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31 July, 2007

Surgeon breaks cover over NHS beds crisis

Specialist wards full to breaking point. Patients with serious injuries denied care. A health service paralysed by arguments about funding. Martin Bircher, one of Britain's most senior consultants, speaks out:

One of Britain's leading trauma surgeons has broken cover to expose the scandal of a national shortage of emergency trauma beds which is leading to thousands of serious injury victims suffering in agony. In an unprecedented intervention by a senior practitioner in the NHS, Martin Bircher, a consultant at St George's hospital in London, one of Europe's leading centres in the treatment of major accident victims, has revealed a system paralysed by red tape and disputes over funding, which is putting thousands of patients waiting for treatment in specialist wards at risk. His revelations have prompted calls for a review of funding for A&E services and a shake-up in the management of Britain's leading trauma centres.

Mr Bircher says the problem is worsened by the bureaucracy of the internal market. He has become so frustrated that he has broken free of NHS strictures against speaking to the press and agreed to talk to The Independent on Sunday about the suffering patients are put through.

Every one of Britain's specialist trauma beds is full, which means some patients can wait up to three weeks after their accident before badly broken bones can be repaired. The delay, says Mr Bircher, can jeopardise recovery. With nothing but praise for frontline staff, he says patients who have been critically injured in road or other accidents have to wait an average of 12 days - often in agonising pain - before they can receive the vital specialist treatment. This is because only a limited number of hospitals have the expertise to repair smashed bones, and those hospitals have a shortage of intensive care beds. With the average cost of keeping a trauma patient at around 500 pounds a day and up to 2,000 a day in intensive care, this is also a false economy.

Reacting to the revelations Andrew Lansley, the shadow Health Secretary, said: "It is vital that clinicians are able to prioritise patients according to clinical criteria. It's only if we dispense with central targets and the bureaucratic burdens of the Department of Health that we can give GPs and local hospitals the opportunity to make services more efficient." John Pugh, the Lib Dem health spokesman, added: "This shows how counterproductive the target culture is. Patients are being shunted in and out of A&E to satisfy the expectations of Whitehall. Medical staff should feel free to act in the best interests of patients."

Squabbles over funding

Mr Bircher, who risks censure from the NHS for speaking out, said primary care trust and bed managers are involved in making the final decision as to whether a patient can be moved. If they have to move them there is often a conflict or reluctance because the new area does not want an extra cost. So after initial admission to a general hospital's emergency wards, where lives are saved, patients can find themselves waiting up to three weeks before their real recovery process can begin.

Mr Bircher, 52, cited one patient who had a motorcycle accident earlier this month and was referred to him to decide if she needed surgery to repair her badly broken pelvis. However, he did not receive the request for a week because an initial referral to another hospital was "intercepted by the primary care trust" and rerouted to a hospital that did not have a surgeon with the expertise to make the decision.

He called for emergency medicine to be funded centrally. "These are basic core services that have to be provided," he said. "We shouldn't be sending each other little bills. Trauma and other emergency services like cardiac and stroke services should be top sliced. The money should come from central government funds." Mr Bircher added that doctors and nurses on the frontline in hospitals should not be criticised. He said they do their best but are hampered by layers of managers whose major concern is the budget rather than patient care.

Delays in treatment

He said: "The delays are caused at various levels. If doctors, nurses, physiotherapists, the treating teams, were left to communicate between themselves without bureaucracy, things would happen much more quickly. In the good old days somebody would ring me up about a patient, I'd say send them across, make one call to sister on the ward and it would happen. "Now I'm loath to accept a patient unless I'm sure their injury requires surgery. If I'm unsure I ask them to send X-rays. Even in this technological age this can take two or three days. It's not unusual for them to be delayed or get lost.

"It may be decided that the patient needs an operation and we decide to bring them in. There can still be a delay because bed managers are reluctant to accept a patient for three or four days before the operation is due because of the extra costs. So the patients often come in just hours before the operation. It is not unusual for a patient to arrive in the early hours of the morning, a very short time before their surgery.

"You suddenly find the patient may develop a problem and you can't operate. So you've accepted a patient for a slot and then you can't operate. A much better system would be to have a free flow of patients to the trauma centre where we can get to know them preoperatively. But because trusts all have separate budgets, though we're all playing for the same team, there seems to be a reluctance to accept patients at an appropriate time before the operation. "You can argue whether a patient needs a hip replacement at hospital x or y," he added. "As long as it's done in a reasonable time by a good team it doesn't matter. You can't have these petty squabbles. There just isn't time with trauma."

Patients in pain

His argument is illustrated by Lucy Lynn-Evans, a 21-year-old student from London who was severely injured in a road accident last month. She was riding her scooter to Brighton when she was run over by a 10-tonne lorry which came to rest on her hip. She is alive only because a laptop in her backpack took the full force when the lorry ran over her spine. Her life was saved a second time by the staff at Redhill hospital, where she was initially taken with a smashed pelvis, smashed knee and leg broken in two places. They gave her a blood transfusion - she had lost five pints - and wrapped her hip, described by doctors as a "bag of crisps", in a sheet which was then pulled tight to keep the fragmented bones together.

This is the correct procedure. But Redhill hospital did not have the expertise to repair Ms Lynn-Evans's bones. That would require specialist surgeons and equipment that can be found only in certain hospitals around the country. All they could do in Redhill was put her on morphine and wait for a bed - which at one point she was told could take up to three weeks.

Her pain was so intense, however, that the morphine "only took the edge off it". "I was in a lot of pain, especially when they log-rolled me to change the sheet," Ms Lynn-Evans said from her hospital bed at St George's on Thursday. "It took four people to turn me. The nights were horrible. The mornings were really painful. The three weeks of waiting is an extra three weeks of pain. You just feel like you're going mad. You feel black and despairing. You want with all your heart for someone to make it better. I asked Dad to leave me outside the hospital because then it would be more likely I'd get a bed, rather than waiting by the phone. I felt despair, lying there feeling empty and feeling that I had to tackle this day by day for weeks."

Lack of beds

Ms Lynn-Evans's problem was that she was stable and not going to die; when a bed became available it would go to another more pressing case. At one point a bed became available at the John Radcliffe hospital in Oxford, but before she could be moved John Radcliffe's fund manager had to agree. The fund manager did not arrive at work until 9.30am. By the time Ms Lynn-Evans's case came to the top of the administrator's pile and permission was granted, the bed had gone. Fortunately for Ms Lynn-Evans her mother, Julie, is a psychotherapist who works in child mental health. She is also a broadcaster with a string of top NHS officials in her contacts book. She was able to make a fuss where it counts, and her daughter was moved to St George's hospital in London after only five days.

"Because of the problems with the beds I didn't know where to go to after the accident," Julie Lynn-Evans said. "Lucy was taken to Redhill on the Friday and they saved her life. I cannot thank the doctors enough. But they knew they didn't have the expertise to fix her so I was told not to go to Redhill because they were going to move her. Then at 4am I was told to go to Redhill after all. I'd spent the whole time living through a mother's worst nightmare and yet unable to go to my child. The same night as Lucy, a woman came in from a car crash. She was 63 and had a clot in her lung. Lucy was considered stable, so the woman got her bed. All the time Lucy's having no treatment. As a mother you'd do anything to help your child when you see them in so much pain. But I know that in securing a bed for Lucy, someone else had to wait longer."

Fortunately Lucy is going to make a full recovery, which she and her family put down to the excellent care they have received from surgeons, nurses and doctors at both St George's and Redhill hospitals. The delays, however, caused by bureaucracy and a shortage of beds, could have led to a very different outcome. "The delays not only cause distress to families and patient, but other serious medical issues - thrombosis, bed sores, chest infections and urine and wound infections," said Mr Bircher. "The longer the bone fragments are left displaced, the more the clot begins to form new bone, thus the harder it is to replace the fragment to the correct position.

Patients suffer

"The first step to dealing with the problem is an acceptance and realisation that the system isn't working with trauma and other emergency services in medicine. Sending each other forms and bills is not a good way of doing it. I'm acutely aware that resources are an issue. But basic emergency services should be of the highest quality. If we consider ourselves a leading nation we should have a first-class emergency healthcare system. We do not, and the situation is worsening. "It's pot luck where you go. There's not a defined system. We have to fight every day to get patients in. We have to break through the bureaucracy and develop a new system. There is a lack of intensive care beds in London and around the country which further magnifies the problem.

"Direct funding from the centre, perhaps cutting out the trusts, is perhaps a good idea. One must involve clinicians at the sharp end in the decision-making. Like the Bank of England the politicians should let it go. Doctors, honestly, know best."

Dermot O'Riordan, a member of the council of the Royal College of Surgeons, agreed that a number of services - not just trauma - needed commissioning at a higher level and in some cases co-ordinating nationally, although not necessarily centrally funding. Mr O'Riordan, the RCS council member responsible for the Delivery of Surgical Services Committee, said: "Commissioning of very specialist services, whether elective or emergency, needs to be done at a higher level than a primary care trust. Some need to be co-ordinated by the strategic health authority and some even at national level."

A spokesman for the Department of Health said: "We recognise that a very small number of patients may wait to receive appropriate care. This is because they need very specialised treatment, and critically ill patients waiting for treatment is the exception rather than the rule. "Capacity in intensive care units has improved dramatically in recent years. We now have almost 1,000 more ICU beds than in 2000 and we are looking at ways to increase capacity further."

Source




More overseas doctor concerns in Australia

The inquest into the death of a 16-year-old girl who died in a Sydney hospital after being hit by a golf ball may have to be reopened following allegations about the competence and assessment of two overseas-trained doctors involved in her care. The allegations -- aired on ABC TV's Stateline program in NSW last night -- claimed neither of the overseas doctors treating Vanessa Anderson had been "subject to any appointments or selection process".

Anderson died in 2005 while being treated for a fractured skull caused by the golf ball. The inquest at Westmead Coroners Court, which held its final hearing two weeks ago, heard there were "a number of deficiencies" in her care, including one doctor's failure to give anti-convulsive drugs as ordered by a consultant. Another doctor, anaesthetics registrar Sanaa Ismail, increased the dosage of painkilling drugs to a level the consultant in charge told the inquest was "too high".

It has now emerged that the inquest may be reopened after a senior hospital anaesthetist, Stephen Barratt, wrote to Deputy State Coroner Carl Milovanich about the allegations. In a statement to Stateline, NSW Health director-general Debora Picone said the "accuracy and relevance of a number of the assertions" made by Dr Barratt were "disputed". "The tragic death of Vanessa deserves proper investigation by the state Coroner and I do not think it appropriate to pre-empt the coronial process," Professor Picone said.

In his letter, Dr Barratt said Dr Ismail -- whom he was supervising -- had previously been judged by him to be "not safe" to treat patients after two previous incidents just months earlier. Dr Barratt also revealed he was "unhappy" with how the inquest had unfolded and added "you need the truth". Azizi Bakar, the doctor who had failed to provide the anti-convulsive drugs ordered by a consultant, was the other doctor whom Dr Barratt suggested had not been properly screened prior to employment.

Dr Ismail faced questions during the inquest over her decision to double the dose of a painkilling opiate drug, oxycodone, to treat Anderson's headache, despite the fact that she only spoke to the patient for a pre-operative check. Dr Ismail said she did not realise Anderson was already receiving Panadeine Forte, a painkiller with a high level of codeine, another opiate drug.

Dr Barratt's letter alleged that Dr Ismail's salary was being paid by the Saudi Government, an arrangement that he said was "not unusual in the public hospital system -- that is, there are many others like her". "In fact, a few months before the Vanessa Anderson incident a bureaucrat from the Department of Health came pleading with us to take more of these 'trainees'," Dr Barratt wrote.

Professor Picone said "learning exchange" arrangements was a "feature of any modern health system". Out of a total 11,000 doctors in NSW public hospitals, about 100 at any one time would be paid for by an overseas government or other agency, she said.

Alison Reid, medical director of the NSW Medical Board, refused to discuss the case specifically but said that generally applications to register doctors first had to come from a prospective employer, supported by letters from the relevant medical college. Qualifications were independently verified and certificates of good standing sought from previous regulatory bodies.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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30 July, 2007

More dead from heat in government-controlled healthcare, this time in Hungary

Post below lifted from Fausta

The universal healthcare system in Hungary (PDF file) is financed through income tax and social-insurance taxes.

Maria just sent this: Hungary heatwave kills hundreds

Up to 500 people have died in the past week from a heatwave in Hungary, a top health official has said.
...
The daily mean temperature in the past week had reached 30C, she said.

In the southern city of Kiskunhalas, the temperature reached a record high of 41.9C.

Here in the USA, the elderly and frail move to Arizona and Florida, where they swim in cooled swimming pools and a 30C day (86oF) in the Summer is an invitation to have dinner on the veranda.

In 2003 15,000 elderly and frail people died during a heat wave in France. Many died in the emergency rooms waiting for someone to bring them water




Out of the frying pan, into the fire? Medical desperation in Queensland, Australia

MORE than two in three people want the Federal Government to take control of Queensland's failing health system, the Queensland: Your Say survey has revealed. Data from the poll shows 69 per cent of Queenslanders have lost faith in the State Government's ability to run their health service. Despite promises that problems will be resolved, patients continue to suffer substandard levels of care, including waiting lists of up to eight years for surgery, a lack of beds, and closure of 38 maternity units in rural Queensland because of a lack of staff.

Queenslanders have spoken out loud and strong with 10,700 people raising their voices in the 2007 Sunday Mail-National Nine News Your Say survey. Readers seized the chance to share their feelings in one of the biggest responses to a survey in any Australian newspaper.

Queensland Opposition health spokesman John-Paul Langbroek said he was not surprised the public was frustrated with the State Government. "Health is such an important portfolio, and yet Beattie and Labor are not running it properly," he said. "It's certainly not a lack of money that is causing the problems because the budget has gone from $3 billion 10 years ago to $7.15 billion now."

Hospital patient Campbell Ney, 64, from Mareeba, is among Queenslanders unhappy with the system. He was last week forced to transfer from Cairns Base Hospital to Mossman Hospital because of a lack of beds. Mr Ney, who has a severe lung infection, said: "I'm a pretty easygoing sort of a bloke but this health system is off the rails."

In the past two years Federal Health Minister Tony Abbott has investigated the possibility of taking control of Queensland's health system, but yesterday told The Sunday Mail he had no plans to do so at the moment. "I'm flattered that people think the Howard Government is much better placed to fix the health system than the Beattie Government," he said. "However, the Commonwealth Government has no plans to take over the public hospital system."

State Health Minister Stephen Robertson blamed the Federal Government for failings in the health system. "Queensland's public hospitals have been short-changed by the Howard Government to the tune of $2.6 billion over the life of the current five-year Australian Health Care Agreement," he said. In a sign of falling support for public health services, the Queensland: Your Say survey revealed 64 per cent of readers had taken up private cover.

Source




Australia: Now it's the NSW ambulance service in strife

Eerily similar to the Queensland ambulance situation

AN ambulance staffing crisis is forcing rookies with just nine weeks' training onto the streets to try to save lives without proper supervision. One in three NSW Ambulance Service officers is a trainee because experienced staff are quitting in record numbers, fed up with being overworked and underpaid, front-line sources say. Last year there were twice as many resignations as in 2002. Tensions among those left behind are said to have reached breaking point, the sources say, with suicide attempts increasing. One senior officer said patient care was being compromised by the exodus of experienced officers. "Make no mistake, patients have died because of this and they will continue to die," she said.

A copy of the service's 2007 corporate culture survey leaked to The Sun-Herald paints a grim portrait of chronically poor morale and employees who feel undervalued, restricted in how they go about their work and disengaged from decision-making processes. The vast majority believe their supervisors do not deal effectively with key issues such as stress, excessive workloads, absenteeism, harassment and bullying, and are not addressing their concerns about industrial relations.

NSW Health Minister Reba Meagher last week countered criticisms of the service's capabilities by pointing to the recruitment of 327 personnel over the past four years. However, Freedom of Information figures obtained by the Opposition and seen by The Sun-Herald show 475 resignations over the same period. Novice ambulance attendants who might normally spend more than a year teamed up with two fully qualified partners are being thrown in the deep end, sources say.

A NSW Ambulance Service spokesman insisted trainees were placed under "close supervision at all times" but Health Services Union Hunter Valley officer Peter Rumball disputed this, saying the practice of pairing trainees with a single unqualified trainer to save money was commonplace. Mr Rumball said the union had repeatedly raised concerns about how one senior officer was supposed to supervise a trainee when he or she had more than one patient to treat at a time, or if the pair had to split up, or one had to stay with a patient while the other drove to hospital or went off to retrieve equipment. "Officers who come straight out of the service's rescue school get no supervision or mentoring at all," Mr Rumball said. "They are classed as fully qualified even though they have never undertaken a rescue."

A paramedic with 10 years' experience said rookies were being pushed onto the front line without proper regard for the consequences. "You have a situation where they are performing extremely demanding tasks without the proper supervision and that is where errors can be made," she said. "The way the roster system is set up is that at training stations there should be 10 fully qualified officers. "But how it is now is that out of those 10, two or three are trainee officers and are actually not qualified but they are rostered on to fill out those positions. "The trainees are being used to fill the holes and are just thrown straight in."

Opposition health spokeswoman Jillian Skinner said the number of calls she was receiving from ambulance officers in distress outstripped even those from within the ranks of the state's 40,000 nurses. "This issue is all about long-suffering ambulance officers who are under enormous stress, not getting any support and burning out," Ms Skinner said. "The fact that they're resigning at a faster rate than ever before speaks for itself. "What we're talking about is people at the coalface being forced to bear the brunt when, instead, it should be the Government dealing with it." Mr Rumball said his concerns about stress levels of the job were grave, and he knew of five colleagues who had attempted suicide in the past few years

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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29 July, 2007

Hundreds of NHS hospital fatalities 'avoidable'

One third of deaths in hospital investigated by a patient safety watchdog could have been avoided, claims a report released today. The National Patient Safety Agency looked into 1,804 fatal hospital incidents reported to it in 2005. It found that 576 were "potentially avoidable" if there had been better communication between staff, faster recognition of the patient's deteriorating state, improved training and more accurate interpretation of test results.

Some 425 of the deaths investigated by the NPSA in 2005 were in acute or general hospitals. Of these, 71 were reported to be related to diagnostic errors, in 64 cases the patient's deteriorating condition was not recognised or not acted upon, and 43 involved a problem with resuscitation after cardiac arrest. The remainder were connected to medication errors, suicide or still-birth.

In 14 of the patients who deteriorated, no checks had been made on them for a prolonged time and changes in their vital signs such as blood pressure, heart rate or temperature were not detected. In a further 30 cases, the checks had been made but staff either did not recognise the patient's worsening condition or they did not act. In 17 other cases help was sought but there was a delay.

Professor Richard Thomson, the NPSA's director of epidemiology and research, said: "These are not new concerns but more effort is needed to recognise and act upon them. "This work helps us to further raise the profile of these issues and support a programme of activities involving a range of national organisations and individual experts. Every preventable death is a tragedy, not only for the family but for the staff involved."

The report says all staff should be trained in dealing with cardiac arrest. Among the 43 deaths involving resuscitation, the study found that many of the incidents suggested that "medical and nursing staff did not have the depth of knowledge and skills required".

It said: "In most cases the delay in starting the resuscitation was reported to be because staff did not recognise the acute situation, failed to call the resuscitation team or did not make an attempt themselves to resuscitate the patient."

Fourteen reported incidents related to the use of equipment. One such report said: "During a cardiac arrest, defibrillator found not to have the correct leads and paddle to fit the defibrillator. This caused a delay of approx five minutes during the arrest."

During 2006, the Medicines and Healthcare products Regulatory Agency (MHRA) received 141 reports of adverse incidents involving defibrillators. Many were related to problems with electrodes or batteries. In the first six months of 2007, the MHRA received 86 reports and receives an average of 14 incident reports a month on these devices, some of which are duplicate reports from manufacturers. The NPSA report said: "Several of these incidents occurred in resuscitation situations, when user error may have contributed to the incident, for example, incorrect connection of suctioning tubes."

The report stresses that there may be many similar cases which have not been reported to the NPSA. Researchers said that about 13 million people are admitted to hospitals in England and Wales each year.

The findings come as the National Institute for health and Clinical Excellence releases guidance to clinicians on how to manage patients in hospital who deteriorate rapidly. It emphasises making a complete medical assessment of the patient, regular monitoring and improving communication between staff.

Source




Australia: Fresh questions over another Muslim doctor

New South Wales Health Minister Reba Meagher says she will not speculate on the state coroner's actions following new revelations about the death of a Sydney teenager. Vanessa Anderson, 16, died in Royal North Shore Hospital two days after being hit in the head with a golf ball in 2005. ABC's Stateline program has obtained a letter detailing concerns about the Saudi Arabian anaesthetist involved in the case. The letter details two critical incidents involving the same doctor.

A coronial inquest has already heard that the same doctor gave Ms Anderson an incorrect dose of painkillers. Opposition health spokeswoman Jillian Skinner says the new details raise concerns. "The question has to be asked, why wasn't the coroner told about this earlier?" she said. But Ms Meagher said: "I think we should allow the coroner to be able to make a statement without speculating." The coroner was due to deliver his findings on Monday, but will instead discuss the new evidence with all relevant parties during a hearing.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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28 July, 2007

BRITS PUT THE WRONG GUY ON TRIAL

They should be prosecuting the filthy hospital that gave the kid MRSA. It was the MRSA that turned a minor problem into a major one

A headmaster accused of breaching safety standards after the death of a three-year-old boy who fell from a flight of steps while pretending to be Batman insisted yesterday that the child had been told the area was out of bounds.

James Porter, 66, was giving evidence before a jury at Mold Crown Court. He is accused of breaking health and safety laws by allowing infants unsupervised access to the steps in a remote part of the playground. Kian Williams, a pupil at the private Hillgrove School, in Bangor, is said to have been playing as Batman when he leapt from the fourth step and fell headlong. The child did not need treatment for a break in the skin or a fracture but later suffered secondary swelling of the brain and died from pneumonia brought on by a MRSA-type infection, on August 11, 2004. Mr Porter denies charges that he took inadequate measures to protect young pupils from the 13 steps leading from one playground to another. He faces an unlimited fine if found guilty. The trial continues.

Source




Remember those Cuban doctors Fidel sent to Venezuela?

Growing numbers of Cuban doctors sent overseas to work are defecting to the USA. Post below lifted from Fausta. See the original for links

A large number of the defectors have fled from Venezuela, which has received some 14 000 Cuban medical professionals, more than the rest of the world combined. Currently, dozens have sought refuge in neighbouring Colombia, often living in precarious conditions, while they await permission to enter the USA.

Andres paid a price to get to Colombia. He and his wife had been assigned to the city of Punto Fijo on the northwestern coast of Venezuela, not far from the border. Their escape went smoothly until they reached the frontier, where Venezuelan guards refused to permit them to cross because the visas on their passports were valid only for travel within Venezuela. Only after Andres bribed the agents with nearly all their possessions did the guards let them leave Venezuela. "We gave them all the money we had, cellular phones, watches, and they let us cross", he said. "e were in Colombia and we had reached freedom. We felt free".

Andres and his wife were fortunate because not all defecting Cubans get across the border but are, instead, arrested and shipped back home. Once across the border, however, Andres and his wife found themselves stranded in north east Colombia's harsh Guajira desert without contacts or money to continue travel. Eventually, however, they were given a lift by truckers, who carried them to the capital, Bogota.

In Bogota, Andres has lived with two other defectors in an unused storage room provided by a church group. They have also received assistance from the UN High Commission for Refugees. But, as they wait for their US visas, many of the Cubans are fearful because of their uncertain legal status in Colombia, whose government has given few of them refugee status.

Several Cuban defectors interviewed in Bogota said that they fled not only because of oppression in their own nation, but also because of unreasonably poor and demanding work conditions in Venezuela. Andres said that he could not stand the conditions in Venezuela, where he lived in a crowded house with a leaky straw roof which he shared with fifteen other Cuban doctors waiting to be put to work.

The doctors also said that in Venezuela, Cuban minders monitored their movements, prohibiting non-work contact with Venezuelans. When not at work, the Cubans were required to be at home after 6 pm. One couple said that after they pointed out some problems with the programme, officials threatened to send them back to Cuba in retaliation.

The Cubans said that the programme they worked in, called "Inside the Barrio", was also plagued with mismanagement and inefficiency. Although many clinics were severely understaffed, newly-arrived medics sometimes sat for months waiting for assignment to a post, they said, and often conditions in the clinics were rudimentary lacking even basic medicines.

You should also bear in mind that Cuba's suffering shortages of healthcare workers because one-fifth of Cuba's health care labor supply - some 14,000 doctors and 6,000 health workers - has been contracted out to work in Venezuela. In return for these medical services, Cuba receives 90,000 barrels of discounted oil per day.

Chew on that the next time you read/hear about the charismatic-leader-helping-the-poor-offering-free-health-care-education-adult-literacy -and-job-training-initiatives-that-help-millions-of-Venezuelans/Cubans/Bolivians, and every time you hear about the excellent Cuban healthcare and other myths. Too bad the folks who have been playing SICKO at the downtown movie theater for the past 5 weeks, and the folks who watch the movie don't care much about reality.

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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27 July, 2007

Canadian system wobbling

Canada, once considered the bedrock of national health care systems, is in the beginning stages of change toward free-market health insurance. But in a country where free health care is an afterthought, change comes slowly. For the first time, private health care clinics are proliferating throughout Canada and arguments for allowing private physicians to practice freely are being heard.

"You are seeing the Medicare orthodoxy of the last 30 years being questioned in Canada," said Dr. David Gratzer, a registered physician in Canada and the U.S., and senior fellow at the Manhattan Institute, a nonprofit public-policy think tank. "Over the last two years, the health care system has dramatically changed to allow more private health care."

The Supreme Court of Canada, widely viewed as among the most liberal in the world, nearly two years ago allowed a man in Quebec to buy health care on his own - striking down 30 years of precedent and giving advocates for private health care a major victory. The case is known as the Chaoulli decision, after Dr. Jacques Chaoulli, who took action against the system after a patient was forced to wait nearly one year for a hip replacement. Chief Justice Beverley McLachlin and Justice John Major wrote in the decision: "The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care."

But the high court's decision is only a springboard for change - a major privatization wave won't occur until each of the 10 provincial governments and three territories moves to align its legislation with the Chaoulli decision and insurance companies step into the arena with new products, said Dr. Zoltan Nagy, executive vice president of the Canadian Independent Medical Clinics Association.....

The Canadian provinces currently use various legal tools to discourage private insurance so that access is based on need, not a person's ability to pay. Six provinces - British Columbia, Alberta, Manitoba, Ontario, Nova Scotia and Quebec - outlaw private insurance for medical services.

But as a result of the Chaoulli decision, the health care debate turned in favor of private financing. "The largest impact of the decision has been to change the consensus on whether or not the health care system is sustainable. It has changed the consensus on whether it's even just," said Brett Skinner, director of pharmaceutical-policy research at the Fraser Institute, an independent research organization in Canada. "There's an evolutionary change that's under way that will be incremental, year over year - a slow expansion of private options, and the development of private insurance for those things," said Mr. Skinner.

But despite a groundswell for more privatization in Canada, it remains illegal under federal law to pay for health care that is deemed medically necessary by a provincial government. Rick Anderson, a Toronto health care consultant, said that less than 1 percent of the health care deemed medically necessary by a province or territory is administered in the private sector. "We're not there yet, and it's going to be a slow process," he said. "But there is more momentum than there has been in years."

It is difficult to accurately gauge the growth rate of the private health care industry since the Chaoulli decision because no organization in Canada tracks the number of private health care facilities. The best guess, Dr. Nagy said, is that there are now 23 private surgical centers offering medical services nationally, as well as 17 cataract clinics.

To stem the tide toward privatization, Canada will have to solve the national health care system's Achilles' heel: wait times to see physicians and for needed surgery. Following a referral from a general practitioner, between 1993 and 2006, it took an average of 20 weeks in the province of New Brunswick to see a specialist, according to an ongoing study by the Fraser Institute. New Brunswick had by far the longest wait time of the provinces, with Ontario and British Columbia tying for the shortest wait time to see a specialist at seven weeks. The average for the entire country was about nine weeks. The average wait time between a referral by a physician and an appointment with a neurosurgeon can take as long as 21 weeks, according to the Fraser Institute. Cancer patients in Canada experience the shortest wait times, generally waiting no longer than three weeks to see a doctor. "If you're healthy and willing to wait, it is the best system in the world," Dr. Gratzer said. "What you discover is there are wait times in Canada for any condition."

Colin McMillan, president of the Canadian Medical Association, attributes long wait times to a lack of capacity in the health care system. During the 1990s in a money-saving effort, the federal government drastically cut back on medical training courses and cut off foreign doctors from legally practicing in Canada. "We thought there was a surplus of doctors at the time. We thought we could save some money," he said. "The chief problem our health care system faces today is access due to a lack of doctors, nurses, hospitals and technology."

Turning around the problem of long wait times will not be an easy task, according to researchers. "We don't have the resources to lower them despite now spending more on health care than every other country with a universal health care system outside of Ireland," said Nadeem Esmail, director of health system performance studies and manager of the Alberta Policy Research Centre at the Fraser Institute.

However, Dr. Rachlis, a staunch supporter of public health care, contends that while the wait time issue threatens the viability of the medical system, there are methods within the system to better manage wait lists. "The government needs to champion public wait-list reforms. Physicians must work in teams, including health care professionals and nurses, rather than on their own, and accountability for wait-list management must be transferred from individual surgeons to health authorities working with groups of surgeons," he said. [More bureaucracy? Really??] According to Dr. Rachlis, these problems are related to a failure to move to a group medical practice and to organize modern patient-flow processes. "We're still using the Pony Express, but expecting communication at the speed of light," he said.

Critics of a national health program point to a dearth of innovation in medical technology and prescription drugs, which can lead to decreased access to life-saving medical equipment and medications.

Throughout the 1990s, opponents of the Canadian system gained considerable political traction by pointing to the provincial governments that were increasingly constraining their health care budgets, which led to more rationing of services and facility shortages. For instance, Canada uses its medical-imaging scanners more intensively than do the U.S. or Britain, largely because it ranks low among developed countries in the number of imaging machines available throughout the country. At the beginning of 2005, Canada had 176 MRI scanners, magnetic resonance imaging machines used to provide clear pictures of the body to detect diseases. Compared with 20 developed countries reporting MRI data for 2005, Canada ranked 12th, with about five MRI scanners per 1 million people, according the Canadian Institute for Health Information. "The lack of MRI and CAT scan machines in Canada is a direct result of the single-payer system," said Sally Pipes, president and chief executive officer of the Pacific Research Institute, a San Francisco health care think tank. The U.S. reported the second-highest number of MRIs, behind Japan, with 27 machines per 1 million people.

A paucity in medical-imaging equipment is not the only consequence of a national health system. Because Canada's government pays for prescription drugs, prices for the medications cannot reach as high as in a free-market system. Ms. Pipes points out that as the biotech industry heads toward major breakthroughs in life-saving medications, specifically for cancer, Canadians may not have access to the drugs as quickly. "There are very few Canadian drug companies, and American drug companies often don't sell their drugs there," she said. "Because of the enormous cost of developing a drug, businesses must first recuperate their costs before entering a market that dictates prices, which are lower than other places."

Source




Official British vendetta against too-successful IVF doctor continues

They hate private medicine so attacking a high flyer -- even on legal technicalities -- turns them on

Britain's most successful IVF doctor was banned from running his own clinic yesterday after he was found guilty of treating patients without the correct licence. Mohammed Taranissi was stripped of the right to be the "person responsible" for his Assisted Reproduction and Gynaecology Centre by the Human Fertilisation and Embryology Authority (HFEA). The decision means that Mr Taranissi, whose clinic boasts Britain's best IVF success rates, will be allowed to continue treating patients only if he appoints another doctor or manager to take legal responsibility for his clinic. If he fails to do so, the clinic will have to close after its temporary licence expires on August 9.

Mr Taranissi, who rejects the charges, said last night that he would appeal. If he does, the HFEA is likely to issue special directions allowing him to complete the treatment of existing patients while the appeal is heard.

The sanction is one of the most serious imposed by the authority's licence committee, and has been imposed only once before. Every clinic is required by law to name an appro-priately trained person as the holder of its licence. The person is required to take legal responsibility for the clinic's work and must be HFEA approved. The ruling follows an inquiry into claims that Mr Taranissi treated patients at an unlicensed clinic in 2006. The clinic, the Reproductive Genetics Institute, was Mr Taranassi's second in London. The allegations formed part of a BBC Panorama programme, over which the doctor has started libel proceedings. It is a criminal offence to perform IVF and some other fertility procedures without a licence from the HFEA, and the matter is also the subject of investigations by the police and the General Medical Council.

In January the HFEA obtained warrants to search both clinics, saying that the doctor had failed to provide it with information needed to investigate the allegations. The raids were ruled illegal by the High Court this month, and the authority agreed to pay most of Mr Taranissi's costs. That judicial review did not consider the substance of the charges against Mr Taranissi, and had no bearing on the HFEA's regulatory action. The authority's licence committee met on July 13, and announced yesterday that it was satisfied that Mr Taranissi had committed a "serious breach" of the law by treating patients at an unlicensed clinic. "The committee considered that the clinic [the Assisted Reproduction and Gynaecology Centre] is a successful one, much appreciated by patients, and Mr Taranissi is a dedicated physician," it said. "However, the committee did not think he had taken sufficient cognisance of the legal requirements of a person responsible to continue to act in that capacity."

The authority has offered the centre a six-month licence, provided that a new person responsible is found. Mr Taranissi was not seeking a new licence for the Reproductive Genetics Institute. Members of the HFEA's executive had argued that the licence should not be renewed at all. Mr Taranissi questioned whether three weeks was sufficient time to appoint a new person responsible, but said that he welcomed the decision to offer a licence. "We are pleased to have been told that we can continue to work, and my priority now is my patients," he said. "The last few months have been extremely distressing for all our patients and staff. The new licence is not for as long a period as we had hoped for, but we are confident that this will be extended and that we can put the unpleasant past behind us and concentrate on doing what we do best.

"The current situation follows the events in January of this year when the chief executive of the HFEA gave what was later described by a High Court judge as `seriously defective' and `highly misleading' evidence to a magistrate in order to obtain warrants to raid our clinic. The High Court subsequently found that these warrants had been unlawfully obtained and we are similarly confident that the grounds for this latest decision will be shown to be wrong.

"HFEA regulation imposes a huge bureaucratic burden on those licensed by them. The HFEA have asked that we appoint a new person responsible to work with me as medical director of the centre. We have made a number of new appointments in the last two months to assist with this regulatory burden and the other requirements of new European legislation."

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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26 July, 2007

Wisconsin reveals the cost of "universal" health care

When Louis Brandeis praised the 50 states as "laboratories of democracy," he didn't claim that every policy experiment would work. So we hope the eyes of America will turn to Wisconsin, and the effort by Madison Democrats to make that "progressive" state a Petri dish for government-run health care.

This exercise is especially instructive, because it reveals where the "single-payer," universal coverage folks end up. Democrats who run the Wisconsin Senate have dropped the Washington pretense of incremental health-care reform and moved directly to passing a plan to insure every resident under the age of 65 in the state. And, wow, is "free" health care expensive. The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes. It represents an average of $510 a month in higher taxes for every Wisconsin worker.

Employees and businesses would pay for the plan by sharing the cost of a new 14.5% employment tax on wages. Wisconsin businesses would have to compete with out-of-state businesses and foreign rivals while shouldering a 29.8% combined federal-state payroll tax, nearly double the 15.3% payroll tax paid by non-Wisconsin firms for Social Security and Medicare combined.

This employment tax is on top of the $1 billion grab bag of other levies that Democratic Governor Jim Doyle proposed and the tax-happy Senate has also approved, including a $1.25 a pack increase in the cigarette tax, a 10% hike in the corporate tax, and new fees on cars, trucks, hospitals, real estate transactions, oil companies and dry cleaners. In all, the tax burden in the Badger State could rise to 20% of family income, which is slightly more than the average federal tax burden. "At least federal taxes pay for an Army and Navy," quips R.J. Pirlot of the Wisconsin Manufacturers and Commerce business lobby.

As if that's not enough, the health plan includes a tax escalator clause allowing an additional 1.5 percentage point payroll tax to finance higher outlays in the future. This could bring the payroll tax to 16%. One reason to expect costs to soar is that the state may become a mecca for the unemployed, uninsured and sick from all over North America. The legislation doesn't require that you have a job in Wisconsin to qualify, merely that you live in the state for at least 12 months. Cheesehead nation could expect to attract health-care free-riders while losing productive workers who leave for less-taxing climes.

Proponents use the familiar argument for national health care that this will save money (about $1.8 billion a year) through efficiency gains by eliminating the administrative costs of private insurance. And unions and some big businesses with rich union health plans are only too happy to dump these liabilities onto the government.

But those costs won't vanish; they'll merely shift to all taxpayers and businesses. Small employers that can't afford to provide insurance would see their employment costs rise by thousands of dollars per worker, while those that now provide a basic health insurance plan would have to pay $400 to $500 a year more per employee.

The plan is also openly hostile to market incentives that contain costs. Private companies are making modest progress in sweating out health-care inflation by making patients more cost-conscious through increased copayments, health savings accounts, and incentives for wellness. The Wisconsin program moves in the opposite direction: It reduces out-of-pocket copayments, bars money-saving HSA plans, and increases the number of mandated medical services covered under the plan.

So where will savings come from? Where they always do in any government plan: Rationing via price controls and, as costs rise, waiting periods and coverage restrictions. This is Michael Moore's medical dream state.

The last line of defense against this plan are the Republicans who run the Wisconsin House. So far they've been unified and they recently voted the Senate plan down. Democrats are now planning to take their ideas to the voters in legislative races next year, and that's a debate Wisconsinites should look forward to. At least Wisconsin Democrats are admitting how much it will cost Americans to pay for government-run health care. Would that Washington Democrats were as forthright.

Source




Another wonderful triumph for goodwill -- but no thanks to NHS bungling: "A couple were advised to abort their unborn child amid fears he would be severely disabled - but he was born healthy. Heather O'Connor, 19, and Jamie Bramley, 24, from Stockport, were told by St Mary's Hospital, Manchester, that scans indicated part of baby Jake's brain could be missing. But after seeking a second opinion the couple continued with the pregnancy. The Central Manchester and Manchester Children's University Hospitals NHS Trust said it would "not actively recommend or dissuade" patients from choosing a termination."

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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25 July, 2007

Government health insurance expenditure eaten up by bureaucracy

Many people are still wondering what happened to the billions of pounds spent on the NHS over the last five years. Apart from slightly improved waiting lists and massively increased doctors wages, there is still a lot to do to explain where the money has gone. However history gives us a sort of precedent for this.

It comes from Lyndon B Johnson’s Great Society and the introduction of Medicare/Medicaid in 1965. At the time, health care spending in the US was a mere 5% of GDP. Today it has exploded to a staggering 16.5% of GDP. An economics professor named Amy Finkelstein from MIT has shown what happened after the implementation of the new state health insurance. She concluded that it is not, as conventional wisdom has it, ageing populations and medical progress, but rather the expansion of the insurance industry itself that is the the real driver of healthcare costs. Her views stirred up the thinking about health care spending since first published last year.

Finkelstein discovered the proof by sifting through long-forgotten paper records in MIT's library. There, she found that hospital spending soared after the federal Medicare program began in 1966. Finkelstein had the papers scanned and shipped to a company in Cambodia, where it took 18 months to turn the records into usable data. The story they told was dramatic. In regions such as the South, where most seniors had no insurance, health spending soared after Medicare. But in New England, where many already had coverage, Medicare had much less impact on costs.

What we begin to understand from her findings is why spending huge sums of money does not necessarily improve health services; the cash simply gets swallowed up in this highly complex system. This supports the argument for devolution of health care purchasing power to the consumer, offering a fair chance that it will be spend more wisely than by any third party, be it governments, HMOs or even paternalistic private insurance.

Source




Socialized waste

Four of the top 10 companies in the $11.4 million business last year of providing power scooters, wheelchairs, prosthetic limbs and other medical equipment to D.C. Medicaid recipients have come under investigation. At least six other "durable medical equipment," or DME, dealers also are being investigated, including one suspected of selling a recipient a walker, then billing the government for a $13,500 deluxe power scooter.

The D.C. Department of Health confirmed the investigations in response to a Freedom of Information Act request by The Washington Times. Agency attorneys withheld several records, saying the documents are "investigatory records compiled for law enforcement," therefore exempt from public disclosure. Officials also would not release the names of the companies under investigation.

The situation raises questions about whether fraud and mismanagement, which have plagued the District's Medicaid transportation program in recent years, also have surfaced in the DME program. The Medical Assistance Administration (MAA), an arm of the health department, oversees the city's more than $1 billion in Medicaid spending, which is funded by federal and local governments to provide health care for the poor.

Nearly 90 DME companies, mostly in the District and Maryland, received a combined $11.4 million in fiscal 2006 to supply the city's poor. The figure is up from $10.1 million in 2005 and $9.8 million in 2004. And while officials say overall costs remain within budget, MAA spending could increase by 40 percent compared to 2004 figures. Already, MAA had paid out more than $12 million in fiscal 2007.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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24 July, 2007

NHS negligence kills little boy



A hospital has apologised to the parents of a baby who died when doctors failed to spot a serious heart condition after mixing up his X-rays. Staff at the Royal Cornwall Hospital in Truro thought that one-year-old Jack Garland was teething and sent him home with painkillers. After a second X-ray two weeks later, they realised that he had mitochondrial respiratory complex, a rare genetic complaint. He was taken immediately to Great Ormond Street Hospital, but died 16 days later of heart failure and a brain haemorrhage.

Jack’s father, Ben Garland, 31, from Truro, said: “Those two weeks when he was first sent home were crucial. The hospital’s mistake cost my son his fighting chance. To hold him while they turned the machines off is something I will never forget. All we want is someone to be honest and say they will take responsibility.”

John Watkins, chief executive of the Royal Cornwall Hospitals Trust, said in a letter to Jack’s parents that a senior doctor had reviewed the first X-ray and could “clearly” see that the child had an enlarged heart. Mr Watkins wrote: “The doctor is at a loss to explain how this happened and can only deduce that the person who reported Jack’s X-ray reported on the wrong film. The conclusion is that it was a failure of the system that caused Jack’s X-ray to be overlooked and not attributable to one individual.” The trust said that a thorough review was under way. The hospital had a 31million pound deficit at the time and had cut 300 staff, although the trust said that no jobs had been cut that would have compromised clinical care.

Source




Hospital rankings coming in Australia

HOSPITALS face closer scrutiny of their performance in areas such as patient safety and infection rates under a scheme the federal Health Minister, Tony Abbott, will put to state governments. Mr Abbott told the Herald he was planning to propose hospital "league tables" on safety, and quality measures be included as part of the hospital funding agreement between the federal and state governments. The transparency measures would enable patients to compare the record of different hospitals in such areas as surgical infection rates, unplanned readmissions and waiting times for elective surgery.

Citing new research showing that Australia has fallen behind other countries in the release of individual hospital performance data, Mr Abbott said such information was readily available elsewhere. "Why should we not have it here?". The research says that, by some estimates, adverse events and infections in Australian hospitals generate $2.5 billion in expenditure every year, but improvements are impeded by the lack of comparative data on hospital performance. Besides letting patients know how hospitals rated on different indicators, it would also help hospitals to identify strengths and weaknesses and spur improvements, Mr Abbott said.

A frequent argument against publishing such information was that it was hard to compare hospital outcomes. But Mr Abbott said the public would be able to factor in differences such as some hospitals having a higher rate of problems because they took on more difficult cases. The Federal Government wanted to see such information included in the next Australian Health Care Agreements, which provide for federal funding of public hospitals and are scheduled for renegotiation with the states after the federal election.

A study undertaken for the Australian Centre for Health Research says "very little" analysis has been published in Australia to assess the hospital system and even less undertaken to determine whether hospitals are working in concert with other parts of the system, such as general practitioners. "This raises the risk of wasted funds, poor health outcomes and reduced access for patients," it says. The report recommends the Government take the lead in defining what standard care information should be collected.

The publication of hospital performance indicators had triggered the establishment of "infomediaries" - companies which analysed the performance figures and could help patients make decisions about their health and how to manage it, in addition to providing a guide to quality care. The research was headed by David Charles, who said that the health system had avoided the trend towards greater transparency that had been accepted in many other sectors of government and business in the past 20 years.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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23 July, 2007

Bush sinks SCHIP

Sorry about that! Seriously: Democrats are trying to introduce socialized medicine piece by piece and SCHIP was going to be a large piece of that. But Bush has seen through it

President Bush yesterday rejected entreaties by his Republican allies that he compromise with Democrats on legislation to renew a popular program that provides health coverage to poor children, saying that expanding the program would enlarge the role of the federal government at the expense of private insurance. The president said he objects on philosophical grounds to a bipartisan Senate proposal to boost the State Children's Health Insurance Program by $35 billion over five years. Bush has proposed $5 billion in increased funding and has threatened to veto the Senate compromise and a more costly expansion being contemplated in the House.

"I support the initial intent of the program," Bush said in an interview with The Washington Post after a factory tour and a discussion on health care with small-business owners in Landover. "My concern is that when you expand eligibility . . . you're really beginning to open up an avenue for people to switch from private insurance to the government."

The 10-year-old program, which is set to expire on Sept. 30, costs the federal government $5 billion a year and helps provide health coverage to 6.6 million low-income children whose families do not qualify for Medicaid but cannot afford private insurance on their own.

About 3.3 million additional children would be covered under the proposal developed by Senate Finance Committee Chairman Max Baucus (D-Mont.) and Republican Sens. Charles E. Grassley (Iowa) and Orrin G. Hatch (Utah), among others. It would provide the program $60 billion over five years, compared with $30 billion under Bush's proposal. And it would rely on a 61-cent increase in the federal excise tax on cigarettes, to $1 a pack, which Bush opposes.

Grassley and Hatch, in a joint statement this week, implored the president to rescind his veto threat. They warned that Democrats might seek an expansion of $50 billion or more if there is no compromise. They also said that Bush should drop efforts to link the program's renewal to his six-month-old proposal to replace the long-standing tax break for employer-based health insurance with a new tax deduction that would help people pay for insurance, regardless of whether they get it through their jobs or purchase it on their own.

"Tax legislation to expand health insurance coverage is badly needed, but there's no Democratic support for it in the SCHIP debate," said Grassley, the ranking Republican on the finance panel. "In the meantime, our SCHIP initiative in the Finance Committee takes care of a program that's about to expire in a way that's more responsible than current law and $15 billion less than the budget resolution calls for."

But Bush said he was not persuaded. "I'm not going to surrender a good and important idea before the debate really gets started," Bush said. "And I think it's going to be very important for our allies on Capitol Hill to hear a strong, clear message from me that expansion of government in lieu of making the necessary changes to encourage a consumer-based system is not acceptable." The Senate committee is scheduled to consider the compromise legislation today, and the House is expected to try to pass its own version before the congressional recess in August.

Rep. Rahm Emanuel (Ill.), the House Democratic Caucus chairman, said he is "bewildered" that Bush is fighting the expanded funding for a program supported by Republicans and Democrats alike. "This is the chance for him to finally be a uniter and not a divider," Emanuel said. "You have consensus across party and ideology, and a unity on the most important domestic issue, health care -- except for one person."

A recent analysis by the Congressional Budget Office concluded that the program would require about $14 billion in new money over five years -- on top of the current $5 billion in annual funding -- merely to keep covering the same number of children, in part because of rising health-care costs. Secretary of Health and Human Services Mike Leavitt, accompanying Bush yesterday, said: "We disagree with that number."

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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22 July, 2007

British woman dies waiting for brain scans

A high-flying television producer died from a suspected epileptic fit while waiting for vital brain scans on the NHS. Laura Price, 30, who worked on shows such as Big Brother and Strictly Come Dancing, was found dead in her home just hours after she had been discharged from casualty.

The evening before she died, Miss Price, from Notting Hill, west London, had begged a junior A&E doctor for anti-seizure drugs but had been told they could only be prescribed by a neurologist.

Two days earlier she had visited a specialist at Charing Cross hospital and was told she would have to wait six weeks for a brain scan. She had felt "concerned and afraid" at having to wait that length of time for a test before being treated for a recurrence of childhood epilepsy, Westminster coroner's court heard.

She had not had a seizure for more than 10 years, but after a series of "strange episodes", including a numb face and flashing lights in her vision, she had visited her GP and was referred to the specialist.

On the night before she died Miss Price entered her flatmate Sarah Jackson's room in a confused state. Miss Jackson told the court: "I was very concerned and called an ambulance." Once at Charing Cross hospital Miss Price begged a doctor for drugs. Dr Christina Coppel, who treated her, told the inquest it would have been against hospital guidelines to prescribe them without a neurologist.

At lunchtime the next day Miss Price was found lying on the floor and an ambulance pronounced her dead at the scene. A post mortem examination concluded it was a sudden unexpected death in epilepsy. Dr Paul Knapman, the coroner, returned a verdict of natural causes. Yesterday, her parents said they were considering legal action against Hammersmith Hospitals NHS Trust.

Source




Dangerous public hospital negligence in Australia

Safety experts say too little is being done to stop patients being harmed or even killed by avoidable errors in Australian public hospitals

PATRICIA Skinner has experienced the sharp end of medical mistakes. She spent 18 months with a pair of 15cm scissors in her abdomen. Why? Because doctors forgot to take them out at the end of an operation. [What happened to the before-and-after count that should have been routine procedure?] "It was agony ... my husband would drive over a bump in the road, and I would scream,'' recalls Skinner. "My husband would say, `What's the matter with you?', and I thought I had cancer. I said to my doctor, `I feel like I've been knocked to the ground and someone's been kicking me with steel-capped boots'.'' In a way, of course, something had. But unfortunately for Skinner, now 79, for some time medical staff refused to believe anything was wrong. She had had major surgery, they told her; what did she expect?

The truth was only discovered after Skinner herself eventually insisted on an X-ray, which was performed at Sydney's St George Hospital [A notorious hospital] in October 2002, 18 months after surgery at the same hospital to remove bowel polyps. "They did the X-ray twice, because I don't think they could believe what they were seeing,'' Skinner says. She went straight back to the hospital, and had surgery to remove the scissors the very next day. But after so long inside her, the scissors - which in the meantime had moved from her abdomen to near her coccyx, the tailbone at the base of the spine - had become partially overgrown by her own tissues. To get them out, doctors had to cut out a chunk of Skinner's bowel as well.

What she wanted then was an explanation of how it could have happened, but Skinner and husband Don had little joy here either. "They said at the time that scissors were `too big to lose', which was absolute nonsense,'' Skinner tells Weekend Health. "Was somebody off sick, or was somebody working for hours and got tired? I said there must have been a reason, but I wasn't allowed to talk to anybody. If you can understand what happened, you think, `OK, I can accept that'. But when you don't know, there's nothing to accept.''

The X-ray images and her story were reported around the world, and eventually Skinner, now 72, accepted compensation from the hospital, the size of which is confidential. The hospital also changed its counting procedures to make sure equipment is properly accounted for after operations.

Sadly, as Australia's first national report on serious mistakes shows, Skinner's experience is far from unique, either in terms of the mistake or the culture of secrecy and denial that surrounded it. The report, published this week by the Australian Institute of Health and Welfare and the Australian Commission on Safety and Quality in Health Care, recorded 130 instances of "sentinel events'' reported by 759 public hospitals in 2004-05. These events fell into one of eight categories of serious events that were agreed by Australian Governments in 2004.

As The Australian reported this week, nearly half (41 per cent) of the 130 events were in the category of wrong site or wrong patient - where an operation or test was performed on the wrong part of the patient's body, or on the wrong patient altogether. Retained instruments - the category that Skinner would have fallen into - took second place, accounting for 27 cases.

The factors that contributed to these and other incidents were varied: staff ending their shift giving inadequate briefings to other staff starting a shift, or staff acting when they didn't know the full facts. For example, in one incident a patient was transfused wiTh blood intended for another patient with an incompatible blood type - a potentially fatal mistake - because the co-ordinating nurse only knew of one transfusion request, and when a courier delivered some blood she assumed - wrongly - that it was meant for that patient. Other reasons included staff not following rules or guidelines, or not recording information on charts or other documents properly.

The report's authors say the reasons for doctors and nurses not reporting mistakes in the past include "fear of litigation and adverse publicity'', and admit that while low, the numbers of sentinel events in this week's report are likely to rise in future editions as doctors and nurses start to feel more comfortable about owning up after something has gone wrong. Even so, outgoing commission chief executive Diana Horvath rejected suggestions the numbers were merely the tip of the iceberg, claiming they were instead "a substantial part of it''.

But independent safety experts disagree, and it's not as if you have to look far to find other examples of medical mistakes every bit as horrifying as that which happened to Pat Skinner. In a bulletin sent to its members earlier this year, doctors' insurance company MDA National revealed an unnamed 24-year-old patient suffered nightmares after a "throat pack'' - a wad of absorbent gauze or dressing to soak up blood and other fluids during surgery - was left in place after prolonged oral surgery. "The patient coughed up the throat pack some hours later on the (recovery) ward,'' the bulletin said. "He was very distressed ... although the pharynx was sucked out under direct vision at the end of the procedure, the bloodstained pack was not seen until the patient coughed it up several hours post-operatively. "Sporadic reports of this complication continue to occur, sometimes with disastrous consequences for the patient.''

MDA National said measures that might help avoid repeat occurrences included labelling patients' foreheads if throat packs were used, and recording the pack on the list of items that have to be accounted for at the end of the procedure.

In another case in the same bulletin, a 35-year-old patient went to an emergency department complaining of severe renal colic. He asked for a painkiller called hydromorphone, also known as Dilaudid, which he had previously found to be the most effective medication. Instead the doctor ordered hydromorphine - a drug eight times more powerful - because she did not realise the difference. The bulletin said this patient did not suffer any negative long-term effects from the overdose, although it added that some other previous mix-ups involving hydromorphone "have resulted in patient deaths''.

This week's report said the reporting culture was improving, and numbers of reported events will be higher in future reports. But other safety experts think Horvath's suggestion that this week's figures already represent a significant proportion of the problem is little short of ridiculous. Steve Bolsin, associate professor of patient safety at Victoria's Geelong Hospital, says the "notion that 130 adverse events is the majority of the iceberg is completely erroneous. Previous work has shown that between 5 and 10 per cent of admissions have adverse events associated with them, and things may be worse in general practice. So there's a huge need to begin to improve in these areas.''

Bolsin points to the findings of the groundbreaking Quality in Australian Health Care Study (QAHCS), published in the Medical Journal of Australia 12 years ago (1995;163:458-71), which claimed that up to 16 per cent of hospitalised patients would suffer an adverse event, and that 50 per cent of these would be preventable. Of these preventable events, 10 per cent would lead to permanent disability or death.

Some doctors have been bitterly critical of the QAHCS findings, saying it was biased and found a much higher rate of adverse events than a similar US study. Had the same analysis applied in Australia as in the US, they say, the rate of adverse events reported in QAHCS would have been up to 25 per cent less. With 4.3 million hospitalisations in public hospitals in 2004-05, the QAHCS suggests Australia's toll of serious adverse events should be closer to 35,000 than 130. But even a 25 per cent pullback from that figure still paints a worrying picture.

A follow-up editorial in the MJA two years ago (2005;182:260-1) asked if there was any evidence that health care had become any safer in the decade since the 1995 report, and promptly answered the question itself: "Unfortunately, the answer is no''.

Adverse events are also associated with significant costs. Another study in the MJA last year (2006;184:551-5), conducted in 45 major Victorian hospitals, found each adverse event contributed an extra $6826 in costs, and the total cost for all the events in the participating hospitals in 2003-04 was $460 million - over 15 per cent of direct hospital costs.

Bolsin says there are "an incredible number of adverse events going on that are not being reported'' through the existing channels. However, a pioneering scheme already piloted at his own hospital in Geelong could hold the answer. For the pilot, 14 anaesthetic registrars used personal digital assistants (PDAs) fitted with special software to report adverse events to a central database, identifying them in one of four categories - events causing death, serious outcomes such as extended hospital stay or permanent harm, transient or minor harm, and "near miss'' adverse events that had no bad effect on the patient. Researchers combed through the notes of cases where no incidents had been reported, to check how many incidents had been missed.

The findings, reported last year in the International Journal for Quality in Health Care (2006;18(6):452-7), found an adverse incident was reported for 156, or 3.5 per cent of the 4441 anaesthetic procedures reported, nearly half (46.2 per cent) of which were near misses. Only one incident was identified in the case notes as having been missed, giving a reporting rate via PDAs of 99.5 per cent - far higher than has been achieved anywhere else in the world. Bolsin says PDAs can also be used to download appropriate clinical practice guidelines and other relevant information to help guide doctors, use of which he says has been proven to improve treatment outcomes.

So far, however, there has been limited enthusiasm from health bureaucrats for implementing a PDA-based system for adverse event reporting. "If we are really serious about safety in health care, we have to start using these technologies, and we have to start using them effectively and constructively,'' Bolsin says.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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21 July, 2007

Myths & Fact About The American Health Care System

Since the release of Michael Moore's "sicko" movie, the U.S. health care system and its alleged failure have been widely debated. But while the U.S. health care system is far from perfect, it is much better than Michael Moore would have you believe. Furthermore, the real shortcomings that it does have are not the effect of its free market elements, but to various regulations and factors unrelated to the health care system.

This will not be a direct review of "sicko", a movie which I haven't seen. But it will of course be a indirect attack on the movie's thesis. For a listing of the lies present in the movie, see this review.

Myth: "The U.S. has a purely free market health care system"

Fact: The U.S. health care system is indeed more market driven than in most other countries, but nearly half of all health care costs is paid for by the government. Already in 2004 roughly 45% of health care costs were government funded a proportion which has likely increased since then due to Bush's Medicare expansion.

Furthermore, the system is burdened with heavy regulations, which contributes to raising its costs, as The Economist recently reported in an interesting article.

Myth: "The U.S. health care system leaves 45 million (or whatever number is claimed)without health insurance"

Even setting aside that a significant proportion of these uninsured are illegal immigrants, which in Sweden is completely excluded from the health care system, this is only true in the sense that nearly 9 million in Sweden is without health insurance. Everyone in America over the age of 65 is covered by the Medicare program and low income earners below the age of 65 can get their health care paid by the Medicaid program. And besides, one can always simply go to an emergency room and demand care there since federal law prohibits hospitals from denying people care there, a possibility which has created some problems in the border regions to Mexico since illegal immigrants have been very good at taking advantage of this (more about this in the link in the beginning of this paragraph). And if you are unable to pay, government will have to compensate the hospitals.

Myth: "Market mechanisms are responsible for the high costs of the American health care system"

Fact: That the U.S. health care system has a very high cost level is one of the few criticisms of it which is basically true. Regardless of how you calculate, U.S. health care costs are higher than anywhere else in the world. It should however be pointed out that many -including reportedly Michael Moore- exaggerate just how much more expensive it is by comparing the cost in PPP-adjusted dollars per capita. Since the U.S. is still the third richest country (After Luxembourg and Norway) in the world according to that method of comparison and because a higher average income will for various reasons drive up the cost in PPP-adjusted dollars this kind of comparison will exaggerate the relative extra cost, while greatly underestimating it in dirt poor Cuba.

Health care costs in the U.S. are roughly 15% of GDP compared to roughly 10% in countries like France, Canada and Cuba. What is then the cause of these higher costs? Well, in part it is actually (see below) the case that U.S. health care quality is higher, and quality costs. And as is also described below, an unhealthier lifestyle among many Americans also contributes to pushing up costs. Moreover, as discussed above various regulations have contributed to pushing up costs (see aforementioned The Economist article) and furthermore American doctors and nurses have much higher pay relative to the rest of the population than in most other countries.

And it is also the case that the American health care system in practice function as an Atlas which carries the world's medical research costs on its shoulders. In Sweden, Canada and most other countries, the government health system purchases medicine for very low prices which doesn't cover the research costs needed to produce it. Drug companies still reluctantly agrees to this since the prices they receive still give them a small profit given the completion of the research needed to produce it and because they can in the United States charge prices which covers not only cost of production but also the cost of research and more. This factors means that real health care costs are overestimated in the United States while being underestimated in the favorite countries of Michael Moore and other socialists.

If the United States were to act as other countries and pay the same low prices for medicin -something which many leading Democrats have advocated- as other countries this would of course contribute to a significant short term reduction in U.S. health care costs. The problem is that this would mean that new research would be unprofitable and so few or no new medicines would appear which in the long run would raise health care costs everywhere.

Myth: "Despite its higher costs, the World Health Organizations ranking show that the American health care system ranks only number 37 in quality".

Fact: No, it doesn't show that at all. The ranking is actually only to a small extent a ranking of health care quality. If you check its details it measures mostly other things. What is being measured is mostly things like a population's health level (why this is not a good indicator of health care quality see below) and to what extent financing and treatment is in accordance with the WHO:s socialist ideals. That socialist systems are better in accordance with socialist ideals is hardly surprising and is definitely not a valid indicator of health care quality. The only one of their indicators which measures quality is "level of responsiveness" which is based on patient satisfaction and how quickly and efficient the system works. And in this category the American health care system is....number one!

Myth: "The somewhat shorter life expectancy and somewhat greater health problems of the United States shows that its health care system doesn't work as well"

Fact: No, it doesn't show that at all. These indicators vary mainly due to other factors, primarily different life style factors. Sweden's and Denmark's health care systems -and the economic system in general- are basically the same, yet life expectancy is a few years higher in Sweden. The difference is caused by the fact that Danes have a less healthy life style than Swedes. Hong Kong has an very high life expectancy and low level of health problems "despite" having a health care system largely privately financed like in the U.S. And as Michael Moore himself is a perfect illustration of, the United States have a higher proportion of people who are fat and/or for other ways live a unhealthy lifestyle. This will both contribute to raising the cost of the system and worsening these health indicators.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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20 July, 2007

Corrupt "backroom deal" in British health system

The Department of Health did “a backroom deal” with a private company that broke Treasury guidance, could not demonstrate value for money and lacked clear benefits, the Public Accounts Committee has concluded. The deal, to create a joint venture between the health information company Dr Foster and the department’s information centre, resulted in a loss of 2.8 million pounds in its first year instead of the small profit predicted.

Last week the director of the information centre, Professor Denise Lievesley, who was responsible for signing off on the deal, resigned after only two years in the job. She claimed that it was the right time for her to pursue other activities, including her forthcoming presidency of the International Statistical Institute. No connection to the imminent PAC report was acknowledged.

The PAC is not critical of Dr Foster, which was set up to make better use of data produced by the NHS. But it does question whether the agreement was good value for taxpayers’ money. Edward Leigh, MP, the chairman of the committee, said: “By pursuing its backroom deal with Dr Foster LLP, the Department of Health failed in its duty to be open to Parliament and the taxpayer. “There was no fair and competitive tendering competition, as laid down in public sector procurement guidelines. And Treasury guidance on joint ventures between public and private sectors was ignored. Instead, the deal was handed to Dr Foster on a plate. “Without the competitive pressure inherent in a tender process, the Department’s Information Centre simply cannot demonstrate that it paid the best price for its 50 per cent share of the joint venture. Certainly, the 12 million that it paid, 7.6 million of which went straight into the pockets of Dr Foster’s shareholders, was between a half and a third higher than its financial advisers’ evaluation.”

The permanent secretary of the department, Hugh Taylor, told the committee that while there were other companies working in health informatics, Dr Foster stood out “in terms of its national profile and the range of its products”. But the committee did not consider this an adequate excuse for ignoring due process and paying over the odds.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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19 July, 2007

NHS fails diabetics

The majority of NHS trusts are not giving people with diabetes enough help in managing the condition at home, a watchdog has warned. The Healthcare Commission said most primary care trusts were offering basic diabetes care such as yearly check-ups. But it warned that almost 130 out of more than 150 failed on home support.

Offering services to help patients manage their weight or plan an exercise regime are seen as crucial in reducing complications like heart problems. As such, they could also save the NHS millions of pounds each year. In 2002, about œ1.3bn - or 5% of NHS expenditure - was used to care for people with diabetes. Estimates from 2006 suggest this could even have crept up to 10% of total spending, the commission said.

Managing diabetes at home by controlling weight, or giving up smoking, have been touted as a key means of tackling complications of the condition. As well as heart problems, these include blindness, kidney failure and limb amputation.

Beefing up community services and the potential for self-management of long-term conditions such as diabetes is also one of the key planks of government policy. Diabetes is seen as a growing problem in the UK. According to the watchdog, the number of diagnosed and undiagnosed cases is likely to have risen by 15% between 2001 and 2010. Some 9% of this was due to increasing numbers of obese people, and a further 6% was the result of an ageing population, it suggested.

The Healthcare Commission said PCTs had to do better in supporting people to manage their condition.

Source




Ethically-challenged NHS doctor

A doctor accused of wrongly causing a health scare over the MMR vaccine paid children 5 pounds each to give blood samples at his son's birthday party, a disciplinary hearing has been told. Andrew Wakefield abused his position as a doctor and showed "a callous disregard" for the distress and pain that the children - thought to be as young as 4 - might suffer, the General Medical Council was told.

The allegations emerged yesterday along with charges connected to research by Dr Wakefield and his former colleagues, John Walker-Smith and Simon Murch, that claimed the combined vaccine against measles, mumps and rubella carried serious health risks. The doctors appeared before the GMC's fitness-to-practise panel charged with serious professional misconduct, which they deny. All three are accused of performing procedures, such as colonoscopies, barium meals and lumbar punctures, on children that were "contrary" to the children's clinical interests and conducted without the proper ethical approval and consent forms.

The GMC accused Dr Wakefield of bringing the profession into disrepute by taking blood from children at his son's party at some point before March 20, 1999, when he joked about the incident while giving a presentation at the Mind Institute, California. Footage was shown on ITN last night of the episode. Dr Wakefield is seen on video saying: "And you line them up - with informed parental consent, of course. They all get paid 5 pounds , which doesn't translate into many dollars I'm afraid. But . . . and . . . they put their arms out and they have the blood taken. All entirely voluntary." [Laughter] He says that two of the children fainted, while one was sick over his mother, which drew laughter from the audience.

Dr Wakefield is then heard joking: "People said to me, `Andrew, look, you know, you can't do this, people, children won't come back to you. [Laughter] I said, `You're wrong'. I said, `Listen, we live in a market economy. Next year they'll want 10 pounds'"

The MMR controversy began after the doctors published their research in The Lancet in 1998, claiming that the jab overloaded the immune system, causing bowel problems and also autism and other illnesses. Further research has quashed these conclusions. At the time, all three doctors were employed at the Royal Free Hospital's medical school in Hampstead, North London. They conducted the study on 11 British children without approval from the hospital's ethics committee, the GMC was told.

The list of allegations against Dr Wakefield took more than an hour to read out. One of the key accusations is that he failed to declare that he was being paid for advising solicitors on legal action by parents who believed their children had been harmed by MMR. Another charge is that he ordered subsequent studies "without the requisite paediatric qualifications". He is also alleged to have allowed one child - Child 10 - to be given an experimental cocktail of drugs, known as "transfer factor", with the view to it being developed into a new measles vaccine. Dr Wakefield admitted being involved in proposals to set up a company to manufacture the drug. The father of Child 10 was to be the company's managing director.

It was alleged that he did not reveal that he had accepted 50,000 pounds from the Legal Aid Board for research to support legal action by parents who believed their children were harmed by MMR. He was also accused of being "dishonest" and "irresponsible" when submitting his views about MMR for publication.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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18 July, 2007

Reforming our beliefs concerning health care

Post lifted from Arnold Kling. See the original for links

"It is not that rulers have been unaware of poor performance. Rather the difficulty of turning economies around is a function of the nature of political markets and, underlying that, the belief systems of the actors."
-- Douglass C. North, Economic Performance Through Time, the 1993 Economics Nobel Prize lecture

Douglass North points out that economic outcomes are shaped by institutions, which in turn are shaped by beliefs. Because beliefs change only slowly, outcomes are much more difficult to change than textbook economics suggests. Building on my previous essays on North's economics, this essay will look at health care reform from the perspective that beliefs are the core issue. Our beliefs about health care, including a belief that health care "ought" to be free for the patient, are what shape our health care system and make reform difficult.

Belief Systems and Economic Development

As an economic historian, Douglass North has focused on the changes in belief systems that are necessary in order to produce a modern economy. For example, he writes,

The contrast between the institutions and beliefs geared to confronting the uncertainties of the physical environment and those constructed to confront the human environment is the key to understanding the process of change...The collectivist cultural beliefs that characterized the former environment produced an institutional structure geared to personal exchange whose cohesion and structure were built around strong personal ties. In contrast the individualistic framework that evolved in response to the new human environment relied less on personal ties and more on a formal structure of rules and enforcement mechanisms.

--Understanding the Process of Economic Change, p. 101

Today, we can still see tribal societies, in which economics, politics, and religion are dominated by clan relationships. For such societies, it is difficult for people to trust outsiders, and therefore the transition to a modern economy based on trade with strangers has been stunted. I have argued, in North-like fashion, that prosperity depends on three ethics. I describe these as a work ethic, a public service ethic, and a learning ethic.

Each of these ethics tends to be reinforcing. That is, if most people believe that the way to get ahead is to work hard, then most people will work hard, and more wealth will be created. On the other hand, if people believe that wealthy people should not have to work, then people will attempt to gain wealth without working, leading to a zero-sum economy. If most people expect public officials to be honest, then dishonest officials will be identified and punished. On the other hand, if people expect corruption, then corrupt officials will survive, and only a simple fool will be honest. Finally, if people value learning in all of its aspects, then everyone will be encouraged to learn. If people believe that learning threatens tradition, then learning will be suppressed.

Health Care and Collectivism

In the passage just quoted, North describes collectivist ethics as suited to societies that are struggling with uncertainties in the physical environment. Individualistic ethics -- the rational, calculating, man of economic textbooks -- are suited to an environment in which we are confident of safety in the physical environment and have moved on to satisfying higher economic needs. (Of course, North argues strenuously that for modern societies to function we need to have ethics that lead us to act according to social norms, not merely on the basis of short-term self-interest.)

Illness deprives us of the sense of physical safety. Disease and injury are a throwback to the circumstances in which our physical environment is threatening and overwhelming. Thus, health problems tend to trigger our collectivist instincts. We seem to recoil from the idea that health care choices should be made on an economic basis, by comparing costs and benefits. Instead, we treat health care as if it is a black-and-white issue: when you need it, you must have it; when you do not need it, you do not want it.

As I studied health care spending in the United States while doing background research for my book, Crisis of Abundance, I found that many common, expensive medical procedures are not black-and-white. Instead, they fall into a gray area, where benefits are highly uncertain. Other economists have noticed this, also. For example, in recent testimony, Peter Orszag, Director of the Congressional Budget Office wrote,

hard evidence is often unavailable about which treatments work best for which patients or whether the added benefits of more-effective but more-expensive services are sufficient to warrant their added costs. In many cases, the extent of the variation in treatments is greatest for those types of care for which evidence about relative effectiveness is lacking. Together, those findings suggest that better information about the costs and benefits of different treatment options, combined with new incentive structures reflecting the information, could eventually yield lower health care spending without having adverse effects on health-and that the potential reduction in spending below projected levels could be substantial. Moving the nation toward that possibility-which will inevitably be an iterative process in which policy steps are tried, evaluated, and reconsidered-is essential to putting the country on a sounder long-term fiscal path. But even if it did not bring about significant reductions in spending, more information about comparative effectiveness could yield better health outcomes from the resources devoted to health care.

As it stands today, our health care system is designed to ensure that cost-benefit analysis is not taken into account. Instead, the collectivist instinct is that individuals should be insulated from having to pay for medical procedures. This belief that medical care ought to be free to the consumer is what underlies our peculiar institution of health insurance that is more like a prepaid health plan than real insurance. Because consumers are insulated from cost, neither they nor doctors are in the habit of comparing costs and benefits when it comes to medical procedures.

Doctors Should be Wealthy

Even though we believe that medical care should be free for those who receive it, we realize that health care providers need to be paid for their services. In fact, another one of our bedrock beliefs about health care is that doctors deserve high status and wealth. I sometimes think of our health care system as a suction device for drawing money into the pockets of physicians. That is, many of our institutions and practices seem designed more to guarantee an affluent lifestyle for doctors than a high-quality outcome for patients.

There is nothing wrong with someone earning a living based on their skills. However, the regulatory environment tends to give doctors more than a market rate of return. Licensing laws serve to restrict supply, yet it is highly unusual for a doctor to lose his license on the basis of incompetence. Pay for performance is rare--doctors are compensated on the basis of procedures, regardless of whether the procedure was appropriate or successful. And with consumers insulated by insurance, the necessity or price of a procedure is rarely questioned.

Can-do Spirit

Another belief that we have about health care is that effort is rewarded. If someone is not yet cured, then we think that the doctor needs to try harder. We have a "can-do" attitude about diagnosis and treatment. Doctors, for their part, hold themselves to very high standards and set high expectations. We also expect immediate action when we are sick. The idea that one person's illness might be low priority and that he or she should accept delay in treatment is unthinkable in this country.

Beliefs vs. Reform

Our beliefs about health care are an obstacle to reform. The collectivist instinct that we have about health care makes it difficult to introduce cost-benefit analysis into medical decision-making. Our belief that doctors should enjoy wealth and prestige makes it difficult to enact cost-containment measures or to reform the way in which physicians are compensated. Any attempt by government or managed-care systems to restrict access to health care services would run afoul of our can-do spirit.

My preference would be for Americans to become more receptive to cost-benefit analysis of health care decisions. Ideally, we would shed the collectivist instinct for health care. We would approach the issue of health insurance as a problem of insurance, not insulation. That is, we would shift from a goal of insulating consumers from the cost of all medical expenses to a goal of protecting consumers from the financial burdens of unusually expensive illnesses.

My reading of Douglass North is that real health care reform in the United States will not happen because of some wonk's clever plan. It will not happen as a result of an election. It will only happen when we change some of our beliefs about health care.




Another Australian public hospital with diagnostic failure

ANOTHER Queensland hospital has cut patient access to vital diagnostic equipment because of critical staff shortages. The Gold Coast Hospital is the latest Queensland Health facility forced to sideline multimillion-dollar diagnostic tools. The move affects equipment such as CT scanners and MRI machines, and could delay the diagnoses of hundreds of patients who could be suffering anything from cancer to brain aneurisms. It follows similar equipment shutdowns at the Royal Brisbane and Women's Hospital, while the Princess Alexandra Hospital has had to scale back its operating theatre services. An acute shortage of radiographers, who are trained to operate the diagnostic equipment, has forced each of the hospitals to act.

In a leaked email obtained by The Courier-Mail, Gold Coast Hospital medical imaging services director John Andersen said planned service cutbacks were necessary to "preserve staff sanity". Mr Andersen outlined plans to stop outpatient access to CT and MRI scanners between 5pm and 9pm. Only patients with imminently life-threatening conditions will get after-hours CT scans on the Gold Coast, while the region's existing 11-week waiting time for an MRI is likely to blow out further. Mr Andersen also detailed plans to cut diagnostic mammography services from five days to one day a week, potentially delaying diagnoses for women with suspected breast cancer. There will also be ultrasound and interventional radiology service cutbacks.

In the email to acting district manager Brian Bell, Mr Andersen warned the hospital would also have to staff a new emergency department at Robina. A Queensland Health spokeswoman refused to comment on the likely impact of the cutbacks.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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17 July, 2007

One in ten Scottish hospital patients 'suffering infection'

ALMOST one in ten patients in Scottish hospitals is suffering from an infection such as MRSA, a survey suggested yesterday. The new study - thought to be the most comprehensive ever carried out in Europe - found 9.5 per cent of people in acute hospitals had a healthcare associated infection (HAI). And the cost of such infections to the NHS is thought to be at least 183 million pounds a year.

Experts and campaigners last night said that HAIs continued to be a problem because of poor hygiene in hospitals and a lack of isolation facilities. Professor Hugh Pennington, Scotland's leading microbiologist, said more attention was also needed to ensure that only patients who needed antibiotics were receiving them to help tackle drug resistance.

Nicola Sturgeon, the Scottish health secretary, yesterday pledged to step up efforts to combat HAIs in light of the latest figures, which give the most accurate picture yet of the issue. This includes the possibility of introducing an MRSA screening programme for those going into hospital.

The new report, by Health Protection Scotland, suggested the rate of HAIs is higher in Scotland than the rest of the UK. A study by the Hospital Infection Society from February to May 2006 found that 8.2 per cent of patients in England had an HAI, 6.3 per cent in Wales and 5.4 per cent in Northern Ireland. Over the same three-month period, the rate in Scotland was 9 per cent. But experts said the differences in rates were most likely due to the more comprehensive nature of the Scottish survey, which covered every acute hospital and a sample of community hospitals.

The HPS report involved teams going into every acute hospital - 45 in total - and a sample of 22 community hospitals between October 2005 and October 2006. There they counted the number of inpatients over the age of 16 with an HAI who were in hospital on the day of the visit. In total, they found 1,103 patients in acute hospitals had an HAI - amounting to 9.5 per cent of all these patients. Of these, 126 had more than one infection. In the sample of non-acute hospitals, they found 157 patients with an HAI, of which seven had more than one. Taken across the country as a whole, this could mean more than 1,800 patients in hospital have an infection at one time.

The report found that Clostridium difficile was the most common bug among infections where researchers had identified the organism, accounting for 17.6 per cent of cases. This was followed by MRSA (methicillin-resistant Staphylococcus aureus) at 17.2 per cent and MSSA (methicillin-sensitive Staphylococcus aureus) at 8.9 per cent.

The hospital with the highest HAI rate in Scotland was Stobhill Hospital in Glasgow at 18.3 per cent, followed by Falkirk Royal Infirmary at 17.2 per cent. But the reason for the higher rates may be that these hospitals were surveyed during winter, when infections are more common. Older hospitals have sometimes been blamed for rising rates of infection. But yesterday's figures showed that this was not necessarily the case. The flagship Edinburgh Royal Infirmary, which opened in 2003, had an HAI rate of 11.6 per cent, compared with 6.8 per cent at the much older Southern General Hospital in Glasgow.

Rates also depend on the type of patients treated, with older people more vulnerable. And hospitals also have to deal with patients and their visitors bringing infections in.

Dr Jacqui Reilly, from HPS, said HAIs clearly had an impact on costs to the NHS, adding: "Patients with an HAI stay in hospital 70 per cent longer than those without an HAI." And she said if infections were cut by 30 per cent, the NHS could save 55 million pounds a year. Ms Sturgeon said this money could pay for an extra 8,000 patients to be treated. She added: "It is not good enough that 9.5 per cent of patients in Scottish acute hospitals have some form of HAI. The 183 million cost to the NHS, together with the human cost of HAI is also unacceptable."

Prof Pennington said the key to tackling HAIs was to continue with measures already in place, but to do them better. He added: "At the moment we are just about holding our own, but cases of MRSA are not going down and C difficile is going up. We need to continue to implement policies to control antibiotic prescribing, which contributes to resistance. "The cleaning and hand hygiene must also be a key focus. I am also in favour of screening, but it would need to consider what we do with patients who are carrying the bugs." Prof Pennington said Scotland and the UK in general did not have enough isolation facilities to care for patients with an infection, and added that there was evidence of more virulent strains of infections spreading.

Moya Stevenson, of campaign group MRSA Action UK, said it wanted to see screening for MRSA in hospitals. She added: "Bed occupancy rates have to be reduced within our hospitals and this will reduce quite significantly those rates of infections." Willie Duffy, from health union Unison, said that the quality of cleaning in hospitals had declined since the introduction of competitive tendering of hospital cleaning in the 1980s and the continuing outsourcing of cleaning at PFI hospitals. He added: "It is no coincidence the lowest levels of HAI in the UK are found where there are the lowest levels of contracting out - in Wales."

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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16 July, 2007

Don't get breast cancer in Britain

An "alarming" number of patients with suspected breast cancer are waiting too long for a diagnosis, doctors warn. Government targets dictate all suspected breast cancers should be seen by a specialist within two weeks. But a team at Bristol's Frenchay Hospital discovered an increase in the number of positive diagnoses among women deemed to be non-urgent cases. Doctors said the target was failing, but the government said it was looking to improve the situation.

The study published in the British Medical Journal reported that the two-week wait target - from GP referral to consultant appointment - was introduced in 1999 because of long waiting lists for diagnosis and treatment. Doctors at the Breast Care Centre at Frenchay Hospital compared nearly 25,000 urgent and non-urgent referrals - where breast cancer is not suspected but a consultant's opinion is still needed - between 2000 and 2005.

They discovered that the number of women referred urgently by their GP had increased, as expected. But the proportion of cancers detected in those seen within two weeks went down from 12.8% to 7.7%. Meanwhile, the numbers seen as non-urgent cases fell, but the proportion diagnosed with cancer rose from 2.5% to 5.3%.

Lead researcher Simon Cawthorn said the target had been very effective in getting many women seen quickly but that most of the time it was impossible to tell whether a breast lump was cancer or not. "The message is that we need to see everyone within two weeks. "Even though it's only a small number in the routine group, it's a significant number." He added that because the two-week wait rule had improved diagnostic services, GPs were now referring women they would have previously asked to come back to see them in a month or two. "They are having to decide whether it's urgent or not and the thing is you just can't tell."

The team have now invested in two specialist breast nurses and see all patients within two weeks. A Department of Health spokesperson said ministers were looking to improve the situation. "We accept that there will always be some patients who do not come through the two-week wait route, because they do not have obvious symptoms, are detected through screening, or through investigation for other conditions. "In 2005, the government made a manifesto commitment to go further on cancer waits and we are considering proposals to do this as part of the Cancer Reform Strategy due to be published at the end of this year."

Maggie Alexander, director of policy and campaigns at Breakthrough Breast Cancer said all patients should be seen within two weeks. "We have known for some time that many women eventually diagnosed with breast cancer are given a routine referral by their GP, and as a result may endure anxious, long waits to find out if they have breast cancer." Hisham Hamed, Cancer Research UK breast surgeon, said the aim was for all patients to be seen in the shortest possible time and the majority referred did not have breast cancer. "It is important to say that research shows an extra week or two will not compromise the patient's outcome."

Source




The IVF `miracle maker' is vindicated; Nasty British bureaucrats defeated

Three cheers for the High Court's ruling that the HFEA, Britain's fertility regulator, acted unlawfully in its witch-hunt against Dr Taranissi

Last week, the High Court in London ruled that warrants obtained by the UK Human Fertility and Embryology Authority (HFEA) in January to support raids of the London clinics of top IVF doctor Mohamed Taranissi were unlawful, and therefore invalid. The HFEA is ordered to pay legal costs in the case, which are estimated to be in excess of 1million pounds. As a former patient of Mr Taranissi's - whose groundbreaking IVF treatments helped me, and many other women, to become pregnant and give birth to healthy, beautiful children - I am relieved and happy that my doctor has been vindicated. But I remain appalled that the HFEA pursued such an outrageous, sensationalist and expensive campaign against him in the first place.

The timing of the police-accompanied raids of the ARGC and RGI - Mr Taranissi's clinics - appear to have been the result of a cynical move by the HFEA to hit the headlines at the same time that a BBC Panorama `expos,' of Mr Taranissi's fertility methods and practice was due to be aired. The chief executive of the HFEA, Angela McNab, now accepts that the evidence she provided to the courts in order to obtain the warrant was inadequate and incomplete. The judge who granted permission for the review of the warrants said the HFEA's applications were `unfair and highly misleading'. It seems the HFEA acted quickly so that the raids could be included in the Panorama programme broadcast on the same day, 15 January 2007. After last week's judgment, Evan Harris MP, a member of the Science and Technology Select Committee, expressed concern that `the HFEA allowed a media timetable and presentational issues to conquer better judgement and due process'.

The recent legal debacle is just the latest in a series of heavy-handed, misguided or just plain incompetent actions by the HFEA. The fertility regulatory authority was established in 1991 following the passage of the Human Fertilisation and Embryology Act of 1990. Its remit is to licence and regulate IVF and other fertility treatments and to oversee research in the field. Since its inception, it has used its powers to interfere in and obstruct the clinical practice and research agendas of doctors, scientists and other specialists.

From `saviour siblings' to animal hybrids, from sex selection to limiting the number of embryo transfers, the HFEA has either erected ethical or bureaucratic obstructions to IVF breakthroughs, or at best encouraged researchers and doctors to proceed with extreme caution. It has continually dragged its feet and prevented progress in the field. It is little wonder, then, that it has consistently clashed with the most cutting-edge and progressive of reproductive clinicians, Mr Taranissi, who has by far the best IVF success rates in Britain. Some refer to him as the IVF `miracle maker'.

There have been numerous calls - from the press and from fertility specialists - for the resignation of Angela McNab for her part in this shambolic affair, not least because of the massive costs involved. There is also some insinuation that she is pursuing a grudge in her vendetta against Mr Taranissi. No doubt there is now very good reason for Ms McNab to consider her position. Yet a change of personnel, even at the very top, will not alter the character of the unelected and seemingly unaccountable HFEA. What is required is a radical overhaul of the way that fertility treatment and research is regulated.

Although there is strong support in the fertility sector for some level of independent regulation, there is also much discontent about the manner in which the HFEA has conducted itself. The British Fertility Society has called for a full investigation by the Department of Health into the HFEA's recent actions, as it is clear that the authority has lost the trust and confidence of the fertility sector. Regulatory reform is certainly in the pipeline: there are plans to merge the HFEA with the Human Tissue Authority in 2008. It remains to be seen whether this will lead to a more liberal system with a greater degree of accountability.

Clearly, the current state of affairs cannot be allowed to continue. That an appointed quango can dupe a judge to allow it to ride roughshod over the rights of a doctor by strong-arming its way into his clinics, terrifying his patients and absconding with his records and computer files in order to stage a dramatic scene for a TV show is - I hope - not the way we ought to conduct government in this country. The HFEA did not even have the decency to apologise to Mr Taranissi for its unlawful actions against him. Instead, its post-trial statements put as positive a `spin' on its actions as it possibly could, and the HFEA proceeded to remind Mr Taranissi and the rest of us that his clinics are still under investigation for breaches of licensing regulations.

The regulation of the fertility sector should not be the authoritarian Big Brother it is in danger of becoming under the auspices of the HFEA. Important policy decisions affecting the sector should properly be made by our elected and accountable representatives in parliament, while the clinical decisions relating to patient treatment should be made between doctors and patients. It is entirely legitimate to call for Ms McNab to resign - but it might be wise to call for the HFEA to be abolished at the same time.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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15 July, 2007

"Sicko" Presents a False View of Cuba's Health System



Leftist filmmaker Michael Moore claims his latest documentary, "Sicko," will "rip the band-aid off America's health care industry,"1 which Moore sees as wrongfully dominated by private drug companies and profit-seeking HMOs.

In part of "Sicko," released June 29, Moore takes a group of ill 9/11 rescue workers to Cuba for health treatment.2 Though most of the workers on Moore's two-week sojourn in March 2007 were insured,3 Moore's motive in going to Cuba is to showcase the supposed superiority of the communist country's "free" national health care and to compare this to "the misery people are put through on a daily basis by our profit-based system" in the U.S.4 (The Department of Treasury has opened an investigation into whether Moore violated the U.S.'s longstanding embargo of Cuba.)5

As with Moore's previous documentaries, "Sicko" provides a brash handling of public policy disputes. The film's underlying push is to, in Moore's words, "ignite a fire for free, universal health care."6 When this premise is examined, the rosy myth of socialized medicine's achievement in Cuba is crushed.

Cuba's Heath Care System: The Reality

Under the Cuban government's health care monopoly, the state assumes complete control. Private, non-governmental health facilities, where ailing citizens could buy treatment, are illegal.7 As a result, average Cubans suffer long waits at government hospitals, while many services and technologies are available only to the Cuban party elite and foreign "health tourists" who pay with hard currency. Moreover, access to such rudimentary medicines as antibiotics and Aspirin can be limited, and there are reports that citizens excluded from the foreign-only hospitals often must bring their own bed sheets and blankets while in care.8

Despite the reality, Cuba's universal health system continues to be glorified. "Defenders of Cuba's communist government cite universal health care and education as 'gains of the revolution,' claiming the average Cuban is far better off today than under the dictatorship of Fulgencia Batista," wrote Tom Carter of the Washington Times.9 Moreover, "The health care system is often touted by many analysts as one of the Castro government's greatest achievements," says an updated 2002 State Department report, which rejects the notion that Cuba's health conditions have significantly improved for most Cuban citizens since 1958.10

When examining the woeful reality of health care in Cuba, Moore's and other liberals' drive to establish a 'socially equitable,' centrally-planned medical system in America should be rejected as a foolish proposal. Though state-sponsored health care is trumpeted in Cuba as a basic human right achieved by the revolution, according to many reports, including those by Cuban defectors, universal availability of and accessibility to top quality care are fantasies.

Below is a snapshot of reports from those who have witnessed Cuba's health care system up front. They serve notice of the horrors of socialized medicine.

Cuba's Health Care System in Practice

Says Canada's National Post, which assessed Cuba and its health system in a three-part series:

Even the most commonly available pharmaceutical items in the U.S., such as Aspirin and rubbing alcohol, are conspicuously absent [in Cuba]... Antibiotics... are in extremely short supply and available only on the black market. Aspirin can be purchased only at government-run dollar stores, which carry common medications at a huge markup in U.S. dollars... This puts them out of reach of most Cubans, who are paid little and in pesos.11

The same National Post story continues, quoting Jasmin, a nurse from Moron, Cuba, "We have nothing. I haven't seen aspirin in a Cuban store here for more than a year. If you have any pills in your purse, I'll take them. Even if they have passed their expiry date."12 Cuban defector Dr. Leonel Cordova told the New York Times about his experience practicing in Cuba, "[E]ven if I diagnosed something simple like bronchitis... I couldn't write a prescription for antibiotics because there were none."13 Along these lines, Patricia Grogg of the Inter Press Service writes:

[A] survey carried out in pharmacies late last year [in 2000] by the local [Cuban] magazine Bohemia failed to find 211 of the medicines included on the official list of products produced to attend to the health of this Caribbean island nation's population of 11 million... 'They say scarcity of medicine is no longer such a serious problem, but I've been trying for days to buy aspirin in this pharmacy, and they always tell me there isn't any,' complained Mara Dolores Pea, a 60-year-old pensioner, outside her neighborhood pharmacy.14

In addition to a limited supply of medicine, according to a 2005 report in the Boston Globe, Cuban health care workers are in short supply:

A 45-year-old nurse in Camaguey Province said she has worked without a doctor in her primary-care clinic for more than two years since the physician was transferred to another clinic to replace a doctor sent to Venezuela. 'My patients complain every day. They want me to act as a doctor, but I can't,' she said. 'The level of attention isn't the same as before.'15

The nurse is alluding to a program in which one-fifth of Cuba's health care labor supply - some 14,000 doctors and 6,000 health workers - has been contracted out to work in Venezuela. Under a special "oil-for-doctors" exchange between Venezuela's Hugo Chavez and Cuba's Fidel Castro, Venezuelans receive free eye surgery in Cuba. In return for these medical services, Cuba receives 90,000 barrels of discounted oil per day.16 Ordinary Cubans have suffered as a result. "Blackouts, shortages of consumer goods and other problems persist," wrote Gary Marx of the Chicago Tribune.17 Indira A.R. Lakshmanan of the Boston Globe wrote:

The system has suffered setbacks... since the cutoff of Soviet aid some 15 years ago, with hospitals and clinics in need of renovation and equipment, pharmaceutical costs soaring, and patients saying they must bring bedclothes, food and fans to hospitals. But complaints about a lack of medical personnel are new, dating to the cooperation with Venezuela that some observers disparagingly call the oil-for-doctors program.18

Lourdes Garcia-Navarro of National Public Radio reported:

[S]peaking privately... some Cuban patients and doctors say the system has been feeling the strain of treating the Venezuelans in their home country and on the island. Doctors say that there's a shortage of trained specialists. Most Cuban doctors now they say become general physicians and forego specialized training because what is needed in Venezuela are community doctors. Patients in Cuba complain that their hospitals are stretched and they're not getting the same standard of care they're used to.19

Finally, the Chicago Tribute reported in 2005:

At least one nurse involved in the eye operations said Cuban physicians are sacrificing quality for quantity as they hurry to complete as many operations as possible. The nurse said the number of eye operations at her hospital has soared from about 15 to more than 120 daily, and many patients fail to receive important preoperative tests, she said. The surgeries are performed round-the-clock... 'Nobody is in agreement with this, but they say that you have to do it without discussion,' the nurse said. 'The patients are being mistreated.'20

Despite shortages of medicine and care, especially since the exchange agreement with Venezuela, not all Cubans suffer. "In Cuba there exists TWO health care systems,"21 explains U.S. Rep. Ileana Ros-Lehtinen (R-FL), who fled Cuba with her family to the United States when she was seven years old.22 "[O]ne [care system is] for tourists, as well as Communist Party officials, and another for Cubans, who are forced to take with them even the most basic necessities when visiting a Cuban hospital; even aspirins are scarce."23

Reports on therealcuba.com, a privately-run website that contains anecdotes, including ghastly images, of suffering anonymous Cubans cut off from the rich foreign-only facilities. As explained on the website,24 the horrors of socialized medicine are not, in fact, evenly or universally experienced:

Castro has built excellent health facilities for the use of foreigners, who pay with hard currency for those services. Argentinean soccer star Maradona, for example, has traveled several times to Cuba to receive treatment to combat his drug addiction. But Cubans are not even allowed to visit those facilities. Cubans who require medical attention must go to other hospitals that lack the most minimum requirements needed to take care of their patients.25

Are Cuba's health care woes the result of the longstanding U.S. economic embargo? Not a chance, according to a group of 18 exiled Cuban doctors. The doctors made their personal views clear in a joint letter in 1997:

We remain mystified as to why people of ordinarily good will and faith would seek to find fault with the United States for the disastrous situation inside Cuba, while failing to direct the blame squarely where it belongs - at the feet of Fidel Castro, who continues to rule our country with an iron fist after 38 years in power.26

The exiled doctors continued:

We, who have only recently emerged from the belly of the beast, can categorically and authoritatively state that our people's poor health care situation results from a dysfunctional and inhumane economic and political system, exacerbated by the willingness of the regime to divert scarce health resources to meet the needs of the regime's elite and foreign patients who bring hard currency.27

Source




NHS aged-care "lottery"

An "unjustifiable postcode lottery" means that some elderly people are 160 times more likely than others to get long-term care paid for by their local authority, according to a report.

Age Concern found that Derby City Primary Care Trust paid for seven people to be looked after last year, or 0.26 people per 10,000, while Harrow PCT funded the care for 826 people, or 41.75 people per 10,000. Age Concern said that this was despite Harrow having a younger population. "Individuals face a postcode lottery in getting NHS continuing care. There can be no justification for such huge variations," Gordon Lishman, director general of the charity, said.

From October 1, a national framework will exist for PCT staff to determine who receives continuing care, in which the NHS fully funds care outside hospital. The new criteria should increase the numbers of people receiving continuing care by about 7,000, at a cost of œ220 million.

Source




Queensland government ambulance system still not fixed -- despite much outcry and many promises

INCOMING Emergency Services Minister Neil Roberts is facing a revolt from disgruntled ambulance officers, with a new report revealing high stress and fatigue levels and plummeting morale. Paramedics fed up with a controversial roster system they say is ruining their lives want Mr Roberts to go on the road with them to see first-hand the pressure they are under. They say the system is leaving them exhausted, compromising patient care and leading to marriage break-ups and health problems.

A survey by the Emergency Medical Service Protection Association, which represents ambulance officers, found 94 per cent of paramedics had low morale. More than 90 per cent said their fatigue and stress levels had risen, 70 per cent felt their job satisfaction had decreased and 70 per cent were taking more sick leave. "To say I am unhappy is an understatement," one said. "I have no time to see my family, and I find I may not actually see my partner for days." Another wrote: "In the 10 years I have been in the job, I have not seen morale so low or job dissatisfaction so low. Stress is increasing, not only mental, but physical stress-related illness as well."

Paramedics previously worked two 10-hour days and two 14-hour days before having four days off. But in 2005, the Queensland Ambulance Service introduced 10-hour maximum shifts, which it said were designed to improve home and work life for paramedics. But EMSPA president Prebs Sathiaseelan said it had done the opposite, with paramedics still working long hours but not getting adequate down-time. "We are so tired, we are so fatigued - and if something isn't done soon, we're going to burn out," he said. "We are not shop workers. We confront trauma and have the lives of the public in our hands daily, and we need time off to recuperate."

Mr Sathiaseelan said former emergency services minister Pat Purcell, who was forced to resign last week after allegedly assaulting two senior bureaucrats, had failed to listen to paramedics' concerns. "We're hoping the new minister will discuss this issue in a civil manner - I'd love him to come out on the road with us to see exactly what we're talking about," he said. "We learn how to use new equipment and new drugs without complaint - but these rosters are causing untold distress."

The QAS has been beset by problems including emergency response time blowouts and high sick and stress leave rates.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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14 July, 2007

Huge error rate in NHS hospitals

Almost 25,000 hospital patients were the victims of reported medical errors last year, leading to death and serious injury in some cases. The National Patient Safety Agency (NPSA), which revealed the figures, has issued new guidelines on patient wristbands after more than 2,900 errors were attributed to cases of mistaken identity. Hospitals in England and Wales currently use a variety of bands, with colours or codes meaning different things. Some hospitals even use handwritten tags. But the NPSA said these bands must now be standardised across the country in order to cut down on errors, which are thought to be widely under-reported in the NHS.

It has received reports of patients being placed in the wrong wards and given the wrong medication and blood. Some of these mistakes could have been lethal, the watchdog admitted. Up to 30,000 patients are estimated to die every year due to avoidable medical errors. But the true scale of the problem is largely unknown due to a reluctance by NHS staff to report mistakes and near-misses.

A statement on the NPSA website said yesterday: "Between February 2006 and January 2007, the NPSA received 24,382 reports of patients being mismatched with their care. "It is estimated that more than 2,900 of these related to wristbands and their use." The errors referred to by the Agency could include patients being given the wrong surgery, medication, or tests with potentially life-threatening consequences.

The NPSA said that no further breakdown of the figures for last year was available. The agency, designed to collect data on patient safety, was denounced last year as "dysfunctional" by the Public Accounts Committee, because it had no idea how many patients died each year as a result of medical errors. It subsequently reported that 41,000 medication errors had been recorded between July 2005 to July 2006, which caused 36 deaths. A further 2,000 patients suffered "moderate or severe harm."

In 2005, the National Audit Office reported that nearly one million errors or safety lapses had occurred in the previous year, causing 2,000 deaths. Half of the incidents could have been avoided if staff had learnt from past mistakes, the auditor said.

More here




NHS GIVES SUBSTANDARD ATTENTION TO HEART PROBLEMS

The way in which people with heart failure are treated on the NHS has been criticised by an independent inspector. A report from the Healthcare Commission says it is concerned about the extent of access patients have to the appropriate tests, drugs and specialist care.

Heart failure, which costs the NHS 625 million pounds per year, affects 900,000 people in the UK, with the "extremely debilitating" condition killing 40 per cent of sufferers within the first year of diagnosis. It most commonly arises following heart attacks or high blood pressure and reduces the amount of blood the heart is able to pump around the body.

The Healthcare Commission claims that the condition's symptoms of tiredness, shortness of breath and swollen ankles and feet are hindering treatment by being confused with less-serious health problems. In the report, the watchdog's chief executive Anna Walker noted the "very positive" progress made since it conducted its last heart failure report in 2003/04. But she goes on to say that "not all those that need treatment are getting it". "Primary care trusts and GPs need to monitor the number of patients they deal with in comparison to national statistics. Symptoms and treatments need to be recorded and followed up by GPs. "The care provided also needs to be audited so lessons can be learnt and improvements made."

Of the 303 primary care trusts evaluated in today's report, just 16 were rated 'excellent' in terms of treatment, with one in seven given a rating of 'weak'. Commenting on the report, the British Heart Foundation's (BHF) Jackie Lodge said the way in which heart failure is treated on the NHS "cannot continue" and called for more specialist nurses to be employed on the health service. "This cannot continue," she claimed. "The BHF believes every heart-failure patient has a right to be given high-quality care so they can manage their condition and symptoms and maximise their quality of life."

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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13 July, 2007

KRUGMAN: A SADLY DECAYED INTELLECT

Post below lifted from Donald Luskin. See the original for links. For a close-up account of the French hospitals that Krugman lauds, see here

Reader Josh White submitted the following remarks to Paul Krugman's commentary page on the New York Times' web site, responding to Krugman's 7/9/2007 column. Something tells us this isn't going to get printed:

"It's perfectly reasonable to have a debate about health care and to discuss the pro's and con's of health care provided by the public sector (government) and the private sector (insurance companies/HMO's). However, your recent column does neither.

First, you grossly mischaracterized the discussion on Neil Cavuto's show ("discussed how health care promotes terrorism"), which was about the necessary importing of foreign doctors due to the lack of native ones (mainly due to the effects of socialized medicine). Second, you claim that the medical-industrial complex and their allies have " used scare tactics to prevent America from following its conscience".

Fair enough. But isn't this the exact same technique used by liberals to protest numerous policies from Supreme Court nominations "Robert Bork's America would be marked by back alley abortions" to welfare reform "children begging for money, children begging for food, eight- and nine-year-old prostitutes" and "legislative child abuse" to global warming "This is treason. And we need to start treating them as traitors." and "Let's just say that global warming deniers are now on a par with Holocaust deniers,"

Hmm, I have yet to see you call out any of those people for their "scare tactics". In any case, it's quite disturbing to see that you resort to the same techniques I mentioned above by questioning the values and morals of anyone who doesn't believe in universal health care.

Also, you cite an example from Sicko "a child who dies because an emergency room that isn't a participant in her mother's health plan won't treat her" but you don't give any of the background info regarding it. The child in question, Mychelle Williams, did not receive the proper tests for sepsis at the 1st hospital she was taken to, Martin Luther King Jr./Drew Medical Center, and this was the eventual cause of death (not being treated quickly enough).

The hospital, which is government run--coincidentally (actually not coincidentally), was found at fault along with the 2nd hospital the child was eventually transported to. The insurance company was not involved in denying treatment or care for the child at any point. The fact is that the doctor at the hospital did NOT perform necessary and immediate tests to fully determine the child's condition (despite words from a doctor at a Kaiser hospital advising to wait on the tests). Also, note that the 2 hospitals were found liable in the suit; nowhere was the Kaiser insurance plan found negligent. I figured someone of your standing would have properly researched the examples Moore provides in the film before throwing them in the film.

Of course, seeing as how you have done this exact same thing in previous columns (including citing a 98% voter turnout rate for one county in Ohio from a clearly flawed Congressional report when the actual number - 72% - was easily available online at the county's website) I guess I shouldn't be suprised.

Later you say "Medicare - which did enormous good, without leading to a dictatorship". Surely Medicare has helped out older individuals, but I guess you missed the current Comptroller of the US on 60 minutes Sunday "By that I mean that the Medicare problem is five times greater than the Social Security problem." and "With one stroke of the pen, Walker says, the federal government increased existing Medicare obligations nearly 40 percent over the next 75 years."

Then you go on to claim that "Meanwhile, every available indicator says that in terms of quality, access to needed care and health outcomes, the U.S. health care system does worse, not better, than other advanced countries". Again, this simply isn't true. Cuba was ranked 39th in the 2000 WHO survey. Yet, Moore gleefully takes people there to get treatement even though Cuba is ranked behind the US (37th).

Also, the Commonwealth Fund did a study which found that the US ranked ahead of Canada in several measures including % of patients who waited 4+ hours to be seen in an emergency room (24%-Canada, 12%-US); % who waited 4 weeks or longer to see a specialist (57%-Canada, 23%-US). While the emergency room times with Britain were comparable with those of the US, the % who had to wait 4+ weeks for a specialist were much higher (60%) in Britain than in the US (23%).

So your claim that the US does worse in "every available indicator" than other countries, simply isn't true. Finally, your claim that "..the French manage to provide arguably the best health care in the world," is where you lose all credibility. Did you not see/hear/read about the Heat Wave which killed nearly 15,000 people in France, during the same time (coincidentally- -well, not really) when many doctors, nurses, and other health personnel were on their mandated vacations. Please explain how the "..best health care in the world" lets nearly 15,000 of its citizens die due to a completely normal occurence (as compared to a disease or virological outbreak).

Lastly, your reasoning that it is purely fear and scare tactics which are arguing against socialized medicine is disingenuous and pretty much a common tactic on the left. Again, you (just as many other liberals do), have managed to use purely emotion (while citing very minimal statistical or factual or numerical evidence) to declare, ipso facto, that socialized medicine is the answer and those who are opposed to it are mean, immoral, and scaring people. Hmmm, where have heard this recently. Oh yes, the immigration debate."




No PET scans for Tasmanians

What happens when you rely on government



HUNDREDS of Tasmanians are missing out on life-saving cancer scans, now the focus of a Senate inquiry, say specialists. Positron Emission Tomography scanners have limited availability to Australians, and there are none in Tasmania. Tasmanian nuclear medicine physician Rob Ware has campaigned to investigate the vexed issue. "Every year 300 to 400 Tasmanians, probably more now, have to travel interstate to get to a PET scanner," said Dr Ware, who spends half his time at the Peter McCallum Cancer Institute in Melbourne. "There are at least that many again who should go but don't."

Scans can cost $800 each but are considered valuable at determining the spread of cancer, often leading to a change of treatment. The whole issue of availability arose after recommendations from a 2000 national Medical Services Advisory Committee report. The report into the effectiveness of the scanners, which is now being scrutinised by a Senate committee, was changed to add the word "potentially" to the words "clinically effective" when referring to the machines.

Greens senator Christine Milne, who is part of the Senate inquiry, and several doctors believe the report was changed after its original recommendation. The change has caused a restricted roll-out of the machines and made claiming the treatment under Medicare doubtful. The Medical Services Advisory Committee advises on what Medicare should cover.

Dr Ware said Medicare only covered the scans for about 22 situations, when they were valuable in more than 60 conditions, including breast, lung, colon, head and neck cancer.

Federal Health Minister Tony Abbott said yesterday there were 16 PET machines in Australia, thanks to the committee, but indicated their availability would increase. "These machines are particularly useful in terms of trying to assess the spread of cancers," Mr Abbott said. "Six of those machines are Medicare-funded for three indications. Ten of them are more or less fully funded by Medicare, three on a grants basis and seven on the basis of 15 indications, which are covered by Medicare." Mr Abbott said the roll-out had been slower than desired and he would make recommendations to the Government about further funding of PET scanning through Medicare and further potential capital funding of PET scanning.

The issue was raised on ABC-TV on Monday night. Senate inquiry chairman ACT Liberal Gary Humphries rejected the accusation of fraud but did describe the Health Department behaviour as "sloppy".

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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12 July, 2007

Media make you sicko

Michael Moore is a documented liar who uses "omission, exaggeration and cinematic sleight of hand" to make his political points. But that doesn't seem to matter to the media who cover his movies. Now journalists are using "Sicko," which opens June 29, to make a giddy, unabashed case for socialized health care in America - and even urging Moore to run for office.

He shows "compassion" and "generosity," he's a great "campaigner" and an "adroit politician," reporters have declared. He's "taking on America's deeply flawed health care system," said Terry Moran on ABC's "Nightline" June 13. And ". the point his movie ultimately makes: fixing health care is a moral, even a religious obligation." Moran led Moore into a dialogue about "Sicko" as a statement of "faith."

"Father Michael Moore - hard to imagine, maybe, or maybe not," Moran said, after learning Moore once ventured to seminary. "Well, try this one: Senator Michael Moore."

The media have been in awe of Moore's film and Moore's charisma, and enthusiastic about the idea of socialized medicine. Overall, coverage has glossed over Moore's distortions in favor of keeping the snowballing policy discussion going. A May 2007 CNN poll indicated 64 percent of respondents "think the government should provide a national health insurance program for all Americans, even if this would require higher taxes." Compare that with November 2006, when Gallup asked whether people would maintain the current U.S. insurance system or would replace it with a government-run system. Only 39 percent said they would welcome the government-run system. Media health hype has certainly increased this spring, using "Sicko" as a jumping-off point.

"Americans may be inching toward the idea that a truly universal system may be the only way to guarantee that we can all afford some coverage," wrote Howard Fineman in the June 18 Newsweek. Some journalists couldn't hold back the gushing praise for Moore and the film:

* "The film emerges as a fascinating exploration and powerful indictment of a pressing national problem," wrote Claudia Puig in the June 22 USA Today. Puig praised Moore's "biggest, best and most impassioned work," claiming it was not "too politically charged."

* "There's something different about this Michael Moore movie," said ABC's Terry Moran on the June 13 "Nightline." "For all the laughs, it's very serious and laced with qualities not usually associated with his films: pity, compassion, generosity, sorrow."

Moore is hardly making his case for socialized medicine alone. In addition to coverage of him and "Sicko," the media have taken the ideas in his movie and run with them. In just the two weeks before the opening of Moore's movie, ABC, CBS and NBC have done numerous health care stories including: the "national disgrace" of children who don't have health insurance; children of illegal immigrants who don't get health insurance; baby boomers caring for aging and sick parents; how the Dutch are taller than Americans because of better health care; a homeless patient who got kicked out of a hospital; and failures of the military's mental health system.

ABC used one extreme, tragic example in the wave of stories advocating a health overhaul. The network did two segments on a Los Angeles emergency room where a woman in urgent need of treatment was ignored by ER personnel and died. "It is stories like this that have led us to take on health care as a major focus for us here on `GMA,'" said reporter Chris Cuomo on the "Good Morning America" June 13. But those stories weren't a coincidence - they were tied in with ABC's coverage of "Sicko."

Cuomo: "It's an election year; this [health care] is a big issue facing everyone. We want you to go to the Web site at ABCNEWS.com, tell us stories about what has gone wrong, about what has gone right, because obviously this is a situation that we need to change. Robin?"

Robin Roberts: "Yeah. And right, and your talk with Michael Moore. More of your conversation in our next hour."

Cuomo: "He is certainly taking on the issue."

Roberts: "Yes, he is."

When they weren't using examples of bad hospitals to advocate socialism, reporters were acknowledging critics of "Sicko" existed - without including their criticisms. On the June 22 "CBS Evening News," reporter Jeff Greenfield said "Sicko" "champions more or less uncritically a government-run health care system," describing the film as "affecting stories of personal suffering at the hands of indifferent corporations" and a celebration of Canada, France and Britain. "The film does not include critics of those systems," Greenfield said. Neither did Greenfield.

Greenfield featured health analyst Paul Ginsburg of the Center for Studying Health System Change, who was supposed to explain why no presidential candidate has thus far announced a Michael-Moore-style health care policy. The reason? "Americans are just different," Greenfield said. "We're much less willing to have government make decisions for people than is the case in Canada and Europe," Ginsburg said. "It's a cultural difference."

Greenfield could have interviewed a health expert who had facts to compare the countries' health programs - in economics, availability and quality. Michael Tanner, director of health and welfare studies at the Cato Institute, has written about some of those differences. For example, the National Health Service (NHS) in Britain - which Moore showed in a glowing portrait in his film - has about 850,000 people waiting for admission to its hospitals, Tanner wrote. "Every year, shortages force the NHS to cancel as many as 50,000 operations," Tanner said. "Roughly 40 percent of cancer patients never get to see an oncology specialist."

Though Moore used life expectancy as a main measure of U.S. care compared to Canada, France, Britain and Cuba, Tanner explained that wasn't a measurement experts would choose. "Most experts agree that life expectancies are a poor measure of health care," Tanner said, because so many outside factors affect them - including violent crime, poverty, obesity, tobacco and drug use. "When you compare the outcome for specific diseases such as cancer or heart disease, the United States clearly outperforms the rest of the world," Tanner said.

Throughout "Sicko," Moore referred to health care in Canada, France, Britain and Cuba as "free." That notion has been only nominally challenged in the majority of media coverage. Chris Cuomo questioned Moore on the June 12 "Good Morning America" about the "huge tax burdens" of the countries with "free" health care in his movie. But when Cuomo asked, "Do you think you pay too little attention to that in your film?" Moore said "No," and Cuomo left the topic.

Just as ABC's Cuomo paid lip service to the taxes that fund socialized medicine, Moore's film dismissed it with a ludicrous example. In "Sicko," Moore visited what he called an "average middle-class family" in France to prove that taxes weren't a burden to them. The couple, who had two children shown on the video, said their combined income was $8,000 per month. That's almost $100,000 per year - not exactly "average middle class." But Moore expected viewers to be satisfied with this well-off couple's smiles and nice house, accepting that "free" health care wasn't really costing anyone anything.

USA Today's Richard Wolf provided some refreshing honesty in his June 22 piece, reporting the drastic difference in countries' tax rates: "In France and Britain, the tax burden is 42% and 27% respectively, as opposed to 12% in the USA, according to the Organization for Economic Cooperation and Development."

Wolf also noted Moore's exclusion of insurance industry and U.S. health care representatives from his film and said "`Sicko' uses omission, exaggeration and cinematic sleight of hand to make its points." Cuban dictator Fidel Castro himself had to admit his surgery was "botched" by Cuban doctors last year, as The New York Times reported May 27. Moore left that detail out of his film, which depicted Cuba as one of the supposedly utopian health care sites.

In a rare display of enlightening context, NBC's Matt Lauer addressed Cuba's "free" health care system with other information about the country on the June 5 "Today" show. Far from Moore's free-prescription paradise, he told viewers "the typical Cuban family uses the black market for even basic goods." People aren't exactly free there - "most Cubans are not free to use the Internet." "Dissent in any form is not tolerated by the Cuban government, which limits outside influence," Lauer explained.

Yet, in a June 13 "Nightline" interview on ABC, Moore had the audacity to say Cubans enjoy "artistic freedom." "I hung out with artists who, who are critical of Castro, and very freely speak their minds," Moore said. ABC's Terry Moran added that "human rights groups, like Amnesty International, say Cuba continues to repress nearly all forms of dissent." Clearly, Moore had spoken from ignorance or outright lies - but the media at large didn't hold him accountable for such statements.

More here




Your bureaucrats will protect you

Australia: The police had to raid a government health department to get it to act!

A MAN accused of spreading HIV allegedly infected two women with the deadly virus after officials twice closed his case file, believing he was not a public health risk. And the Department of Human Services issued an order compelling Solomon Mwale to have safe sex only after police executed a search warrant on its offices.

A woman allegedly infected with HIV by Mr Mwale told Geelong Magistrates Court yesterday that she fell in love with the 38-year-old after a meeting in a video store developed into a passionate, three-year affair. "I trusted him and I believed inhim," the alleged victim - who said she had no idea of the man's HIV status - told the court. "I will take my love for him to the grave." Mr Mwale was committed to stand trial on three counts of engaging in reckless conduct that placed a woman in danger of serious injury between February and November 2004. He pleaded not guilty.

The case follows that of Michael Neal, committed to stand trial earlier this year on charges of intentionally spreading HIV. Evidence of departmental inaction in that case triggered the sacking of the state's chief health officer, Robert Hall.

Evidence heard at the Geelong court yesterday showed public health officials failed to act to curb Mr Mwale's alleged unsafe sex practices, despite repeatedly receiving evidence the accused man was ignoring DHS warnings. DHS nurse Elizabeth Hatch told the court that Mr Mwale first came to the attention of the department's Partner Notification Office - which monitors individuals suspected of recklessly spreading HIV - in December 2003. Mr Mwale was counselled on his obligations not to infect others and his file was closed because he was not considered a health risk. "No further action needed - case closed," said the file notes.

But in January 2005, a doctor notified the department after a newly diagnosed patient told the GP she had been infected with HIV by Mr Mwale. Ms Hatch told the court she interviewed Mr Mwale after the notification, when he admitted to having sex once with a woman outside of his marriage, but insisted he wore a condom. "We thought we really didn't have much evidence to say it was a public health risk if he had used a condom," she said. Ms Hatch said she contacted the doctor who had notified the department to check Mr Mwale's version of events against the time in which the patient had been diagnosed with HIV.

The doctor did not call back, she said, so the file was closed on March 10, 2005, with a note: "We have had no further contact from physician re time frames. No extra information so we will now close this case again." Under cross-examination by Mr Mwale's barrister, David Sexton, Ms Hatch agreed that she would have kept the case file open if she had any concerns that Mr Mwale was continuing to practice unsafe sex. When Mr Sexton asked why she did not continue to investigate the 2005 allegation against Mr Mwale after the GP did not call back, Ms Hatch said she believed the doctor concerned would monitor the accused man. "It was because I knew the doctor and I knew the clinic, and if they had been concerned or worried, they were very good at making sure things were followed up correctly," she said.

The court heard that nine months after closing Mr Mwale's file for the second time, the DHS became aware he had infected a woman other than the alleged victim in yesterday's case. At that point, a letter of warning to Mr Mwale was signed by then chief health officer Robert Hall, but orders restricting his behaviour were not issued until after police seized material during their investigations into the case. Mr Mwale was ordered to appear at the Victorian County Court on August 7.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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11 July, 2007

British bomb plot and Michael Moore-style health care

The legacy of Britain's socialized medical system is a growing reliance on foreign doctors, like seven of the eight suspects arrested in the failed London car bombing and Glasgow airport attack

There are many things wrong with U.S. health care, as there inevitably are with any health care system. The question is whether America wants to go down the British-Canadian-Cuban route, to name three government medical systems that Michael Moore admires in his new film "Sicko." Cuba, of course, is a totalitarian state, and even Hollywood celebrities, though they like to visit, wouldn't want to live there. (Incidentally, the best health treatment available on Cuba is at Gitmo.) The United Kingdom, by contrast, is a free society, but last week's incendiary Jeep Cherokee at Glasgow Airport has shone a rare light on the curious character of its government health system.

Of the eight persons arrested as of Friday in the terrorist plot, seven are doctors with the National Health Service (the eighth is the wife of one, and a lab technician at the same hospital). The bombs failed to go off because a medical syringe malfunctioned. I don't mean it malfunctioned as a syringe (even in the crumbling NHS, the syringes usually work) but as a triggering mechanism, to which it had been adapted, though evidently not too efficiently.

Does government health care inevitably lead to homicidal doctors who can't wait to leap into a flaming SUV and drive it through the check-in counter? No. But government health care does lead to a dependence on medical staff imported from other countries.

Some 40 percent of Britain's practicing doctors were trained overseas - and that percentage will increase, as older native doctors retire, and younger immigrant doctors take their place. According to the BBC, "Over two-thirds of doctors registering to practice in the UK in 2003 were from overseas - the vast majority from non-European countries." Five of the eight arrested are Arab Muslims, the other three Indian Muslims. Bilal Abdulla, the Wahhabi driver of the incendiary Jeep and a doctor at the Royal Alexandra Hospital near Glasgow, is one of over 2,000 Iraqi doctors working in Britain.

Many of these imported medical staff have never practiced in their own countries. As soon as they complete their training, they move to a Western world hungry for doctors to prop up their understaffed health systems: Dr. Abdulla got his medical qualification in Baghdad in 2004 and was practicing in Britain by 2006. His co-plotter, Mohammed Asha, a neurosurgeon, graduated in Jordan in 2004 and came to England the same year.

When the president talks about needing immigrants to do "the jobs Americans won't do," most of us assume he means seasonal fruit pickers and the maid who turns down your hotel bed and leaves the little chocolate on it. But in the United Kingdom the jobs Britons won't do has somehow come to encompass the medical profession.

Aneurin Bevan, the socialist who created the National Health Service after World War II, was once asked to explain how he'd talked the country's doctors into agreeing to become state employees: "I stuffed their mouths with gold," he crowed. Sixty years later, no amount of gold can persuade Britons to spend their working lives in the country's dirty, decrepit hospitals (they spend enough of their nonworking lives there, waiting to be seen, waiting for beds, waiting for operations). According to a report in the British Medical Journal, white males comprise 43.5 percent of the population but now account for less than a quarter of students at UK medical schools. In other words, being a doctor is no longer an attractive middle-class career proposition. That's quite a monument to six decades of Michael Moore-style socialist health care.

So today the NHS is hungry for medical personnel from almost anywhere on the planet, so hungry that the government set up special fast-track immigration programs: Mohammed Asha, Mohammed Haneef and their comrades didn't even require a work permit to come and practice as doctors in state hospitals. You don't have to be the smartest jihadist in the cave to see that as an opportunity, any more than it required no great expertise for the 9/11 killers to figure that the quickest place to get the picture IDs with which they boarded the planes was through Virginia's "undocumented worker" network. Everyone else from the Venezuelan peasantry to the Russia mafia knows the vulnerabilities of Western immigration systems, so why not the jihadists?

Maybe their mistake was trying to blow up the airport instead of wreaking subtler havoc on the infidels. Did you see this week's scare-of-the-week from the Chinese health system? "About 420 bottles of fake blood protein, albumin, were found at hospitals in Hubei province but none had been used to treat patients, said Liu Jinai, an official with the inspection division of the provincial food and drug administration."

Well, this being China, where public lies about public health are routine, we just have to take Liu Jinai's word that "none had been used to treat patients." But imagine what Doctor Jihad could get up to if he stopped trying to use the syringe as a detonator and just resumed using it as a syringe?

But beyond that the Glasgow Jeep story symbolizes a more basic reality. The NHS is the biggest employer in Europe, and it's utterly dependent on imported staff such as Dr. Asha and Dr. Abdulla. In the West, we look on mass immigration as a testament to our generosity, to our multicultural bona fides. But it's not: A dependence on mass immigration is always a structural weakness and should be understood as such. In the socialized health systems of the Continent, aging, shrinking populations of native Europeans will spend their final years being cared for by young Muslim doctors and nurses. Indeed, in the NHS, geriatric medicine is a field overwhelmingly dependent on immigrant staff.

And what of the other end of the medical business? Take Japan, a country with the same collapsed birth rates as Europe but with virtually no immigration. In my book, I note an interesting trend in Japanese health care: The shortage of newborn children has led to a shortage of obstetricians. For in a country with deathbed demographics, why would any talented ambitious med-school student want to go into a field in such precipitous decline? In Japan, birthing is a dying business.

Back at the Royal Alexandra Hospital, three doctors were under arrest, and the bomb squad performed a controlled explosion on a vehicle in the parking lot. Pulled from the flaming Cherokee, Dr. Kafeel Ahmed is now being treated for 90 percent burns in his own hospital by the very colleagues he sought to kill. But at one level he and Dr. Asha and Dr. Abdulla don't need to blow up anything at all. The fact that the National Health Service - the "envy of the world" in every British politician's absurdly parochial cliche - has to hire Wahhabist doctors with no background checks tells you everything about where the country's heading.

Source




Staff crisis cripples an Australian public hospital



HUNDREDS of patients have had their diagnoses for deadly afflictions such as cancer and strokes delayed because of acute staff shortages at one of Queensland's biggest hospitals. The Royal Brisbane and Women's Hospital is being forced to conduct rolling shutdowns of multimillion-dollar diagnostic equipment because of a lack of radiographers to operate the machines. The revelation is another blow to the State Government's claim that the struggling Queensland health system is "turning the corner" after a $10 billion funding injection over five years.

In a damning email obtained by The Courier-Mail, RBWH medical imaging technology director Paul Esdaile warned that equipment closures were expected to continue for months. "Due to the poor response to the recent advertising campaign attempting to attract radiographers, the department has no choice but to close some clinical rooms," he wrote in the email late last month. "There will be more to follow in the months ahead, as the chances of employing additional staff are very slim." The email outlined ongoing closure of equipment, including one outpatient MRI machine over the first two weekends of this month.

The adjoining Royal Children's Hospital is already in danger of having to mothball Queensland's only pediatric MRI scanner after the resignation of key staff members. The RBWH hierarchy is also being forced to conduct Monday- to-Friday shutdowns of one of its two outpatient CT scanners, which help doctors to diagnose ailments from cancers to internal injuries of accident victims. Other closures are also occurring on ultrasound and digital fluoroscopy machines, which diagnose throat cancer and strokes. Unofficial waiting times recently posted on hospital bulletin boards state there is a 60-day wait for a CT scan and a 148-day wait for an MRI scan.

One radiographer at the RBWH said medical imaging at the hospital was now in "meltdown". It is understood other hospitals, including the Mater and Princess Alexandra, are suffering similar difficulties keeping their machines operating at normal levels. A Queensland Health spokesman said there was a national shortage of radiographers and Queensland hospitals were not immune. RBWH acting chief executive officer Judy Grabes agreed the hospital did have a radiographer shortage and plans had been developed to ensure it did not "greatly" affect patients. "This means that some medical imaging rooms for non-urgent cases will be periodically closed," she said.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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10 July, 2007

FDA Delay In Cancer Therapy Is Attacked

It's the whole FDA system that is insufferably arrogant. As long as a drug has been shown to meet realistic safety criteria, doctors should be allowed to prescribe it to those it might help. Bureaucrats are the LAST people who should be making decisions about people's health

Oncologists do not usually need bodyguards when they present scientific data at a medical symposium. But when Howard I. Scher of the Memorial Sloan-Kettering Cancer Center and Maha Hussain of the University of Michigan spoke at a recent meeting of the American Society of Clinical Oncology, they were in fear for their safety. The two doctors have been at the center of an unusually bitter debate over an experimental therapy for prostate cancer, ever since they helped persuade the Food and Drug Administration to delay approving it, enraging both patients and investors. The first-of-its-kind therapy, called Provenge, is a "vaccine" designed to extend the lives of patients with advanced prostate cancer by stimulating their immune systems.

The debate over Provenge illustrates the highly charged atmosphere that often surrounds new treatments as the desperation of deathly ill patients increasingly converges with the high-stakes intensity of biotech investing in the anything-goes forum of the Internet. The result in this case has been anonymous threats, accusations of conflicts of interest, Capitol Hill protests, congressional lobbying and vitriolic postings on blogs, Web sites and MySpace pages. "This case may be different and all the more controversial because it's at the intersection of patient advocacy and the nervous world of biotech investors," said Daniel P. Carpenter, who studies the politics of health care at Harvard University. "It makes for a much more volatile politics."

A panel of experts recommended in March that the FDA approve Provenge. But in May, the agency instead asked for more evidence that the vaccine works after specialists, including Scher and Hussain, questioned its effectiveness. Scher and Hussain told the FDA that Dendreon Corp., the small Seattle biotech company that developed Provenge, submitted a study to win approval for the drug that was so small that the apparent benefit it showed could have been the result of chance.

The FDA's surprise decision unleashed a spasm of criticism by prostate-cancer patients, advocacy groups and investors in Dendreon. After the price of Dendreon's stock quadrupled and then plummeted, irate investors wrote hundreds of letters to the FDA and Congress, posted blistering critiques in Internet chat rooms, and created Web sites and MySpace pages denouncing the FDA, Hussain and Scher. They alleged various motives for the decision, including internecine rivalries within the FDA and pressure from larger rival drug companies. "Why else would they object?" said Ray Vestal, a Huntsville, Ala., investor. His "Approve Provenge Now" MySpace page asks, "Hey, Hey, FDA, How Many Dads Did You Kill Today?" as images of Hussain and Scher flash across a backdrop of crooked crosses and Mozart's "Requiem" plays. "Perhaps there's something else behind the scenes," he said.

Patients and advocacy groups, meanwhile, borrowing strategies from AIDS activists and breast-cancer advocates, mounted an orchestrated lobbying effort. They launched a letter-writing campaign and Web sites, staged a Capitol Hill rally June 4, and demanded and got a meeting with FDA Commissioner Andrew C. von Eschenbach the same day. They began lobbying to amend FDA legislation moving through Congress to allow easier access to experimental treatments. "The prostate-cancer community has probably been awakened for the first time. We're clearly upset about what has happened," said Thomas A. Farrington of the Prostate Health Education Network, which created the ProvengeNow.org Web site. "The true victims are the prostate-cancer patients whose lives could be saved. We're talking about terminally ill men, many of whom have no other options."

Scher and Hussain, meanwhile, began receiving anonymous e-mails, phone calls and letters attacking and sometimes threatening them.

The FDA said it continues to work with the company as it completes more research on Provenge. "Additional scientific data is required before a definitive decision can be made," spokeswoman Kristine B. Mejia wrote in an e-mail.

The campaign for Provenge has been seized on by other groups who want to make it easier for patients to get experimental therapies. "It's certainly glaring proof of what we've been talking about and the need for change," said Frank Burroughs of the Abigail Alliance, which advocates expanded access to developmental drugs and is suing the FDA in federal court. "What we're saying is that when you have a drug like Provenge, you should let people have access to it who have run out of options."

But that argument worries those who say the FDA needs to be more vigilant, not less, about ensuring the safety and effectiveness of new treatments to avoid another Vioxx debacle. "I certainly understand the desperation that patients feel," said Nancy Davenport-Ennis of the National Patient Advocate Foundation. "But at the end of the day, our society is protected through the system that we have and the process that assures us that when a drug is approved by the FDA, adequate testing has been completed to assure safety and efficacy."

Source




London hospital does not give a damn about infection control

Back to the 18th century

A hospital that is failing to tackle superbug infections has been served with an official warning in the first case of its kind, the health watchdog will announce today. Inspectors from the Healthcare Commission have found Chase Farm Hospital in Enfield, North London, to be in "serious breach" of the Hygiene Code, the latest government rules to manage healthcare-associated infections such as MRSA and C. difficile. Even basic requirements, such as providing hand-washing gels at a patient's bedside, were not in place, the watchdog said.

Barnet and Chase Farm Hospitals NHS Trust, which manages the hospital, has now been served with an improvement notice, ordering immediate changes to infection control practices. Despite reporting more than 600 superbug infections in a six-month period last year, there was "no evidence" that the trust learnt from its mistakes, the commission said. Among "fundamental problems" highlighted during a spot-check were failures to keep wards clean, to properly assess the risks of superbug infection and to isolate infected patients so that they could not spread illness.

The commission was given powers to issue improvement notices last year. This is its first. The Barnet and Chase Farm Trust, which had told the commission that it was meeting the three core standards relating to the Hygiene Code, was found during an unannounced visit on June 7 to be in breach of several key duties set out in the code. The trust was rated as "weak" in quality of services and use of resources in the 2005-06 annual health check by the Healthcare Commission. Its provision of potentially misleading information to the commission could affect its rating in this year's assessments of NHS Trusts.

According to latest figures from the Health Protection Agency, there were 584 cases of C. difficile in patients aged over 65 at the trust from January to September last year. From April to September 2006 there were 29 reported cases of MRSA. Updated figures are expected to be published by the end of the month. The problems, described as "wide--ranging and serious", included:

- A failure to provide and maintain a clean and appropriate environment for healthcare.

- A failure to provide adequate isolation facilities for patients already suffering from infections.

- A lack of appropriate management systems for infection prevention and control.

- A failure to assess risks of acquiring healthcare-associated infection and to take action to reduce or control them.

In addition, only one microbiologist, working four hours a week, was employed to monitor infections at the trust, which serves a catchment of 500,000 people. There was also no identified budget for training of staff in infection-control and attendance at such training was not monitored. Clinical staff were found to be "confused" about isolation policies, "indicating that they are not always adhered to".

The commission said in a statement: "Because the trust does not conduct analysis to determine the cause of infection on all patients confirmed to have MRSA, it is difficult for the trust to monitor and learn from outbreaks and incidents." It has now been given deadlines to address issues raised by the commission, with the local strategic health authority overseeing the work. Anna Walker, chief executive of the Healthcare Commission, said: "I hope this sends out a strong message to all trusts that we will not hesitate to use our powers when it comes to enforcing the Hygiene Code."

Richard Harrison, medical director at Barnet and Chase Farm Trust, said: "Our issues around infection control follow the national picture, but with an extra 500,000 pounds investment in cleaning the wards, screening patients before admission and our prudent antibiotic policy, the trust is winning the battle against hospital-acquired infections. The trust reported 74 new case of C. difficile in April and only 16 cases in June."

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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9 July, 2007

NHS only for the peasants: Doctors won't go there for their own treatments

MORE than half of the country’s hospital consultants have turned to private medical treatment instead of using the National Health Service. A survey commissioned by Bupa, the health insurer, found that 55% of senior doctors pay medical insurance, despite the reduction in waiting times for operations on the NHS. [No mention of the endemic superbug problem?]

The Patients Association, a pressure group, criticised specialists for spurning the NHS when most patients cannot afford private care. Katherine Murphy, communications director, said: “Those who work in the NHS at the highest level should have enough confidence in the system to use it themselves.” Consultants earn, on average, 110,000 pounds from their NHS work.

Dr Jacky Davis, a consultant radiologist in London and a founding member of the campaign group Keep Our NHS Public, believes doctors are deserting the NHS because they are no longer guaranteed special treatment. “Until recently, doctors could go to any of their colleagues for treatment for themselves or their family and that was accepted as one of the perks of working in the NHS. Now there is less leeway for doctors to treat each other,” said Davis.

Bupa surveyed 500 consultants, more than 90% of whom work in the NHS. All the consultants questioned carry out some private practice. Dr Natalie-Jane Macdonald, medical director of Bupa, said there was a gulf in the differing expectations of private medicine and the NHS. “The NHS target of having to wait no longer than 18 weeks by December 2008 is ambitious but our members would still see that as a very long time to wait,” she said. As well as having shorter waiting times, private hospitals advertise their lower rates of MRSA – the so-called superbug.

About 6m adults and children in Britain, one-tenth of the population, are covered by private medical insurance. Jonathan Fielden, chairman of the British Medical Association consultants committee, defended doctors’ preference for private treatment. “What consultants do with their own healthcare is very much a personal matter,” said Fielden. “Consultants will try to minimise the time they are away from work in order to maximise their ability to care for patients.” He also maintains that consultants might switch from the NHS to avoid being treated by colleagues or recognised by their own patients. He claimed that if the NHS could guarantee privacy by offering more single rooms, doctors would feel less need to go private. “This certainly isn’t a reflection of the consultants’ faith in the NHS,” he added.

Source




Discrimination against the English

A comment from Prof. Brignell on what the British government does to keep the Scots happy (i.e. give them more money):

Two elderly neighbours live either side of the English/Scottish border. The one to the north is entitled to free drugs to combat cancer, dementia or blindness due to macular degeneration. The one to the south is denied all of these. The body that is responsible for this denial not only has an Orwellian name, but also an Orwellian acronym. It is NICE, the National Institute for Clinical Excellence.




Australia: Sickbeds in public hospital corridors

Mexico, here we come!

HEALTH bosses have been forced to appoint a crisis manager to deal with a severe bed shortage at one of Brisbane's largest hospitals. In recent weeks, growing numbers of patients at the Princess Alexandra Hospital have been put on trolleys and treated in corridors because there are not enough beds available.

Now Queensland Health is copying a policy used by the National Health Service in Britain, in the hope it will speed up the process of finding beds for emergency department patients. The system, which will be in place from July 23, involves a nurse acting as a bed monitor to find beds within the hospital. An emergency department source, who refused to be named because of a Queensland Health ban preventing staff from speaking out, fears the policy will backfire. "Nurses with a full patient load should not be made to leave assigned patients to run up and down the corridors. This is a substandard way of treating patients."

Queensland Health spokeswoman Kirrily Boulton declined to discuss staff concerns. A member of the PA Hospital district executive said patients would be transferred to a bed as "quickly as possible upon arrival in the wards". "This system will help ensure that emergency staff can focus their attention and resources on critically ill patients as they arrive," he said.

Australian Medical Association Queensland president Dr Ross Cartmill, who works at the PA, said the hospital needed an extra 100 beds. He said surgery had been cancelled in past weeks because patients on trolleys were cluttering areas around operating theatres. "There aren't enough staff to look after patients on trolleys as well as beds and it can become dangerous," he said. "As well as the safety issue, it is also an inadequate way to treat patients in terms of privacy."

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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8 July, 2007

SICKO misrepresents the NHS

Comment from Britain

The film is Sicko, a two-hour take-down of the mighty US healthcare industry directed by and starring the potato-faced Michael Moore (he of Bowling for Columbine, Fahrenheit 911 and subject of too many right-wing diatribes to count). In it, Rick is an uninsured sadster who loses two fingers to a chainsaw and has to talk hard cash with an accountant before his general anaesthetic. It'll be $12,000 to reattach the easy finger, he is told; $60,000 for the pair. Rick goes for the budget option.

Fully half of Sicko is devoted to envious glimpses of better-run, more equitable and more compassionate healthcare systems in other countries, such as Canada (where another power-saw victim gets all five digits reattached for nothing) and Britain, where Moore would clearly choose to live if he didn't have such an avid following and such comprehensive health insurance at home. "Keep your British health system," he told one of our reviewers after a screening on Skid Row in LA. "Never get rid of it. It's a wonderful thing." He has also made the mistake of calling British healthcare "free".

Let us be clear: Michael Moore is amiable, fearless and funny, especially when provoked. He is also a brilliant film-maker who has transformed his genre in the US, where documentaries now pack out cinemas from coast to coast. You can take this as official. I have met him and liked him and am entirely trustworthy. The same cannot be said of Moore, of course. He is routinely denounced as a misleading, self-serving propagandist by critics who fail entirely to grasp that these are his great strengths.

When Moore barged his way into General Motors headquarters, and American culture, while making Roger & Me in 1988, it was about time. Here at last was a booming, populist, shamelessly blinkered voice from the American Left to answer those that had boomed unanswered from the Right throughout the Reagan years. Small wonder that he found a far-from-fringe constituency and became embarrassingly rich.

Moore's European critics, in particular, continue to misunderstand his challenge and his audience. They delight in exposing his crafty way with "facts", as if the corporate interests he attacks weren't just as crafty. They worry that the millions of Americans who pay to see his output might actually believe everything he says, as if, being Americans, they lack the power of critical thinking. And they forget that many of those millions of Americans do in fact, quite reasonably, share Moore's view that GM ignored its social responsibilities when Japanese competition hit home; that Kmart never had any business selling lethal handgun ammo to kids; and that when Charlton Heston raised a rifle in defiance a few days after the Columbine high-school massacre, he was a berk.

Moore, by contrast, was the man-grizzly who stood up to the idiot president of the NRA and lived to tell the tale. He was my hero. But now he has started spouting nonsense about the NHS, and he should know it's nonsense, and know that we know. It goes without saying that healthcare on the NHS isn't free. But just how unfree it is gets too little attention. We pay for it through our noses, every month.

Next year's NHS budget will be about 104 billion. That's roughly 1,733 pounds per man, woman and child. Multiplied by four for a typical two-child family, then divided by 12, that equates to median monthly family healthcare expenditure of 577, or $1,155 in American money. I can buy some very respectable US health insurance for $1,155 a month. In fact, on a quick and painless stroll through the website for Kaiser Permanente, a leading nonprofit US healthcare provider, entering my basic family details and the Beverly Hills zipcode, the most expensive family policy I can find that does not depend on contributions from the state or an employer costs $400 less than the sum Gordon Brown currently chooses to spend from my taxes, each month, on the NHS.

Being honest, I must add a few hundred to my US bill to cover "deductibles" and the portion of my US taxes going to federal schemes like Medicare and Medicaid. But I must also cop to earning more than the UK average, which means I pay more than average for my NHS care; through the nose, as I say.

American roadworks tend to be adorned with signs announcing, "Your Tax Dollars at Work". There should be signs saying "Your Tax Pounds at Work" at the entrance to every NHS hospital and surgery, and whenever "at work" fails to describe what goes on inside them, taxpayer-patients should whinge like hell. They may not like it. They may not think it British, but nothing else is working and in the meantime they are being royally ripped off.

Really? But aren't waiting lists down, as Mr Blair used to tell us every Wednesday? I would refer the Right Honourable gentleman to a recent ruling by the Canadian Supreme Court in favour of a man who sued to be allowed to buy insurance to speed up an operation. "Access to a waiting list," the court found, "is not access to healthcare."

Forty-seven million Americans are uninsured. This is a problem. Several million more are inadequately insured. Another problem. But that leaves more than 200 million fully insured Americans who've never heard of waiting lists. I envy them.

Source




NHS shuffles the deckchairs again

The Government sought to regain the initiative over the NHS yesterday by announcing another review. It was heralded by Alan Johnson, the Health Secretary, as "unprecedented", and will be conducted by Sir Ara Darzi, a distinguished surgeon who has been drafted into the Department of Health as a junior minister. The main aim of the review seems to be to win over NHS staff to the reform agenda, but critics are interpreting it as a sign of weakness.

Mr Johnson promised that the review would be different from the one two years ago that led to the White Paper Our Health, Our Care. He acknowledged that staff morale was low and affecting the public's perception of the NHS. "We've put a lot of money in, but that hasn't led to a lot of happy bunnies," he said. "If there's a problem with morale, it's our responsibility, and it's our responsibility to put it right. The bit that has gone wrong is taking the public with us." Sir Ara, who will travel round the country gathering information, has been given four tasks:

* Putting clinical decisions at the centre of NHS care;

* Improving patient care, particularly for those with long-term and life-threatening conditions;

* Making care more accessible and convenient;

* Establishing a vision for the next decade based "less on central direction and more on patient control".

His problem will be that the reforms of Tony Blair were not intended to make staff happy, but to change the NHS culture, inctroducing market forces and the private sector. Persuading staff that further reforms are in their interests may be difficult. In a statement to the House of Commons, Mr Johnson said that Sir Ara's review represented a "once-in-a-generation opportunity to ensure that a properly resourced NHS is clinically led, patient-centred and locally accountable". But the announcement provoked a sceptical reaction.

The British Medical Asociation and the Unison union welcomed the review. The pressure group Keep Our NHS Public said that it did not go far enough. Nick Bosanquet, Professor of Health Policy at Imperial College, London, and consultant director of the Reform think-tank, said: "It is not clear why another review is needed to go over these general issues again which have been well covered in two reviews in the last five years. A year-long review risks damaging delay when practical solutions are needed now. "Urgent problems include the redefinition of [the Private Finance Initiative] to a more local programme, the need to empower local staff to get value for money and the [removal of] barriers to the involvement of independent sector companies. All these issues need clear action and a way forward in weeks rather than years."

Andrew Haldenby, director of Reform, said: "This is exactly the wrong moment to kick health policy into the long grass. The evidence is mounting that the Department of Health's reform drive has lost momentum just as the service's big funding increases come to an end. "The focus of government should now be on delivering reform rather than reopening a debate on the direction of policy that was actually resolved years ago."

Niall Dickson, chief executive of the King's Fund think-tank, said that the proposed review must be not be a signal to reverse important reforms to the service and that the terms of engagement must be clear. "It is important that the Government does not raise expectations among staff or the public that cannot be met," he said.

Andrew Lansley, the Shadow Health Secretary, told the Commons: "The only thing the Secretary of State seems to have understood is that morale in the NHS is at rock bottom. Where is the autonomy and accountability that the NHS is so calling out for? Where is the leadership and direction that the NHS so badly needs?"

* Mr Johnson also announced another 50 million pounds to help to tackle infections such as MRSA and Clostridium difficile. This will be used to double the size of the department's infection improvement team [More bureaucracy is going to solve anything?], groups of experts who advise NHS trusts on developing plans to cut infections.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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7 July, 2007

Two Muslim bombers were rejected for hospital jobs in Australia -- but fine for Britain's good old NHS!

Two of the men arrested over the weekend terror attacks in Britain applied to work as doctors in Western Australian but were rejected - and at least one is related to the young Gold Coast doctor set to spend a week in secure custody.

As new links emerged in the car bomb investigation last night, a Brisbane magistrate gave police approval to detain Mohamed Haneef - arrested at Brisbane airport on Monday night on suspicion of being connected to a terrorist group - for another four days. Dr Haneef is the cousin of Sabeel Ahmed, 26, one of seven suspects detained in Britain, and may have been related to another suspect arrested when a Jeep Cherokee exploded at Glasgow airport.

The West Australian branch of the Australian Medical Association, which runs a recruitment agency in the state, last night revealed that Dr Ahmed and his brother Kafeel had applied for work but had been rejected. Dr Haneef and Sabeel Ahmed worked together in Britain. According to reports, Kafeel is also known as Khalid Ahmed, who suffered life-threatening burns when he drove the Jeep packed with petrol and gas canisters into the Glasgow terminal building.

London's The Daily Telegraph said Dr Haneef and the two Ahmed brothers were born and raised in Bangalore, India, and graduated with medical degrees from the Rajiv Gandhi University.

AMA state president Geoff Dobbs said the association had also rejected an application from Gold Coast doctor Mohammed Asif Ali, who worked with Dr Haneef and drove him to the airport before the suspect's laptop was found in his car. "We believed their qualifications and references did not meet the standards required in Western Australia," Professor Dobbs said, adding that one of the three had made repeated applications for work. The Medical Board of Western Australia last night refused to comment on the case, while its Queensland equivalent offered no fresh information.

Before leaving Britain last year, Dr Haneef left his mobile phone SIM card with Sabeel Ahmed. Reports suggest the prime suspect in the bombings, Jordanian-trained doctor Mohammed Asha, contacted Dr Haneef via email and text messages. Dr Haneef's family insist he is innocent.

The eight detained suspects are doctors or have medical links, and a British cleric claims to have been warned by an al-Qa'ida figure in Iraq in April that "those who cure you will kill you". Police found suicide notes left by the occupants of the Jeep, which allegedly indicated they intended to detonate the vehicle while still inside. Allegations emerged that Bilal Abdulla, a suspected passenger in the Jeep, was associated with a hardline Muslim group in 2004.

Police have been interviewing Dr Haneef's colleagues, some of whom trained in India and worked in Britain, amid fears of a "sleeper cell" in Australia. The case has renewed debate over overseas-trained doctors and prompted Queensland Senate candidate and One Nation founder Pauline Hanson to call for free medical degrees for Australians to bolster the system.

Source




Google supports "SICKO"

They are apologizing because one of their employees criticized it!

In a world of 24/7 news cycles, a summer weekend can bring considerable -- and unanticipated -- excitement. Take for example the reaction we've just seen to an item on our new health advertising blog. Frankly, we were surprised by the pickup, but perhaps we shouldn't have been. We've been proponents of corporate blogging for some time, despite the significant communication challenges that obviously arise from having many voices from all parts of our company speak publicly through blog posts. In this case, the blog criticized Michael Moore's new film "Sicko" to suggest how health care companies might use our ad programs when they face controversy. Our internal review of the piece before publication failed to recognize that readers would -- properly, but incorrectly -- impute the criticisms as reflecting Google's official position. We blew it.

In fact, Google does share many of the concerns that Mr. Moore expresses about the cost and availability of health care in America. Indeed, we think these issues are sufficiently important that we invited our employees to attend his film (nearly 1,000 people did so). We believe that it will fall to many entities -- businesses, government, educational institutions, individuals -- to work together to solve the current system's shortcomings. This is one reason we're deploying our technology and our expertise with the hope of improving health system information for everyone who is or will become a patient. Over the last several months, we have been blogging about our thinking in this area. See: November 30, 2006, March 28, May 23, and June 23, 2007.

In the meantime, we have taken steps on our own to address the failures we see in our health care system. In our case, the menu of health care options that we offer our employees includes both direct services (for example, on-site medical and dental professionals in certain locations) as well as a range of preventive care programs. It's one of the ways we're attempting to demonstrate corporate responsibility on a major issue of our time.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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6 July, 2007

REAGAN ON SOCIALIZED MEDICINE

Most posts on this blog concentrate on the details of how badly socialized medicine works in practice. There is however a case to be made against socialized medicine IN PRINCIPLE -- and the audio clip below is a reproduction of a speech made by Ronald Reagan many years ago which covers just that.

Double click on the image below to hear a great speech from a great man:

(Via STACLU)




An Australian State government deliberately slack on doctor standards

The New South Wales Government has been accused of being slow to act on a plan to tighten national scrutiny of foreign doctors. The Australian Doctors Trained Overseas Association says it has developed a national agreement, including a set of standards, to assess the clinical abilities of all foreign doctors. But the association says that the other states are unwilling to sign off on the new agreement, because NSW Health is dragging its feet.

The association's president, Andrew Schwartz, says he believes that NSW does not want to join the agreement because it will interfere with its ability to recruit doctors. "The NSW public health system recruits most of its doctors from overseas and rates them as occupational trainees and they are actually not not doing any trainee work," he said. "They are just doing ordinary service work." "Because of the wording of what they are called, they avoid that assessment process that everybody else has to go through by the NSW Medical Board."

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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5 July, 2007

SICKO OR PINKO?

From start to end, SiCKO, the latest "documentary" from notorious writer and filmmaker Michael Moore, is a stunning example of the Big Lie. Almost shockingly devoid of fact and context, it's instead based on highly selective, emotionally-driven, and deeply flawed anecdotes, strung together by writer-director-producer Moore's trademark folksy, soft-spoken, whimsical personal narrative. SiCKO (the unusual capitalization is Moore's conceit) is not a documentary at all, but a naked propaganda exercise on behalf of full-bore socialism. A better title for it would be Pinko.

The intent is to mislead rather than to inform or enlighten. SiCKO strikes me as even worse than Moore's previous, problematic long form works, the anti-gun Bowling for Columbine and the rabidly anti-Bush Fahrenheit 9/11.

SiCKO is opening today in limited release. Originally scheduled to open "wide" theatrically in the U.S. on June 29, its distributors have just announced that its formal opening has been pushed up one week, with pre-release "sneak previews" also now scheduled in 27 urban markets around the country. These developments are in the wake of a big publicity push for the film over the last few weeks, pulled off with the complicity of the mainstream media, and considerably boosted by viral marketing.

In mid-June, a 124 minute-long version of SiCKO-apparently the complete final cut-began appearing in fairly high quality streams and downloadable files on the Internet, allowing for an early review. (As of this writing, it is unclear if a copy of SiCKO was actually "leaked" to the Internet, or whether it's popping up on an offshore Web site that facilitates peer-to-peer file sharing and for a time on YouTube was just another ploy in the film's manipulative viral marketing plan. In a search of Google News yesterday thousands of website posts already highlighted the "SiCKO leak," further calling attention to the movie with tons of free publicity in the crucial days before its official commercial release.)

It may not be surprising that a polarizing political icon like Moore, with a hefty fan base, has produced another piece of pure Leftist cant, but the brazenness, magnitude, and absolute chutzpah inherent in this latest sleazy project are surely greater orders of magnitude over the top than any of his earlier work. It's as if he believes that he's finally connected with an issue-socialized medicine (or "universal health care")-that is poised to change history-to wrestle private enterprise-driven health care to the ground, once and for all, and to snuff the last breaths of freedom, autonomy, and choice out of it.

In this big picture sense, the film (despite its limitations it's an obvious benefit to the cause) struck me as far more overwhelming, dangerous, and insidious-and ultimately more shameless and ambitious in its agenda-than I had imagined it would be. (Never underestimate the Left, I guess.) The fact that it has received mostly good early notices, including by the Fox News Channel's reviewer who saw it at the Cannes film festival in May ("brilliant" and "uplifting" he called it), speaks volumes about the mainstream media's inability to review a new work without ideology, ignorance, or confusion, or some combination of the three, ruling the day.

My fear after seeing SiCKO is that it may become the most highly applauded and influential of Moore's films (not least because of his timing, which is very much in sync with the new and potentially unstoppable political push in the U.S. on behalf of government-controlled universal health care).

Before I sat down to watch SiCKO, I felt that I already knew way more than I wanted to about Moore, his M.O., and this particular production. As a journalist reporting on the complexities of American health care for three decades, I've charted with dismay the gathering momentum towards a government takeover of the field. I wasn't prepared, however, for the extent of the other freebies Moore wants to flow unhindered from the government on down. Free college education, free day care, government-compensated months' long maternity leave, and even state workers going into the homes of new mothers to do their laundry and other chores without charge-in other words, Socialism with a capital S that will lead, Moore and his ilk hope, to the complete socialist-statist "paradise" imagined by him and his heroes (including Che, Hugo, and Fidel).

Such an overarching theme would be absurdly funny if it weren't so deadly dangerous-if Moore were not, in effect, playing with fire. But our society is now teeming with people who are ready to take Moore's kind of nonsense completely to heart, conditioned and taught as they have been since birth that they have a "right" to everything they think they deserve, just by being here.

The education industry, the media, politicians and special interest groups have prepared people to anticipate nothing less than complete accommodation of their needs and wants. And now, "health care as a right" has been added to the growing list of entitlements. Since most Americans have yet to agree to go willingly into this bleak and government-controlled future, the current crop of left politicians is adopting a centralized model, such as they admire in France and Cuba, to forcefully take all of us there. And along with the expansion of these myriad new "rights" to "free" health care go the extinction of many of our freedoms.

A June 2007 public opinion poll of residents in Massachusetts by Suffolk University found that "an overwhelming number, 92 percent, said everyone has a right to health care." The website of the non-profit foundation run by former Democrat Congressman from Iowa Berkley Bedell, who used his influence with Iowa Democrat Sen. Tom Harkin to force the National Institutes of Health to start spending hundreds of millions of dollars on complementary and alternative medicine, says that "Cuba" is the "model for alternative medicine" in the U.S.

Moore plays these themes like a virtuoso-actually like a hot new conductor, baton in hand, standing before a full symphony orchestra that's tuning up and waiting for direction. Even the American Medical Association, for decades vehemently opposed to "socialized medicine," has joined the chorus. In 2001, the AMA added to its "Principles of medical ethics," which its members must subscribe to, this one: "A physician shall support access to medical care for all people."

With news of SiCKO's subject and plot (including the film maker's and his cast members' potentially illegal trip to Cuba) all over the media, I thought I was prepared for what I'd see on the screen. But the way the film actually proceeds, leading up to its final half hour, with Moore gauzily rhapsodizing everything about life in socialist France (which has one of the most firmly entrenched, nanny state entitlement cultures anywhere) and then in communist Cuba, is astonishing. Meanwhile, Moore completely whitewashes the sclerotic, inefficient, and stagnant mess that socialism (including its socialized medical system) brought to the French economy. Only now, as the center-right of French politics has begun reforming the worst socialist absurdities (the 30 hour work week for example) is France throwing off some of its torpor. Cuba's failed, frequently deadly and murderous Marxist police state doesn't matter, because both countries have freebies to offer!

And Moore has managed to find in France and Cuba personalities out of central casting, who come across as hip, smart, empathetic, and successful professionals, and get them on film singing their country's praises!

The absence of any actual, verifiable information, and essential context, about the big and extremely complex subject at hand (health care, after all, represents one-sixth of the entire U.S. economy) is appalling, but that probably won't bother either the hard core collectivists and statists who will eagerly pay to see this thing or the fans of the expanding entitlement culture, who will root for SiCKO's commercial success and, more to the point, the progress of Moore's single payer universal health care agenda in the evolving national political debate.

Fortunately, a number of Web sites and blogs, and even competing filmmakers, are taking Moore and his fellow travelers to task for their misrepresentations, omissions, and obfuscations. To correct just two of the lies:

* Moore throws around a figure of "50 million uninsured Americans." It's more accurate to report that the number of Americans who are uninsured cannot be verified. A significant percentage, however, can afford insurance but choose not to buy it. In addition, as many as one-third of the uninsured are eligible for Medicaid or other free government programs but fail to apply for them. And, ultimately, "uninsured" does not mean without access to care.

* Literally every day, the mainstream media in the countries whose government-run medical systems Moore holds up as superior models publish stories documenting the failure of mandatory, no-opt-out, state-run medical care. The laundry list of ills, in the U.K. alone, includes patients waiting months or even years for critical drugs and treatments (sometimes becoming disabled or dying because of the delay or lack of care), people denied therapies altogether because of rationing or cost (see, for example, an article last February in The Scotsman, "Cancer patients told life-prolonging treatment is too expensive for NHS"), an explosion in the size of the medical bureaucracy, and thousands of physicians taking to the streets earlier this year to protest.

One bottom line, so to speak, is particularly telling: Moore, who is obese, would most likely be denied a number of common health care procedures and treatments in one of his favored government-controlled socialist medicine systems, the U.K.'s National Health Service (NHS), because of his excessive weight. Recently, the cash-strapped NHS actually started limiting or prohibiting therapies for residents who are fat or who smoke cigarettes or drink alcohol.

Oh, but these are just details, after all, that would only get in the way of the misty-eyed collectivist party line. This past week, preaching to his chorus, Moore engaged in a first round of high gloss soft ball interviews and media appearances including on ABC TV's Good Morning America, Nightline, and The View, and he was the only sit down guest on David Letterman's CBS TV show on Friday June 15.

Earlier in the week, Moore spent a day at the California state capitol in Sacramento, headlining a rally for single payer health care, appearing at a press conference with leading Democrat politicians, and-hold on to your hats-testifying as an expert witness at a California Senate hearing advocating single payer socialized medicine in the nation's biggest state. (The hearing, captured by the California Channel's cameras, starts 39 minutes and 20 seconds into the streaming Windows Media video file at this url.)

All of this posturing, needless to say, is truly sickening. . . including the vision of Moore as a pied piper of endless freebies, a Santa Claus (one can easily imagine him actually playing that role) with a bottomless bag of gifts. What we're seeing, with SiCKO not even in theaters yet, is the attempt at the final push over the finish line for the complete takeover of American health care by the government-potentially the biggest change in the way medicine is practiced in the U.S. since the time of the Founding Fathers.

Unfortunately, judging by the media's fawning reception, and the promises by many politicians to deliver up mandatory government-run universal health care a la Moore with the '08 elections, it really feels like the fix is in.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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4 July, 2007

It has not occurred to European governments that pregnancy is a private matter

Universal European regulations for fertility treatment are needed to reduce legal differences between countries that are encouraging “reproductive tourism”, one of the Continent’s most senior IVF specialists said yesterday. National laws banning infertility therapies that are available elsewhere in the European Union are denying couples the chance to start a family and driving others to seek expensive treatment abroad, according to Professor Paul Devroey, of Brussels Free University.

Many assisted reproduction techniques that are considered to be best practice in some EU member states are heavily restricted or outlawed in others, and safety measures introduced in parts of Europe are contravened routinely elsewhere. Germany and Italy, for example, ban embryo-freezing, egg donation and embryo-screening for inherited diseases, forcing couples who need these services to pay for treatment in countries that permit them, such as Britain, Spain and Belgium.

Thousands of British couples who require donated eggs have become fertility tourists, travelling to Spain, Cyprus and Eastern Europe. Britain has a long waiting list, mainly because donors can be paid a maximum of just 250 pounds for expenses and lost earnings.

Rules on the maximum number of embryos that can be transferred to a woman’s womb also differ widely, despite the scientific consensus that the safest policy is to limit implants. In Britain, Scandinavia and the Low Countries, only one or two embryos may be used, to prevent multiple births, by far the biggest hazard of IVF treatment. Germany and Italy insist that every embryo created is implanted, increasing that risk.

Professor Devroey, chairman of the European Society of Human Reproduction and Embryology (ESHRE), told The Times that there was an urgent need for uniformity based on the best scientific advice, to secure access to effective treatments and to protect patients. He is setting up a task force to compare legislation and to propose a basic set of standards, and he wants the European Commission and the European Parliament to consider how rules might be harmonised. “The human right to reproduction and access to assisted reproductive technology \ for infertile couples should be preserved in similar legislation throughout Europe as part of a unified strategy to address human infertility,” Professor Devroey said. “These laws should aim to ensure that ART treatment is safe, constructive and reimbursed. The reality, however, is that legislation varies greatly between countries in Europe. Some countries, such as Belgium and the UK, take a very rational and liberal approach to ART and implement practice guidelines or/and legislation in response to published data. In contrast, other countries appear to dismiss or misuse scientific findings, which may increase the risk to the mother or child.”

Speaking at State of the ART, a satellite meeting held before the ESHRE annual conference in Lyons, which opens today, Professor Devroey said he accepted that countries would want to set their own policies on controversial issues such as treatment for lesbians and single women. Similar standards should apply, though, when the scientific evidence was clear. “There is only one human body and human reproductive system,” he said. “It is quite astonishing that well-proven treatments are not allowed in some countries, some of which also have laws on embryo transfer that are not in the best interests of patients’ health. What this has done is to build medical tourism into a billion-euro market. It’s very sad for me to see patients coming to my clinic because their countries’ own laws are needlessly restrictive, and sadder still for the patients.”

Bill Ledger, of the University of Sheffield, said that he agreed with Professor Devroey’s sentiments but doubted whether EU action would be possible or desirable. “He is absolutely right that some countries have over-restrictive policies that are bad for patients, but I am not sure that going to the EU is the best way to resolve this,” Professor Ledger said. “It is hard to see politically how Germany and Italy will be persuaded to take another line, and once Brussels gets involved you never know what you will end up with. It could be that the more conservative countries will try to overturn the liberal systems we have in Britain, Belgium and the Netherlands, as they have attempted with stem-cell research.” The EU would do better to look into basic clinical standards for fertility treatment, so that IVF patients in every country could be assured of high-quality care, he said.

Source




HEALTHCARE AND LIFESPAN

Not as closely connected as many critics say

Health care actually has a fairly small effect on our health and life expectancy! This sounds silly to a lot of people. They know that life expectancy has increased dramatically in the last 100 years, and is better in the rich world than in poorer countries. They figure modern health care is responsible for this, and that without it, you would die young. This is not the case.

One way to separate out various factors is to look at history. According to the Census Bureau, white male life expectancy at birth in 1900 was about 48 years. It’s now about 76 years (28 year increase). For white women, it went from 51 years to 81 years (30 year increase). But remember that there was very little of what we'd call effective medicine in the early part of the century. According to Wikipedia, penicillin was not used to treat disease until 1942. What they had were public health measures, such as malaria and hookworm eradication, improved sanitation, improved water supplies and food supplies. Most people didn't have access to a doctor, and there wasn't much the doctor could do for you anyway. (read The Youngest Science, by Lewis Thomas).

Despite that, by 1940, life expectancy was at 63 years for men, 67 years for women. So 15 of the 28 years for men and 16 of the 30 years for women was due to public health measures, not any kind of advanced medicine. Even today, this is the main difference between rich and poor countries.

After 1940, antibiotics and vaccines become available, and going to a doctor becomes worthwhile. Primary care is the next tier of the medical system. It includes some prenatal care, giving birth in a (clean) hospital, treatment of infections, etc. Let's say that era goes to 1970. By then, male life expectancy is 68 and female is 75 years. So we've gotten another 5 years for men and 8 years for women from primary care (the extra gains for women are probably a result of reducing the risk of childbirth.)

That leaves 8 years improvement for men and 6 years for women since 1970, which covers the era of intense high-tech care in the U.S. All the expensive stuff, from MRIs to cancer treatments to organ transplants, is in this category (Wikipedia says that transplants routinely failed until the discovery of cyclosporine in 1970.) So of all the improvements we've had in life expectancy, public health and primary care (the cheap stuff) have been responsible for most of it.

This sounds surprising, but it should agree with your intuition. Most people are healthy most of their lives. Their mothers get a little prenatal care, they get some vaccinations, maybe some mild childhood ailments (infections, etc.), perhaps a broken bone. Then nothing much until old age. Sometime after age 60, they die of one of the big three – heart disease, cancer or stroke. None of these is particularly treatable even now. Half of all cancer patients survive less than 5 years, as do half of heart attack victims.

Much more here

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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3 July, 2007

An unhealthy burden: America's health-care market is not as unfettered as it seems

TO MANY outside the United States, America's health-care system might seem an example of capitalism at its rawest. Europeans and Canadians enjoy universal health care and cheap drugs thanks to government-run systems, the argument goes, but the market-based approach taken by the world's richest nation leaves many millions uninsured and leads the rest to pay the highest drugs prices in the world. Such doubts are sure to be reinforced by this week's release of Michael Moore's "Sicko", a much-trumpeted new film on health care that bashes the free-market Yankee model even as it praises the dirigiste alternative north of the border.

So is America's health system really red in tooth and claw? Hardly, according to a growing body of academic evidence. As a result of interference at the federal and state levels, health care is one of America's most heavily regulated industries. Indeed, its muddled approach to health-care regulation may act as a massive drag on the American economy-what one expert has called "a $169 billion hidden tax".

Costing an arm and a leg

That figure comes from a path-breaking study* of a few years ago by Christopher Conover of Duke University. It looked at the many ways in which the American legal and regulatory systems affect the provision of health services and lumped them into five categories: medical torts; the Food and Drug Administration (FDA); insurance regulation; and the certification of both health professionals and health facilities. His team concluded that the overall benefit to society of $170 billion per year delivered by this system of oversight was far outweighed by the $339 billion in annual costs that it imposed (see chart). Even ignoring the cost of big federal tax breaks for employer-sponsored health insurance (which Mr Conover left out), his study estimated that the net cost of America's health regulations resulted in perhaps 4,000 extra deaths each year and was responsible for more than 7m Americans' lacking health insurance.

Building on this point, a forthcoming paper+ by Michael Cannon of the Cato Institute, a libertarian think-tank in Washington, DC, investigates the biggest federal component of this regulatory burden: the FDA's oversight of pharmaceuticals. It notes that some 20 cents out of every dollar spent by consumers goes on purchases under the purview of the FDA, which it calls "one of the most pervasive federal agencies in the country."



Citing the best evidence to date on the costs and benefits of FDA regulation, Mr Cannon argues that the agency "is too slow and demands too much testing", ultimately harming consumers. He points out that drugs regulators can make two broad types of errors. First, they might approve a drug too quickly, only to find out after its launch that it is dangerous or even deadly. Second, they could delay the launch of a highly innovative drug by demanding onerous or unnecessary trials and thereby deny many needy patients a new therapy.

Proper regulation requires balancing these two risks, but the pitch may be queered by bureaucratic self-interest. If the regulator allows even one drug to slip through the approval process that later proves harmful to some people some of the time, a hue and cry is sure to follow. Look no further than the recent public backlash against the FDA after several deaths were linked to Vioxx, a blockbuster pain remedy made by Merck.

And yet the second (and probably bigger) risk of leaving people untreated because of restrictions on drugs rarely gets the regulators into trouble. As Mr Cannon puts it, "no FDA official has ever been fired or faced a congressional inquiry for delaying the approval of a promising new drug, however unjustified the delay." What is more, he speculates, big drug firms may quietly acquiesce to this burdensome red tape because it acts as a barrier to entry against newcomers without the cash or lobbying power to navigate the FDA.

The FDA's caution may result in the biggest federal "tax" on health care identified by the Conover study but an even bigger component is to be found in America's distorted system of malpractice insurance, which is regulated at the state level. That is the conclusion of John Graham of the Pacific Research Institute (PRI), a think-tank in San Francisco. In a paper++ published this month, Mr Graham has taken Mr Conover's federal analysis and applied it to all 50 states. The idea is to rank which states allow Americans the greatest amount of "health ownership".

Mr Graham's analysis concludes that because regulation of health insurance and overzealous pursuit of medical torts are both typically handled at the state level, states are to blame for most of that $169 billion annual burden imposed by excessive health-care regulation (as the chart also shows). The heavy-handedness, he notes, includes groups of surgeons being denied permission to open specialist clinics because rival one-size-fits-all hospitals invoke state regulations protecting their patch. Meanwhile, enterprising "nurse-practitioners" are blocked from offering simple treatments at inexpensive clinics by state rules requiring costly supervision by doctors.

New York-a liberal bastion and home to Hillary Clinton, who in the 1990s unsuccessfully advocated a sweeping reform of America's health provision-comes out rock bottom on the PRI ranking of health freedom. That will undoubtedly please conservatives who still deride her earlier proposals for a government-run health system, which they dub "HillaryCare". But the unstated and awkward inference of these studies will not. If America's health-care regulations are as costly as they claim, the system is merely masquerading as a free-market model and may be no better than others.

Source




A big wait in the public hospital system of Victoria, Australia

Crippled woman faces 3-year surgery wait

A PENSIONER who cares for her invalid husband while hobbling around on crutches faces a three-year wait for ankle surgery. Jennifer Haffenden, 65, says she is barely able to care for herself because of an excruciating arthritic ankle. She thought help was in sight, until she looked more closely at her appointment card for the orthopaedic specialist at Maroondah Hospital. "I thought it was for this year and I nearly turned up before I realised it was June 2008," she said. By that time, the Croydon pensioner will have been waiting 14 months. She is then likely to be put on another waiting list for surgery, for up to 18 months.

"It's very short sighted because the longer people have to wait for an operation, the worse the problem gets and the more it's going to cost," she said. Mrs Haffenden said her ankle had degenerated over the past three years and she resorted to crutches six months ago because she "hit the roof" in pain every time she put weight on it. Out of desperation, she went to an orthopaedic specialist as a private patient a few months ago.

The specialist told her she could operate within two weeks. But with the bill expected to hit $4000, Mrs Haffenden was forced to go on the 14-month waiting list to see the same specialist as a public patient. Mrs Haffenden also has Meniere's disease, a disorder of the inner ear that causes vertigo and vomiting, and has heart problems. Husband Roy, 79, is recovering from recent back surgery, is in a back brace and has serious heart problems.

Mrs Haffenden said that as well as caring for her husband, she also helped her 91-year-old mother, who lives in a retirement home. "It is really very difficult," she said. "The Government can find money for non-essential things, like millions of dollars for sport or giving themselves a pat-on-the-back pay rise, and I don't see why they can't give more money to hospitals," she said.

Opposition health spokeswoman Helen Shardey said Mrs Haffenden's case was a typical example of the falling standards of health care. However a Government spokesman said significant commitments had been made to reduce waiting lists and speed up service delivery. This included funding an extra 72,000 outpatient appointments in this year's budget as part of a $324 million promise to provide 200,000 new appointments. A spokesman for Eastern Health, which runs Maroondah Hospital, said he was not aware of Mrs Haffenden's case but urged her to return to her GP if she was unhappy or believed her condition had changed. Her GP could then reassess her case and liaise with the hospital about finding a more suitable appointment. [Translation: You CAN get prompt treatment but it takes publicity]

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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2 July, 2007

British medical bureaucrats defeated

Individualist doctor too successful -- and hounded because of it. My post of Jan. 23rd. details just how evil this witchhunt was

The head of the Government's fertility watchdog was under pressure last night to resign after raids on the clinics of Britain's most successful IVF doctor were ruled unlawful, leaving the regulator facing a legal bill that could exceed 1 million pounds. Warrants authorising the search of Mohammed Taranissi's two London premises in January were quashed yesterday by the High Court, after the Human Fertilisation and Embryology Authority (HFEA) admitted that it had presented insufficient evidence to justify them. It had been investigating claims that the doctor had practised illegally without a licence.

The authority has agreed to pay most of Mr Taranissi's costs, which his lawyers estimate at 1.2 million - more than a tenth of the regulator's annual expenditure of 11.3 million - and its own costs are also thought to be substantial. As the HFEA is funded by the Department of Health and fees from clinics, the bill will be passed on ultimately to taxpayers and private infertility patients.

The HFEA's humiliation led senior doctors, MPs and patient groups to question the position of Angela McNab, the chief executive who ordered the raids and applied for the warrants. Lord Winston, the prominent fertility expert, said: "This is further evidence of the complete incompetence of the HFEA and the need for the workings of this organisation to be radically reviewed. With the loss of this amount of public money, the chief executive . . . will presumably need to consider [her] position." Evan Harris, the Liberal Democrat MP, said: "There is a real question as to whether the admitted inadequacy in her evidence when obtaining the warrants and the error of judgment in failing to settle the case until now means that the chief executive's position is untenable."

Mark Hamilton, chairman of the British Fertility Society, which represents IVF professionals, asked the Department of Health to conduct a formal inquiry. "The regulator needs to be accountable, and it needs to maintain the trust and confidence of the sector," he said. "In this case, this has not happened. It is a matter of grave concern that so much money has been spent on something that has ultimately come to nothing."

The High Court ruling may also influence an HFEA hearing on July 13 that will consider the original allegations against Mr Taranissi and that could withdraw his licence to treat patients. His lawyers said yesterday that they would be applying for the return of all the documents that were seized illegally. The HFEA applied to search Mr Taranissi's clinics in January on the same day that a BBC Panorama documentary alleged that he had treated patients without a licence, a criminal offence. The authority was widely criticised by doctors for appearing to co-operate with the programme.

In March Mr Taranissi was granted permission to seek judicial review of the warrants, which he argued were "unjustified, disproportionate and unlawful". The High Court rejected a further claim that the HFEA had acted out of improper purpose.

Mr Taranissi said yesterday: "The events in January of this year were hugely distressing for those of our patients and staff who witnessed them. "I am obviously very pleased about the outcome, but continue to be dismayed that our regulatory body saw fit to present to the magistrates on the day of the raids information described by a judge at an earlier hearing as seriously defective and highly misleading. "The cost to the taxpayer of this exercise must be enormous. It grieves me that money, estimated to be in excess of 1 million, which could have been spent on research or genuine issues of patient safety has instead ended up in the pockets of the lawyers. "The whole episode raises serious public interest questions about the way the HFEA acted in this case."

The authority insisted the ruling would not affect its licence committee hearing on Mr Taranissi. "We would wish to stress that the HFEA acted in good faith, and on advice," a spokeswoman said. "Our aim is to protect patient safety and ensure patient choice and we regret any distress that may have been caused to Mr Taranissi's patients." Ms McNab was not available for comment.

Source




Diagnostic testing of children in trouble because an Australian State government is too mean to pay public hospital staff properly



A LEADING radiographer has revealed how severe staff shortages are putting public hospital patients at risk. Ben Kennedy resigned from the Royal Brisbane Children's Hospital last month because working for Queensland Health left him "burnt out" and unable to work safely. Speaking for the first time since resigning, the 35-year-old said patients were waiting too long for scans, and radiographers were suffering from working long hours with constant on-call commitments.

He said he was forced to work on-call for up to eight weeks at a time, sometimes finishing at 2am and starting again at 7am. "It's the equivalent of being drunk at work," said Mr Kennedy, who starts a new job tomorrow at a private radiology clinic. "You're dealing with critically ill patients, like babies with tumours, and if I had made a mistake because of tiredness, I would be the one who would be burned for it. "I had no choice but to work because there was no one else, but in the end I had to let my feet do the talking."

Mr Kennedy was one of two radiographers qualified to use the state's only pediatric MRI scanner. He set up the service two years ago, enabling thousands of children to receive diagnoses. His departure has left hospital bosses desperately trying to find a replacement. Mr Kennedy said Queensland Health had failed to provide other staff to undertake the three-month training program because of shortages. Queensland Health is suffering from a severe shortage of radiographers. At the Royal Brisbane Hospital there is a shortfall of about 17 staff. Radiographers warned more than a year ago they would walk out unless wages were increased by 40 per cent, in line with other states.

Mr Kennedy said more staff would follow him by the end of the year unless an agreement was met. "The work we do is taken for granted," he said. "Nothing in the hospital can happen without imaging, but the Government doesn't realise this. "A high percentage of children end up going for lifesaving surgery because of what our scans detect. Instead of recognising this, the Government goes around telling everyone we are just on a big money-grab, and if we blow the whistle and speak to the press then they can sack us."

Mr Kennedy started his career at Queensland Health in 1993, and has also worked at a public hospital in London. "In the UK, they went out on a limb to keep radiographers," he said. "They sent me on courses to further my education and did a great job trying to retain their staff. "Queensland Health does not adequately acknowledge the specialised skills that many radiographers have, or the years of postgraduate study required to do this work. "It is just all about crisis management and throwing a heap of money at something when it goes really wrong."

Queensland Health is in wage negotiations with unions representing radiographers. A Government spokesman denied radiographers were overworked or that there was a staff shortage. "Radiography staffing levels are determined on the basis of patient demand and the need to deliver safe, timely services," he said.

Source

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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1 July, 2007

Socialized Medicine Showdown

It's time for some GOP spine on health care

While most of Congress scrapped over immigration this week, a small band of Republicans doggedly toiled behind the scenes on quite a different subject. National Economic Council Director Al Hubbard and health secretary Mike Leavitt shuttled to and from the Hill; Senators hashed out the topic at a steering committee lunch; congressmen canvassed members, wrote and wrote legislation. Even President Bush gave a speech on the subject, exhorting his party to get it together.

The result--if Republicans know what's good for them--may be a broad new GOP health-care vision, a free-market reform to replace today's faltering employer-based system. The party has circled this for years, throwing out free-market ideas here and there, yet never proved unified (or brave) enough to get behind one bold, top-to-bottom reform. Democrats are now forcing their hand.

The setting is the upcoming debate over the State Children's Health Insurance Program, or Schip, a brawl that could well determine the future direction of U.S. health care. Democrats see expanding Schip as the first step toward socialized medicine. If Republicans fail to meet that challenge with their own more compelling plan for market-based, consumer-driven reform, it may prove the beginning of the end of today's private model.

If that sounds dramatic, consider the Democrats' strategy. The left still bears the wounds of HillaryCare, and knows that even with spiraling health-care costs, the nation still has little appetite for an abrupt shift to all-government care. So they've developed a craftier approach, one that takes longer but gets them to the same end. The new plot is to enact national health care one citizen at a time, slowly expanding the reach of existing government programs until they encompass the population.

Schip is the first step. The program, with its $25 billion budget, was originally designed to provide insurance to only the poorest children. Democrats want to throw an additional $60 billion at it, expanding Schip's rolls by three million. They would expand eligibility so much that as many as half joining would drop private insurance to do so. Even adults could sign up.

Next: Even as Democrats work to expand Schip to cover older Americans, they'd expand Medicare to cover younger Americans. House Energy and Commerce Committee Chairman John Dingell is said to have recently floated the idea of allowing the struggling Big Three auto makers to enroll workers in Medicare at the age of 55, or 10 years early. Consider this a pilot program for dropping Medicare's age limit overall and instantly subjecting tens of millions more Baby Boomers to the government's tender care.

Democrats will meanwhile argue the only way to pay for Schip and other expanded programs is to gut Medicare Advantage and similar free-market reforms. See how clever? Swallow up ever more Americans into federal programs, banish any last vestiges of popular market plans, and voilà! It is Hillarycare! Only nobody ever had to use the dreaded word!

Republicans beat back the original HillaryCare by warning about Canadian waiting lines, but a negative message alone won't do this time. Our third-party-payer system, while still stacks better than France, is nonetheless collapsing--and Americans know it. Republicans can't simply be against socialized care, while not being for anything else. The left also chose its first battle wisely, with a program for "the children." The GOP's only Schip response so far has been to grouse about cost. And it's realizing a message of "We're for the children, just not as much as them," isn't a political winner.

This week's backroom talks--led by health-care innovators Tom Coburn and Jim DeMint in the Senate, and Paul Ryan and Jim McCrery in the House--were therefore about getting beyond Schip. The goal: a system that eliminates today's corporate subsidy and gives the money to individuals, cutting costs and reducing the number of uninsured. The political message: Dems want to put a few million more under government control for $60 billion, Republicans want to put 300 million in charge of their own care at zero extra cost.

The good news is that after 10 years of tinkering, Republicans have laid the foundation for bigger reform, from Health Savings Accounts to tort liability reform. The more intense policy debate this week instead focused on the biggie: how to revamp the tax code to get that money to individuals. On one side are tax wonks, among them Sen. Jon Kyl, who prefer giving every American a tax deduction--as President Bush has advocated. They argue it does the least damage to the tax code, and is less of a handout. On the other side are health-care wonks, among them Sen. Coburn, who prefer a refundable tax credit. They argue it does more to help with the uninsured, and is coincidentally a better political sell.

By the end of this week, the architects were coalescing around a tax-credit approach, on the belief it will attract the most GOP support. In a signal of White House approval, President Bush deliberately noted in his speech Wednesday that a tax credit would have a "similar outcome" to his deduction plan, and that he was "open to further discussion." Word was that Republican leaders were also climbing on board, with all concerned hoping to debut something big in coming weeks.

The challenge then will be to get the rest of the party to overcome its nervelessness on health care. The ringleaders of today's effort admit they may have to do a Sen. Phil Gramm, who in 1993 led by example, singlehandedly tearing into HillaryCare, proving his position a winner with voters, and pulling his colleagues in line. They'll need to roll up their sleeves. Most Republicans don't understand health care, so don't want to talk about it; many grimace at voting down money for "kids"; quite a few face tough elections and would rather not jump into an unknown debate. Reformers also aren't getting cover from should-be allies. Insurers and lobby groups like PHRMA--who ought to understand that a bigger Schip is a threat to their long-term business--are instead focused on short-term profits and PR images. Republican governors--who'd be huge beneficiaries of an individualized market--seem to only care about keeping federal dollars flowing into state coffers.

Democrats will hail a Schip victory as an example of how they can help Americans on their top concern of health care. They want to ride it to the White House and to bigger congressional majorities, making it that much easier to institute incremental national health care. If Republicans don't unify now, they might not get a better chance.

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Australia: Public dentistry meltdown

THE true extent of the state's dental crisis can be revealed for the first time today, with figures showing a backlog of almost 200,000 people awaiting treatment. Of those, more than 45,000 are children living with tooth decay and oral disease so severe it could turn life-threatening. Exclusive waiting figures obtained by The Daily Telegraph show for the first time our decaying dental health industry. This is the first time in three years the data has been revealed and it shows on May 31 there were 178,876 waiting in NSW for dentistry, including 45,339 children. At one Sydney hospital, almost 60 patients were treated for dental infections so severe their airways were closed off.

The growing list reveals a country in crisis, with new Medicare data showing the federal dental scheme for people with chronic diseases has had poor uptake. Despite 650,000 Australians awaiting dental treatment, only 4027 in NSW have accessed the scheme in three years.

Federal Opposition health spokeswoman Nicola Roxon said: "This is more evidence that the Government is investing in the wrong area with dental health." A spokeswoman for federal Health Minister Tony Abbott said the project would pick up later in the year when new money from a Budget announcement of $378 million takes effect.

But Association for the Promotion of Oral Health chairman Hans Zoellner said the scheme was "a waste of money" and was flawed because it relied on a complicated referral system. "Government has increased funding but we think the medical barriers to getting to the funding are too high and that is a big mistake." Dr Zoellner said the high number in NSW awaiting treatment is creating a generation whose preventable dental decay is turning into chronic, life-threatening illness.

The Daily Telegraph understands up to 60 patients have been treated at Westmead Hospital this year with dental infections so severe their airways became closed. New research from The Australian Consumers Association released yesterday revealed 30 per cent of adults avoided dental care because of the cost, one quarter had untreated tooth decay and more than 20 per cent had moderate to severe gum disease.

And with recent medical studies showing poor oral health is a contributor to conditions like cardiovascular disease and diabetes, families across the country are now turning to charities for help. Armidale toddler Mark Schumacher was unable to eat and was living in pain and discomfort because the three-year-old's tooth enamel had worn away. Faced with a wait of up to 15 months for surgery, his mother Tracy pleaded for help and a local dentist did the procedure for free. "His four top teeth had no enamel and he wasn't eating - now we can't stop him eating," his relieved father told The Daily Telegraph. "He's eating fruit and everything now -- he was barely eating at all before."

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

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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