show that there are no problems." By late yesterday, Ms Allan had started labour at home and was in the care of her midwife.
The incident comes as the debate over the safety of homebirths continues, with the Federal Government under pressure to change the law to allow midwives insurance if they attend a home birth. Homebirths Australia secretary Justine Caines said the case demonstrated how women "are too often treated during pregnancy and birth very poorly".
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists president Dr Ted Weaver said women were usually induced 14 days after their due date. "If the mum did not want to be induced after 14 days then you would conduct extra tests," he said. "The reason people get worried about going overdue is because there's a slight chance that the baby could die suddenly in utero for no reason."
Congress Should Say "No" Now to the Health Care Penalty Tax
Emerging from his closed door, backroom meetings with top union bosses, Barack Obama has come up with his most unique proposal yet for providing what he terms "quality health care": impose sky-high tax penalties on those who need and use health care most. And then force non-union workers to foot the bill for his new Health Care Tax Penalty.
Specifically, the new Obama proposal calls for adopting a Senate plan that would force insurance companies to pay a 40 percent excise tax on all policies above the limits of $8,500 for an individual and $23,000 for a family plan -- knowing all the while that the massive increase would be passed on to already strapped health insurance customers.
While its proponents call the proposal a "Cadillac Tax," the Congressional Budget Office has revealed that the massive cost increase will hit one in five Americans within the next three years. Within six years, it would reach a fifth of all households earning as little as $50,000 annually. And it would hit especially hard the elderly and chronically ill, whose insurance premiums often already top the Administration’s proposed taxable limits.
To make matters worse, the Obama White House and the bill’s supporters in the Senate and House make it clear that one of the primary reasons for the new Health Care Tax Penalty is to force Americans to seek less health care. As New York Times columnist Bob Herbert writes, “Proponents see this as a terrific way to hold down health care costs. If policyholders have to pay more out of their own pockets, they will be more careful — that is to say, more reluctant — to access health services.”
He then adds ominously, “On the other hand, people with very serious illnesses will be saddled with much higher out-of-pocket costs. And a reluctance to seek treatment for something that might seem relatively minor at first could well have terrible (and terribly expensive) consequences in the long run.”
Little wonder that AFL-CIO union health care lobbying chief Gerald Shea has observed, “People are going to see this as a huge middle-class tax hit.” And that is why his Big Labor bosses have reached a backroom deal with Barack Obama to have the nation’s 8 percent of union workers exempted from the staggering fees the remaining 92 percent of workers will be forced to pay.
Unless the members of the Senate and House – especially those from Right to Work states – block the Obama-union deal, the Health Care Tax Penalty will become law. And Barack Obama will have paid back the union bosses for the tens of millions of dollars (including $67 million from SEIU boss Andy Stern alone) in union campaign contributions he received in 2008.
Middle-class Americans should not be penalized with higher taxes and rising premiums for seeking quality health care. Independent workers should not be punished for choosing to remain free of union restrictions in merit shops. And Barack Obama should not pay off his debts to union bosses by selling out the American people in tawdry, backroom deals.
The Health Care Tax Penalty (“Cadillac Tax”) should be removed from the Obama health care bill before the measure is given any further consideration. And no one, union or non-union alike, should be forced by Washington to pay higher insurance premiums for lower quality care.
Another Special Interest Gets Sweetheart Deal in Health Care Bill
After a long-week of negotiations, unions have won an exemption from the excise tax on high-cost “Cadillac” health insurance plans. The excise tax would fall on health insurance plans that cost more than $8,500 for individuals and $23,00 for families (the union deal reportedly slightly increases these thresholds) starting in 2013. It is one of the many tax hikes proposed by Congress to partially offset the cost of its take over of the health care system.
Under the terms of the deal cut between Congressional negotiators, union leadership and the White House, union members would not have to pay the tax until 2018 – although this could be extended in the future and further delay union members from paying the tax. This latest deal for a special interest further demonstrates that the push for health care reform has always been about politics – not the best policy for the American people.
If it had been about setting the right policy, Congress would have capped the unlimited income tax exclusion for employer-provided health insurance. A cap would have been the right decision from both a health care and tax policy perspective, but President Obama assailed it during the campaign. The excise tax is an inferior, roundabout way of capping the exclusion without explicitly doing so.
Excluding union members from the excise tax is grossly unfair for non-union workers left paying it. For instance, two workers at the same company, one in the union and one not, that have identical health insurance plans would end up paying significantly different amounts of tax. The tax is 40 percent on the value of health plans in excess of the levels described above. The union worker would not pay this hefty tax, but the non-unionized worker would. There is no policy justification for exempting the union worker. They would get the exemption because they have powerful representation in Washington. Non-unionized workers would pay it because they don’t.
The tax code is already monstrously complex and the union carve-out from the tax will only make it worse. Tax authorities, taxpayers and employers will need to determine which workers are subject to the tax and which get a free pass based on union membership. They will also have to strip out the portions of the plans that cover dental and vision benefits since the new deal exempts them from the tax. This will add a new set of complicated paperwork for everyone to deal with.
Their exclusion from the tax means that Congress will need to find additional revenue to replace the revenue the tax would have raise had it applied to union members. This most likely means a further increase of the payroll tax, and applying it to investment income for the first time, for taxpayers earning more than $250,000 a year. This tax increase will hurt those that earn much less by lowering investment. Lower investment will mean businesses will create fewer jobs and wages will be lower for workers.
The backroom deal to exempt unions from the excise tax is a bad deal for any taxpayer that is not in a union. And not only will union members not have to pay the tax, but unions will get an extra benefit because they will have a new selling point to pitch potential members and help swell their ranks: join the union – get a tax cut.
This latest backroom, sweetheart deal for a special interest should anger all taxpayers. Even if they aren’t impacted by this particular deal, unless they have powerful friends at the negotiating table, they could be on the chopping block next. Business as usual in Washington.
Pelosi: Health care reform bill will be posted online for 72 hours before vote for review
In this Jan. 6, 2010, file photo House Speaker Nancy Pelosi, seen with House Ways and Means Chairman Rep. Charles Rangel, D-N.Y., left, and House Education and Labor Chairman Rep. George Miller, D-Calif., right, speaks to media outside the West Wing of the White House after meeting with President Barack Obama in Washington.
House Speaker Nancy Pelosi announced on Thursday that the final health care bill will be posted online for the public to view for 72 hours before the chamber votes on it.
The move comes after Senate and House Democratic leaders have been criticized for not allowing the media and television to view their intense negotiations to produce a final bill.
Democrats have been huddled for days behind closed doors both in Congress and at the White House, with sporadic press conferences and press releases intended to make the talks appear more open, although no real details have been disclosed.
"The House Democratic Leadership is committed to having the final health insurance reform legislation online for 72 hours before the House votes, for all Members and the American people to review," Pelosi said in a statement released jointly with House Majority Leader Steny Hoyer, D-Md. "We will continue the transparent process this landmark legislation has had for months."
No word yet from Senate Majority Leader Harry Reid, D-Nev., on whether he plans to follow the House on the 72-house public viewing.
With the immoral and intrusive Obama health care plan on the verge of passing both houses of the U.S. Congress, twenty Republican governors and governors-elect sent a letter to the House and Senate leaders urging them to pass “meaningful health care reform, not hastily prepared partisan legislation which omits reform and saddles American taxpayers for generations to come.”
“Governors of both parties have said for months how bad this bill is for the states and our nation,” said Republican Governors Association chairman Haley Barbour. ”Now is the time for leaders in Congress to finally listen and restart this process so they can get health care reform right.”
The RGA blasted the lack of transparency in the legislative process and called the current health care bills “a lost opportunity to improve the lives of Americans, create a sustainable system of health care and help stabilize both our state and national economies.”
The governors assert that the House and Senate bills fail to fix the broken Medicaid and Medicare systems and instead entitle 15-20 million more people to Medicaid. The net result of this expansion “will be a significant cost shift to those privately insured around the country” and will further damage already hurting state budgets.
The RGA also criticized the inflexibility forced upon states in the current bills. The governors write that the current proposals would eliminate the ability of states to negotiate Medicaid-provider rates and force the states into a one-size-fits-all, federally-designed health insurance exchange.
While the mainstream news media continue to hype President Barack Obama’s health care aspirations in the midst of a dismal, economic picture in the United States, more and more states are debating the prospect of declaring sovereignty.
According to political experts such as strategist Mike Baker, Americans are becoming disenchanted with the federal government’s lack of perspective on issues of great concern — especially health care — while intruding into the private lives of citizens with federal laws and other intrusions.
“Many [citizens] are angry at federal government intrusion into their lives and into matters that were intended by our Founding Fathers to be relegated to the individual states,” said Baker.
“Take, for instance, the police power. Since the beginning of our republic, police and law enforcement was considered a function of each state in the union. Now we have federal law enforcement agencies who are taking away police powers from states. Why does an agency -- the ATF -- created to oversee issues related to alcohol, tobacco and firearms need to have SWAT teams?” asks the conservative political strategist.
Not only does the US Constitution provide for the sovereignty, the US Supreme Court also ruled in New York v. United States, 112 S. Ct. 2408 (1992), that Congress may not simply commandeer the legislative and regulatory processes of the states.
In Washington State, House and Senate bill HJM-4009 declares:
“The Tenth Amendment to the Constitution of the United States specifically provides that, [T]he powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people; and the Tenth Amendment defines the total scope of federal power as being those powers specifically granted to it by the Constitution of the United States and no more; and… [F]ederalism is the constitutional division of powers between the national and state governments and is widely regarded as one of America’s most valuable contributions to political science….”
In the Northeast, long considered a bastion of liberal politics, New Hampshire has joined the fray. HCR-6 is a resolution “affirming States’ rights based on Jeffersonian principles.”
The bill states: “[T]he Constitution of the State of New Hampshire… declares that the people of this State have the sole and exclusive right of governing themselves as a free, sovereign, and independent State; and do, and forever hereafter shall, exercise and enjoy every power, jurisdiction, and right, pertaining thereto, which is not, or may not hereafter be, by them expressly delegated to the United States of America in congress assembled; and… the Constitution of the State… declares that the people inhabiting the territory formerly called the province of New Hampshire, do hereby solemnly and mutually agree with each other, to form themselves into a free, sovereign and independent body-politic, or State, by the name of The State of New Hampshire….”
The government health care threat posed by the Democrat Party's deceptive and destructive legislation and tactics may well be the proverbial straw that broke the camel's back. Hopefully, it will lead to a return to Reagan conservative principles that have all but been abandoned by the Grand Old Party.
Black doctor from Germany employed by the NHS was a disaster for several patients
A locum doctor who gave a patient a fatal dose of painkillers on his first shift in Britain was “dithery” and “muttering to himself”, the dead man’s partner told an inquest yesterday. David Gray, 70, was given more than ten times the recommended daily dose of diamorphine [heroin] by Daniel Ubani, who had flown from Germany to provide out-of-hours GP cover.
Mr Gray’s partner, Linda Bubb, told the inquest in Wisbech, Cambridgeshire, that Dr Ubani arrived four hours after she called for a doctor when Mr Gray began experiencing acute pain from kidney stones. She described Dr Ubani, who could speak only limited English, as “very tired and not as alert as he could have been”. She added: “The doctor seemed a bit dithery. He was muttering to himself.”
Rita Prchlik, from the country’s Department of Health, said he contacted the authorities two weeks after the incident. “He said, ‘I have made a mistake in England due to tiredness which resulted in a death’,” she said in a statement read to the court.
Dr Ubani had been on his first shift for the out-of-hours service provider SuffDoc, now called Take Care Now, when he injected Mr Gray in February 2008 at his home in Manea, Cambridgeshire. Ms Bubb said she told him Mr Gray usually received 100mg of pethidine as pain relief. “I knew they did not carry pethidine so I said it needed to be diamorphine,” she said. “To my knowledge he did not physically examine David. I did not see him take his pulse or blood pressure, but I was out of the room for a short time.”
Ms Bubb said that Dr Ubani gave Mr Gray two injections. “David then took the doctor’s hand and said, ‘thank you’.” Ms Bubb said that she checked on her partner after half an hour and he appeared to be asleep. “Some time later I realised there was something wrong. He did not seem to be moving.” He was pronounced dead after emergency services arrived.
The inquest was told that Dr Ubani’s care of another patient was described by her GP as “unusual and not correct”, while a third patient started vomiting after he gave her an injection. The hearing was told Dr Ubani read the British National Formulary, the guide to medicines, between call-outs.
Phyllis Fletcher, who had a severe form of the lung condition COPD, was given a linctus by Dr Ubani. But in a statement to the inquest, her GP, Carol Walcott, listed seven alternative courses of action that she felt should have been taken. Another patient, Sandra Banks, said in a statement that she had begun vomiting after Dr Ubani gave her an injection. She was later admitted to hospital. Her partner Stephen Cowley said in a statement: “There was something about Dr Ubani I wasn’t quite sure about. The main thing was a breakdown in language.”
Mr Gray’s family say the case raises questions over the use of overseas doctors for out-of-hours cover.
The non-jury inquest is also examining the death of another of Dr Ubani’s patients, Iris Edwards, who died a day after he treated her.
Mr Gray’s case prompted the Care Quality Commission to investigate Take Care Now. An interim report raised questions about the standard of GP out-of-hours services.
Dr Ubani was charged in Witten, Germany, with causing death by negligence over Mr Gray’s death, given a nine-month suspended sentence and ordered to pay ¤5,000 (£4,400) costs, according to the law firm Anthony Collins Solicitors, which is acting for Mr Gray’s family. The prosecution means he cannot be charged in Britain. Dr Ubani is supposed to give evidence tomorrow but is not expected to attend.
Betrayal of a Spitfire hero: NHS withdraws care home funding for war veteran struck down by dementia
As a Spitfire pilot in the Second World War, John Mejor risked his life for this country. He went on to devote his working life to conservation, helping to preserve the nation’s heritage and landscape. But in his hour of need, when he might have expected something in return, the state he gave so much to has betrayed him. The 88-year-old grandfather, who requires round-the-clock nursing at a home because of dementia and diabetes, has had the funding for his care withdrawn despite the advice of his GP.
His family now fear they will have to sell the house where his 94-year-old wife Cecile lives to cover the care home costs. On Thursday his daughter Sally Mejor, 54, said: ‘My father made great sacrifices for his country, he is a war hero and deserves better than this. I feel totally let down and hurt that he has been treated in this way. ‘It is a complete nightmare, a disgrace and an insult. He was, and still is, a very dignified man.’
Mr Mejor was moved from his house in Exmouth, Devon, to a care home 18 months ago because his family could no longer look after him following a series of mini-strokes. At first his NHS Trust paid the £800-aweek costs at the nearby Linksway Care Home under its ‘continuing health care’ scheme. Mr Mejor was eligible for the scheme, which is not means tested, because of the assessment of his GP.
But now his health needs have been reviewed by a different doctor acting for the trust. Officials say he is no longer considered a ‘severe’ case and will only receive £106 per week towards his care. Miss Mejor, however, says her father’s condition has not improved and his GP does not agree with the findings.
Miss Mejor, who lives at the family home in Exmouth as her mother’s full-time carer, said: ‘I cared for him myself for the first five years of his illness and if I could manage to continue I would. At no point was it said there would be any timeframe or, that should his condition improve, even slightly, it would be pulled from us. ‘If there was plenty of money to cover it, I would be willing and happy to pay. But because there isn’t, I have to stand up for him.’
Mr Mejor was born in Belgium but moved to Britain as a young boy and was awarded the Distinguished Flying Cross for bravery in the war. During a mission over Malta in 1942, in which he shot down German bombers, he was forced to bale out over the sea after his plane was hit – but returned to battle the very next day. His last operational flight was on D-Day, and after the war he rose to the rank of wing commander, in charge of a squadron of Vampire fighters. He retired in 1964 and set up the Devon Conservation Forum and the Devon Historic Buildings Trust.
Miss Mejor said: ‘What worries me is the money we are going to have to find for his care is going to have an effect on my mother’s life. ‘I’m fearful for her future, too, because we’re going to have to sell this house and she very much wanted to spend the rest of her life here.’
The family could apply for the NHS to pay for the residential care, but this is means tested and it is highly likely they would be unsuccessful. A health care source said that because Mr Mejor’s health was thought to have improved, extra funding would be an issue of social care – such as help with washing and dressing – rather than health care. This would make it a matter for the local authority, not the NHS.
On Thursday NHS Devon said the cost of Mr Mejor’s care would still be covered while an appeal was heard. This could take several months. Parveen Brown, who is responsible for continuing health care funding at NHS Devon, said: ‘There is no question of funding being suddenly cut off, or of houses having to be sold abruptly. ‘We deal with these issues as sensitively as we can and we will offer our support throughout.’
The Daily Mail’s Dignity for the Elderly campaign has repeatedly highlighted the unfairness of the system. Means test rules in England state that anybody who has been assessed as ineligible for nursing care must pay for residential care if they have assets worth more than £23,000. Last month it was revealed that at least 3,000 elderly people a year are forced to sell their homes to pay for residential care. There are fears that cash-strapped health trusts will use public spending cuts as an excuse to reduce funding further.
Unions struck a deal to exempt them from 'cadillac tax' funding health care reform?
National Journal is reporting that the unions have struck a deal on health care reform:
Unions tentatively struck a deal Tuesday to exempt collectively bargained healthcare plans from a tax on high-cost plans expected to be used to help raise revenue for the healthcare overhaul.
AFL-CIO President Richard Trumka, Service Employees International Union President Andy Stern and United Auto Workers President Ron Gettelfinger met with House Speaker Pelosi Tuesday, a day after labor leaders met at the White House to express their opposition to the excise tax.
House and Senate Democratic leaders are to meet with President Obama this morning at the White House to discuss health care. House Ways and Means Chairman Charles Rangel said he hopes there could be an agreement on the excise tax as early as today after the White House meeting, but then conceded: "That's stretching the word `hope.' "
Exempting collectively bargained plans would appease unions that often offer expensive health plans in lieu of higher wages. The deal could also help Obama avoid breaking his promise not to tax those earning less than $200,000. Obama recently expressed a preference for the excise tax.
The excise tax could further be tweaked to ensure Obama's promise is kept for non-union workers as well.
The so called "cadillac tax" on expensive health plans is a major funding mechanism for health care. So if a huge percentage of people with expensive health care plans now become exempt from the tax, isn't this going to have a radical impact on the bill's finances and how it is being paid for? Won't the CBO have to re-score the whole thing? It's hard to imagine that exempting unions from the tax isn't going to make the bill much more expensive without some new mechanism to raise revenue.
It's also utterly bizarre that the Senate just passed health care reform without addressing this issue with the unions. Striking a deal now makes Democrats appear completely captive to union interests.
When I think about what I like most about American liberalism, I think of my father's great, good friend, Smiling Bill. A Roosevelt Democrat, Bill believes in using the power of the government (and the money of rich people) to ameliorate the pain of the poor and lighten the load of the "little man." The son of a large, upwardly mobile Irish Catholic family, Bill started out on a familiar path for men in the middle of the American Century: college (Notre Dame) and then the service (Air Force in the Aleutians) before starting a family and career.
While my old man followed a similar path straight through (51 years with my late mother and a career as a corporate commander), Bill took a more circuitous route. Bill's midlife change in direction gave my father one of his best lines. When a big business associate asked my dad how the economy was back in West Virginia, he quipped, "I don't know, but my stockbroker just joined the Peace Corps."
Bill is now an artist and doer of quiet good deeds who shares a home in the hills with his lovely wife and scruffy dog. If a hopeless drunk needs a ride to rehab or the nuns at the after-school center can't make budget, Smiling Bill is there. For more than 30 years, he and my father have been perfecting their "Grumpy Old Men" routine over tennis games and piles of pancakes that obliterated the benefits of their on-court exertions.
During the Bush years, Bill razzed my father mercilessly about the "Republican wars" and crony capitalism, arguing that George W. Bush operated the government for the benefit of the few at the expense of the many. It was payback for too many Clinton jokes the decade before. A year ago, their harassment cycle promised to continue with my father teasing Smiling Bill about Barack Obama's socialist agenda and wimpy foreign policy. But as the year went on, Bill wasn't smiling anymore.
One morning as I fried eggs for them on a visit home, Bill said he was "so disappointed" that he "felt sick" about Obama. Obama's deal with the drugmakers to block reimported pharmaceuticals from Canada and acquiescence on a second surge in Afghanistan had dashed his hopes. Bill had believed that the little man would finally have an advocate in Washington but found that Obama had other priorities.
I've had reason to think of Bill almost every day since then as the administration and Democrats in Congress have continued to justify cynical actions with liberal goals. The president has argued that Congress needed to pass his health plan, despite widespread opposition in the center and Right, because otherwise the Democratic base would desert them in this fall's elections. Now, as Massachusetts voters are demonstrating, Democrats might be in worse trouble with the Left if they actually pass the plan.
The legislation has become an appalling welter of special interest deals crafted in secret and funded through middle-class taxes and impractical cuts to services for the poor and elderly. Worst for Obama, it shows him to be neither liberal nor a policy pragmatist, but a politician who favors expedient means to self-preservation.
Liberals of the Washington breed say that giving the federal government responsibility for all health care is the first step toward a single-payer system. They believe what's on the cusp of passage will fail in practice, but that its failure will lead to successive reforms that eventually fulfill the New Deal dream.
To conscientious liberals, selling out to Big Pharma and the insurance industry sounds idiotic. But they do not feel the burning need to beat Republicans, by any means necessary, as their representatives in Washington do.
The Democratic Party is begging Massachusetts voters to give them the 60th Senate vote they need to finally squeeze through a scrofulous health bill and get on with the business of the next election. But in a weird referendum on the plan, ultra-liberal Bay Staters don't seem moved by the pleas, expressing apathy or even hostility about helping Obama save face by sending him a winning health care vote in Martha Coakley. Watching her bag contributions from drug and insurance lobbyists on Tuesday night in Washington couldn't have helped their affection for Coakley or the plan. She may still prevail, but Democrats in Washington may soon fear victory on health care as much as they once feared defeat.
Inside sources on Capitol Hill say a new surge of pink slips could effectively derail the passage of the health-care bill – now facing reconciliation between the House and Senate. So far, a record 9 million pink slips protesting socialized medicine and other big-spending legislation have been delivered to every member of Congress. "I truly believe, based on what I'm hearing from members of the House and Senate, that we still have a chance to kill a government takeover of health care," said Joseph Farah, editor and chief executive officer of WND and one of the organizers of the campaign. "Quite honestly, I believe if we hit 10 million this month, we have a legitimate shot at this big goal."
Farah says there are several factors working toward that goal. Next week, a replacement for the late Sen. Ted Kennedy, D-Mass., will be elected in Massachusetts. Polls show Republican candidate Scott Brown edging ahead of Democrat Martha Coakley – an event considered next to impossible a month ago.
In addition to that possibility, polls showing formerly entrenched Democrats in House and Senate leadership positions faring badly in their own states and districts are giving many members of Congress pause for reconsideration of their support for the health care bills approved separately in the House and Senate. "What I'm hearing from Capitol Hill is really simple – give the pink slips one more big push," says Farah. "Hit 10 million and it may be the end of health care."
The pink slip campaign is the most economical way ever devised to send out 535 personalized messages to Congress delivered individually to every office in the Capitol. That's what the pink slip program is all about. And it is winding down now with a big push to the 10 million mark. "Be a part of history," says Farah. "Be a part of a program that will result in a voter revolution this fall. Show them you mean what you say ands say what you mean."
He adds: "If you are one of those Americans who can't wait to vote this fall, let every member of the House and Senate know what's coming in November. Let them know it's time for them to start job hunting – just like so many other American they helped put out of work with this reckless spending and unconstitutional practices."
For just $29.95 you can send an individualized notice to every member of Congress in the form of a "pink slip." The grassroots effort, organized by Farah and WND columnist Janet Porter, has warned members of the U.S. House and Senate they could be facing a "pink slip" as early as 2010. The pink slips campaign ensures Fed Ex will deliver this powerful message to all 535 members of the House of Representatives and the U.S. Senate – all for a remarkably low price based on economies of scale. At $29.95, that translates to 6 cents per message – shipped by Fed Ex.
So far, the onslaught of support for the campaign has twice wiped out supplies of pink paper across North America. As boxes of "Send Congress a Pink Slip" notices pile up in their offices, many members of Congress have embraced the effort and openly admit that they're getting the message. Others are "talking about it, but they're only talking about it behind closed doors and in the elevators as they go up and down and in very whispered tones," said Rep. Tom Price, R-Ga.
"What you hear are people saying, 'How many of those did you get or how many people came to your office today? And what are you going to do and how are you going to vote on this?'" Price continued. Price recently joined Reps. Trent Franks, R-Ariz., Steve King, R-Iowa, Michele Bachmann, R-Minn., and Louis Gohmert, R-Texas, in publicly thanking Farah and Porter for the program's results. "It's an amazing feat, to get that many slips to Congress," King told WND. "If you look through them, you can index each one back to an individual. That's powerful. There is a person behind each one of the slips."
"This is putting everyone on notice," said Sen. Jim DeMint, R-S.C., during an interview on Fox News. "And I think this is what the American people have been doing for months now, saying if you keep spending and borrowing, you're going to get fired." Rep. Todd Akin, R-Mo., said: "The pink slip campaign serves as a good reminder of the unavoidable fact that every member of Congress answers to their constituents and that they ignore their voices at their own peril."
Voices in unison pose the best hopes for stirring the conscience of Congress, said Farah, and the program makes the cost of sending mail to 535 people not only manageable but a downright bargain. "We encourage citizens to take individual actions," said Farah. "But when we act as a group, it's more cost-effective and the results more dramatic. Just try Fed Exing members of Congress yourself and see what it costs. We have learned from past experience that Fed Ex actually ensures delivery to members. What they do with them at that point is their choice."
If all the pink slips Congress has received were put end to end, the stripe of pink would stretch from Washington beyond Phoenix, at more than 2,400 miles. Stacked, they would soar 3,000 feet in the air, or nearly six times as high as the Washington Monument.
Dementia patients are being failed by the NHS as doctors and nurses lack knowledge and training, a highly critical report by the National Audit Office has found. Improvements to dementia services are not being given priority in the NHS despite repeated assurances from officials. In addition £60m handed out to local organisations in the last year has disappeared, the NAO said in an interim report.
GPs knowledge of dementia has not improved in the last five years although family doctors are more confident in diagnosing the condition, the report said. There is no basic training in the care of patients with dementia even though three quarters of patients in hospital are over the age of 70 and cases of the condition are expected to double in the next 30 years to reach more than 1.2 million in England, largely fuelled by an ageing population.
Karen Taylor, director of health at the NAO, said: "In 2007 we found value for money for dementia services was poor. The Department of Health published the dementia strategy in February last year and whilst it was comprehensive and welcome, it was delayed and the response since then is that it has not been given the priority or addressed with the urgency that both we and the Public Accounts Committee was led to believe it would be." She said 'a couple of years at least' has been lost.
Mr Amyas Morse, head of the National Audit Office, said: “The action has not so far matched the rhetoric in terms of urgency. "At the moment this strategy lacks the mechanisms needed to bring about large scale improvements and without these mechanisms it is unlikely that the intended and much needed transformation of services will be delivered within the strategy’s five year time frame.” Dementia is set to cost the country £15.9 billion this year, rising to £34.8 billion by 2026, the report said.
The estimated £1.9 billion that the dementia strategy, which sets out objectives to improve care, will cost to implement over the next ten years is expected to come from efficiency savings in the NHS and social care but this is at risk because of a lack of co-ordination. Dementia care is likely to cost a lot more than estimated after recent court cases which mean many patients with the condition who were paying for their care home place, should be funded by the NHS, the report said. Savings could be made if people were supported to stay in their own homes for longer, the report said, as specialist dementia care home places could £1,000 a week, around double a normal place.
Local NHS organisations do not even know how much they currently spend on dementia services and have not mapped out future need in their areas so cannot plan effectively, the report said. The first £60m given to local NHS organisations to improve dementia services has been absorbed into their bottom line and it is not clear what it has been spent on, the report said.
Edward Leigh, chairman of the Committee of Public Accounts said: "The Department of Health is in danger of not being able to follow up on its dementia strategy which it announced nearly a year ago. Dementia has not been made a national priority. "Almost every doctor, nurse and care home worker will at some point look after people with dementia and still there is no basic training for staff; GPs knowledge of dementia has not improved in five years; and the speed with which people are diagnosed with dementia varies across the country and so many are mossing out on the care that they should be receiving."
Andrew Ketteringham, Director of External Affairs of Alzheimer’s Society said: "This influential report shows just how big the dementia crisis is. "Change can't come soon enough for the millions of families battling daily with this devastating condition. The strategy will transform lives but only if local health authorities are compelled to give dementia the priority it deserves. Millions depend on the Strategy succeeding. It's a race against time."
Phil Hope, Care Services Minister, said: “We welcome this report, however it is important to remember that the field work was done five months after the National Dementia Strategy was published. Our implementation plan is on track. “Improving the quality of care and treatment for people with dementia is fundamental to our work to improve the lives of those affected. We will give careful consideration to all the recommendations made in this report. “We are in the first year of our ambitious five year National Dementia Strategy - change will not happen immediately. There is still much more to be done and we are working hard to put the plans outlined in the strategy into place.
British councils trying hard to cut back care for the elderly
Council officials are attempting to force through plans to abolish round-the-clock wardens in housing for vulnerable elderly people despite the worst winter in decades. A High Court judge ordered Portsmouth City Council to restore 24 hour staffing for hundreds of residents of sheltered housing schemes after a landmark High Court case last month. Judge Milward Jarman QC said that there were “serious failings” in the cost-cutting plans to replace overnight wardens with a “mobile” team of just two people patrolling the city, covering seven separate housing blocks. But officials have now secured a temporary order allowing them to continue with the cheaper scheme while the council appeals last month’s decision.
Replacing the wardens with two-man teams is expected to cut costs by an estimated £365,000 a year. But residents said that they felt frightened and vulnerable without round-the-clock staffing and claimed that the cuts could lead to tragedy. “If they win and I hope and pray they do not we are going to have deaths on our hands, I can see it coming, especially with this weather,” said Ron Smith, one of the residents, in whose name the original legal challenge was brought. “Our own staff who used to do the nights knew the residents, knew what is wrong with them, what pills they need, everything like that."
Just under 350 residents, some aged in their 90s and others suffering from illnesses including cancer, were told last summer that overnight wardens were being withdrawn as part of a plan to “improve” the service. Almost half personally signed up to support judicial review proceedings brought by Yvonne Hossack, the campaigning solicitor, in a joint case which also challenged a similar scheme in Barnet, north London, supported by hundreds more residents. But although they won the case, the Portsmouth residents are now facing the prospect of a fresh attempt by the council to abolish 24-hour wardens.
With roads across the city blocked by snow, the council was forced to abandon its mobile teams last week, hiring in agency staff to temporarily restore overnight staffing during the extreme weather. But it plans to revert to the two-man teams as soon as possible while it prepares to appeal last year’s ruling. “We believe that this is an essential service it is a matter of life and death,” said Miss Hossack.
David Mearns, the council’s assistant housing manager said: “We have always maintained that the mobile night service provides a safe, effective service that meets residents’ needs. “To date, the service has run for 64 nights, and received very positive feedback from the residents who have requested their help. “This has been supported by scheme staff, who say the night service is working extremely well.”
Doubts linger about final passage of Democrats' health plan
Senate and House Democrats intend to pass a final health care bill by next month, but as they return to Congress, Democratic leaders face a barrage of criticism and outright opposition to the bill from lawmakers and important interest groups that could put passage in jeopardy. Democratic leadership aides in the House are insisting Congress can clear a health care bill by mid-February, but Senate leadership aides won't commit to a date. Sen. Christopher Dodd, D-Conn., who announced his retirement last week, went so far as to declare the bill's passage was "hanging by a thread."
Public opinion polls confirm a lack of support for the health care plan, with disapproval growing as time passes. "I think they know how unpopular this is," said Senate Minority Leader Mitch McConnell, R-Ky. "And so I have some hope that they will have difficulty ramming this ... down the throats of the American people."
Republicans highlight a string of reports questioning the cost savings claimed in the Democratic plan. The most recent report was released last month by the Health and Human Services Department. It found that the Senate-passed bill would not shrink health care costs as promised, but rather would increase them by .7 percent in the next decade. The report, issued by HHS's Center for Medicare and Medicaid Services, said the plan included potentially "unrealistic" policy changes needed to curb Medicare costs, and such reductions could lead to a loss of services for seniors. Democrats point out that the report shows that the bill would ultimately keep Medicare solvent by reducing costs associated with it.
House Democratic leaders will soon begin negotiating in earnest with their rank and file to reduce opposition to a final bill that will likely mirror legislation passed in the Senate. Many House Democrats oppose the Senate bill because it lacks a government-run insurance program and includes an excise tax on expensive insurance policies.
Interest groups on the Left and Right who don't like the bill's taxes and abortion language are also bearing down on lawmakers. On Tuesday, a coalition of business and union leaders sent a letter to Senate Majority Leader Harry Reid, D-Nev., demanding lawmakers to get rid of the excise tax, which will hit many union workers. "We urge you, instead, to choose alternative revenue-raisers that are less likely to undermine the objectives of reform," the letter says. "Viable options have been proposed."
If the House insists on any significant changes, such as substituting the excise tax with an income tax on the wealthy, Senate Democrats risk losing a vote, which will leave them shy of the 60-vote supermajority needed to block a Republican filibuster.
Brendan Daly, spokesman for House Speaker Nancy Pelosi, said these differences wouldn't block passage. "Congress will soon pass, and the president will sign, a bill that provides affordability for the middle class, accountability for the insurance companies and accessibility to many more people in our country to quality, affordable health care," Daly said.
Having failed to persuade President Obama to scrap a proposed tax on high-cost health insurance policies, labor leaders took their case Tuesday to Speaker Nancy Pelosi, and they said they received a more favorable response. “I love the House, and I love the speaker,” Andrew L. Stern, president of the Service Employees International Union, said after the meeting.
House and Senate Democrats are trying to iron out numerous differences in bills passed by the two chambers to expand coverage and rein in health costs. “We are not ready at this point to get a single bill that we can agree to,” said Representative Louise M. Slaughter, Democrat of New York, the chairwoman of the Rules Committee and a member of the speaker’s leadership team.
House Democrats held a caucus on Tuesday night to figure out how they could finish work on legislation to remake the health care system along the lines proposed by Mr. Obama. Having devoted much of 2008 to the legislation, senior House Democrats said it could be a political disaster if they failed to pass it in this election year. But House Democrats made clear on Tuesday that they would not simply accept the Senate’s positions on major issues.
House Democratic leaders said, for example, that they would insist on a single national insurance exchange, where many individuals, families and small businesses could shop for coverage. The Senate bill calls for dozens of state-based exchanges.
And House Democrats said they would also insist on eliminating the exemption from federal antitrust law that health insurance companies have long enjoyed. The House bill would revoke the exemption, while the Senate bill would maintain it. If the exemption is repealed, Democrats said, it would be easier for federal officials to take action against price-fixing or other anticompetitive practices in the health insurance industry.
Under the Senate bill, the federal government would impose a 40 percent tax on the value of employer-sponsored health coverage exceeding $8,500 a year for an individual and $23,000 for a family. The bill would make certain allowances for plans covering retirees 55 and older and workers in high-risk occupations.
Ms. Pelosi noted that the president wanted the tax. But Representative Jerrold Nadler, Democrat of New York, said: “The view of many progressives is that the tax is unacceptable. It would affect a lot of middle-income people.” Mr. Nadler said the politics of the tax should worry Democrats. In effect, he said, “the tax tells blue-collar workers that you should pay higher taxes and get lower benefits to help finance coverage for the uninsured.” The Congressional Budget Office estimates that the tax would raise $149 billion over 10 years.
The House bill would not tax health benefits, and Representative Joe Courtney, Democrat of Connecticut, said that at least 190 House members had signed a letter opposing such a tax.
Mr. Stern, the union president, said that many workers with plans costing more than $23,000 a year did not have luxurious coverage. At a White House meeting on Monday, he said, labor leaders told Mr. Obama that some workers with rather ordinary health plans had to pay very high premiums because insurance companies faced little competition. Mr. Stern said that many union leaders were concerned more about the formula that would be used to increase the tax thresholds in the future than about the initial thresholds of $8,500 and $23,000. Union leaders said they feared that under the formula in the Senate bill, the tax would hit more and more health plans, which would pass on the cost to more and more workers.
Representative Charles B. Rangel, Democrat of New York and chairman of the Ways and Means Committee, said it would be difficult to win support in the House for the proposed tax on high-cost plans. “That’s going to be a problem,” he said.
Some Democrats had assumed that the House would yield to the Senate on many issues because any changes in the Senate bill could imperil the 60-vote majority needed to overcome opposition from Republican senators. But Ms. Slaughter said, “It is as hard for us to find 218 votes in the House as for the Senate to find 60.”
At their caucus, House Democrats said, they felt pressure to make concessions to get a deal on health care. “A lot of people think we have a gun to our head and don’t like it very much,” said Representative Anthony Weiner, Democrat of New York.
Ms. Slaughter said “it is really critical” to have a single national insurance exchange managed by the federal government. “If you leave that up to the states,” she said, “some states will not do what we are asking them to do.”
The National Association of Insurance Commissioners took a different view. In a letter to Ms. Pelosi, the association said that states should retain primary responsibility for regulating insurance, and that insurance exchanges should be “established and administered at the state level, with the flexibility to meet the needs of our local markets and consumers.”
While Democrats tried to work out their differences on Tuesday, the Senate Republican leader, Mitch McConnell of Kentucky, said, “We are going to do everything we can to stop this bill.” “I have great hope that enough Democrats are going to wake up and say we should not thumb our noses at the American people and cram this down their throats, no matter what they think,” Mr. McConnell said. “It’s an act of incredible arrogance.”
Democratic leaders negotiating a compromise health care bill appear likely to reject a House provision requiring employers to offer generous coverage to their workers or else pay a steep payroll tax, specialist say. The handful of moderate Senate Democrats who hold the political upper hand in shaping the final bill are expected to insist on hewing much closer to the Senate’s relatively lenient approach, which does not include a strong requirement that employers offer coverage. “I think that the House structure . . . will not fly in the Senate, given that they need 60 votes for the bill,’’ said Robert Greenstein, director of the Center on Budget and Policy Priorities.
Killing off the strong employer mandate in the House version would represent a substantial victory for business lobbies, who last year confronted the possibility that large Democratic majorities in the House and Senate could stick businesses with heavy regulations and fines.
Several influential business groups remain hostile to the Senate bill even so, but moderate Democrats have set their sights on at least keeping the Business Roundtable, a group representing large corporations, from not actively campaigning against the final bill. John Castellani, president of the Business Roundtable, called the Senate employer regulations “a much better approach.’’ He said they would give firms more flexibility in what kind of insurance they offer. “You don’t want to lose the ability to be creative and innovative, to drive better care, and to lower the cost trajectory,’’ he said.
But liberals and union leaders warn that the Senate’s approach would not strengthen coverage for many Americans who already have insurance, because unlike the House bill it would not set minimum standards for health benefits for large employers with more than 100 workers. Americans will want to know, “Is it going to stop this trend where employers are charging me higher premiums for skimpier coverage, or is it going to allow it to continue?’’ said Richard Kirsch, director of Health Care for America Now, a coalition of liberal groups.
In the coming weeks House and Senate leaders will meet to reconcile the differences between the health bills that each chamber passed last year. The employer responsibility issue has been overshadowed by noisier debates over abortion, taxes, and the public option. While the final product will require most individuals to obtain insurance, Democrats must now decide what employers’ obligations should be. A spokesman for House Speaker Nancy Pelosi had no comment on the negotiations.
About 56 percent of private firms offered coverage to employees in 2008, according to the Kaiser Family Foundation. Under the House bill, all firms with more than 50 workers would have to make substantial contributions toward relatively generous insurance for employees - including part-time workers, adjusted for hours worked - or face stiff financial penalties of up to 8 percent of payroll.
The latest nuttiness from Britain's government health scheme
Note: No acknowledgment that medium-weight people live LONGER than skinny people
Overweight people could be paid up to £1,750 for slimming under the latest trial involving NHS trusts and privately-run schemes. Earlier this year, the Telegraph disclosed that NHS has spent more than £3m in three year sending overweight patients to slimming classes at taxpayers’ expense. The latest trial follows a successful pilot in Kent where patients earned up to £425 from private firm Weight Wins for meeting weight loss targets.
Although the NHS pays a £185 administration fee for enlisting each patient, the bonus payments are made by Weight Wins. Eastern and Coastal Kent Primary Care Trust, which supervised the pilot involving about 400 NHS patients and about 150 private members, said it was pleased with the results.
One person in the pilot earned the maximum £425 payout after reaching the target of losing three stone 8lbs (50lbs) in seven months and keeping the weight off for six months. The scheme has now been extended and the maximum payments increased to £1,750 for shedding ten stone in 21 months. Other NHS trusts are understood to be taking part in the latest trial.
In 2006, the NHS's rationing body, the National Institute of Health and Clinical Excellence, recommended that GPs send patients to free slimming classes, because it was cheaper than weight loss pills or stomach stapling. Since then, Slimming World has sold more than 53,000 vouchers costing £45 to the NHS at a total cost to the taxpayer of more than £2.3 million.
In 2007 and 2008, more than 20,000 people were referred from the NHS to Weight Watchers, for courses which cost the NHS £35 per head, and £700,000 in total.
Australian public hospital negligence: Couple forced into dangerous baby delivery at home
And the response is theorizing. No inquiry ordered. It needs a front-page story in a major newspaper to generate an official inquiry
A Stafford Heights couple forced to deliver their baby alone at home are seeking a ``please explain’’ from their hospital. Royal Brisbane & Women’s Hospital (RBWH) sent Louisa Tomon home seven hours after she presented at the maternity ward on December 22.
When Mrs Tomon returned to her parents’ house, she knew the baby was coming. The Tomon’s called the ambulance ``straight away’’, but within 10 minutes the baby had arrived. Husband Matt Tomon delivered baby Julian despite the umbilical cord being wrapped around his neck.
``The first few minutes weren’t great, he was pretty blue when he came out and wasn’t really breathing and then he eventually started crying,’’ Mr Tomon said. "It was the best sound. It’s just one of those situations, it could have been a lot worse.’’
They question why they were sent home when Mrs Tomon claimed to have had three contractions every 10 minutes and had undergone an internal examination, a process known to kick-start childbirth.
RBWH executive director of Women’s and Newborn Services, Professor Ian Jones, said there were often a variety of reasons for a patient to leave a birthing suite after being admitted. ``One of the most common is because contractions become less intense and less frequent, or stop all together,’’ he said. ``This is called spurious labour.’’
Professor Jones said in these cases the patient was given the option to go home and return if they progressed to labour, or be admitted to an appropriate ward. Professor Jones said there was no evidence to suggest the high standard of care was not followed in this case.
Queensland Minister for Health Paul Lucas did not wish to comment specifically on the case but a spokeswoman for the minister said: ``If the patient or any patient has any genuine concerns they are welcome to contact the Health Quality and Complaints Commission (HQCC) regarding this.’’
Obama health reform bill makes Bernie Madoff look like a piker
Today the Wall Street Journal asks what many of us have been asking for quite some time – why aren’t the numerous and specific warnings about the real cost and destructiveness of the proposed health care plan being heeded?
Of course the simple answer is those who are determined to take health care under the government’s purview really don’t care – they finally have the opportunity long denied them and they plan on taking advantage of it. So, much like the “science” of man-made global warming, they’ve picked their narrative, settled on it and will not entertain anything which might impede them from attaining their goal – government control of the health care market.
Those who’ve read this blog are very familiar with how Democrats have gamed the system (CBO’s statutory 10 year window) and used cheap accounting tricks (collect taxes immediately, don’t start paying benefits for 5 years – gives the appearance of bending the cost curve down) to make the case that they’re actually spending less on health care over the years and saving us from the bankruptcy they claim the status quo will eventually bring.
Another report, which I mentioned last week, carries a devastating warning about the plan being considered behind closed doors by Congressional Democrats. Yet it has received no major media exposure.
It is the Centers for Medicare and Medicaid Services (CMMS) report. And chief actuary Richard Foster is very candid about the impact of what Congress is planning. Not the smoke and mirror show Congress puts out there, but a peek at the reality of what Congress is proposing:
Richard Foster, the chief actuary for the Centers for Medicare and Medicaid Services, reports that under his analysis national health spending will rise under the bills by $222 billion over the next 10 years. In other words, ObamaCare really does “bend the cost curve”—up.
Even that estimate exists only on paper, as Mr. Foster has the honesty to admit. Because “most of the coverage provisions would be in effect for only six of the 10 years of the budget period, the cost estimates shown in this memorandum do not represent a full 10-year cost for the proposed legislation,” he writes. The report is punctuated by phrases like “unrealistic” and “doubtful,” and Mr. Foster adds that “the scope and magnitude of these changes are such that few precedents exist for use in estimation.”
Let’s stop right here with the obvious point to be made. The $222 billion, as mentioned, is the estimate for the next 10 years. However, as Foster points out, the spending would occur in only 6 of those 10 years. So that spending is offset by 4 years of revenue collection. If we remove that buffer and simply take 6 into 222 and then multiply it by 10, we’re most likely a bit closer to the real spending number than the contrived one – $370 billion, a difference of a mere $148 billion. Or, in reality, the $222 is a number that was tweaked to ensure when it was added to the other numbers the total fell below the threshold of $900 billion – the point at which it was claimed the cost curve would be bent upward. Had Congress found that to get to the number they needed they would have to collect taxes for 10 years and not provide benefits for 8 years, that’s how the bill would have been written.
It was never really about actually bending the cost curve down – it was all about creating the perception that the cost curve was being bent down, nothing more.
And there’s more to understand about that $222 billion number:
That $222 billion is a net figure, even after accounting for the fact that most of the newly insured—18 million people—will be dumped into Medicaid, “where provider payment rates are well below average.” And for the fact that ObamaCare is “paid for” only in the sense that Medicare’s payments to doctors are assumed in the bill to be cut by more than 20% this spring and even deeper after that, which will never happen in practice.
Mr. Foster adds that other planned Medicare cuts would damage doctors and hospitals: “Over time, a sustained reduction in payment updates, based on productivity expectations that are difficult to attain, would cause Medicare payment rates to grow more slowly than, and in a way that was unrelated to, the providers’ costs of furnishing services to beneficiaries.” This is how price controls would work in practice, even as Medicare has hit its spending targets only four times in the last 25 years.
Again, we know that Congress plans a “doc fix” which will amend the law to keep the 20% cut from taking place this year. And there’s nothing, given the history of this program, that argues that 20% cut will ever take place. It is a figure based on an assumption that will most likely never happen. Note well the last sentence – with an addition of 18 million new Medicaid insured, how many times in the next 25 years do you supposed Medicaid will hit its spending targets? You might also want to keep in mind that is mostly a federally mandated program administered by the states who share the cost. What will this addition of 18 million new insured do to state budgets – especially if the assumed cuts in payments are never made?
But let’s say Congress, somewhere along the line, finds the intestinal fortitude to cut those payments to providers as they say they are. What would be the impact?
He says many providers will be forced to stop accepting patients who are insured by the government, as opposed to those who have private coverage “with relatively attractive payment rates.” The resulting two-tier health-care system “should be considered plausible and even probable initially.”
If they cut, those patients they bring on may not be able to find a health care provider, so the patients suffer. If they don’t make the cuts, spending goes through the roof and the taxpayer suffers. It’s a lose/lose. But what should be patently obvious to anyone reading all of this is the $222 billion net spending claim by Congress for this particular part of the health care reform bill is as bogus as their promise of transparency.
Just delving into the particulars of this one portion of the bill should disabuse any objective person of the belief that what is being proposed is going to cost less than what we presently have. It is all a wretchedly wrought political façade designed to gain your support for long enough to pass this monstrosity. And my guess is should it pass, we’ll all be poorer and eventually sicker for its passage.
House and Senate Democrat leaders, and President Obama, argue that they can "pay for" health insurance "reform" by cutting $500 billion from Medicare spending over the next decade—largely through arbitrary reimbursement cuts,— without reducing the quality of care delivered to beneficiaries.
Yet, in January, 2011, Medicare will implement a new payment system for patients receiving dialysis for end stage kidney disease that will severely ration care to this vulnerable (and largely minority) population based on equally arbitrary payment reductions. These patients will be the unfortunate canary in the Medicare coal mine: "reform" legislation will expose millions of Medicare patients to rationing and reduced quality of care.
In 1972, Congress passed legislation creating an entitlement to Medicare for patients diagnosed with end stage renal disease. The bill allocated about $140 per treatment (or $1820 per month) per patient. This facility fee was large enough to incentivize the creation of dialysis centers, the expansion of dialysis treatment to all patients, and an end to what were very real "death panels." The ESRD program became a model for what good government could accomplish. There was broad consensus that payment for this catastrophic illness was a legitimate federal function and use of taxpayer funds. Unfortunately, Congress neglected to index the payment for inflation, leading the constant-dollar value to dwindle to around $14 per treatment. Dialysis units were able to survive, and even prosper, by aggressive cost-cutting (substituting technicians for nurses), consolidation into ever-larger chains, boosting efficiency (sometimes by cutting treatment times with a negative impact on outcomes), and by generating revenue from sales of drugs used during dialysis.
In the late 1980s and early 1990s, recombinant erythropoietin (Epogen®, manufactured by Amgen) was introduced to treat the anemia associated with chronic kidney failure. An active vitamin D analog (Calcijex®, by Abbott) was also synthesized to replace deficiencies associated with kidney disease. Both drugs were administered during each dialysis session intravenously, and were paid for separately by Medicare. Medicare paid dialysis units 95% of the average wholesale price for these drugs. The units, especially the large chains, were able to buy at deep discounts below the AWP, generating significant margins. These margins became the major source of profit for dialysis units over time. A debate of the scientific merit of using these agents and their clinical outcome benchmarks is beyond the scope of this article. But clearly the payment model that had evolved led to incentives to prescribe that were potentially hazardous, and needed reform.
Evidence that treatment of anemia might not be beneficial or benign emerged in 2006, and this led to partial payment reform. Congress, in 2003, also instructed the Center for Medicare and Medicaid Services to come up with a "bundled" payment system for dialysis in which one payment per treatment would cover these additional medications. Under contract with CMS, the University of Michigan Kidney Epidemiology and Cost Center provided early in 2008 a detailed report on how this could be instituted. Congress then mandated implementation of a bundled payment system by 2011.
The UM-KECC model proposed payment of roughly $235 per treatment, with some adjustment for local wages and patient case-mix variables. Using this methodology, small dialysis providers Premila and Ganesh Bhat modeled their patient population in an article published in Nephrology News and Issues in June, 2009. They estimated losses in excess of $100,000 per year.
Last month CMS shocked the nephrology and dialysis community when they issued the final rule: Payment would be $198 per treatment. In addition, oral drugs typically used by dialysis patients were to be included in the bundle, with only an extra $14 per treatment thrown in to cover this added burden.
Nephrologists prescribe medications to dialysis patients to limit absorption of phosphorous from foods, and other drugs to treat the bone disease that accompanies kidney failure. Some of these are expensive, but are often covered under private insurance, Medicaid, or Medicare Part D (Full disclosure: I have received honoraria from companies that manufacture several of these drugs). Again, this is not the forum to debate the relative merits of these medications. However, no one in the medical community thinks they should be banned, or their use severely curtailed.
Yet that is what will almost certainly happen if the current scenario is enacted (The official comment period ended on December 16). Dialysis providers have already been looking at different strategies to lower the use of epogen and vitamin D analogs to minimize the financial impact of bundling. There is no question that similar cost-saving strategies will be used for these outpatient drugs. Formularies will almost certainly be introduced that will make it difficult for physicians to prescribe expensive oral medications since these will now be coming out of the dialysis unit budget.
The new rule contains even more disincentives for high quality dialysis care, including higher levels of federal micromanagement, lack of incentives for home dialysis, pressure to limit laboratory testing and hospitalizations, and increased staffing that would be required to administer outpatient medications. The end result is a highly restrictive practice environment that imposes de facto rationing of care to the most vulnerable population of Medicare patients.
Remember that the current payment structure is a result of congressional mismanagement of the basic dialysis payment. The "solution" now being proposed will greatly increase financial pressure on the dialysis industry and will very likely lead to bankruptcies and closures of many independent units, further limiting the availability of dialysis. Even the large dialysis chains will struggle to remain afloat. Their situation will worsen dramatically if private insurance (which covers dialysis at rates well above Medicare) disappears as a result of the added costs and regulatory burdens imposed on them by ObamaCare. In effect, this legislation sets the stage for an eventual nationalization of the dialysis industry.
The dialysis community has been under the heavy hand of federal regulation since the beginning. We are the first victims of Congress' misguided price control schemes. Whatever happens to us will eventually be extended to other segments of health care that come under government control. Medicare rationing is well under way.
My first thought after reading the headline of an article in the Watertown (N.Y.) Daily Times, was, “I’m gonna become Amish.” The headline: "Amish families exempt from insurance mandate".
Delving into the article, I learned that the health care reform legislation now floating through the halls of Congress does not specify that members of the Amish community are the only ones who will be exempt. In fact, the provision could apply to other groups.
The article mentioned Old Order Mennonites and perhaps Christian Scientists by name, but I suspect members of other denominations — Baptists, Catholics, Jews, Muslims et al — will experience “health care awakenings” in the near future and and decide they, too, wish to exercise “religious conscience” and, in turn, receive the same break as the Amish.
In the case of the Amish, according to the article, the religious conscience exemption stems from the fact that, among other things, the Amish “generally rely upon a community ethic that disdains government assistance.”
If you’ve read a newspaper, watched television, listened to the radio or surfed the web lately, you’ve heard of people protesting against government-run health care. I have, and I’m willing to bet that most of those protesters would say they, too, generally rely upon a community ethic that disdains government assistance.
Do you see where I’m going with this? There’s a giant loophole in the government-run health care legislation Democrats are trying to force down the throats of the American people. It allows people of faith to be exempt from the so-called “ObamaCare.” So, I say, let it pass!
That’s right! Stop the protests, stop calling your elected officials, and just let it pass! As soon as it passes, declare your religious freedom! No buggy required!
I'd say that libertarians could make very similar claims to the Amish
12 January, 2010
India's Uneducated Villagers and the American Congress
By Dinesh Shah
As I look at US Congress voting on the Healthcare bill without reading what’s in it, I can’t help thinking of India’s uneducated villagers voting in India’s elections. Earlier this year, the House of Representatives voted on this bill. Most members voted without having first read it. Now the US Senate, too, has approved the bill without knowing what’s in it.
In India where I grew up, the Constitutional democracy was established in 1950. During the first couple of decades the Congress party (then officially known as the Indian National Congress), won the majority and hence the privilege to elect the PM. Most notable leaders of the Independence movement belonged to the party. So, riding the wave of post-independence patriotic passions, it would have been natural for the Congress party to win, as these leaders were well liked and looked up to.
But although they were well liked and respected, it was not enough to ensure victory at the ballot box. The majority of the population lived in rural areas, uneducated and unable to read even the candidates’ names on the ballot. So, there had to be a fail-proof way to translate the party’s popularity into votes, to ensure that villagers voted for the right candidate and right party.
The Congress Party’s symbol “Two Bullocks with Yoke” helped overcome that hurdle. To rural villagers, “Two Bullocks with Yoke” symbolized plowing/farming, and hence prosperity. Two-Bullocks occupied the top-rung position in voters’ minds in the days well before the positioning concept was popularized by Al Ries and Jack Trout.
Voters were constantly hammered with a message to just put their voting stamp on the “Two Bullocks” symbol. It didn’t matter who the candidates were. This made it convenient for politicians to campaign and easier for uneducated voters to remember what to do. A voting stamp? Yes, it meant not having hanging chad problems even in those early primitive days.
Today, the words “Health care” in the bill’ title is the American equivalent of the Two Bullocks symbol. Congress, not unlike India’s uneducated villagers, is hammered by the President, House and Senate leaders to just vote “Yes” – to put their stamp of approval on the bill – without having ever read it.
Indian villagers were uneducated and couldn’t read the ballot even if they wanted to. America’s Congress is mostly made up of highly educated lawyers. So, what is their excuse? In reality, how are these supposed erudite solons any different from those uneducated Indian villagers? These representatives are expected not only to read the documents, but to thoroughly understand all the pros and cons before casting their vote. They are predominantly lawyers who would fight in courts on behalf of their clients to nullify any contracts being signed before being fully read or understood. Yet, they blithely shirk such a basic responsibility.
In the private sector, executives and professionals are disciplined for misconduct, often by their respective professional organizations and sometimes by law. Shouldn’t members of Congress be subject to similar discipline? Has the American Bar Association stated its position on such misconduct by its members? Organizations that don’t take corrective actions end up destroying themselves, ruining lives and destroying investments. Think of Enron, Madoff, housing and the sub-prime lending industry, just to name a few. Can the American Congress and hence America survive?
What is the people’s recourse? The only solution bandied about so far is to wait until the next election cycle. Live with it until the next November and take chances with the unpredictable memory and mood of the fickle population?
Perhaps it’s time to revisit the Constitution for a little timely updating. Maybe it’s time for a “Read to Lead" Amendment. In short, those who won’t read can’t lead. I jest, of course. But, the truth is: since Congress sets its own rules of conduct, it should surely establish such baseline standards – even if it takes an occasional pop quiz to enforce them. Oh, how low the Republic has sunk!
Donny Seyfer, the manager of an auto repair shop here, had high hopes when President Obama and Congress tackled health care as their top priority early last year. “This is good,” Mr. Seyfer remembers thinking. He expected Congress to “find out what Americans wanted.” But, he said in an interview at his shop, the Congressional debate deteriorated into a partisan brawl, and Congress has virtually ignored his biggest concern: holding down health costs. “I am an automotive diagnostician,” Mr. Seyfer said. “We look for the root cause of problems. If we treat the symptoms, the problem always comes back. With health care, we are not treating the root cause: Why does it cost so much?”
Mr. Seyfer’s disappointment was echoed in dozens of interviews here and in Fort Collins, Colo. People from both sides of the political spectrum — and apolitical consumers — said they were deeply skeptical about the health care bill being put together by Congress and the White House.
The concern illustrates the challenge Mr. Obama and Democratic lawmakers face in trying to meld House and Senate bills in a way that can be sold to the public. All kinds of issues are still in play, from how to cover abortion to whether to tax high-cost health plans.
President Obama hopes to sign a bill that guarantees access to insurance, outlaws the denial of coverage for pre-existing conditions and subsidizes premiums for many low- and middle-income people. Heading into Congressional elections this fall, Democrats hope voters will reward them for a historic achievement.
But Republicans are already using the bill as ammunition against Democrats who voted for it, like Senator Michael Bennet of Colorado. About 800,000 Colorado residents, representing one-sixth of the state’s population, are uninsured. The state’s politics are mixed and somewhat unpredictable. Colorado has a sizable contingent of people who want a single-payer government-financed health care system, as well as libertarians and Tea Party protesters opposed to big government.
Few of those interviewed here expect to see direct benefits from the legislation. Many complained of sweetheart deals done to win votes in the Senate. Liberals and conservatives alike said Congress was too influenced by special interests.
Tamara L. Kirch, who is uninsured and stands to benefit from the legislation, bristled at the proposed requirement to buy insurance. “We have a frontier mentality,” Ms. Kirch said. “I don’t want the government telling me what to do.” (She feels the same way about abortion: “The government should not tell a woman what to do with her womb.”)
Democrats, Republicans and independents each account for about one-third of registered voters in Colorado. Mr. Obama carried the state with 54 percent of the vote in 2008. But Gov. Bill Ritter Jr., a Democrat who was facing a tough fight for re-election, pulled out of the race last week.
Representative Diana DeGette, a Democrat from Denver, is a champion of the bill passed by the House in November. But Representative Betsy Markey, a freshman Democrat from the district that includes Fort Collins, voted against it, saying the bill did not do enough to cut costs.
Ron Vaughn, who provides health insurance to his 60 employees at Argonaut Wine and Liquor near the state Capitol, said: “I’m a middle-of-the-road kind of guy. I want the Democrats out of my pocket and Republicans out of my bedroom. The one word I would use for what’s going on in Washington is embarrassing. I am embarrassed for Republicans and for Democrats. They started out on the right foot, but it’s degenerated. “Republicans misled people and tried to scare seniors by putting out misinformation about death panels,” Mr. Vaughn said. “Then to pass a bill in the Senate, Democrats stooped to bartering for votes. It demeans the whole process.”
James W. Noon, who runs a packaging supply business here, said he was irked to see Senate leaders secure votes by promising extra Medicaid money to Nebraska and Louisiana. “Don’t they realize how dumb that looks?” said Mr. Noon, a Republican.
Michael R. Stone, a private investigator who describes himself as a political independent, was bothered by those deals, too. “President Obama campaigned on a promise to change the way things are done in Washington,” Mr. Stone said. “But it seems like business as usual to me.”
Richard F. Barkey, a former chairman of the Jefferson County Democratic Party and a leader of the advocacy group Health Care for All Colorado, said: “We had huge expectations for President Obama and the Democrats in Congress. But they could not build a dam big enough to stop the flood of money from corporate interests that have influenced the health care debate.” Eliza Carney, a member of the same group, said, “Obama and his administration have really — I won’t say betrayed, but — disappointed us.”
Even in Massachusetts, weak support for Dem health care bill
The race to replace the late Sen. Ted Kennedy in Massachusetts is shaping up as a referendum on health care reform. If you look inside the numbers of the Boston Globe poll -- the one that has Democrat Martha Coakley leading Republican Scott Brown by 15 percentage points -- you'll see that more voters name health care reform as the election's top important issue than name jobs and the economy. That's a striking reversal of opinion among the American public overall. And just 43 percent of Massachusetts voters support the Democratic national health care plan now making its way through Congress, versus 36 percent who oppose. In one of the bluest states in the country -- and one with up-close experience with a state health care regime that resembles the plan under consideration for the nation as a whole -- that is strikingly weak support. And that support is pretty much limited to Democrats; independents and Republicans are opposed.
Breaking down opinion by party, 65 percent of Democrats support reform, while 11 percent say they oppose it and 20 percent say they don't know. Among independents, 33 percent favor reform, while 43 percent oppose it and 23 percent say they don't know. And among Republicans, five percent favor reform, while 82 percent oppose it and 10 percent say they don't know.
Looking a little more closely at the numbers, it's clear that opponents of reform are far, far more intense in their feelings than supporters. Among Republicans, 65 percent say they strongly oppose reform, while 17 percent say they somewhat oppose it (making for that total of 82 percent opposed). Among Democrats, just 28 percent say they strongly support reform, while 37 percent say they somewhat favor it (making for the 65 percent total figure). Among independents, 29 percent strongly oppose it, while just 13 percent strongly support it.
That intensity of opposition likely accounts for the poll's finding that Massachusetts voters believe health care reform, and not the economy, is the most important issue in the race. Among all voters, 31 percent name health care reform as the most important issue, while 27 percent say jobs and the economy. Thirty-five percent of Republican voters name health care reform as the most important issue, versus 20 percent who say jobs and the economy. Among independents, 29 percent name health care reform, versus 23 percent who say jobs and the economy. Among Democrats, 29 percent say health care reform, versus 32 percent who say jobs and the economy.
The bottom line: In a state where support for the Democratic national health care plan should be strongest, the current bills making their way through Congress cannot muster majority support. If Coakley is elected, she will cast the 60th and decisive vote in the Senate to pass a plan that not even half the people in her home state support.
Big Labor to Obama: Don’t tax us for health “reform” scam we supported
Underscoring a rift in the Democratic political coalition, national labor leaders met with President Obama on Monday and raised objections to a proposed tax they said would harm union members and cause a backlash in the 2010 mid-term elections. Obama has come out in favor of the so-called "Cadillac tax" that is part of the healthcare bill passed by the Senate. The tax, meant to help finance the healthcare overhaul, would apply to the most expensive insurance plans.
The House has come up with an alternative approach: a new surtax on single taxpayers making more than $500,000 a year and couples earning more than $1 million. The two bodies are working out a compromise behind closed doors.
The dozen labor leaders who spent two hours with Obama and White House officials in the Roosevelt Room said they preferred the surtax on wealthy Americans, according to a person familiar with the meeting. They also told Obama that the healthcare "exchanges" envisioned in the bill, intended to help many Americans buy insurance policies, should be national in scope--not state-based--so as to provide more competition to the insurance industry, the person said.
The White House arranged the meeting last week. Participants included including James P. Hoffa of the Teamsters, Richard Trumka of AFL-CIO and Gerald McEntee of American Federation of State, County and Municipal Employees. The White House gave no details on the meeting except to call it "productive." A spokesman for one of the labor leaders in attendance said the White House asked the unions not to discuss the meeting with the press. As a candidate in 2008, Obama promised that healthcare negotiations would take place amid unprecedented transparency. He said he would invite C-SPAN cameras to broadcast the discussions. That hasn't happened.
Labor leaders warn that the Senate tax, if left intact, would amount to a middle-class tax increase--something Obama had promised to avoid. They contend the tax would hit everyday workers who are covered by expensive insurance plans and who in many cases gave up wage increases to get the health plans in hard-fought negotiations.
Appearing at the National Press Club on Monday, before his meeting with Obama, Trumka told reporters that organized labor--which was crucial to the Democrats' election victories in 2008--might stay home in the mid-term elections next fall if the healthcare bill is not to their liking. "I think there's that chance" that union members will boycott the elections, Trumka said.
In his speech at the press club, Trumka said: "The tax on benefits in the Senate bill pits working Americans who need health care for their families against working Americans struggling to keep health care for their families. This is a policy designed to benefit elites--in this case, insurers, hospitals, pharmaceutical companies and irresponsible employers--at the expense of the broader public."
Many healthcare economists believe that such a tax will help restrain healthcare spending by discouraging overutilization of healthcare services by people who have to pay very little for the care they receive.
A compromise may be in the offing. Democratic negotiators are exploring a possibility that would not eliminate the tax entirely, but rather raise the threshold at which it applies in order to ensure that more middle-income Americans are spared. To make up the lost revenue, Democrats might boost the Medicare payroll tax on high-income Americans.
The Joint Committee on Taxation estimated last month that the "Cadillac tax" would generate nearly $149 billion over the next decade. Much of that would come from income taxes paid by workers, under the assumption that businesses would trim back health plans to avoid the new tax, then raise wages to make up the difference to their employees. House Democrats rejected the tax amid pressure from labor and other interest groups.
In Virginia: Bolling and Mims Oppose Government Health Care
Virginia Lieutenant Governor Bill Bolling (R-VA) wrote to Attorney General Bill Mims (R-VA) about the constitutionality of several provisions in the Senate Health Care Bill. The opinion from Mims on the matter is informative.
Mims, in response to a letter from Bolling, had the following to say: “you inquire about the constitutional validity of two provisions. One provision would, after a period of several years, exempt Nebraska in perpetuity from increased costs associated with the expansion of Medicaid. No other state, including Virginia, is afforded similar treatment. The other provision would require every citizen of the United States to obtain health insurance or face significant penalties. I share your concerns about the constitutionality of both provisions.”
Interestingly, Mims points out that the General Welfare Clause of the Constitution may be proven meaningless if this bill is signed into law. Mims wrote, “In my view, carving out an exception for a specific state, unrelated to any policy objective other than to secure the vote of a particular senator, would exceed the bounds of what Congress may do under the Spending Clause,” wrote Mims. “Where the taxing and spending is intended to effectuate a benefit for a single state, solely to garner the vote of a particular senator from that state rather than for the general welfare, the spending at issue is unconstitutional. To conclude otherwise, would mean that the General Welfare Clause is meaningless.”
I'm waiting for more states to get involved in what may be the largest constitutional battle of all time. Mims, who did not appear on the ballot this past November, will be leaving office next week for incoming Attorney General Ken Cuccinelli. Bill Bolling will be sworn in to a second term as Lieutenant Governor this Saturday.
Health is an area where the gains of one would not normally come at the detriment of others. If one person is cured, it does not usually involve another person becoming ill. As society becomes wealthier and better educated, most of its members ought to have access to better health and greater longevity, without impeding the ability of others to do likewise.
Alas, the NHS has changed that. Given its universal provision and its necessarily finite resources, decisions have to be made about which treatments and procedures can be afforded and which cannot. In a recent case a leukemia sufferer was denied access to a possibly life-prolonging drug because the NHS regarded the £30,000 a year cost as an ineffective use of resources, given likely clinical outcomes.
The point is that within a closed system of finite resources, each treatment has to be assessed to see if it is worth denying funding to other treatments in order to supply it. Television reporters interview someone demanding extraordinary (and very costly) treatments for their brain-damaged premature baby, without ever alluding to the brutal fact that others must die if it is to be kept alive. In the NHS people have to ask if that extended life is worth more than the ten kidney patients who might otherwise have been saved. They have to ask if a drug which might offer a few extra years to one patient is worth the suffering to dozens of elderly patients who will not receive their hip replacements if the money is spent elsewhere.
The NHS has turned health into a zero sum game, in which the survival of some takes place at the expense of the death or suffering of others. The QALY, or quality-adjusted life year, was devised to facilitate these complex, and some would say repugnant, calculations. Many people also blanch at the way the NHS can withdraw all treatment if people obtain privately the drugs the NHS has refused to allocate to them. Gods might behave like this, but men and women shouldn't.
There has to be a better way, and it might involve encouraging charities and communities to rally round people who lose out on NHS allocations, and raise extra funds to support them. That breaks out of the fixed pie of the zero sum game, and brings in additional resources instead of taking them at the expense of others.
The number of women wrongly given the all clear for breast cancer at a hospital in Lancashire has risen. Accrington Victoria Community Hospital, which gave the all-clear to 18 women with breast cancer after screening errors, has now admitted another case was missed. In September it was revealed the women had been misdiagnosed by a radiologist at the hospital. But the BBC has now learnt that another woman, Susan Gilmore, was also called back and later had a mastectomy.
East Lancashire Hospitals NHS Trust has admitted she is the 19th woman who was misdiagnosed and has apologised, the BBC said.
Mrs Gilmore, from Earby in Barnoldswick, Lancashire, was given the all-clear by the same radiologist at the hospital in 2002 and 2005, outside of the period under review. She found out that she had the disease after being recalled for a third time in December 2008 to a different consultant. "It was only after I read about it, because I wasn't one of the 18 who were [originally] recalled," she told the BBC's Inside Out North West programme, to be screened in the North West region on Monday. "Once I'd read those reports I started to mull things over in my mind and thought, it's going to be this man, it's going to be this same consultant who sent me home twice."
The original blunder came to light through internal monitoring in the screening service which sparked an independent investigation, revealed in September 2009. Of the 355 cases reviewed in the study, 85 women were retested and 14 were diagnosed with invasive breast cancer. A further four had a non-invasive cancer which had not progressed. The radiologist involved last screened patients in December 2008 and has been suspended since April 2009.
Dr Richard Dobrashian, director of the East Lancashire breast screening programme, said: "We have now included Mrs Gilmore in the reviewed ladies so the 18 has become 19 in the misdiagnosis by this particular radiologist."
Seven of the women who were wrongly given the all-clear have instructed solicitors to fight for compensation.
Democratic Sen. Ben Nelson thought he'd struck a deal that would please Nebraskans and give him cover for helping push his party's health care overhaul over its biggest hurdle to date. But his state's voters still don't like the bill and are embarrassed by the $100 million in special Medicaid payments he secured for Nebraska, leaving the embattled senator with a bigger bull's-eye on his back as Republicans and groups that oppose the overhaul search for converts.
Senate Democrats need to keep all 60 members of their caucus on board to pass a bill. House Democrats had a slim three-vote margin for their health care bill, turning every lawmaker into a potential make-or-break vote and spotlighting a list of potential defectors.
California Gov. Arnold Schwarzenegger, a Republican, upped the pressure last week in his state of the state address. He told California's congressional delegation to secure "the same sweetheart deal" on Medicaid as Mr. Nelson got for Nebraska, or else vote against the bill. "Health care reform, which started as noble and needed legislation, has become a trough of bribes, deals and loopholes," the governor said. "You've heard of the bridge to nowhere. Well, this is health care to nowhere."
In the House, which will resume work Tuesday, Republicans have listed 37 Democrats who they think are vulnerable to political pressure on the issues of Medicare funding, abortion and the federal budget. The list includes several Democrats in moderate districts who could face difficult re-election fights.
"If we can convince enough of these 37 members (along with the 39 Democrats who already voted no) to reconsider and switch their position on the bill, I know that we can defeat this government takeover of our health care before it becomes law," Minority Whip Rep. Eric Cantor of Virginia said in a memo to Republicans. He listed 18 Democrats who have a significant number of constituents enrolled in Medicare Advantage, whose funding would be cut under Democrats' plans. Mr. Cantor also pointed to 11 Democrats who he said might be forced to vote against the bill if a pro-life amendment that the House adopted is weakened in a final compromise.
If three Democrats switch their position, the bill will be defeated. The National Republican Congressional Committee has started targeting many of their districts with analyses showing how the bill would hurt their constituents.
House Democratic leaders are trying to hold together at least 218 votes, despite disagreement over how to pay for the bill. They largely oppose the Senate's method, backed by President Obama, that would tax high-valued insurance plans.
Senior House Democrats have largely abandoned hopes of including a government-run insurance option in the final compromise health care bill taking shape, according to several officials, and are pushing for other measures to rein in private insurers.
House Speaker Nancy Pelosi and other senior Democrats told President Barack Obama in recent meetings they want the legislation to strip the insurance industry of a long-standing exemption from federal antitrust laws, officials said. That provision is in the House-passed measure, but was omitted from the bill that the Senate passed on Christmas Eve.
They also want the final measure to include a House-passed proposal for a nationwide insurance exchange, to be regulated by the federal government, where consumers could shop for private coverage. The Senate bill calls for a state-based system of exchanges.
Additionally, House Democrats want to require insurers to spend a minimum amount of premium income on benefits, thereby limiting what is available for salaries, bonuses, advertising and other items. The House bill sets the floor at 85 percent; the Senate-passed measure lowers it to 80 percent for policies sold to small groups and individuals. The officials spoke on condition of anonymity because the negotiations are private.
The maneuvering comes as the White House and majority Democrats intensify efforts to agree on a final measure, possibly before Obama delivers his State of the Union address late this month or early in February.
Government intervention into the insurance market is one of the most contentious issues to be settled. Others include the fate of a Senate-passed tax on high-cost insurance plans, bitterly opposed by some labor unions; the extent to which abortions could be covered by insurance to be sold in the new exchanges; and the amount of money available to help lower-income families purchase coverage.
Liberals long have pressed to include a government-run insurance option in the legislation, arguing it would create competition for private companies and place a brake on costs. House Democrats included it in their legislation. In the Senate, it drew opposition from Democratic moderates whose votes are essential to the bill's fate. Even attempts to include an expansion of Medicare for uninsured individuals as young as age 55 _ widely viewed as a face-saving proposal for liberals _ had to be jettisoned.
Given the opposition in the Senate, Pelosi, D-Calif., signaled late last year she did not view a public option as a requirement for a final compromise. Asked in an interview Dec. 16 whether she could support legislation without it, she said, "It depends what else is in the bill." More recently, she listed her goals for a House-Senate compromise without mentioning the provision she long has backed.
"We are optimistic that there is much that we have in common in both of our bills and that we will resolve or reconcile this legislation in a way that is a triple A rating: affordability for the middle class, accountability for the insurance companies, and accessibility to many more people in our country to quality, affordable health care," she said.
While Obama favors a government option, he has said repeatedly it is only a small part of his overall effort to remake the health care system, and is not essential.
Pelosi and Senate Majority Leader Harry Reid, D-Nev., have expressed optimism about chances for a swift agreement, but there appears to be relatively little maneuvering room. That is particularly true in the Senate, where 60 votes will be needed to overcome a Republican filibuster, and any change carries the risk of alienating a Democrat whose vote is crucial.
The bill's future is further complicated by a scheduled Jan. 19 election in Massachusetts. Some polls show Democrat Martha Coakley in a closer-than-expected race against Republican Scott Brown and an independent contender. The winner will replace Sen. Paul Kirk, who became the 60th member of the Democratic caucus when he was named to his seat as successor to the late Sen. Edward M. Kennedy. A Republican upset would deprive Democrats of their 60th vote.
Some House Democrats say the proposed government insurance option remains alive, although they speak publicly of its possible demise as long as insurance companies aren't let off the hook. California Rep. Xavier Becerra, who's on the leadership team, said House members would only be willing to abandon the public plan if they were certain the final bill achieves the goals they want, as Pelosi described. "We're willing to give up what's good for America as long as we get something good back," he said.
Rep. Chris Van Hollen of Maryland, also a member of the leadership, agreed. "I think the House is very much of a view that before they'd consider dropping the public option" they have to be assured of a bill that achieves the goals they wanted the public option to meet.
But officials said little if any time has been spent in White House meetings on the issue, and there was scant discussion of it during a conference call for members of the Democratic rank and file earlier this week.
British criminal records checks 'delay children's operations'
The usual British bureaucratic madness
Children's operations are being delayed and cancelled as surgeons face criminal records checks every time they work in a different part of the country, it has been warned. Specialist surgeons working with children face delays in being cleared to start work when covering for colleagues on sick leave at other hospitals.
The repeated checks can take months and the problem is leading to delays and cancellations in treatments for children, the Royal College of Surgeons has warned. They called for surgeons to be issued with 'passports' so their CRB (Criminal Records Bureau) check from one NHS organisation is valid in another.
Richard Collins, Vice-President of the Royal College of Surgeons, said: “It is absolutely right that there should be robust checks for anyone who works with children, but there needs to be some common sense to ensure patients don’t suffer. "The NHS needs flexibility to enable surgeons in specialist fields to undertake operating lists in other Trusts, often on an ad hoc basis. To require them to repeat the same time-consuming bureaucratic process each time is a completely unnecessary delay that must be revised.”
Surgeons work on the basis of sessions, usually half days, in outpatients clinics or operating and most can take up sessions at another hospital in addition to their normal workload if necessary. The extra locum work is particularly important in highly specialised areas where there may be only a few surgeons able to carry out the work. Surgeons also move between NHS trusts regularly while training.
The experience of David Jones, paediatric orthopaedic surgeon at Great Ormond Street Hospital, is one example of how the system is causing problems. He was asked to cover a colleague’s sickness leave in Leeds over December and January but the CRB check has taken so long all the clinics and operations he was due to do have been delayed. He said: “Despite filling out all the documentation at the beginning of November, the process dragged on in spite of many phone calls to CRB from Leeds General Infirmary. "All the clinics and lists planned for December had to be cancelled, thereby causing large numbers of very upset families. In December, I wrote to The Secretaries of State for Children, Skills & Family; The Home Office and Department of Health along with Senior Management of NHS but have had no response.
"This week’s clinics were also cancelled. My clearance finally came through on Thursday and we are trying to get clinics set up for next week. I think more than a month has been wasted needlessly and many children and their families seriously let down.”
Dr Shree Datta, Chairman of the British Medical Association’s Junior Doctors Committee, said: “There have been issues for several years with the CRB system, particularly for junior doctors, who frequently move between posts. “In theory, the checks should already be portable - it’s entirely up to employers whether they accept previous clearance. Having to go through the process every time you move to a new hospital - which can be every six months - can result in delays in taking up posts. "The other big issue is the amount of money it costs the NHS to repeat checks unnecessarily. Clearly the safety of children is paramount, but we’d like to see a more common sense approach, with improved communication between hospitals."
A spokesman for the Department of Health said: "We recognise that there have been occasions when the requirement to undertake a check through the CRB has created local administrative difficulties. However, the requirement to undertake a CRB check provides an important safeguarding measure which should be observed in full by the NHS."
A spokesman for the Home Office said: "In the case of surgeon David Jones, the CRB completed his check within its published target of 28 days. The CRB did not receive his application until 4 December, despite Mr Jones signing his application form four weeks earlier. "The CRB is currently receiving unprecedented demand for its service and as a result, some Enhanced checks are now taking slightly longer to complete. "Despite this increasing level of demand, the CRB is continuing to process almost 90 per cent of Enhanced checks within the 28 day target.”
Can we trust Congress to do the reasonable thing and go slow and deliberate on health reform? With the daily onslaught of Obamacare propaganda I doubt it.
First, it is not true that the entire world, or even Europe, is committed to socialized medicine. For every testimonial to government health care, you can find a horror story. Second, it is not true that insurance companies are the primary problem. Fact is they average a 2.5 percent profit margin, which is comparable to your local supermarket.
Fact is that Medicare is twice as likely to deny a claim as is a private insurer. Let the feds allow insurance companies to compete across state lines, give them protection from predatory lawyers and make it possible for individuals to get the same tax breaks on insurance plans that big corporations do.
Next, it is not true that 46 million Americans cannot get health insurance. Nine million of those are not U.S. citizens, and we're waiting for Congress to settle the issue of illegal immigration. Another 9 million of that figure are on Medicaid but incorrectly stated on their census that they were uninsured.
Fact is 90 percent of Americans are insured and of the remaining 10 percent nearly half make $50,000 a year (26 percent more than $75,000). So I ask: Is it reasonable to overhaul the health care of 300 million Americans to deal with an issue that affects 5 percent of the population?
It is also not true that this legislation will have a major cost-saving effect. In my lifetime health care has gone from 3 percent to 17 percent of the Gross National Product. Technologically, we are approaching the point where we can do more than we can afford. As mentioned, insurance profits account for only a tiny slice of the pie. By far the greatest costs come from paying for good health care personnel and buying quality medical supplies.
Have these issues been confronted?
Even worse, the true price tag of this plan is being hidden. Unlike the presentation of the Clinton health care plan, this time the cost of individual and employer mandates is not being openly stated. Instead of the $848 billion Harry Reid bill, we are looking at a $2.1 trillion Reid bill. (See Michael Cannon of the Cato Institute.)
Finally, the most hurtful untruth is the accusation that those opposing this bill are selfish and uncaring. It is the classical liberal ruse of class warfare. First, the contributions of volunteer supplied community health clinics and the success of health care sharing ministries is ignored. Second, the fact is the vast majority are not opposed to some kind of government help to the down and out.
We do have the reasonable expectation, however, that the government get its financial house in order and put Medicare and Medicaid in the black before taking on even more. Maybe its time to change eligibility requirements for Medicaid or Medicare, perhaps to include those with chronic diseases. Maybe we need more programs like Florida Kids Care. Make your case and tell me how much tax money you need, but don't call my reluctance to let bureaucrats make my family health care decisions uncaring!
Third, there are a lot of people who sincerely think that a government-run system could never be as efficient and caring as unfettered private health care.
Fourth, many of us believe that the real selfishness lies with those who want all the benefits now but are content to stick the bill with seceding generations. Given the out-of-control spending on Capitol Hill, I don't trust them with the future health care of my children and grandchildren.
One of the key voices for Congressional health care legislation, MIT economist Jon Gruber, is taking fire from the precincts of the left that oppose the Senate plan over the fact that he is on contract with Department of Health and Human Services.
He's been paid $297,600, according to federal documents, to produce "a technical memorandum on the estimated changes in health insurance coverage and associated costs and impacts to the government under alternative specifications of health system reform." The contract, which was awarded June 19, wasn't widely known or regularly disclosed.
"[D]on’t you think it’s rather, um, dubious that the guy evaluating the heath care reform–for $300,000–is also the package’s single biggest champion? And no one has been transparent about this contract?" writes Firedoglake blogger Marcy Wheeler of the contract, which was first mentioned on DailyKos.
I asked Gruber about the reports, and he responded by stressing that the contract was not for public relations, but for analysis, and that he's long advocated for a consistent set of policies:
I do indeed have a contract with HHS. Throughout this year I have provided technical assistance to the administration and to Congress with my micro-simulation model, as well as based on my experience as a member of the Massachusetts health connector board. But NONE of the work I have done in public, or any public declarations I ahve made, has been in any way funded by the Administration. That funding was strictly for internal work that I did for the administration and, via the administration, for congress. All externally visible work and comments, such as my editorials or public reports, have been done on my own time.
Moreover, at no time have I publicly advocated a position that I did not firmly believe - indeed, I have been completely consistent with my academic track record. On the two issues this article raises:
1) I am known in economics as one of the leading experts on the impact of health insurance costs on wages - indeed, I wrote my thesis on that topic and have written extensively since on the fact that health insurance costs are fully translated into wages. I was asked by the editors of the Handbook of Health Economics, a review of literature in this area, to write the review article on this topic.
2) In my role as a member of the MA Health Connector board, I had to help decide what were affordable subsidies for our citizens. I was surprised to find how little work there was on this topic so I undertook a study to help lay out what might be considered affordable. I have since replicated that analysis at the federal level. Every position I have advocated on this topic is completely consistent with these reports.
Gruber told POLITICO that he has told reporters of the contract "whenever they asked" and noted that he formally disclosed that "I am a paid consultant to the Obama Administration" in a form attached to his most recent, December 24 article in the New England Journal of Medicine, though it wasn't widely known by reporters on the beat.
A Democratic senator says party leaders should open health care negotiations to C-SPAN cameras, echoing Republicans who have called for greater transparency.
Missouri Sen. Claire McCaskill said in a statement Friday that hundreds of hours of debate on health care have been open and further talks between the House and Senate should be on C-SPAN.
C-SPAN chief executive Brian Lamb sent a letter to congressional leaders this week asking for the talks to be opened to cameras. As a candidate, President Barack Obama pledged during a January 2008 debate that negotiations would be on C-SPAN.
Democrats say they have kept Americans informed throughout the process. Republicans have criticized them for taking the final, most crucial stage of the discussions behind closed doors.
U.S. Chamber's Health Care Warning: Taxes, Taxes Everywhere!
At the doctor. In the drugstore. In the hospital and in your paycheck. They're hidden, but you'll pay.
New hidden taxes that Congress wants on your health care. Hidden health care taxes on medicines, medical devices and health insurance. Hidden health care taxes in the middle of a deep recession.
Call Congress: Tell them, no hidden health care taxes in a recession.
Are you "open," "honest," and ethical"? These three questions to the Congressional leadership form the crux of a new paper released today by the National Center for Public Policy Research in Washington.
The paper, "Bad Faith & Broken Promises: Accountability and Transparency Casualties of Health Care Debate," by policy analyst Matt Patterson, asks House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid:
* Is it "honest" to hide the true cost of your legislation with budgetary gimmicks in which three years of new taxes precede the bulk of the spending, making your program seem more affordable than it really is in an artificial budgetary window?
* Is it "open" for the Congressional leadership to "secretly craft the final bill behind closed doors," far from the prying eyes of the press, the public, and the rest of Congress, or to have important procedural votes in the middle of the night, or pass critical legislation on Christmas Eve, when most sane people are blissfully distracted from the machinations on Capitol Hill?
* Is it "ethical" to buy the votes of recalcitrant members of your caucus with hundreds of billions of taxpayer dollars in backroom deals, such as "the inclusion of $100-$300 million in added federal aid for Medicaid recipients in Louisiana, the home state of Sen. Mary Landrieu," in return for her vote, or the offer to Senator Ben Nelson of "a permanent exemption from the state share of Medicaid expansion" for his home state of Nebraska, in exchange for his vote?
"Despite promises made by Congressional leaders, they have shepherded health care legislation through Congress in a manner that is demonstrably secretive, unethical and dishonest," says Patterson. "Promise after promise made by the Congressional leadership to conduct an open, bi-partisan process to reform health care has been shamelessly broken. It's really quite astounding; Nancy Pelosi, Harry Reid, and Barack Obama, don't even try to pretend to hold to their many and frequent promises to conduct open and fair negotiations to reform American health care."
Patterson concludes: "The question we have to ask ourselves is: Why have they done this in secret? What is it about this process that they don't want the public, the press, or even fellow members of Congress to see?"
Fueled by voter dissatisfaction over the government takeover of the nation’s health system and the unbridled expansion of government as a whole, 2010 is already shaping up to be a plus-year for Republicans. A growing consensus in Washington suggests that Republicans stand to pick up a windfall of seats in both houses of Congress. As reported by the Washington Post, “Democrats now face the evaporation of their 60-vote filibuster-proof majority in the Senate and losses in the House that a number of strategists across party lines conservatively estimate in the range of 20 to 25 seats.”
Since late-June, Republicans have led Rasmussen Reports’ generic Congressional ballot, numbering 28 weeks in a row. Since then, their lead has not abated, nor has their support dropped below 40 percent. Today, their lead stands at 44 percent to 35 percent — a 9-point spread — indicating a growing trend in their favor.
The key question is “Why?” Other polling by Rasmussen suggests that the answer largely lies in public opposition to the Democrats’ health care takeover. Quite simply, it’s an Albatross around the necks of Congressional Democrats, especially for vulnerable members who voted in favor of it. Since Rasmussen’s September 13th-14th poll, opponents of ObamaCare have outnumbered supporters in every single poll the organization has taken. In fact, supporters have only outnumbered opponents twice throughout the entire year: in the June 27th-28th poll (50 to 45 percent) and in the September 11th-12th poll (51 to 46 percent). And that was out of 31 polls taken. Today, opposition is holding with 52 percent against the legislation, and only 42 percent in favor. Making matters worse for Obama and the Democrats, a recent Quinnipiac University poll showed Independents opposing the legislation by a staggering 58 to 30 percent.
The key point: as opposition to ObamaCare has intensified, Republicans’ lead in the generic ballot has expanded. And support for Obama and Democrats across the board has plunged.
Which is not at all surprising. This is, after all, the same legislation that would ration health care away from seniors, raise taxes by hundreds of billions of dollars, take private choices away from the American people and force them onto government-run plans, and bankrupt the Treasury with an another unsustainable entitlement.
In short, while Medicare and Medicaid are going bankrupt and every year depend on more taxpayer funds drawn from general income tax revenue, Congressional Democrats have sought to expand the nation’s health care entitlement by 30-45 million. Not only is that clearly unaffordable — Senate Republicans say it will cost $2.5 trillion over ten years once fully implemented — leaders have added insult to injury by attempting to disguise the gargantuan cost with accounting gimmicks that few Americans any longer believe, as ALG News has previously reported.
In fact, the Qunnipiac poll reveals that 73 percent of voters believe Obama’s government health care takeover will increase the burgeoning deficit. And, because the government entitlement being established is so inherently unsustainable, the American people understand intuitively that it will mean that there is less health care to go around. They also understand that increased burdens on the system will mean less research and development, leading to declining quality.
All of which explains why 2010 is shaping up to be a banner year for Republicans politically. Not only are voters dissatisfied with the state of affairs, they are increasingly prepared to address the issue by ousting incumbents currently in the majority. In short, it’s not so much an anti-incumbent feeling as an anti-Democrat one. And one needs look no further than the ObamaCare Albatross vulnerable Democrats have hoisted over their own necks.
For decades, among the first thing cub reporters learned when covering local government was that the words "executive session" meant public officials were going behind closed doors to conduct business they wanted to keep out of the public eye. More often than not, the journalists barred from the meeting passed influential developers and other special interest lobbyists on their way in to confer with the decision makers. Thanks to public meetings laws requiring city councils, county boards of supervisors, and other local and state officials to meet and vote in public, it's much tougher for them to hold such clandestine gatherings.
Judging by the silence of the hundreds of professional journalists covering Congress for the mainstream media, however, it appears this lesson from Covering Government 101 has been forgotten. President Obama, Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi -- all of whom have in recent years promised unprecedented levels of transparency in government -- are flouting their own words by meeting in secret to write the final version of Obamacare. They are doing this to avoid the public meetings of a bipartisan conference committee representing the Senate and House and the multiple, on-the-record roll call votes required in both chambers on a conference committee report.
The most radical expansion of central government power in American history is happening right under these journalists' noses, and yet they raise not a peep of protest when the doors close, effectively barring them from doing their jobs at a critical juncture. Where are the Society of Professional Journalists, the American Society of Newspaper Editors, and the Radio and Television News Directors Association? These august organizations vigorously and rightfully protested former Vice President Richard Cheney's secret meetings with oil company executives in the early days of the Bush administration. They also wailed loud and long about the Bush administration's abuses, many real and some imagined, of the Freedom of Information Act.
To be sure, many of the reporters on the Hill gripe and complain to each other and to their editors about these closed-door meetings. And many of them stand keeping vigil outside the doors, waiting for Reid or Pelosi to come out and offer them a morsel of information. But that's not good enough. It's time for a sit-down protest by journalists whose first job is to uphold the public's right to know what its government is doing. Invite readers to come join them in demanding open meetings. The last thing Reid and Pelosi want is the spectacle of the Capitol Hill Police dragging protesting journalists away from the closed doors. It's time to show some cojones, people.
Pelosi says she will not accept Senate health bill without changes
A massive conference call on health care legislation among the House Democratic Caucus ended Thursday afternoon with House Speaker Nancy Pelosi, D-Calif., promising her rank-and-file members she plans to make changes to the final bill that will ensure more affordability and access.
Pelosi also told the 175 Democrats who participated in the call that despite some reports, a formal conference committee has not been ruled out for merging the House and Senate version. "The Speaker answered the question of whether the White House is going to force us to just take the Senate bill and she made clear that wasn't the case," said a Democratic aide who listened to the call. "We are going to negotiate a final bill and it has to meet," the House standards.
Rep. Rosa DeLauro, D-Conn. described "a very positive call" in which members voiced their concerns about differences between the two bills, including proposed tax increases, abortion and immigration. The call also focused on implementation. The House bill calls for a national insurance exchange while the Senate bill incorporates state-wide exchanges. "A national exchange is something people want to ensure because that builds in the mechanism for lowering cost and for competition," DeLauro said.
Pelosi also told members, according to a Democratic aide, "they wanted to ensure equity," on federal reimbursement for the proposed expansion of Medicaid. In the Senate bill, some states received much more generous federal funding than others but lawmakers from other states are demanding the same deal, which could raise the cost of the bill by billions of dollars.
GOP Has A Shot In Mass. Senate Race; Win Could Block Health Care Overhaul
A new poll showing Massachusetts GOP Senate candidate Scott Brown in striking distance of Democrat Martha Coakley prompted some pundits to predict a political earthquake. Yet longtime Bay State observers say it's little more than minor tremors. Coakley, the state attorney general, leads state Sen. Brown 50%-41%, according to a Rasmussen poll released Tuesday. That's a dramatic shift from two months ago, when a Suffolk University poll showed Coakley leading by 26 points. The Jan. 19 special election will fill the rest of the late Ted Kennedy's term. Paul Kirk is temporarily occupying the seat.
A GOP victory would have major ramifications nationally. Brown would become the 41st Republican senator. That could give the GOP enough strength to block a final health care bill.
Democratic politicians across the country would be stunned. If the party loses in Massachusetts, it could lose almost anywhere in 2010. That could spur a few more House Democrats to vote no on the health care bill — enough to defeat it. Others could decide not to seek re-election.
Calling the poll "Earthquake rumblings in Mass.," blogger and Cornell law professor William Jacobson wrote: "Coakley has been a statewide figure for years, and has much better name recognition, SEIU and other union support, and the Massachusetts Democratic machine behind her. Obama won the state by over 20%, and Coakley should have had at least a mid-teens lead at this point."
The latest official figures show 37% of state voters registered as Democrats vs. 13% as Republicans. But 50% are "unenrolled." Brown leads Coakley by 65% to 21% among un affiliated voters, Rasmussen found. But the Brown camp is cautious. "The poll is encouraging, but we recognize we are an underdog in a state controlled by a political machine," said Felix Browne, a spokesman for the Brown campaign.
Tobe Berkovitz, an advertising professor at Boston University, says Brown is right to be circumspect. "This is among the bluest of blue states, and you can never forget that," he said. "Coakley starts with a huge advantage since the state elects Democrats. She also has money, and a large Democratic machine. And unions, which are important to turnout, are behind her."
But David Tuerck, executive director at the conservative Beacon Hill Institute, said Massachusetts "is not the tax-and-spend state that you might think it is. Our taxes are relatively modest and we have a wildly popular tax limitation measure at the local level." He also noted that "Massachusetts is not immune" to the declining popularity of President Obama and Congress. He thinks Brown's chances for victory are small, but that it has become a possibility.
Brown could benefit from what is likely to be low turnout. Rasmussen's poll found that among those who said they are certain to vote, Brown trails by only 2 points. "(It) is clear from the data that Brown's supporters are more enthusiastic," said a Rasmussen press release....
Dr. Darshak Sanghavi, an academic pediatric cardiologist who (like all physicians) financially benefits from the cartelization of medicine, explains in Slate, the online magazine, that health care markets can’t work because of the information asymmetry between physician and patient (“Talk to the Invisible Hand”). So we need the cartel. This is not particularly surprising; most physicians think that. But it ain’t so.
Through several examples Sanghavi attempts to demonstrate that a medical market with the customer/patient in charge just doesn’t make sense. With the U.S. government now paying half of all medical bills and consumers paying only 10 percent out of pocket, it is not surprising that Sanghavi can show that marginal efforts to move toward a market without making any fundamental changes in the system do not always work, but let’s look at his examples:
In 2004 President Clinton developed chest pain, was diagnosed with coronary artery disease (CAD) and treated with coronary artery bypass grafting (CABG). Sanghavi notes that Clinton, savvy though we know him to be, did not study New York state’s database of hospital- and surgeon-specific death rates from heart surgery. Had he done so, he might have thought twice about having the surgery at Columbia-Presbyterian in New York City, which the database lists as having “the highest death rate of any of the 35 hospitals doing bypass surgery.” Sanghavi sees this as evidence that even savvy consumers cannot deal with the complexities of the medical marketplace. But is it?
First, in a true medical marketplace, hospitals might find it profitable to advertise the results of the database, something they have little incentive to do now, when patients remain rationally ignorant of the quality of hospitals not covered by their employer-chosen insurance. More important, the database in the form developed by New York state is crude. Are you better off going to a cardiac surgeon who does 50 CABGs per year, restricting his surgery to only otherwise healthy patients with mild CAD, and has a 1 percent complication rate, or are you better off going to a cardiac surgeon who does 500 CABGs per year, takes patients refused surgery elsewhere because they’re viewed as “too risky,” and who has a 2 percent complication rate overall (but among otherwise healthy patients with mild CAD has a complication rate of 0.4 percent—though this breakdown is not in the raw data offered by the New York database)?
How can one obtain such detailed analysis of the data? One can do what Clinton did: Go with the recommendation of the cardiologists he entrusted with his care. In a true medical marketplace he’d have even more options: Businesses would develop that analyzed such data and provided their analysis for a fee (or perhaps it would be available for free on the Internet, paid for by ads, like Google searches).
Sanghavi questions whether it helps for consumers to “have skin in the game”—that is, pay some health care costs directly so they no longer treat it as essentially a free good, overusing it and driving up costs. He acknowledges that the famous RAND Health Insurance Study (1982) showed that when patients paid 25 percent of costs, overall medical spending dropped 20 percent.
But Sanghavi is concerned. He notes that consumers “cut back equally on highly effective and largely pointless treatments.” He fails to say this means that under the highly regulated system he defends, where medical experts are in charge of determining what is needed without worrying about patient cost concerns, “largely pointless treatments” are still available. Of the RAND results Sanghavi notes with a concern that can only be felt by physicians: “The cost savings came from mostly avoiding doctors altogether.” But most people who see doctors have transitory complaints that resolve on their own, caused by problems or pathologies that are never determined, no matter the expense of the workup (headache and back pain being the two most common complaints). So it is good that “the cost savings came from mostly avoiding doctors altogether.”
Most important, the RAND study showed, though Sanghavi didn’t mention it, that with few exceptions, seeing doctors less often and spending 20 percent less overall “had no adverse effects on participant health.”
Of course, if we had a competitive market in health care, with all its implications for easier access to information, broader advertising of various options, direct price competition, easier access to medications, and more, I would expect that consumers might better distinguish “highly effective” from “largely worthless” medical practices. They seem to make good choices now when given the opportunity, in areas like Lasik and plastic surgery.
For Sanghavi, “The usual rules of the marketplace seem not to apply to health care” because doctors apparently know more about medicine than patients do. So doctors control the interaction. So regulations are needed. So the argument goes.
But this argument proves too much. Information asymmetry is the norm not the exception. Car dealers know more about cars than consumers do. The guys behind the Genius Bar know lots more about computers than Apple customers do. Are consumers always being ripped off? Sanghavi the pediatric cardiologist claims—correctly, I’m sure—that no parents ever questioned him when he ordered a special type of color Doppler cardiac ultrasound on their child. But he unfortunately seems to believe a medical marketplace is everything we have now—all the regulatory burdens, supply restrictions, informational prohibitions—except patients will pay more out of pocket. He ignores various other innovations that may help consumers get what they need despite information asymmetry. For example, competing cardiologists trying to simplify matters for patients might offer flat fees, including labs and imaging, so the consumer could compare physician costs more easily and not need to know whether a specific lab or ultrasound was “needed.” Alternatively, consumers could go on the web and use the services of Medical Cost Advocate. Such services would be more commonplace in a truly free market in health care.
Some say that health care is different, and if by that they mean the health care market has been artificially restricted, segmented, regulated, and distorted by government interventions dating back more than a century, they are right. Only the educational and financial industries come close in the degree of government regulation, which doesn’t speak well of regulation’s success. But if they mean health care is more complicated than anything else offered in the marketplace or that health concerns don’t respond to supply and demand or that medical services can only be provided when medical cartels battle government payers while insulating patients from the true costs of care . . . it just ain’t so.
Frontline services such as social work, meals on wheels and road maintenance may have to be cut to cover the cost of controversial plans for elderly care at home, local authority leaders have warned. The £670 million required to provide free care for those most in need in their own homes — a key government policy — will add pressure to councils already trying to find multimillion-pound savings.
A rise in council tax of between 1 and 2 per cent will be needed to meet the cost, while cuts in adult and childrens’ social care services are an “unwanted but very real possibility”, council chiefs have told The Times.
The warning came as Andy Burnham, the Health Secretary, was forced to defend his Personal Care at Home Bill yesterday in a two-hour appearance before the Commons Health Select Committee. He was questioned repeatedly about concerns surrounding the Bill reported by The Times, including its impact on care and clinical research budgets. Critics believe that the costs calculated by the Government are a significant underestimate and care experts have attacked the policy for disrupting elderly care strategies and being little more than an attempt at eye-catching electioneering.
The draft Bill, set out in the Queen’s Speech in November, was described by Labour peers as an “exocet” on social-care reform and “a demolition job” on budgets, while MPs and care providers have also criticised it for being ill-conceived and uncosted.
In the latest blow to Mr Burnham’s plans, council chiefs have told The Times that the extra costs will force tax rises and service cuts. Backroom staff, from lawyers and human resources workers to environmental planners, would also be at threat, as well as infrastructure programmes such as road maintenance. Plans to introduce or upgrade local amenities such as sports facilities, bus services and meals on wheels would have to be reassessed.
The annual cost of the Bill is put at £670 million, which ministers say will support 400,000 people with the highest needs to stay in their own homes. Of this total, £420 million is to come from existing Department of Health budgets. Local authorities have been told that they must provide the remaining £250 million from efficiency savings. The first year of the scheme, running from October to April 2011, would require £125 million of local authority efficiency savings.
Mr Burnham said that he “fundamentally rejected” the suggestion that the cost calculations were flawed. “The characterisation of an exocet is 100 per cent wrong,” he said. Pressed on how £60 million of clinical research savings would be made to NHS budgets to help to fund the plans, and which areas would be affected, Mr Burnham said that it had yet to be finally decided, but would not involve frontline services.
Ken Thornber, head of Hampshire County Council and a member of the social care board of the Local Government Association (LGA), said that for councils already making multimillion-pound savings in backroom staff, this could be met only with an increase in council tax. His council, one of the largest, was already trying to save £15 million a year and a further £15 million in 2011 to absorb inflationary pressures. “As things stand we would have to find between £5 million and £10 million over and above the £30 million which we are presently projected to need to find in 2011-12,” he said. Mr Thornber added that it could mean up to £20 a year on council tax bills for the 550,000 households in Hampshire.
The funding from the Department of Health would not alleviate pressures on services, he said, because it was covering people who previously would have been cared for by the NHS or in care homes.
Jenny Owen, president of the Association of Directors of Adult Social Services (Adass) and director of adult social care for Essex County Council, said the council estimated that it would need to find £4 million of savings. “If you do not increase council tax by 1 or 2 per cent it will be a reduction in services.”
Andrew Lansley, the Conservative health spokesman, said that the plans were being rushed through for electoral gain. “While in an ideal world we want to give free care to as many elderly people as possible, it is simply not affordable, particularly since we are in the throes of a debt crisis. The reality is that Gordon Brown will only be able to pay for this through cuts to the NHS and higher council taxes.”
Australia: Corrupt health bureaucrats finally carpeted
TWO unidentified Queensland Health staff face disciplinary action following a financial probe into the Royal Children's Hospital. Two staff subject to the long-running investigation have been served with show-cause notices asking them to explain why action should not be taken against them. Queensland Health director-general Mick Reid would not reveal their identities, insisting both public servants had to be shown natural justice and be allowed to respond within 14 days.
The move comes after The Courier-Mail revealed that a Queensland Health ethical standards probe was investigating allegations including:
• RCH boss Doug Brown and former finance manager Alan Fletcher, now the chief financial officer for the Queensland Children's Hospital, processed an $8000 no-interest loan of taxpayer funds to a senior colleague for overseas travel.
• Mr Brown approved $6500 worth of luxury beauty treatments for 65 nurses as part of an alleged payoff following a dispute sparked when new staff scored free parking.
• Junior staff paid for wedding and baby gifts such as cookware for colleagues out of hospital funds.
Mr Reid said he was now acting on recommendations relating to "a number of matters" after the CMC completed a review of the Queensland Health ethical standards probe. "I have issued show-cause notices to two Queensland Health staff that were subject to the investigation," Mr Reid said in a statement. "As is standard procedure and in accordance with natural justice, the officers have been given 14 days to respond." It is not known whether Mr Brown and Mr Fletcher are the subjects of this action.
The moves came as Health Minister Paul Lucas criticised his department's handling of the affair, saying the two-year investigation had taken too long. "It has taken longer than I thought it should have," Mr Lucas said.
The Opposition has called for a broader inquiry into all public hospitals, with leader John-Paul Langbroek saying the allegations raised serious questions.
The more we read about Obama's health care scheme and his handling of it the more obvious his arrogance and contempt for the people become. This is stunning behavior, really, for any administration (and his party), but especially one that holds itself out as a servant of the people and a model of transparency.
Just consider headlines from the past few days: "Obama Reneges on Health Care Transparency: As a Candidate, President Obama Promised to Put Health Care Reform Negotiations on C-SPAN," "White House REFUSES To Discuss Broken C-Span Promise," "Dems Will Bypass Conference Committee To Get Health Care Passed," "Sources: Obama, Dems to sidestep GOP on health care," "Hatch: Healthcare bill 'rich' for challenges on constitutionality," "AP sources: Obama OKs taxing high-end health plans," "Obama Pushes for Quick Health Care Deal," "Conference Committee Bypassed," "House Will Vote on Pro-Abortion Senate Bill" and -- get this one -- "Pelosi: 'There Has Never Been a More Open Process.'"
Seriously, who do these people think they are? No wonder they always assumed the worst of former President George W. Bush and then accused him of sinister motives he never had and actions he never committed. As I've noted before, they were projecting. They knew how they would behave if in power. Now, once again, they're proving it.
Think about it. Obama promised at least eight times -- memorialized in video recordings -- that he would air health care debates and negotiations on C-SPAN for all to see. If you watch the videos, you'll notice that he was even wearing that smug, self-righteous look as he made his deceitful pledge, as if to say: "When I take over, we are finally going to return power to the people. We'll be open and transparent. We won't behave as Washington politicians are used to behaving. We're better than that. We're morally superior."
But now, his highness is not only not going to air the negotiations on television; he and his party are making sure to negotiate behind closed doors, period. Even the Republicans -- you know, that other political party -- will not be invited or permitted to participate in the discussions.
It gets worse. When pressed to respond to the open-and-shut claim that he deceived the people in promising a transparent process, he simply says -- through his disgraceful surrogates -- that he isn't going to be bothered to discuss it. He doesn't have to explain himself. He's the messiah. Who are we to doubt -- much less question -- him?
Keep in mind, folks, that this is a bill the public has clearly indicated it does not want passed. Americans are not ready for socialized medicine. But Obama and his party don't care. They are forcing it down our throats as quickly as they can, unilaterally -- to borrow their favorite term to criticize President Bush's foreign policy.... A question for you lingering Obama supporters: How is his "man of the people" facade looking to you now?
An Entitlement Certain to Grow In Spite Of 'Firewalls'
One of the main arguments President Barack Obama and other Democrats have made on behalf of the health care bills that have passed the House and the Senate is that they would reduce the federal budget deficit in the coming decade and in the years following as well. Their claim is backed up by the official cost estimates provided by the Congressional Budget Office that show modest improvements in the budget outlook through 2019 if the bills become law. But there are important reasons to be very skeptical that a final health care bill will improve the nation’s budget outlook, both in the short and the long term.
For starters, neither bill addresses the impending cut in the fees paid to physicians under the Medicare program. There is bipartisan opposition to these cuts, but the cost of fixing the problem would exceed $200 billion over 10 years. Consequently, congressional Democrats aren’t providing a permanent solution in the health care bills; they are in effect understating the cost of the reform program they have promised to deliver. If the so-called “doc fix” were included in the accounting, the health care reform effort would no longer be a deficit reducer at all.
In addition, CBO expects the financing provisions of the bill to produce revenue and spending reductions that more than offset the growing cost of the new health entitlement expansions contemplated in the legislation. That would be no small feat, because the entitlement spending is expected to increase at a very rapid rate indeed, just as Medicare and Medicaid spending have for more than four decades. By 2019, the Medicaid expansion and the subsidies for health-insurance premiums in the exchanges are expected to cost about $200 billion annually, and grow at an eight percent rate every year thereafter.
On paper, of course, CBO is right. The “pay fors” would grow at an equally rapid rate, as they are currently written in the bills. But that’s only because they assume key indexing provisions that function like a tightening of the vise over time.
The House bill includes a new surtax for upper income taxpayers, while the Senate passed an increase in the Medicare payroll tax for high earners as well as a new excise tax on high-cost insurance plans. In all instances, the thresholds used to determine tax liability would be set in ways that capture more taxpayers over time. The threshold for application of the Medicare payroll tax hike — $200,000 for individuals — would not be indexed at all to keep up with inflation. Nor would the House-passed income-tax surtax.
Meanwhile, the threshold for what constitutes a “high-cost” insurance plan would be indexed below expected medical inflation. Consequently, in 10 or 15 years’ time, many more Americans would find themselves in plans deemed to be unacceptably costly.
CBO also gives both the House and Senate bills credit for substantial savings in the Medicare program. A large part of that would come from shaving off a half percentage point every year from the normal Medicare inflation update for hospitals and other service providers; that annual cut assumes improvements in productivity.
Both the Chief Actuary of the Department of Health and Human Services, as well as CBO, have essentially raised serious doubts about whether such a perpetual cut in payment rates can be sustained without leading large numbers of hospitals and other service suppliers to drop out of the Medicare program, and thus harm beneficiary access to timely care. Nonetheless, that’s what the House and Senate sponsors of the health legislation are relying on when they claim their bills will improve the nation’s fiscal standing.
But even if all of the offsets work out as planned, which is not likely, the House and Senate bills would still create substantial budgetary risks because of the pressures for entitlement expansion they would unleash.
Both bills assume the new entitlement spending can be held down with the so-called “firewall” provisions. These are the rules that essentially preclude individuals from gaining access to premium subsidies available in the exchanges. If an employer offers "qualified" insurance coverage to a worker, the employee really has no choice but to take it if he wants to avoid paying the penalty for going uninsured. But these rules would create large disparities in the federal subsidies made available to workers inside and outside the exchanges.
Gene Steuerle of the Urban Institute has calculated that, under the Senate bill, a family of four with an income of $60,000 with employer-sponsored health care would get $4,500 less in federal support outside of the exchange than a similar family inside the exchange would get in 2016. And there would be many tens of millions more families outside the exchange than in it, according to CBO. Today, there are about 127 million Americans under the age of 65 with incomes between 100 and 400 percent of the federal poverty line, but CBO expects only about 18 million people will be getting exchange subsidies in 2016.
If enacted as currently written, it’s entirely predictable what would happen next. Pressure would build to treat all Americans fairly, regardless of where they get their insurance. One way or another, the subsidies provided to those in the exchanges would be made more widely available, driving the costs of reform well above the $900 billion limit the administration has set for the initiative.
The president has said that he wants a health reform bill in large part because it’s necessary to get better control of the federal budget. But the bills that have been developed in Congress fall far short of his stated objective. The new entitlement expansions are certain to occur, followed quickly by irresistible pressure to make them even more widely available and generous. Meanwhile, Congress would have to show heroic restraint to allow the tax increases and spending cuts to play out as written. That’s a recipe for another unfunded federal program.
Congress on Health Care: Sticking It To The States
In their quest for universal health care coverage, liberal lawmakers have come to a harsh awakening. As it turns out, insuring everyone is expensive! So, in an attempt to make good on their vast promises without going beyond President Obama’s $900 billion spending limit for health care reform, the Democrats have turned to Medicaid as a means to expand coverage in both the House and Senate health care bills.
Momentarily putting aside the question of whether expanding the nation’s worst program counts as reform, expanding Medicaid poses yet problems, using Medicaid to cover the uninsured is appealing to federal lawmakers because they can share the burden of paying for it with the states. Most state officials, unlike Congress, actually have to balance a budget.
In a recent paper, Heritage scholar Dennis Smith outlines why the states are simply incapable of carrying this burden, regardless of how high the federal matching rates are. Smith points out that, though state general fund expenditures over the last 32 years have increased at an average rate of 5.6 percent each year, in 2009 expenditures actually decreased. This trend is expected to continue into 2010.
In their budgets for 2010, states made across the board spending cuts. 30 states made cuts to their K-12 education budgets, 30 states cut higher education, and 28 states even made cuts to Medicaid. And yet Congress expects these same states to increase spending on Medicaid by adding more people to the program.
Adding to these dim prospects is the fact that states have become more and more dependent on federal funding to meet their budgets. Federal funding for the states has increased 21.2 percent, mostly due to the stimulus bill. When these funds expire, which they will, it will be up to the states to either make further cuts to state programs or somehow come up with the funds themselves.
The states are currently facing a fiscal crisis. Adding to their financial obligations will only result in more drastic cuts to other state programs. Since Medicaid and education account for the majority of state spending, and states will be forced to increase spending in Medicaid, it only seems logical that budgetary cuts will be made to education, another area in which reform is needed. Federal lawmakers should take these matters into account when voting for a mandate on the states to increase their Medicaid spending.
Expanding Medicaid does not count as health care reform. True reform would include restructuring Medicaid as it currently stands, an issue which has been excluded in the current health care reform bills.
British government dithering over use of private health services
The government is to be investigated after Andy Burnham, Health Secretary, said the NHS should be the first option when health care contracts are awarded. Mr Burnham said the NHS should be the 'preferred provider' of health care with private companies seen a second choice if the health service cannot meet requirements. It was designed to boost the NHS in the face of growing criticism that the health service was facing creeping privatisation.
But the statement appeared to row back on earlier pledges that the NHS and private sector would compete on an equal footing to provide health care services. Voluntary organisations and charities objected to the change in stance and a joint complaint was submitted last month to the NHS's Co-operation and Competition Panel.
It has agreed to look into the complaint brought by NHS Partners Network, representing private companies that providers treatment to NHS patients and Acevo, the Association of Chief Executives of Voluntary Organisations.
One primary care trust blocked bids from voluntary and private organisations for a contract to provide community health services after Mr Burnham's 'preferred provider' statement in September saying only NHS organisations could bid. This was unfair, it has been claimed.
Peter Kyle, the deputy chair of ACEVO, said: "Although this is a complaint against one PCT, it is the first instance of a PCT implementing Andy Burnham's 'preferred provider' policy, so can therefore be interpreted as a complaint against the secretary of state's position."
This is perfectly reasonable when the generic and the branded drug are identical but that is not always so. There is the additional concern that doctors may be encouraged to prescribe ONLY those drugs with a generic equivalent
The NHS is to increase its use of cheap, generic drugs in a bid to save more than £20 million a year. But patients' groups have expressed concern that the plan could put people with life-threatening medical conditions at risk.
Ministers insist that doctors should prescribe fewer expensive, branded medications to reduce the NHS drugs’ bill, which topped £10 billion in 2007, 10 per cent of the overall budget. Already around 83 per cent of drugs prescribed are off-patent, meaning they can be manufactured and sold at a cheaper rate. But ministers estimate that that figure could rise to 88 per cent of all drugs.
Under proposals being considered certain conditions or drugs could be made exempt from the plans.
Experts have warned that most generic drugs are slightly different from their branded counterparts and that the changes could prove fatal to people with serious health conditions such as epilepsy, asthma or those who have had an organ transplant.
Ministers estimate that even just switching half of those drugs for which a generic version exists could save £20.5 million a year. But official estimates show that the scheme could cost £4.5 million a year to run, on the top of £9 million in start-up costs.
Norman Lamb, the Liberal Democrat Health spokesman, said: "There are legitimate reasons to make savings in the NHS and to increase the use of generic drugs. "However, the bottom line is patient safety is paramount. People's health must not be put at risk, and there is a danger that these plans could do that."
Simon Wigglesworth, deputy chief executive at Epilepsy Action, said: “We are pleased to see that the government has listened to our concerns and that their 'preferred option' currently excludes anti-epileptic drugs from automatic generic substitution. "However, we will be campaigning strongly to ensure that there is public consultation over any future changes to the proposed list of drugs that can be substituted to safeguard people with epilepsy."
I had a little chat with a postal worker on why they aren't delivering mail to the apartment building that I just moved into. I also spoke to the representative of the building owner on why she can't get the post office to deliver mail to the building.
An iron law (if not THE iron law) of bureaucracy is that the so-called workers in the system will make the least effort necessary in order to collect their paychecks. The ideal situation of course is that the bureaucrat should do no work at all in order to collect their pay. Thus it should be no surprise to us that a new generation of Islamic suicide bombers are penetrating security checkpoints manned by the employees of a Federal agency.
In the private sector a serious failure of that magnitude would result in the firing of the employee who failed to do his job and possible criminal prosecution. In the Federal sector a lazy bum is protected by the civil service apparatus. And God help you if you try to discipline an affirmative action diversity hireling.
The Left, in what they imagine to be their infinite wisdom, is now pushing for placing the entire field of medicine in the hands of people who have no stake in the outcome of medical treatments. Whether you, or the most precious members of your family, live or die is simply irrelevant to them as long as they collect their paychecks and pensions. There is no shortage of horror stories coming out of nations where the state provides universal health care.
Innocent people will die needlessly when the state takes over the field of medicine. The nice term for this is murder.
The ability to achieve victory largely comes down to one’s determination to win, versus another’s willingness to accept defeat. United States history is replete with examples of Americans overcoming far greater odds than those currently faced by the opponents of Obamacare. In fact, it’s not clear that Obamacare opponents face long odds at all, or even that they face odds longer than those faced by Obamacare supporters, despite the latter’s grossly premature declarations of victory.
The Democrats are determined to expand the federal government’s portfolio beyond the Post Office, Amtrak, and General Motors, by adding the entire health-care industry to its holdings. But before they can subject what will soon be one-fifth of our economy to the federal government’s command-and-control model, Democrats must clear three major obstacles. And they have to do so without losing even three of the 220 votes that Obamacare received in the House or even one of the 60 votes it received in the Senate. In short, they have essentially no margin for error. The Democrats’ three major hurdles are as follows:
(1) The “public option.” The House has previously insisted upon it; the Senate can’t pass it. Early indications are that the House will ignore the calls of Howard Dean and others and will quietly and meekly acquiesce to the Obama administration’s lobbying and coercing. But this could change, and even the slightest dissent within the House Democratic flock could kill the bill.
(2) Abortion. Obamacare supporters conveniently seem to be forgetting that Obamacare wouldn’t have passed the House without the Stupak Amendment’s prohibition on taxpayer funding of insurance plans that cover abortions. Senate Democrats, who are more universally committed to public funding of abortion than Democrats in the House, rejected that approach.
There is no real middle ground between these two positions. One side or the other will have to cave. The very pro-abortion Obama administration will push hard to make the House members give ground. President Obama and Rahm Emanuel are more than happy to sacrifice several handfuls of anti-abortion Democrats in swing districts. But it’s not remotely certain that those members will be willing to sacrifice themselves. True, most of them will be pleased that the “public option” will have been jettisoned, but that won’t go very far in helping them to explain an abortion flip-flop to their constituents. This is a serious hurdle, and it will almost certainly result either in the defeat of many Democratic members or of Obamacare itself.
(3) Public opinion. Poll after poll has shown that, both in terms of sheer numbers and intensity of sentiment, Americans don’t want Obamacare. The Democrats must therefore hope to clear the first two hurdles and pass this unpopular legislation, and then be rewarded by voters with a return trip to Congress and the White House so that they can implement it in 2013 or later. To say the least, that’s a tall order.
And public opinion is likely to continue to move further against them, the more that Americans realize how much Obamacare would politicize medicine. The exemption of the longshoreman’s union from the excise tax on “Cadillac plans,” the survival of full Medicare Advantage benefits in Florida but nowhere else, and the loophole that says that Nebraska wouldn’t have to continue paying into Medicaid while the other 49 states would, are all quite glaring examples of how a shift from private to federal control would politicize health care in an ugly and unseemly way.
Any one these three hurdles can fatally trip up Obamacare. So, at this point, the only thing that would ensure Obamacare’s victory is if its opponents quit running the race. On some level, Obamacare supporters know this, which is why they are already declaring victory and trying to demoralize an opposition that they think lacks resolve. But if Obamacare opponents are determined to match its supporters’ will to win, and if they are determined to run this race for as long as it takes, the smart money is on one of these three hurdles taking Obamacare down.
In November, House Speaker Nancy Pelosi (D., Calif.) lassoed 219 other Democrats and eked out a narrow passage for Obamacare in her chamber. With the Senate’s health-care bill heading back to the House, that number could dwindle. Rep. Eric Cantor (R., Va.), the House minority whip, released a memo this morning that points to 37 House Democrats who may be looking to jump ship.
Cantor tells NRO that the upcoming retirements of Sens. Chris Dodd (D., Conn.) and Byron Dorgan (D., N.D.) and Gov. Bill Ritter (D., Co.) can be attributed partly to the American people’s growing frustration with the Democrats’ handling of the health-care debate. “The Democrats had decided to avoid an open debate,” says Cantor. “That strikes the wrong tone with the public, and people are wondering what they are hiding and who may be rewarded behind closed doors. From the ‘Cornhusker Kickback’ to the ‘Louisiana Purchase,’ it has been a reprehensible practice to watch.”
With the GOP gaining momentum, Cantor tells us that he has “a very plausible formula to stop this bill.” All Republicans need is “three Democrats to change their vote to a ‘no,’ and that’s a real possiblity,” he says, since “many Democrats” feel that the Senate legislation “falls way short” on issues like Medicare cuts, budget costs, and abortion. Here are some choice snippets from Cantor’s memo:
"Millions of Americans have made clear their opposition to the Democrat take-over of our nation's health care system. Together with my Whip Team, I have identified 37 Democrats who — we believe — can be persuaded to vote against a final health care agreement. Because each of these 37 Democrats voted for the House bill, we only need to turn 3 votes to prevent a final agreement from passing. . . .
"If we can convince enough of these 37 Members (along with the 39 Democrats who already voted no) to reconsider and switch their position on the bill, I know that we can defeat this government take-over of our health care before it becomes law. . . .
"Democrat Leaders are telling the press and pundits that the hardest part of the process toward enacting their government take-over of our nation's health care system is past them, but long-time students of the legislative process know better."
For conservatives, it’s good to see Cantor working hard to build a case for both GOP and Democratic opposition to Obamacare. Although he’s the House GOP whip, and the memo was sent out as fodder for the Right, you can be sure that House Democrats in pro-life districts (such as Dahlkemper, Donnelly, Kaptur, and Oberstar) or in districts with many Medicare Advantage enrollees (such as Space, Moore, Kagen, and Maffei) will be taking close notice.
President Barack Obama signaled to House Democratic leaders Wednesday that they'll have to drop their opposition to taxing high-end health insurance plans to pay for health coverage for millions of uninsured Americans. In a meeting at the White House, Obama expressed his preference for the insurance tax contained in the Senate's health overhaul bill, but largely opposed by House Democrats and organized labor, Democratic aides said. The aides spoke on condition of anonymity because the meeting was private.
House Democrats want to raise income taxes on high-income individuals instead and are reluctant to abandon that approach, while recognizing that they will likely have to bend on that and other issues so that Senate Majority Leader Harry Reid, D-Nev., can maintain his fragile 60-vote majority support for the bill.
House Speaker Nancy Pelosi and four committee chairmen met with the president Wednesday as they scrambled to resolve differences between sweeping bills passed by the House and Senate. The aim is to finalize legislation revamping the nation's health care system in time for Obama's State of the Union address early next month. Despite the dispute over the payment approach, Pelosi, D-Calif., emerged from the meeting expressing optimism. "We've had a very intense couple of days," Pelosi said. "After our leadership meeting this morning, our staff engaged with the Senate and the administration staff to review the legislation, suggest legislative language. I think we're very close to reconciliation."
Congressional staff members stayed at the White House into the evening to continue work, and a conference call of the full House Democratic caucus was scheduled for Thursday. Obama is taking a more direct role than ever, convening Oval Office meetings Tuesday and Wednesday of House Democratic leaders.
The House and Senate bills are alike in many ways. Both impose first-time requirements for almost all Americans to purchase health insurance, providing subsidies for lower- and middle-income people to help them do so, though the subsidies in the House bill are more generous. Both establish new marketplaces called exchanges where people can go to shop for and compare health insurance plans. Both would ban unpopular insurance company practices including denying coverage to people with pre-existing health conditions.
Differences include whom to tax, how many people to cover, how to restrict taxpayer funding for abortion and whether illegal immigrants should be allowed to buy coverage in the new markets with their own money. The House bill covers about 36 million uninsured Americans over 10 years, costing more than $1 trillion, while the cheaper Senate bill covers about 31 million.
House Democrats are steeling themselves to abandon establishment of a new government insurance plan opposed by moderates in the Senate, but in return hope to get the Senate to rescind insurers' antitrust exemption, make subsidies more affordable and agree to establishment of national rather than state health insurance exchanges, among other things. Obama has signaled his support for the House position on the subsidies and other areas, aides said.
The difference in how the bills are paid for is emerging as among the toughest disputes. The House wants to increase income taxes on individuals making more than $500,000 and couples over $1 million, which would raise $460 billion over 10 years to pay for the bill. The Senate wants to tax insurance companies on plans valued at over $8,500 for individuals and $23,000 for couples, raising $150 billion. Most analysts say the insurance tax would be passed on to consumers, and organized labor is strongly opposed, as are House Democrats, some of whom contend that the tax would violate Obama's campaign pledge not to tax the middle class.
"We did in our house bill something that protects middle class Americans from having to pay more for health insurance," Rep. Xavier Becerra, D-Calif., a member of the House leadership, said Wednesday. "So far we want to stay to that principle." House members "have been very clear on that issue and working with the president to stick to what he said when he was campaigning for president, we're trying to make sure this does not affect middle class Americans," Becerra said.
Obama has defended the tax as a way to drive down health costs. "I'm on record as saying that taxing Cadillac plans that don't make people healthier but just take more money out of their pockets because they're paying more for insurance than they need to, that's actually a good idea, and that helps bend the cost curve," the president said in an interview with National Public Radio just before Christmas. "That helps to reduce the cost of health care over the long term. I think that's a smart thing to do."
In the end the House likely will have to accept the insurance plan tax at some level - say starting with plans valued at $25,000 or more, with carve-outs for certain union professions - but it might not happen without a fight. A provision in the Senate bill to increase the Medicare payroll tax on high-earners could provide some middle ground, although that measure would raise only $87 billion over a decade.
Patients are having their health put at risk by staff who feed them through tubes unnecessarily because they are too busy to help them eat normally, a report has warned. Putting a tube into the stomach to give nutrition artificially should be a last resort but busy hospital wards and care homes are using them inappropriately, the report from the Royal College of Physicians said.
Experts said that there could be a "hidden agenda" for fitting feeding tubes due to staffing issues and costs. Care homes are refusing to take some patients without a tube in a widespread practice which was condemned by the working party who compiled new guidelines for clinicians. Dementia patients are often tube fed but evidence has shown it does not prolong their life and may be harmful, the report said. Dr John Saunders, co-chairman of the working party and experts in medical ethics, said: "In the demented patient it does not prolong life, the treatment is inappropriate and futile. It is actively unethical and dubious."
Concerns over artifical feeding have been raised after palliative care experts warned that food and water were wrongly being withdrawn from some terminally patients on the Liverpool Care Pathway.
Feeding tubes may be inserted directly into the stomach through a small hole in the abdomen and liquid feed administered by carers or the patient themselves. It is done if the patient cannot safely swallow food without choking or inhaling it but in many cases this can be overcome with specialist nursing care. Patients who have had a stoke, those with other brain injuries, multiple sclerosis and Huntingdon's may require tube feeding and some will also be able to eat some food orally if helped and may recover.
In other cases patients may be fed artificially at the end of life and in these cases clinicians should consider if the treatment is to improve their condition and if not it is futile, the report said.
Around six per cent of patients who have a feeding tube will die within 30 days while 10 per cent will suffer a complication such as an infection or bleeding. It is thought up to a fifth of patients with feeding tubes have them inappropriately because either they are futile or they could eat normally if given appropriate help, Dr Rodney Burnham, co-chairman of the working party said.
He said there was a "growing problem" of care homes refusing to take patients unless they have a feeding tube fitted. "We come down very strongly on any blanket refusal on those grounds," he said. "They may cite patient safety but there could be a hidden agenda on grounds of staffing or costs."
A survey found there was an 11 per cent increase in the number of people being fed artificially outside hospital in just one year to reach 39,000 people in Britain in 2008. Every hospital or nutrition team will have experienced a care home refusing to take a patient unless a tube is fitted, Dr Burnham said. "The reasons can be surmised as being ostensibly for patient safety but it is an invasive procedure with a risk. "Where institutions have a laissez-faire approach the 30 day mortality has been well over 30 per cent. It is not appropriate to be done unless it is in the patient's best interests," Dr Burnham said.
In deciding whether to feed patients artificially who cannot communicate or do not have capacity to make decisions for themselves, doctors should consider what the objective is for the treatment, what it is in their best interests and if it will be tolerable, the report said. Where patients have given advance directives or so-called living wills, to refuse artificially nutrition those decisions should be respected. The courts may be called on to decide in cases where family members and medical staff disagree, the report said.
[British Conservative leader] David Cameron will pledge today to divert billions of pounds to healthcare in the most deprived parts of the country if he forms the next government.
This decision on health funding, I am told, is the first in a series of policy statements by the Conservatives aimed at countering claims that the party is intent on slashing core public services, and countering 'class war' claims that they are a party of the rich. So I can see why 'Dave' (as his spin-doctors prefer him to be called) wants to do this. I just think it will be an ineffective policy, and therefore a waste of our money – money that is pretty short right now, and could be used to better effect.
If health outcomes reflected the amount of money we spent in different areas, then the fittest, sprightliest, longest-living folk would be in the Calton area of Glasgow, and the sickest ones with the rottenest teeth would be in Wokingham. The fact is, of course that although residents of leafy Wokingham can expect to live comfortably longer than the national average (75 for men and 80 for women), a male in Calton cannot expect to see his 54th birthday. (That is 13 years shorter than Iraq, even after a decade of sanctions, and 16 years less than North Korea, likewise.)
In the Calton, a quarter of the population say their health is not good and over half smoke. Two-fifths are on incapacity benefit. Calton residents suffer from their drink, drugs, and poor diet. Alcohol abuse is far above the national average. Heart disease, diabetes, and hospital admissions with drug overdoses are high.
Would more money from the NHS change that? Not a chance. Of course, Dave's health supremo, Andrew Landsley, says that he is going to turn the NHS from a sickness service to a health service, concentrating more on prevention rather than cure. He would still have his work cut out to make an impact on statistics like these. No, Calton residents are already the victms of too much government spending – poor-quality public-sector housing, a social benefit system that encourages family break-up and makes it almost impossible for people to get back into work, and a state school system that leaves inner-city kids underqualified and devoid of any hope of improving themselves. Yet more of the same will not help. We need to think much more radically if we are to change ill-health – and the causes of ill-health.
PRESIDENT OBAMA is a great admirer of the Mayo Clinic. Time and again he has extolled it as an outstanding model of health-care excellence and efficiency.
"Look at what the Mayo Clinic is able to do," the president proclaimed at a rally in September. "It's got the best quality and the lowest cost of just about any system in the country. . . . We want to help the whole country learn from what Mayo is doing." A few months earlier, in a letter to Senator Max Baucus of Montana and the late Senator Ted Kennedy, the president had singled out the Mayo Clinic and the Cleveland Clinic for praise. They "offer the highest quality care at costs well below the national norm," he wrote. "We need to learn from their successes and replicate those best practices across our country." On the White House web site, you can find more than a dozen other instances of Obama's esteem.
So perhaps the president will give some thought to the Mayo Clinic's recent decision to stop accepting Medicare payments at its primary care facility in Glendale, Ariz. More than 3,000 patients will have to start paying cash if they wish to continue being seen by doctors at the clinic; those unable or unwilling to do so must look for new physicians. For now, Mayo is limiting the change in policy to its Glendale facility. But it may be just a matter of time before it drops Medicare at its other facilities in Arizona, Florida, and Minnesota as well.
Why would an institution renowned for providing health care of "the best quality and the lowest cost" choose to sever its ties with the government's flagship single-payer insurance program? Because the relationship is one it can't afford. Last year, the Mayo Clinic lost $840 million on its Medicare patients. At the Glendale clinic specifically, a spokesman told Bloomberg, Medicare reimbursements covered only 50 percent of the cost of treating elderly primary-care patients. Not even the leanest, most efficient medical organization can keep doing business with a program that compels it to eat half its costs.
In breaking away from Medicare, the Mayo Clinic is hardly blazing a trail. Back in 2008, the independent Medicare Payment Advisory Commission reported that 29 percent of Medicare beneficiaries -- more than 1 in 4 -- have trouble finding a primary-care doctor to treat them. A survey by the Texas Medical Association that year found that only 38 percent of that state's primary-care physicians were accepting new Medicare patients.
But if you think things are bad now, just wait until Congress enacts the president's health care overhaul. A central element in both the House and Senate versions of ObamaCare is that Medicare reimbursements to hospitals and doctors -- already so low that many providers lose money each time they treat a Medicare patient -- will be forced lower still.
The Centers for Medicare and Medicaid Services, a branch of the US Department of Health and Human Services, estimated last month that the Senate bill would squeeze $493 billion out of Medicare over the next 10 years. As a result, it cautioned, "providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and . . . might end their participation in the program (possibly jeopardizing access to care for beneficiaries)." In short, the Democrats' idea of health-care reform -- more government power to set prices, combined with reduced freedom for individuals -- will only make medical care harder to come by: an Economics 101 lesson in the pitfalls of price controls.
Nearly six months ago, the Mayo Clinic tried to sound an alarm. Instead of making American health care better and more affordable, it warned, the legislation working its way through Congress "will do the opposite" and "the real losers will be the citizens of the United States."
Each year Medicare loses tens of billions of dollars to fraud and abuse. The program's long-term deficit is a staggering $38 trillion. Its expenditures have raced ahead of inflation from the day it was created: Medicare's price tag has skyrocketed from $3 billion in 1966 to an estimated $453 billion this year. Yet its reimbursement of medical providers is so meager that more and more of them cannot afford to treat Medicare patients. Whatever else Medicare might be, it is no model for rational reform.
Obama says he want the country to "learn from what Mayo is doing." What Mayo is doing is trying to provide high-quality medical care in the face of Washington's compulsively misguided interference. As 3,000 Mayo patients have just learned, government interference can hurt. Ratchet up that interference with ObamaCare, and the pain will only grow worse.
Meet the Beltway bloodsuckers. They convene in the dead of night, when most ordinary mortals have left work and let their guard down or are lying asleep in bed. Pale-faced and insatiable, the nocturnal thieves do their nefarious business in backrooms and secret chambers. Their primary victims? Taxpayers, the free market and deliberative democracy.
Democratic leaders have been promising the most ethical, transparent, open and engaged administration for years. Instead, they have delivered a bleak and creepy legislative environment that could double as a “Twilight” movie set.
Skulking Senate Majority Leader Harry Reid rammed the government health care takeover package through under the cover of darkness before Thanksgiving and Christmas. House Democratic leaders forbade debate on all but one amendment not authored by themselves. The Senate Finance Committee killed a GOP amendment that would have required Demcare to be available online for 72 hours before the committee voted. Reid and his Volterra-style henchmen cut last-minute cash-for-cloture deals behind closed doors.
And now House and Senate Democratic leaders are reportedly preparing to cut dissenters out of the reconciliation process by bypassing the formal conference committee.
In Hill parlance, this legislative shortcut is called “ping-ponging.” A better game analogy: dodgeball. With mounting opposition from both conservative Republicans and progressive Democrats, President Obama’s water-carriers must use every trick in the book to speed the final merging and passage of the bill before the end of the month.
The hypocrisy reeks stronger than rotting garlic. In 2006, House Democrats asserted that “House-Senate conferences are a critical part of the deliberative process because they produce the final legislative product that will become the law of the land.” That same year, Reid railed on the Senate floor against informal deal-making that circumvented the conference committee process -- and he attacked the use of manager’s amendments to avoid public scrutiny:
"Of course, nobody can see the manager’s amendment. It is composed of over 40 amendments. How could anyone vote for a piece of legislation such as that -- a manager's amendment with 42 separate amendments? Now, these amendments were not put in a conference committee. People complain about that. But at least in a conference committee, you have people working together, sticking things in. … Here, you have one person making a decision as to what is going to be in the manager’s amendment. There is no way to know what is in it."
But four years later, it was Reid who snuck his 383-page manager’s amendment -- stuffed with payoffs, special breaks and concessions on health care -- into the Senate hopper on the Saturday before Christmas break. Four years later, it is Reid stifling the open, collaborative conference committee process he so fiercely championed.
Where’s Barack Obama? As a candidate, he promised repeatedly to broadcast legislative negotiations on C-SPAN “so that the American people can see what the choices are” and “so that the public will be part of the conversation and will see the choices that are being made.” But the most transparent presidential administration ever is shrugging its shoulders. On Tuesday, White House press secretary Robert Gibbs pooh-poohed C-SPAN’s request to allow electronic media coverage of the Demcare negotiations.
Instead, Gibbs thinks Americans should be grateful for what they got last month: “The Senate did a lot of their voting at 1:00 and 2:00 in the morning on C-SPAN. … And I think if you watched that debate -- I don't know -- I wasn't up at 1:00 or 2:00 in the morning for a lot of those votes, but I think if the American public had watched … you'd have seen quite a bit of public hearing and public airing.” And if you missed the middle-of-the-night broadcasts, tough noogies.
Team Obama’s contempt for meaningful transparency has been on display from Day One. A year ago this month, Obama broke his vaunted open government pledge with the very first bill he signed into law. On Jan. 29, 2009, the White House boasted that the Lilly Ledbetter Fair Pay Act had been posted online for review. Except: Obama had already signed it -- in violation of his “sunlight before signing” pledge to post legislation for public comment on the White House website five days before he sealed any deal.
From the stimulus to the health care takeover to holiday bailouts for bankrupt financial behemoths Fannie Mae and Freddie Mac, it’s been all backrooms and blackouts ever since. The Prince of Darkness at 1600 Pennsylvania Ave. is perfectly happy with his Vampire Congress. Wraiths of a sunshine-evading feather flock together.
President Barack Obama is prodding House and Senate Democrats to get him a final health care bill as soon as possible, encouraging them to bypass the usual negotiations between the two chambers in the interest of speed.
Obama delivered the message at an Oval Office meeting Tuesday evening with House Speaker Nancy Pelosi and House Majority Leader Steny Hoyer. Senate Majority Leader Harry Reid and his No. 2, Sen. Dick Durbin, D-Ill., joined in by phone.
They agreed that rather than setting up a formal conference committee to resolve differences between health bills passed last year by the House and Senate, the House will work off the Senate's version, amend it and send it back to the Senate for final passage, according to a House leadership aide, speaking on condition of anonymity in order to discuss the private meeting.
Obama himself will take a hands-on role, convening another meeting with congressional leaders at the White House on Wednesday, the aide said. The aim is to get a final bill to Obama's desk before the State of the Union address sometime in early February.
Facing the need to maintain a tenuous 60-vote coalition in the Senate, House Democrats will probably have to give up on starting a new government insurance plan to compete with the private market, something that's a nonstarter with Senate moderates. In its place they hope for more generous subsidies for lower-income families to buy health insurance.
Obama agreed at Tuesday evening's meeting to help strengthen affordability measures beyond what's in the Senate bill, the aide said.
Pelosi suggested Tuesday that House members wouldn't insist on the government plan as long as the final bill provides "affordability for the middle class, accountability for the insurance companies, ... accessibility by lowering cost at every stage." "There are other ways to do that, and we look forward to having those discussions," she said.
House Democrats want the Senate to agree to language revoking insurers' antitrust exemption as a way to hold insurance companies accountable in absence of direct government competition, said Rep. Chris Van Hollen, D-Md., a member of the House leadership.
The bills passed by the House and Senate both would require nearly all Americans to get coverage and would provide subsidies for many who can't afford the cost, but they differ on hundreds of details. Among them are whom to tax, how many people to cover, how to restrict taxpayer funding for abortion and whether illegal immigrants should be allowed to buy coverage in the new markets with their own money.
Concerns about affordability are paramount. Major subsidies under the bills wouldn't start flowing to consumers until 2013 at the earliest. Even with federal aid, many families still would face substantial costs. The House bill would provide $602 billion in subsidies from 2013-2019, covering an additional 36 million people. The Senate bill would start the aid a year later, providing $436 billion in subsidies from 2014-2019, and reducing the number of uninsured by 31 million. "Affordability is a critical issue," Van Hollen said.
But sweetening the deal for low- and middle-income households could require more taxes to pay for additional subsidies. And the House and Senate are also at odds over whom to tax. The House wants to raise income taxes on individuals making more than $500,000 and couples over $1 million. The Senate would slap a new tax on high-cost insurance plans. Although the Obama administration supports the Senate's insurance tax as a cost-saver, labor unions, which contribute heavily to Democratic candidates, are against it.
The House may end up accepting the insurance tax if it hits fewer people than the Senate's design now calls for. There also could be common ground in a Senate propo
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