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31 July, 2009

ObamaCare Will Rid Us of Useless Eaters



Some old Nazi propaganda above. A quick translation: "60,000 Reichsmarks is what this born-disabled man costs the peoples' community during his lifetime. People's comrades, this is your money. Read "New People", the monthly magazine of the race-politics bureau of the National Socialist German Workers' Party"

The defeat of Nazi Germany was a big setback for the progressive cause, but under Chairman Zero, it's making up ground fast. A key player in his bid to seize control of the healthcare industry is Ezekiel Emanuel, brother of top teleprompter programmer Rahm "Dead Fish" Emanuel. Ezekiel

wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.

Many doctors are horrified by this notion; they'll tell you that a doctor's job is to achieve social justice one patient at a time.

Emanuel, however, believes that "communitarianism" should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens … An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).

Translation: Don't give much care to a grandmother with Parkinson's or a child with cerebral palsy.

Here's how Ezekiel defends denying healthcare to the elderly:

Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years (Lancet, Jan. 31). You had your chance to be young. Now you're done paying taxes so die already.

Welcome to Logan's Run.

SOURCE




What Obama Doesn't Know Can Hurt the Rest of Us

President Obama admits he doesn't know about major parts of the House health care bill, but he's promoting the measure anyway. He's violated a cardinal rule of salesmanship: Know your product. Nobody should buy from a salesman willing to make false claims.

When asked in his blogger phone conference about Section 102 and its destruction of private health coverage, Obama replied, "You know, I have to say that I am not familiar with the provision you're talking about." Anyone who even skims the 1,018-page bill finds this part immediately; it's right at the start, actually beginning with Section 101, and it would impose restrictions on private health insurance. (The entire bill is available online at fixhealthcarepolicy.com.)

The ability of private carriers to make a profit is curtailed. One provision empowers a presidential appointee to dictate how much profit or administrative costs will be permitted.

Obama's approach is stealthier than President Clinton's 1993 proposal for a total health care makeover. Realizing that whoever controls the payment system can call the shots, Obama has chosen the takeover route. Supplant private insurance with a government-run program and government now has control. Takeovers are the vogue, in health care as in banking, mortgages and auto-making.

So let's look at the consequences, and then the details.

Polling shows 77 percent of Americans are satisfied with their existing coverage. Too bad for them: 88 million Americans would be forced out of their current private health plans, with 83-million of them pushed into a government-run plan. That means almost half of everyone with private coverage today would lose it very soon. (The numbers come from a Lewin Group report, commissioned by The Heritage Foundation.) Remaining private plans would then wither and be supplanted more gradually.

President Obama simply doesn't like private enterprise. He told NBC News' Nancy Snyderman last week, "A whole lot of people are having bad experiences because they know that recommendations are coming from people who have a profit motive."

So he's backing a bill that would drive private health plans into government-sponsored oblivion by destroying their ability to succeed.

How? By outlawing the methods used by private insurance to control costs and hold down the premiums you pay:

Section 101 outlaws new health benefits plans that don't meet the new federal requirements.

Section 102 requires existing employer group plans to meet the new requirements within five years.

Section 111 requires insurers to accept anyone regardless of previous health, without limits or conditions. Presumably, you could enroll after arriving at the hospital and still be covered for whatever problem sent you there.

Section 113 requires charging the same premium to everyone, varying only by age and geography. No discounts for non-smokers, non-drinkers, fitness buffs, healthy eaters or anything else. It also limits higher premiums based on age, thereby increasing the premiums charged to younger people.

Section 114 outlaws any limits on coverage of mental health and substance abuse.

Section 115 shifts authority over networks of health care providers, moving them from state regulation to federal control.

Section 116 is the real kicker. If insurers are able to turn a profit despite the federal restrictions and public plan competition, they must give back much of that profit to their customers, as dictated by a new federal bureaucrat. This so-called "medical loss ratio" gives power to a presidential appointee, the new Health Choices Commissioner, to dictate the permitted level of administrative costs and profits.

Even without these provisions, the bill gives an automatic advantage to the new public health plan. The public plan uses price controls, requiring doctors and hospitals to accept Medicare-designated payment amounts. Typically, these are significantly lower than private plan payments, often paying less than the cost of providing the care. (This is why so many doctors today refuse Medicare patients.)

Private plans lack this power, so doctors, hospitals and clinics will offset their public plan losses by shifting the costs onto the bills of their other patients -- making private plans even costlier. The Lewin study estimates this cost-shifting will add an extra $460 per person per year to the cost of private insurance. That worsens the automatic disadvantage they have of competing against a taxpayer-subsidized government plan.

Trying to rush this 1,018-page bill through Congress before the public disenchantment grows worse is like a midnight burglar trying to grab all the goods before the homeowners wake up. When the president doesn't know what's in a bill, that's a sign everybody else should start finding out. Ignorance may be bliss for some, but not for the rest of us.

SOURCE




Does Obama believe what Obama is saying?

Listening to President Obama explain "his" health care plan, I can't help but wonder if he actually believes his own words. Maybe it's been so long since the adoring press corps has held him accountable for his innumerable exaggerations, omissions and misstatements that he believes he can create a new reality simply by speaking it into existence. However, for anyone who's been paying attention, the President's recent health care pep rally disguised as a press conference was littered with statements that just don't square with reality:

- Obama: "So let me be clear: if we do not control these costs, we will not be able to control the deficit." Here, the President comes so close to the truth as to stare into its eyes before veering away like an over-correcting teenage driver on a country road. Medicare and Medicaid, the government's previous forays into health care, are devouring the budget and exploding deficits. Controlling the costs of those programs should be the target, but few in Congress have demonstrated the courage to do so. Instead, Obama's prescription is to fix these fiscal disasters by expanding government's authority over what's left of the voluntary private health care market. That's like your doctor wanting to break your right arm to be sure he sets your broken left arm correctly.

- Obama: "I have also pledged that health insurance reform will not add to our deficit over the next decade - and I mean it." Reminds me of the famous "read my lips" pledge by the first President Bush. We all know how well that worked out. Congress has consistently under-estimated the costs of government health care programs. Medicare cost $3 billion when first implemented in 1966. At that time, costs for 1990 were estimated at $12 billion (allowing for inflation), but actual costs in 1990 were $107 billion - or 791% greater. When the Congressional Budget Office pegs the cost of ObamaCare at an opening bid of $1 trillion (others estimate as much as $4 trillion), that should scare the pants off anybody who cares about how deeply in debt we bury our children and grandchildren.

- Obama: "In addition to making sure that this plan doesn't add to the deficit in the short-term, the bill I sign must also slow the growth of health care costs in the long run." CBO economists recently told a Senate committee that the current legislation, which the President admits he "isn't familiar with," would actually make matters worse by "significantly expand(ing) federal responsibility for health care costs." Over the long run federal spending would keep rising at an "unsustainable pace."

- Obama: "It will keep government out of health care decisions, giving you the option to keep your insurance if you're happy with it." What's the point of this huge expansion of the federal health care bureaucracy if not to put government - instead of silly, selfish citizens - in charge? If the President really believes what he says, then the prescription is simple: repeal federal laws governing private health care. That's the surest way to "keep government out of health care decisions." That, however, would undermine the nanny-statists inherent desire to regulate and tax everything that might adversely affect your health. And then why would you need government? Instead, Obama and the Democrats demand that you purchase insurance, micro-manage the coverage you must buy, empower the IRS to penalize you should you refuse, and establish a government commission to decide which treatments your doctor can provide for you.

All this from the President who says, "When you hear the naysayers claim that I'm trying to bring about government-run health care, know this: They're not telling the truth." Whatever you say, Pinnochio

SOURCE




Health care: We don't need the Lexus

by Jeff Jacoby

IMAGINE THE SORT OF CAR you'd drive if government regulations made it illegal to sell any automobile that didn't feature 380-horsepower direct-injection V6 engines, computer-controlled electric power steering, eight-speed automatic transmission, four-wheel-drive, automatic climate control (including humidity and smog sensors), "smart key" technology, touchscreen navigation, backup cameras, LED headlights, acoustic glass, surround-sound stereo, and leather seat stitching.

If those were the minimum requirements every car had to meet before it could be offered for sale, would you commute to and from work every day in a Lexus LS 460 or some other luxury vehicle? Well, you might, if the steep price wasn't an obstacle. But it's more likely you wouldn't be driving at all. If the government barred you from buying anything but a high-end car, you might have no choice but to rely on the bus or subway, or to find a job closer to home.

Make the Lexus mandatory, and fewer people would drive

Lawmakers can decree that every car on the road be a Lexus or its equivalent, but they can't make driving more luxurious for all. They can only make it more expensive -- and for many drivers, unaffordable. And what is true of transportation is true of everything else: Raise the number of amenities that a product or service must include, and more consumers will be unable to pay for that product or service.

That is why one of the simplest strategies for making health insurance more affordable is to reduce the minimum number of benefits that insurers are required to cover.

In every state in the union, legislators and regulators drive up the cost of health care by making insurance policies more comprehensive. Rather than allow the free market to determine which medical services health plans will cover, states force consumers to pay for an array of covered benefits they may not need nor want. For example, 45 states require insurance policies to include treatment for alcoholism and 34 mandate coverage of drug abuse treatment. By law, contraceptives are covered in 31 states, as are hairpieces in 10 states, and in vitro fertilization in 13 states. It is not unusual for consumers who want health insurance to be forced to buy coverage for services they may consider highly dubious, such as acupuncture (benefits are mandatory in 11 states), chiropractic (46 states), osteopathy (22 states), and naturopathy (4 states).

Forty years ago, there were only a handful of benefits that health policies were required by law to cover. Today, the Council for Affordable Health Insurance identifies an astonishing 1,961 mandated benefits and providers. While any one mandate may not add appreciably to the price of an insurance policy, in the aggregate their cost is huge. The Cato Institute, citing the Congressional Budget Office, estimates that state regulations increase the cost of health insurance by 15 percent. And since "each percentage-point rise in health insurance costs increases the number of uninsured by 300,000 people," as scholars John Cogan, Glenn Hubbard, and Daniel Kessler point out, it is clear that the proliferation of insurance mandates is one reason why millions of Americans are uninsured.

Yet instead of pruning back this thicket of compulsory benefits, lawmakers are busily planting even more of them.

As Kay Lazar reported in the Boston Globe on Monday, Massachusetts legislators have filed more than 70 bills this year to increase the array of services the state's health insurers are required to cover. Among the benefits the pending bills would mandate are hearing aids for children, cleft palate surgery, treatment of infantile cataracts, 48-hour hospital stays following a mastectomy, smoking cessation products, "asthma education," vitamin supplements for mitochondrial disease, post-partum depression screening -- and the list goes on and on.

As it is, health insurance in Massachusetts -- which already mandates coverage for more than 40 itemized benefits, providers, and patient populations -- is among the nation's most expensive. The last thing the Bay State (or any state) needs is for government to be driving the cost of medical coverage higher still. It should be left to the market, not to lawmakers and lobbyists, to decide which medical services should be included in a basic-vanilla insurance policy. When lawmakers yield to special-interest pleas that this or that benefit be made compulsory, the results are less choice, higher premiums, and more individuals priced out of the market.

The key to health care reform is lively competition, not the dead hand of government compulsion. Legislators, take note: Enacting new mandates won't make medical insurance more affordable. Repealing old ones just might.

SOURCE




ObamaCare: It’s not about money

People have always quarreled about money, and sometimes these conflicts conceal a deep animosity.

President Obama has made Health Care Reform a priority for his first year in office. His website promises that his program will "Reduce costs, guarantee choice, including a public option, and ensure quality care for all." The big claim is that the President's Health Care Reform will be a vast improvement compared to the present system.

Supporters of the President's initiative point out that health care spending is enormous, that the price of health insurance for businesses and individuals is increasing and becoming unaffordable, and that the consequences of failing to bring down costs is dire. They argue that only the government can make things right.

But critics of the President's plan are warning that it will bring about both lower quality health care and will have a more expensive price tag. Free market advocates point out that government health care programs - such as Medicare - not only do not save money but also have ballooning costs that exceed their original forecasts.

It does not help the case for the Obama plan that the Congressional Budget Office has estimated that the proposed program will increase health care spending in the United States - exactly the opposite of what its supporters claim it is intended to do.

Of course, ObamaCare enthusiasts say that the Congressional Budget Office is mistaken, and even if spending goes up for a few years, costs will be reduced in the long run under wise government guidance.

So we have two factions slugging it out. The Obama team, representing the statist approach, insists that its plan will economically make the nation healthier. Free market advocates, the principled opposition to increased government intrusion, are convinced that Obama's Health Care Reform will be extravagant and ineffective.

You might imagine that the way to resolve the conflict between the partisans is to find a fair way to forecast what health care spending would be with and without ObamaCare. But that would miss the point, because the dispute is not really about cost: it is about who will control health care. Statists yearn for a system where the government is in charge, while free marketers want individuals to make their own decisions. Both sides are focusing on health care spending because they know that cost is always important, and saying you are thrifty while your opponent is wasteful makes for a good talking point. But in their attempt to be persuasive the antagonists are deliberately sidestepping the core issue.

Consider the typical attitude of the ObamaCare advocate: he believes that people often make foolish choices and health care is an area where they need to be 'nudged' to make wise decisions. Of course, the assistance should come from experts who are empowered by the government to 'assure the right choice is made.' He understands that when the government becomes the major player in health care it has the power to control costs - by rationing services, if necessary. And rationing does not bother him because he feels that a lot of health care expenditures are currently wasted and there is a need for a more sensible way--other than the unbridled choices of individuals--to decide who gets treated and how.

If the ObamaCare enthusiast believed that total spending on health care would go down if the government refrained from fiddling he would not be impressed. A health care system that is allowed to go its own way, that relies on markets, that is not centrally planned is odious to him. It is worthwhile to spend more money on health care if the result is a system managed by progressives who are looking out for 'the interests of society as a whole.'

And what is in the mind of the free marketer? He knows that each person owns his life and has a natural right to manage it for himself. He understands that the proper role of government is to protect natural rights - not to direct the lives of individuals. He appreciates that people have the capacity to make intelligent choices, and that when some people act imprudently, it is not a justification for a government takeover. He knows that when government extricates itself from meddling in the health care system the result will be more innovation, better services, and less expensive costs. But it is the importance of freedom, not saving money, that is the essential reason to proscribe government interference.

If the free marketer believed that additional government intervention in health care would result in reduced spending he would not be impressed. A health care system---and a human life---that is managed by a central authority is unacceptable. It is worthwhile to spend more money on health care if the result is a citizenry that is self-reliant and not subjugated to the will of the government.

People have always quarreled about money, but the ObamaCare debate is about much more.

SOURCE





30 July, 2009

Britain's Left-run NHS deliberately kills off older people

Do you really think Obamacare will be different?

Older women with breast cancer are less likely to receive “standard” treatments such as chemotherapy, radiotherapy or surgery than younger women, a report says today. Only 16 per cent of patients over 65 received chemotherapy compared with 77 per cent of patients under 50, according to an audit of British health services by the charity Breakthrough Breast Cancer. A total of 48 per cent of women aged 80 and over did not receive any type of surgery, compared with 3.5 per cent of women aged under 50. Only 42 per cent of women aged 65 and over received breast-conserving surgery, compared with 51 per cent of women under 65. Meanwhile, only 31 per cent of breast cancer patients over 80 received radiotherapy, compared with 78 per cent of patients under 50.

The audit, which was published in the British Journal of Cancer, analysed 48,983 cancer patients from 11 regional cancer networks. Breakthrough Breast Cancer said that although some of the findings could be accounted for by some women not wanting some of the treatments or surgery, the figures were too high to be explained through patient choice alone.

Maggie Alexander, the charity’s director of policy and campaigns, said: “Breakthrough is concerned that there appear to be significant differences in treatment given to patients depending on their age. “All women should be offered appropriate treatment options no matter what their age, and that’s why we are now investigating this issue to find out what lies behind these differences.”

Gill Lawrence, the director of the West Midlands Cancer Intelligence Unit, who led the project, added: “We encourage breast units to review their services and to identify ways in which they can be improved. “Although the data in this report are for breast cancers diagnosed in 2004, we are confident that the data highlight issues that still exist today.”

SOURCE




Is There a ‘Right’ to Health Care?

In Britain, its recognition has led to substandard care

By THEODORE DALRYMPLE

If there is a right to health care, someone has the duty to provide it. Inevitably, that “someone” is the government. Concrete benefits in pursuance of abstract rights, however, can be provided by the government only by constant coercion.

People sometimes argue in favor of a universal human right to health care by saying that health care is different from all other human goods or products. It is supposedly an important precondition of life itself. This is wrong: There are several other, much more important preconditions of human existence, such as food, shelter and clothing. Everyone agrees that hunger is a bad thing (as is overeating), but few suppose there is a right to a healthy, balanced diet, or that if there was, the federal government would be the best at providing and distributing it to each and every American.

Where does the right to health care come from? Did it exist in, say, 250 B.C., or in A.D. 1750? If it did, how was it that our ancestors, who were no less intelligent than we, failed completely to notice it? If, on the other hand, the right to health care did not exist in those benighted days, how did it come into existence, and how did we come to recognize it once it did?

When the supposed right to health care is widely recognized, as in the United Kingdom, it tends to reduce moral imagination. Whenever I deny the existence of a right to health care to a Briton who asserts it, he replies, “So you think it is all right for people to be left to die in the street?” When I then ask my interlocutor whether he can think of any reason why people should not be left to die in the street, other than that they have a right to health care, he is generally reduced to silence. He cannot think of one.

Moreover, the right to grant is also the right to deny. And in times of economic stringency, when the first call on public expenditure is the payment of the salaries and pensions of health-care staff, we can rely with absolute confidence on the capacity of government sophists to find good reasons for doing bad things.

The question of health care is not one of rights but of how best in practice to organize it. America is certainly not a perfect model in this regard. But neither is Britain, where a universal right to health care has been recognized longest in the Western world. Not coincidentally, the U.K. is by far the most unpleasant country in which to be ill in the Western world. Even Greeks living in Britain return home for medical treatment if they are physically able to do so.

The government-run health-care system—which in the U.K. is believed to be the necessary institutional corollary to an inalienable right to health care—has pauperized the entire population. This is not to say that in every last case the treatment is bad: A pauper may be well or badly treated, according to the inclination, temperament and abilities of those providing the treatment. But a pauper must accept what he is given.

Universality is closely allied as an ideal, ideologically, to that of equality. But equality is not desirable in itself. To provide everyone with the same bad quality of care would satisfy the demand for equality. (Not coincidentally, British survival rates for cancer and heart disease are much below those of other European countries, where patients need to make at least some payment for their care.)

In any case, the universality of government health care in pursuance of the abstract right to it in Britain has not ensured equality. After 60 years of universal health care, free at the point of usage and funded by taxation, inequalities between the richest and poorest sections of the population have not been reduced. But Britain does have the dirtiest, most broken-down hospitals in Europe.

There is no right to health care—any more than there is a right to chicken Kiev every second Thursday of the month.

SOURCE




10 Questions for Supporters of 'ObamaCare'

1. President Barack Obama repeatedly tells us that one reason national health care is needed is that we can no longer afford to pay for Medicare and Medicaid. But if Medicare and Medicaid are fiscally insolvent and gradually bankrupting our society, why is a government takeover of medical care for the rest of society a good idea? What large-scale government program has not eventually spiraled out of control, let alone stayed within its projected budget? Why should anyone believe that nationalizing health care would create the first major government program to "pay for itself," let alone get smaller rather than larger over time? Why not simply see how the Democrats can reform Medicare and Medicaid before nationalizing much of the rest of health care?

2. President Obama reiterated this past week that "no insurance company will be allowed to deny you coverage because of a pre-existing medical condition." This is an oft-repeated goal of the president's and the Democrats' health care plan. But if any individual can buy health insurance at any time, why would anyone buy health insurance while healthy? Why would I not simply wait until I got sick or injured to buy the insurance? If auto insurance were purchasable once one got into an accident, why would anyone purchase auto insurance before an accident? Will the Democrats next demand that life insurance companies sell life insurance to the terminally ill? The whole point of insurance is that the healthy buy it and thereby provide the funds to pay for the sick. Demanding that insurance companies provide insurance to everyone at any time spells the end of the concept of insurance. And if the answer is that the government will now make it illegal not to buy insurance, how will that be enforced? How will the government check on 300 million people?

3. Why do supporters of nationalized medicine so often substitute the word "care" for the word "insurance?" it is patently untrue that millions of Americans do not receive health care. Millions of Americans do not have health insurance but virtually every American (and non-American on American soil) receives health care.

4. No one denies that in order to come close to staying within its budget health care will be rationed. But what is the moral justification of having the state decide what medical care to ration?

5. According to Dr. David Gratzer, health care specialist at the Manhattan Institute, "While 20 years ago pharmaceuticals were largely developed in Europe, European price controls made drug development an American enterprise. Fifteen of the 20 top-selling drugs worldwide this year were birthed in the United States." Given how many lives -- in America and throughout the world – American pharmaceutical companies save, and given how expensive it is to develop any new drug, will the price controls on drugs envisaged in the Democrats' bill improve or impair Americans' health?

6. Do you really believe that private insurance could survive a "public option"? Or is this really a cover for the ideal of single-payer medical care? How could a private insurance company survive a "public option" given that private companies have to show a profit and government agencies do not have to – and given that a private enterprise must raise its own money to be solvent and a government option has access to others' money -- i.e., taxes?

7. Why will hospitals, doctors, and pharmaceutical companies do nearly as superb a job as they now do if their reimbursement from the government will be severely cut? Haven't the laws of human behavior and common sense been repealed here in arguing that while doctors, hospitals and drug companies will make significantly less money they will continue to provide the same level of uniquely excellent care?

8. Given how many needless procedures are ordered to avoid medical lawsuits and how much money doctors spend on medical malpractice insurance, shouldn't any meaningful "reform" of health care provide some remedy for frivolous malpractice lawsuits?

9. Given how weak the U.S. economy is, given how weak the U.S. dollar is, and given how much in debt the U.S. is in, why would anyone seek to have the U.S. spend another trillion dollars? Even if all the other questions here had legitimate answers, wouldn't the state of the U.S. economy alone argue against national health care at this time?

10. Contrary to the assertion of President Obama -- "we spend much more on health care than any other nation but aren't any healthier for it" -- we are healthier. We wait far less time for procedures and surgeries. Our life expectancy with virtually any major disease is longer. And if you do not count deaths from violent crime and automobile accidents, we also have the longest life expectancy. Do you think a government takeover of American medicine will enable this medical excellence to continue?

SOURCE




The Perils of Socialized Medicine

by John Campbell

Regular readers know that I am a numbers, financial, and economic guy, as betrayed by my CPA certification. As important as these issues are, we are now presented with an issue even more vital. The socialized healthcare bill being considered by the House will likely result in tens of millions of Americans dying sooner than they otherwise would have to.

When the free-market, doctors, and patients are taken out of health care decisions, and the care is paid for by somebody else, the establishment of an organization to ration care is inevitable. In fact, the legislation creates the National Institute of Comparative Effectiveness. As benign as it may sound, this is the bureaucracy that will be used to ration care. A similar institution exists in Britain, and has the rather ominous acronym of NICE (National Institute for Health and Clinical Experience). Rulings on whether people live or die are made frequently in Britain and Canada, and if you have a pre-existing condition, are elderly, or for some reason deemed ‘unfit’ for a life saving procedure, then your chances of being granted that life saving procedure become even murkier. Your life will hang in the balance, subject to the whims of government and its bureaucrats. This is why the survival rates from cancer, heart disease, and many other life-threatening diseases are 30-50% lower in countries with socialized medicine than they are in countries with private medicine.

And why are we doing this? It is generally accepted that about 85% of Americans have some form of health insurance. But, 15% do not. Of the 15% that do not, about one third have plenty of income and wealth, but choose not to buy insurance because they think they are healthy and want to save the money, and if they have a problem they will just go to the emergency room. Another third are eligible for Medicaid or Medicare or other subsidized care, but have not signed up. Only that last third, or 5% of the population, are truly uninsured, want insurance, and have no realistic option to get it.

Without question, there is a problem with which we must deal. But we should not sacrifice the quality of care and the life expectancy of 95% of the population for 5% as the Obama/Pelosi plan does. Furthermore, their plan fails to cover that 5%.

The Democrats in the House are practically at war amongst themselves over this because their more moderate members see the folly in socialized medicine. As I left the Capitol earlier today, the final committee with jurisdiction on this bill, Energy and Commerce, still had not met to vote on the bill. Committee Chairman Henry Waxman (D-CA) suggested that maybe his committee should just be bypassed if the votes to pass the bill weren’t there. That, is truly desperation.

They know how powerful a message it is. Democrats, led by Nancy Pelosi are so nervous that the public might find out what is really in this health care proposal that they have taken the unprecedented step of trying to use the rules of the House to censor the minority, and restrict what we are allowed to say or send out to you. In other words, they want to limit the only real power the loyal minority has, which is the power to communicate criticisms of the majority's proposals and present alternatives. Among the items to which they have objected to is the chart shown below. They have not been able to say that this chart, which reflects the organization of the Obama/Pelosi Health Care bill, is inaccurate. They say that some of the descriptions of the agencies are "misleading." Right. If you want to see misleading, read my blog on the 10 "inaccuracies" in President Obama’s news conference last week.

The Greeneyeshade Blog - Obama Misleads us on Healthcare

Your government run health care system will look like this if this bill passes. The Speaker and her minions just don't want you to know it.



John Locke must be rolling in his grave. This socialized medicine package is a leap in a direction to which the government will now view its citizens as liabilities. This is in a republic that was founded on the premise that the government derives its power from the ‘consent of the governed.’ If this bill passes, perhaps we should change that to ‘consent of the governed, unless they represent too high of a liability.’

I admit, I am little worked up about this. But darn it, it's really important.

SOURCE (See the original for a larger chart)




The uninsured now secondary

That sudden jolt just felt by the 40 million uninsured Americans and their supporters was the presidential carpet being yanked out from under their feet, as President Barack Obama unexpectedly abandoned so-called “universal coverage” as the chief reason a health care overhaul bill was so urgent. He’s decided instead to focus on the cost of health care for all, insured or not.

Unfortunately, the plans he and the congressional Democrats are offering would be as ineffective at that as at covering the uninsured.

The president’s abrupt abandonment of the uninsured came after a series of polls showed his proposal has lost support now that the public has discovered how expensive and intrusive it would be.

A Rasmussen Reports poll released July 13 showed more Americans (49 percent) oppose Obama’s health care proposal than favor it (46 percent). Five days later, another Rasmussen poll showed 61 percent believe high costs are the biggest problem the nation’s health care system currently faces, with only 21 percent saying so-called “universal coverage” was their chief concern.

The loss of his initial casus belli didn’t lessen Obama’s eagerness for a government takeover. As concern about universal coverage dwindled, he simply abandoned the uninsured and changed his tune to a concern for cutting costs. In a speech on Monday (July 20) Obama placed the emphasis squarely on the latter. “I’ve said this before,” he said. “Let me repeat: The bill I sign must reflect my commitment and the commitment of Congress to slow the growth of health care costs over the long run.”

Unfortunately for the 62 percent of Americans who see high costs as the biggest problem, the bills proposed by the congressional Democrats and supported by Obama would increase taxes while doing nothing to lower costs. You don’t have to take my word for it. In his July 16 testimony before the Senate Budget Committee, Doug Elmendorf, director of the nonpartisan Congressional Budget Office, reported the proposed health care bills would add significantly to the federal budget deficit while doing nothing to “reduce the trajectory of federal health spending by a significant amount.”

The bills before Congress are designed to push millions of Americans into a government insurance plan—in evaluating it, just consider what a great deal you’re getting from Social Security—and somehow cut costs by taking advantage of government’s universally acknowledged brilliance at running lean and mean. What that all really means is forcing consumers into a government program that rations your care, as other countries’ nationalized systems do. Get ready for long waits for treatment, if you can get treatment at all.

The sensible alternative is to deal directly with the cost problem by enabling consumers to cut costs by giving them more choice, not less. The government could do that very easily by stripping out unnecessary mandates and regulations and standardizing the tax treatment of health insurance. The increased competition would reduce insurance premiums, thus allowing the uninsured to find affordable policies if they want them.

Unfortunately, Obama and Congress aren’t considering such liberating notions, preferring instead to increase government power and decrease consumer choice.

As for the uninsured, the CBO said the proposed overhauls would enable only about a third (16 million) of them to gain coverage. That probably made it even easier for Obama to drop them from his list of concerns. But instead of throwing the uninsured overboard, he and his fellow Democrats in Congress should consider liberalizing measures that would benefit everybody.

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29 July, 2009

More beds, not more bureaucrats, are what Australia's hospitals need

Australia shows where socialized medicine leads

RUDD should invest in a voucher scheme instead of taking over hospitals. It's a quarter of a century since Medicare was established, but no one is celebrating. No wonder, considering the critical condition of the public hospital system throughout Australia. Instead we have a 300-page reform blueprint from the National Health and Hospital Reform Commission.

At least the report has identified the main problem. The reality is that Australia's dangerously overcrowded public hospitals don't have enough beds to provide a safe and timely standard of care even for emergency patients. Unfortunately, the commission has strongly supported a range of non-solutions. The primary care reforms it proposes will not help our dysfunctional state-run public hospitals cope with an inexorable rise in demand from an ageing population.

Since 1983 the state health bureaucracies that are responsible for allocating funding, planning services and rationing public hospital care have cut the number of public hospital beds by one-third: from 74,000 beds to just over 54,000. This is a 60 per cent cut, taking population growth into account, from 4.8 public acute beds for every 1000 Australians to 2.5 beds.

Overcrowding occurs when bed occupancy exceeds 85 per cent in hospitals, operating near or beyond full capacity. Average bed occupancy in most leading metropolitan public hospitals is above 90per cent and hospitals routinely operate above 100 per cent occupancy because of political pressure to reduce electorally sensitive waiting times for elective surgery.

The nationwide bed shortage means one-third of emergency patients wait longer than eight hours for a bed to become available. Emergency staff spend more than one-third of their time caring for these patients, which leads to more than 30 per cent of patients not being seen in emergency departments within the recommended time.

The queue for free public hospital care now starts in crowded hospital corridors lined with ailing, mostly frail, elderly patients who are parked on trolleys for hours and sometimes days.

The pressure on hospitals is intensifying because rising numbers of older patients with complex conditions are requiring unplanned admission for bed-based medical and nursing care. In the past five years, admissions by patients aged between 75 and 84, and 85 and older, increased by 25 per cent. A decade ago, the 85-plus demographic wasn't even distinguished in the statistics.

The problem is not that hospitals are underfunded. Over the past decade, real expenditure on public hospitals increased by 64 per cent to top $27 billion in 2006-07. The real problem is that not enough of the money gets through to the frontlines. Between 1996 and 2006 the number of acute public hospital beds fell by 18 per cent per 1000. But between 2001 and 2006, the number of administrators increased by 69 per cent.

The large and costly area health services that administer public hospitals in most states are better at paying for bureaucrats than for beds, and have a deservedly notorious reputation among overworked hands-on hospital staff for warehousing armies of clerks and managers who have no involvement in patient care.

As more and more people live to older ages, a tsunami of demand will break in public hospitals. Increasing numbers of very old patients will inevitably require emergency and bed-based hospital care due to the age-related onset of chronic conditions. Going by the state of the health reform debate, the hospital crisis will become a catastrophe. The wrong-headed premise of the Rudd government's reform agenda is that the commonwealth must spend billions on a national network of comprehensive general practice "super clinics" to take pressure off hospitals.

The NHHRC has fully endorsed this approach. It claims that 10 per cent of public hospital admissions can potentially be prevented by providing better co-ordinated primary and allied health care for chronically ill and elderly patients.

Yet even the discussion paper on the subject commissioned by the commission shows that trial co-ordinated care programs have failed to keep people out ofhospital.

The 15 per cent boost in bed numbers recommended by the commission is welcome. But even if the government accepts this, a one-off and costly boost in bed numbers is not a long-term solution.

Instead of wasting money building stand-alone elective hospitals and wasting political capital trying to take full responsibility for the primary care system, the Rudd government should focus on structural reform of the hospital system.

Flexible and responsive funding and administrative arrangement must be created to allow hospitals to increase the supply of beds and meet the demand that rising numbers of older and sicker patients will generate in coming decades.

The first step towards rebuilding the hospital system is for the commonwealth to take full control of public hospital funding and introduce Medicare-issued, case-mix-calculated hospital vouchers to pay for treatment in either public or private hospitals. The second step is for state governments to agree to re-introduce local public hospital boards with full financial and administrative responsibility for their facilities. The third step is to close down the area health services and use the money saved to fund vouchers and open and staff more hospital beds.

This isn't a plan for Canberra to take over and run hospitals. Funding will be centralised by converting the present federal grants and state hospital budgets into vouchers, while the management of hospitals will be decentralised to local boards. Nor is this a plan to privatise the health system. Tying taxpayer funding to the treatment of patients, increasing choice and competition, and freeing hospitals to respond appropriately to the health needs of the community is not that radical.

This parallels the voucher-based policies the Rudd government is considering implementing to increase efficiency and improve access to publicly funded education in schools, TAFE and universities.

A 50 per cent increase in patients presenting at emergency aged over 85 is predicted over the next five years alone. Bed numbers must increase significantly to equip the hospital system to cope with the unprecedented impact of demographic change. The challenge for policy-makers is to dispense with the failed methods of running public hospitals that have created a continuing crisis 25 years in the making.

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Obamacare: It’s even worse than you think

President Obama's strategy to pass sweeping health care legislation rested on stealth and speed. The idea was to fill the conversation for months on end with vague talk about expanding coverage, "bending the cost-curve," improving quality, and rooting out waste, without showing the public how the plan would actually work or what it would cost. Legislation, meanwhile, would be composed behind closed doors, and the bills would be introduced as close as possible to when they might come up for a vote to minimize the time in which they could actually be read and thought about by those who would vote on them and those who would live under them. By the time the details emerged, maybe momentum and being "closer than ever before" would be enough to overcome the torrent of objections that were sure to be raised when people got a real look at the nuts and bolts.

That moment has now come. House Democrats finally unveiled their plan on July 14, with the aim of passing it by July 31, the last day before the August congressional recess. The Senate's Health, Education, Labor, and Pensions Committee has released its part of the plan, but the Finance Committee (which must figure out how to pay for it all) has yet to do so. There, too, the leadership hoped for a vote before the recess.

But things have not gone as the Democrats intended. As details have emerged, an extraordinary wave of public concern has washed over the debate and left the plan's champions reeling. It is all but certain that both the House and Senate will recess for August without voting on health care, despite the president's insistence on its urgency. And the emerging tone of the public debate casts serious doubt on the fate of Obamacare more broadly.

The reasons for the public revolt are easy to see. The Democrats want to spend $1.5 trillion over a decade, impose an $800 billion tax increase in the midst of the worst recession in a generation, increase federal borrowing by $239 billion (on top of the $11 trillion the Obama budget already requires us to borrow through 2019), impose costly mandates on employers that will discourage hiring as unemployment nears 10 percent, force individuals to buy one-size-fits-all government defined insurance, and insert the government in countless new ways between doctors and patients. All of that would occur whether or not the plan includes a "public option," which at this point it does include and which will exacerbate all of these problems.

As these facts have become clear, Obama's standing has fallen and public opinion has grown decidedly less enthusiastic for the administration's approach. The trend is likely to continue, because the details of the plan reveal that its two most serious drawbacks--its cost and the prospect of government rationing--are worse than even most of their critics have grasped.

First, there are massive hidden costs inherent in a little-understood provision of the plan. The centerpiece of Obamacare is a new premium subsidy program. In the House bill, families with incomes up to four times the poverty level would get a fixed cap on their insurance premiums, tied to their incomes. For instance, a family whose income is twice the poverty level would pay no more than 5 percent of its total income for insurance. But providing that guarantee to all such households in America would cost far more than even the Democrats are willing to propose. The plan therefore would make subsidies available only to households getting insurance through the new "exchanges," insurance pools set up in each state as a parallel system to job-based coverage. And full-time workers in all but the smallest firms would be barred from entering the exchanges, at least for a time, so they wouldn't have access to the new entitlement.

More here




Giving less care is the only way healthcare can be made cheaper

President Obama has made many promises about his health-reform agenda, but none looms larger than: "You will save money." Not only has the president promised to lower consumers' health-insurance bills; he says his plan will trim federal spending as well. Thus, when the head of the Congressional Budget Office (Congress's fiscal watchdog) testified last Friday that none of the bills under consideration in the House or Senate would rein in spending--and that all would likely increase it--the president's reform push took a heavy hit. The CBO's assessment underscored an important reality about health care. Lowering health-care costs (which have been rising faster than inflation for decades, except for a brief perio! d in the 1990s) while improving quality is possible, but it's awfully hard, for one simple reason: when it comes to health-care spending, death is the only really cheap option.

William Osler, a renowned nineteenth-century doctor and the first physician-in-chief at Johns Hopkins Hospital, once remarked, "Pneumonia may well be called the friend of the aged. Taken off by it in an acute, short, not often painful illness, the old man escapes the 'cold gradations of decay,' so distressing to himself and to his friends." If Osler were alive today, he might call pneumonia the friend of Medicare accountants, since it kills victims quickly, in contrast with the lingering and expensive chronic illnesses that account for about three-quarters of all Medicare spending.

Few policymakers working on health-care reform in Washington stop to consider the obvious corollary: dying early is cheap, and keeping people alive long enough to collect Medicare is expensive. Instead, experts talking about health spending promulgate what I call the Eat Your Vegetables Theory: we can save gobs of money by focusing on technological fixes (like electronic health records) and disease prevention, which will yield a healthier population that is cheaper to treat. The savings generated can then be used to subsidize coverage for millions of the uninsured. But this approach is unlikely to work as advertised: as Osler's dictum suggests, increasing prevention efforts may wind up costing more.

Take pneumonia. We have relatively cheap and effective treatments for it, especially vaccines and antibiotics. As a result, many older Americans who might have died from pneumonia in Osler's day now live years or decades longer--long enough to qualify for Medicare and then develop much more expensive ailments like diabetes, cancer, and Alzheimer's. Researchers at the RAND Corporation noted the conundrum across several studies and came to roughly the same conclusion: "Medical innovations will result in better health and longer life, but they will likely increase, not decrease, Medicare spending."

In one study, the researchers postulated three different scenarios for the health costs of seniors entering Medicare from 2002 to 2030. Scenario A took into account everything that we know today about the health of the current cohort of seniors entering Medicare and future enrollees, up to 2030. (This is a mixed bag. Seniors' health started improving in the 1980s, but rates of chronic diseases have been increasing rapidly in recent years, and newer enrollees are likely to be sicker and thus more expensive.) Scenario B assumed that future cohorts would be as healthy as those in the 1990s. And Scenario C (the most optimistic) assumed that seniors' health would continue to improve. Under rosy Scenario C, the researchers found, health spending would be $10,275 per Medicare enrollee in 2030--just 8 percent lower than under Scenario A. Why? Healthier seniors live longer and accumulate more costs; also, costs are rising faster among less disabled seniors, presumably because they! use more new drugs and devices that prevent them from becoming disabled (knee replacements, for example).

In another study, RAND researchers looked at how ten important medical innovations likely to emerge in the near future might affect Medicare spending in 2030. These included anti-aging compounds for healthy people, cancer vaccines, tiny defibrillators implanted near the heart, better treatments for stroke and cancer, and Alzheimer's prevention. Every hypothetical innovation, the researchers found, would increase Medicare spending. Even the cheapest, an anti-aging compound taken by healthy people that would cost just $11,245 per life-year saved, would increase health-care spending by 14 percent in 2030--because there would be 13 million more beneficiaries collecting benefits.

Finally, RAND examined the effects of fighting four risk factors for heart disease. If we could get all the elderly to stop smoking and control their diabetes, their health would improve, of course, but costs would rise, again because those ex-smokers and diabetics would eventually be vulnerable to other health problems. If we effectively treated hypertension and slashed obesity rates by 50 percent, however, health would improve and costs would fall. Reducing obesity produced the clearest gains because obesity, though it sharply increases costs, doesn't reduce longevity significantly.

What all three studies suggest, then, is technological innovations or disease prevention will likely result in slight savings or even increased costs (though obesity may be the exception to this trend). This doesn't mean, of course, that we shouldn't keep inventing drugs and devices to keep people alive longer, or that we shouldn't develop better prevention strategies. It just means that we should stop pretending that good health is always cheaper. Sometimes, you really do get what you pay for.

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Ghoulish science + Obamacare = health hazard

by Michelle Malkin

Health and Human Services Secretary Kathleen Sebelius tried to reassure citizens in New Orleans this week that Obamacare bureaucrats will make sound medical decisions for all Americans. She failed. Under the government-run plan, she promised, a team of health care experts will recommend what should be covered: “I think it would be wise to let science guide what the best health care package is.”

Gulp. It’s precisely the Obama administration’s view of sound “science” that should send chills down patients’ spines. Case in point: The president’s prestigious science czar John Holdren refuses to answer questions about his radical, published work on population control over the last 30 years.

Last week, I called the White House Office of Science and Technology Policy (OSTP) to press Holdren on his views about forced abortions and mass sterilizations; his purported disavowal of Ecoscience, the 1977 book he co-authored with population control zealots Paul and Anne Ehrlich; and his continued embrace of forced-abortion advocate and eugenics guru Harrison Brown, whom he credits with inspiring him to become a scientist.

After investigative bloggers and this column reprinted extensive excerpts from Ecoscience, which mused openly about putting sterilants in the water supply to make women infertile and engineering society by taking away babies from undesirables and subjecting them to government-mandated abortions, the White House issued a statement from Holdren last week denying he embraced those proposals. The Ehrlichs challenged critics to read their and Holdren’s more recent research and works.

Well, I did indeed read one of Holdren’s recent works that reveals his clingy reverence for, and allegiance to, the gurus of population control authoritarianism. He’s just gotten smarter about cloaking it behind global warming hysteria. In 2007, he addressed the American Association for the Advancement of Science conference. Holdren served as AAAS president; the organization posted his full slide presentation on its website.

In the opening slide, Holdren admitted that his “preoccupation” with apocalyptic matters such as “the rates at which people breed” was a lifelong obsession spurred by scientist Harrison Brown’s work. Holdren heaped praise on Brown’s half-century-old book, “The Challenge to Man’s Future,” then proceeded to paint doom-and-gloom scenarios requiring drastic government interventions to control climate change.

Who is Holdren’s intellectual mentor, Harrison Brown? He was a “distinguished member” of the International Eugenics Society whom Holdren later worked with on a book about – you guessed it – world population and fertility. Brown advocated the same population control-freak measures Holdren put forth in Ecoscience. In “The Challenge to Man’s Future,” Brown envisioned a regime in which the “number of abortions and artificial inseminations permitted in a given year would be determined completely by the difference between the number of deaths and the number of births in the year previous.”

Brown exhorted readers to accept that “we must reconcile ourselves to the fact that artifical means must be applied to limit birth rates.” If we don’t, Brown warned, we faced a planet “with a writhing mass of human beings.” He likened the global population to a “pulsating mass of maggots.”

When I pressed Holdren’s office specifically about Holdren’s relationship with Harrison Brown, press spokesman Rick Weiss told me he didn’t know who Brown was and balked at drawing any conclusions about Holdren’s views based on his homage to lifelong intellectual mentor, colleague and continued inspiration Brown just two years ago.

Weiss lectured me rather snippily about the need for responsible journalism (he was a Washington Post reporter for 15 years). He then me not to expect any response from Holdren’s office to my question on whether Holdren disavows his relationship with a eugenics enthusiast who referred to the world population as a “pulsating mass of maggots” and championed a scheme of abortion and artificial insemination quotas. If this is the kind of ghoulish “science” that guides the White House, we can only hope that Obamacare is dead on arrival.

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28 July, 2009

Australian mother sues public Hospital after nearly bleeding to death

A DIABETIC mother has begun legal action against Ipswich Hospital, alleging staff's negligence nearly caused her to bleed to death during childbirth. The 32-year-old has served Ipswich Hospital, west of Brisbane, with a notice of claim for negligence.

The Ipswich mother of four, who only wanted to be known by her first name Kylie, said she was traumatised after haemorrhaging 1.5 litres of blood two hours after giving birth in May. "Instead of sending me to the operating theatre, they were giving me morphine and trying to fix the clotting by reaching into my cervix not just once but four agonising times," she said. "I was screaming in agony and they had my legs pinned down telling me to be quiet.

"My daughter, who was there holding the newborn, was crying and my sister was crying because the midwives and the doctor wouldn't listen."

Her lawyer Olamide Kowalik said Kylie had begun action against the hospital over her treatment and also for the trauma her 12-year-old daughter suffered from witnessing her mother's ordeal.

Ipswich Hospital was served the notice of claim in early July and has 30 days to respond and supply medical records. The hospital's executive director, Dr Gerry Costello, declined to comment, saying it was inappropriate due to ongoing legal action.

Ms Kowalik said the hospital should have been aware there would be complications because medical records showed Kylie bled through her three previous pregnancies.

SOURCE




Another big government medical bungle in Australia

Something very similar happened in Britain a couple of years ago but do governments ever learn? Rhetorical question

HUNDREDS of international medical students were told this week they would not be guaranteed internships in NSW public hospitals because there are not enough staff to supervise them. The warning comes despite the Federal Government ramping up university places in the past three years to solve the state's crippling shortage of doctors.

The students, who each paid about $200,000 in course fees, are furious, saying it is now too late for them to get internships in their home countries and any forced break between the end of their studies this month and starting work in a hospital was "career suicide".

For the first time, the State Government invoked a priority system this year when 879 students applied for 670 positions, saying it did not have enough money to offer internships to all graduates wanting to work in NSW.

The Institute of Medical Education and Training, which allocates internships, has blamed a surge in the number of interstate students applying for jobs in NSW because they have been unable to find enough supervised roles in their home states. It said the problem was compounded by some students accepting multiple internships in several states, then not showing up for work when the rotations began in January.

Under the priority system, NSW students are offered places first, then Australian and New Zealand residents from interstate, then other international students studying in Sydney.

But overseas students have been told final offers will not be made until January, well after interns overseas have started their hospital rotations. "We're shell-shocked," one student said. "All along we've been assured we would get placements, then on Monday afternoon we got a two-line email rejecting us. "We wanted to live our lives in Australia and work in the NSW hospital system. Now we don't know what to do. You just can't take a break between university and vocational training. It is virtually impossible to get back in."

Medical student numbers in NSW soared from 493 in 2007 to 1104 last year, prompting universities to issue warnings the health system would not be able to support the rise. "These are people who want to work in the system," the president of the Australian Medical Association, Andrew Pesce, said yesterday. "They've paid for something and they have every right to be angry that they are not getting it. "What is the point in training yourself if you are not able to work as a doctor at the end? The Government needs to make a serious commitment to investing properly in training these people. It's an investment, not a cost."

The president of the Australian Medical Students Association, Tiffany Fulde, said hospitals were facing a "student tsunami" which would only worsen with three more medical schools turning out graduates in the next three years. "The system isn't coping now, so where will we be when we have double the number of students?" she said.

In April, the dean of medicine at the University of Sydney, Bruce Robinson, said the restrictions made NSW a "less attractive destination" for international medical students. "[It] places an extraordinary additional stress on them," he said. "International students in every year of their medical studies are rightly expressing deep concerns about their future prospects, and [this] is detracting from their experience of studying here," he said.

International students deserved a "fair go", he said. "We simply would like to be able to offer our international students the same education and training opportunities as we provide for our local students."

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Obama has only himself to blame for his faltering healthcare measure

Here’s the dirty secret behind Washington’s health-care “fight”: Democrats won everything in last year’s election. You wouldn’t know it from the way President Barack Obama is blaming the GOP for his flagging health agenda. “There are those [read the GOP] who are advocating delay just as a desperation move to try to kill it,” complained White House budget director Peter Orszag. Republicans are working to “block health-care reform,” groused the president. “Republicans should immediately put an end to their political games,” demanded Democratic Rep. Chris van Hollen.

Indeed. The party of the left owns the White House, a filibuster-proof Senate, and a 70-seat House majority. As one House Republican aide quipped: “We could have every GOP congressman and their parents vote against a Democratic bill, and still not stop it.” All Democrats have to do is agree on something.

You can’t blame the GOP when you own every Washington institution. That they can’t is testimony to Team Obama’s mismanagement of its first big legislative project. The president is a skilled politician and orator, but the real test of a new administration is whether it can shepherd a high-stakes bill through Congress. In retrospect, the mistakes are growing clear.

• Living in the short term: The administration thought it was clever back in February, using its $787 billion “stimulus” as an excuse to pass all manner of non-stimulating spending. But the bill sent deficits soaring, forcing those numbers to the center of today’s health debate and unnerving Democratic deficit hawks. Mr. Obama’s demand that a bill be deficit-neutral enthused House liberals to propose crushing tax hikes that further alienated conservative Democrats.

Mr. Obama boxed himself in on taxes back in his campaign. Senate Finance Chairman Max Baucus and counterpart Chuck Grassley were merrily on their way to a bipartisan deal based on taxing existing health benefits. Yet having slammed John McCain for that idea, the White House vetoed the compromise, derailing an agreement. “The President is not helping us,” bluntly stated Mr. Baucus. “He does not want [that tax]. That’s making it difficult.”

• Unleashing Congress: Not wanting to repeat Hillary Clinton’s mistaken attempt to micromanage Congress, the administration took the equally dangerous path of no management at all. Left to wild impulses, Nancy Pelosi, Henry Waxman and Ted Kennedy took the most radical of Mr. Obama’s proposals (a public option entitlement) as a starting point, and ran left with new mandates, income tax surcharges, and business penalties. The House bill stirred a Blue Dog rebellion and mired the bill in committee. Mrs. Pelosi failed to include enticements for susceptible Republicans, leaving her hard-pressed to poach GOP votes.

The White House’s decision to let Mrs. Pelosi charge ahead with her climate bill has also been a disaster. To get that unpopular energy tax through, Mrs. Pelosi had to strip conservative Democrats of their committee rights and then arm-twist them into votes. Their egos and poll ratings bruised, this crew is balking at taking a second one for the team. “If you’re a member who voted for cap and trade and had a bad experience back home, you’re probably not looking forward to a bad vote on a health-care bill that’s not going to go anywhere in the Senate,” says Pennsylvania Blue Dog Jason Altmire.

• The perils of spin: Selling a huge expansion of government health care in the middle of a recession was never going to be easy. The Obama team hit on the argument that by adding to the government rolls, it would in fact save money and boost the economy.

Bizarre as this claim was, it became the administration’s prime rationale for “reform.” Until last week, when Congressional Budget Office director Douglas Elmendorf blew it up, noting that the existing House and Senate bills would “significantly expand” federal costs. This gave Democratic senators such as North Dakota’s Kent Conrad an excuse to back away from existing bills, and place new emphasis on a highly uncertain Baucus compromise.

• False deadlines: Mr. Obama is right to worry this project is a race against time and falling poll numbers. But the administration’s unwavering demand for bills before recess led to the gridlock it hoped to avoid. The deadline inspired the House leadership to rush out a bill without consensus, further antagonizing the Blue Dogs. In the Senate, the pressure on Mr. Baucus to produce has very nearly pushed away Mr. Grassley, who Democrats need for cover.

A unified Republican message helped raise public alarm. But if they were the problem, Mr. Obama’s campaign arm, Organizing for America, wouldn’t be running TV ads that target his own Democrats. This debate has a stretch to go, and we’re about to see if the administration is nimble enough to adapt its strategy. Some Democrats are even hinting the White House needs to start over. At this point, that might not be bad advice.

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A CORNUCOPIA OF HEALTHCARE FALLACIES

How many ways can the "reformers" be wrong?

The effort to reinvent medical care is so full of fallacies and bad logic that it would take volumes to properly expose them. Nevertheless, in this short space, let’s take a crack some of the problems.

To begin, the “reformers” want to compel insurers to cover people who are already sick for the same price charged healthy people pay. But if someone is already sick, no government plan to pay his medical bills can be accurately called “insurance.” Insurance is a voluntary way to spread risk. Risk comes from uncertainty. But someone already sick doesn’t face a risk that he might need medical attention for his ailment. He is certain to require the attention. There’s a reason you can’t buy homeowner’s insurance after your house has burned down or life insurance for a deceased person. Why should one expect to be able to buy insurance to cover medical treatment for a disease one already has contracted? When private donors voluntarily pay the bills, we call it charity or philanthropy or benevolence. When government pays them after extracting money by force from taxpayers or by requiring insurance companies to overcharge healthy people who are compelled to buy coverage, we should call it (at the very least) welfare.

If someone wants to defend medical welfare, let him do so. But don’t let him get away with calling it insurance. He not only does violence to the language; he also clouds the discussion. This is another application of the tacit premise that no one should have to pay for his own medical care. Bastiat’s line about the state being the means by which we all try to live at everyone else’s expense comes to mind.

President Obama says he will finance “reform” by shifting Medicare reimbursement decisions from Congress to an independent board of experts. Too bad he is unaware of the Austrian critique of central planning. Outside the marketplace, no one can know how much doctors and hospitals should be paid. Bureaucrats can’t tell what is too much or little compensation because they can’t have the relevant knowledge. Markets are good at setting prices because that knowledge is communicated through people’s buying and abstention from buying.

This is not just an academic discussion. Prices are information, and when they are “wrong” there are consequences. If the bureaucrats pay too little, costs will be shifted to others and providers will leave the market, creating shortages. If the bureaucrats pay too much, resources and labor will drawn away from other needed areas. With the collapse of the Soviet Union and the continuing examples of Cuba and North Korea, we should all know that government doesn’t know how to set prices.

Obama promises overall “cost containment.” But government has only two ways to accomplish this: rationing or price controls. The drawback to the first is obvious. People are forbidden to buy the services they want, even when they are willing to pay for them themselves. Bureaucrats — rather than individuals and their doctors — decide what tests and procedures are necessary. The drawback to the second is that services will disappear from the marketplace. Price ceilings create shortages.

On the other hand, the market has a method for containing costs. It’s called economizing, and people practice it naturally when they face the costs and consequences of their decisions. People are less likely to buy unnecessary services if they have to pay for them. And if they were buying their own insurance, they wouldn’t typically buy policies that covered smaller, routine expenses. The administrative overhead would make such policies a bad buy.

Conflicting Goals

The New York Times points out that the reformers have two conflicting ostensible goals: “to expand health coverage to nearly all Americans while reducing the growth of health spending.” How can they do both? Obama goes back and forth between stressing universal coverage and cost containment, but he doesn’t discuss one in relation to the other. Newly subsidized coverage will bring new demand for medical services and put more upward pressure on prices. As noted, higher prices can be counteracted only by denying service (say, hip replacements for octogenarians) or by imposing price controls, overtly or covertly.

What is it government’s business how much we spend on medical services? Government’s only concern should be to eliminate the ways it interferes with and influences our choices. The aggregate cost of our freely chosen actions is our concern alone, not the government’s.

But of course, government interferes with and influences our choices in many ways, and by doing so raises the costs. As Obama said the other night, “[T]he biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid.”

For once Obama was conceding that the government is at fault. Medicare and Medicaid are two ways the government forces the taxpayers to pay for medical care. Those who obtain their medical care through those programs have no incentive to economize because it’s free to them. That’s why the budgets are out of control — people act rationally according to the incentive system they are in — and why Obama is looking for ways to control costs. As long as those programs exist, he won’t be able control costs without bureaucratic rationing of services one way or another.

If the “reformers” get their way, something much like this failed system will be extended to the general public.

Ending Waste

Obama says two-thirds of the estimated cost of “reform” — at least $1.5 trillion over a decade — will be paid for “by reallocating money that is simply being wasted in federal health care programs.” I wouldn’t take seriously any of the reformers’ numbers. The safe bet is that cost of the program will far exceed what they project, and the most of the savings will never materialize. When Medicare was being put together, the pooh-bahs projected that by 1990, hospitalization coverage would cost only (!) $9 billion. when 1990 arrived, the price tag read $66 billion.

The final third of cost would likely come from surtaxes on upper-income earners. Are high earners likely stand still when targeted for new taxes? No. They will adjust their income-earning activities to minimize the tax take, and that will mean lower-than-projected revenues. Then what? Taxes on the middle class, perhaps. Or more debt and inflation.

Competition and Choice

Does anyone else laugh when politicians promise that government will bring competition, choice, and efficiency to the medical industry? Government routinely can’t account for millions, even billions, of dollars. And competition and choice? As a compulsory monopoly, government is the enemy of those things.

Competition and choice is what you get when the government backs off. You don’t get them by having government interject itself even further in an area of life.

Finally, the way to rig a debate over public policy is to never acknowledge the only genuine alternative your proposal. Obama says, “I’m confident that when people look at the costs of doing nothing they’re going to say, we can make this happen.” Why is “doing nothing” the alternative to a conscious attempt to reinvent the healthcare industry? While it is true that doing nothing would be preferable to what Obama and his congressional allies want to do, it is not the best alternative. The best alternative is the free market. But have you ever heard the advocates of government control offer an argument against the free market? The answer is no, and the reason is that to argue against it would be to acknowledge it as an alternative. And that they cannot afford to do. Better to have the people think we already have a free market in medicine and that it has failed. That way they will be more likely to win support for government control. The “reformers” task would be more difficult if people understood that what has created the problems is government, not the free market.

This effort ignore the market solution is abetted by an alleged limited-government party that is unwilling or unable to speak the truth. That help explains the predicament we are in.

SOURCE




Obama Health Care Bill Contains Race Preferences

Black Activist Speaks Out Against Proposed Unequal Allocation of Health Resources

An examination of the 1018-page "America's Affordable Health Choices Act of 2009" (H.R. 3200) - the official Obama health care bill - finds several cases in which grant money for medical training can be awarded solely on factors of race and class.

Project 21 member Bishop Council Nedd II, an Anglican bishop and director of the Ecumenical Institute for Health Policy Research based at Valley Forge Christian College, is condemning the addition of racial preferences to the President's legislation.

"The U.S. Supreme Court just struck down racial preferences. So why does a newly-introduced bill want to perpetuate something that has just been declared unconstitutional?" asked Project 21's Nedd. "Racial preferences will not improve health care. They will increase tensions when some people are being unfairly put at the front of the line."

Between pages 878 and 909 of H.R. 3200, in an area related to grants for medical training, the Secretary of Health and Human Services is empowered to grant preference in awarding training grants. For the specialties of "family medicine, general internal medicine, general pediatrics, geriatrics and physician assistantship" (pages 878-882); "medical residents on community-based settings" (pages 883-886) and "general, pediatric and public health dentists and dental hygienists" (pages 887-891), it is written that "the Secretary shall give preference to... entities that have a demonstrated record of... training individuals who are from underrepresented minority groups or disadvantaged backgrounds."

Further, the bill amends the Public Health Service Act to give preferences in "advanced education nursing grants" to programs that "increase diversity among advanced education nurses" (pages 892-895). Grants for "enhancing the public health workforce" similarly give preference to "entities that have a demonstrated record of... training individuals who are from underrepresented minority groups or disadvantaged backgrounds" (pages 907-909).

Nedd added: "By making racial preferences a shortcut to federal funding, schools will reduce their quest for the best and turn it into a hunt for the right racial numbers. This, in the long run, will hurt the quality of our nation's health care. We need to stop the social experimentation and focus on cost and performance."

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27 July, 2009

Australia: More public hospital negligence

Would YOU like to be the one being operated on in such circumstances? Where warnings were ignored, equipment wasn't working and personnel had no previous experience in the procedure? That could be coming to you too under Obamacare

A DOCTOR whose patient died after a common throat operation says he "neglected to go through the paperwork" and failed to heed warnings from a nurse to delay the procedure. The comments came yesterday during an inquest into the 2007 death of popular Emerald grandmother Yvonne Davidson, who died at Rockhampton Base Hospital.

A critically ill Mrs Davidson died shortly after intensive care specialist Dr Robin Leigh Holland performed a percutaneous tracheostomy to help her breathe easier. Although her official cause of death was septicemia (blood poisoning) triggered by pneumonia, an examining pathologist said the operation hurried her death by two days to two months.

New hospital guidelines for the procedure stated two specialists had to perform the operation after the relevant equipment was checked. Registered nurse Lois Gillespie said she gave Dr Holland a printout of the guidelines and told him about the need for another specialist to be present, and that the monitor to be used was problematic.

Although Dr Holland denied the nurse told him the monitor was not working, he admitted appointing Dr David Guitierrez, who had never performed the procedure, to assist him. "Robin said David was as good as any consultant and (David) was his consultant," Ms Gillespie told the court. "Robin was saying that he would do it right and that he didn't need (the monitor)."

The nurse then said Dr Holland couldn't get the bronchoscope light to flash, but assured her "I'd be right. I'll go blind". She claimed she advised Dr Holland to delay the operation in light of equipment failures and a shortage of back-up staff.

Dr Holland said he did not recognise the hospital guidelines given to him because they looked like a list of medical equipment on a trolley. He said he had all confidence in the pair's ability to complete the operation, even when Dr Guitierrez's first attempt to insert a tube did not work.

SOURCE




Four years to ban a horror surgeon in an Australian public hospital

The usual level of protection that you can expect from Australia's medical "regulators"

A SURGEON being sued for allegedly performing botched gynaecological operations - some without consent - on women in WA public hospitals has been banned from practising medicine. The obstetrician and gynaecologist, who has now left the country, has been permanently stripped of his right ever to work as a doctor in WA.

The ban comes as the Medical Board of WA pursues further shocking allegations of misconduct by the surgeon involving more than 100 female patients. The Sunday Times can now reveal the first details of what is potentially the most serious medical scandal in the state's history after a blanket suppression order was partially lifted on Monday following legal action by this newspaper and the Medical Board.

It can now be reported: The doctor is facing civil court claims that could result in large compensation payouts for the State Government. One woman interviewed by The Sunday Times said she was ``angered and disgusted at the outcome'' and the doctor had left her ``feeling and thinking I'm not normal''.

While knowing of the investigation against him, the doctor attempted to cover up the allegations while trying to obtain work overseas. He lied in an interview and produced fake documents of his good standing in WA.

The judge who banned the doctor ruled his behaviour as ``disgraceful or dishonourable'' conduct for a member of the medical profession. The scandal was so serious former attorney-general and health minister Jim McGinty thought public exposure so important he personally intervened and challenged the suppression in late 2007. He lost the application.

The Medical Board lawyers have been fighting to suspend the doctor since November 2005 and have filed 14 complaints against him in the State Administrative Tribunal. The Sunday Times, which understands all potentially affected WA patients have been contacted by health officials, has been investigating the scandal for more than a year, fighting to bring the case to the public's attention.

The doctor is also being sued by five former patients in the District Court, seeking personal-injury damages for medical negligence. More civil actions will follow in coming months. One woman claims in a writ that surgery performed by the doctor ``constituted trespass as it was performed in the absence of the plaintiff's consent to do so''.

Another alleged victim and her husband filed a writ over a botched sterilisation in which the doctor failed to apply a fishie clip to her right fallopian tube and resulted in her becoming pregnant and having a child.

The doctor at the centre of the scandal is now believed to be in South Africa, having fled halfway through the tribunal and court proceedings. He hasn't worked in WA since June 2006.

Tribunal president John Chaney ordered the doctor's permanent work ban in March this year and in a judgment found he deceived South African health officials while trying to work at a hospital near Durban....

Judge Chaney allowed his judgment to be made public but he ordered the continued suppression of the doctor's identity and all details of the 13 unresolved tribunal cases, including patient names

Mediation is listed for later this year but one alleged victim said she was ``angered'' that she has been gagged from talking about her case and the length of time taken in hearing her complaints. Health Minister Kim Hames declined to comment. The Sunday Times has lodged an appeal in the WA Supreme Court seeking to overturn the remaining suppression orders and allow us to inform the WA public about what is going on.

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Stupid British health bureaucracy overwhelms the ambulance service

Overstretched ambulance crews are needlessly attending emergency call-outs from people wrongly advised to dial 999 by the Government’s swine flu hotline

One paramedic said he had raced to four unnecessary calls in one 12-hour shift on Friday. None of those he attended needed emergency treatment but all had been told to dial 999 after ringing the flu hotline for an assessment. It is feared that a combination of unqualified staff and a series of vague questions at the start of the telephone assessment are to blame.

The situation was revealed after the paramedic, from East Midlands Ambulance Service, rang the flu line from the home of a 55-year-old woman in Nottingham whose daughter had been advised to ring the emergency services. By chance his call was answered by a Mail on Sunday reporter working at the Teleperformance call centre in Leicestershire. He told the reporter: ‘This lady doesn’t need an ambulance, she just needs the drugs.’ He added: ‘This is the fourth today. Four call-outs to people who think they have swine flu and have been told to ring an ambulance.’

The reporter explained what had happened to the team leader, Adam, who was clearly very busy. All the agents at the centre said they had referred callers to 999. There are fears seriously ill patients could be put at risk while ambulances are diverted needlessly. As our investigation found, one worker at the centre, Brian, admitted he had instructed all six of his callers to ring 999 ‘because that’s what the computer tells me to do’.

At the start of each call, the workers have to ask 11 vaguely worded questions to assess whether the suspected swine flu victim is in need of emergency treatment. An affirmative answer to any of these questions, which include ‘Are they breathing irregularly?’, immediately leads the staff to a screen that says: ‘Assessment Complete – Dial 999.’

An ambulance worker, who asked not to be identified, said: ‘If you ask someone if they have difficulty breathing, they might say yes, even if they just have a blocked-up nose. That makes it a high priority call. 'It would be better if they employed medically qualified people who were able to ask follow-up questions.’

A spokesman for the Department of Health said: ‘Staff in the call centres have to ask certain questions to make sure anyone who needs emergency treatment gets it. We are keeping an eye on this and how often it’s happening and are talking to the ambulance trusts.’ [Talk is all they are capable of]

SOURCE




Obama throws old people ‘under the bus’ with Obamacare

By Vincent Gioia

"Doctors take the Hippocratic Oath too seriously, as an imperative to do everything for the patient regardless of the cost or effects on others" (Journal of the American Medical Association, June 18, 2008).

Would you vote for a person to be president if you knew when elected he would appoint someone who thought and said this, Obama did? The President appointed Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel, to two key positions: health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research. Emanuel added to his comments that Doctors take their jobs too seriously and need to change to reduce costs – "Savings will require changing how doctors think about their patients," he wrote.

Emanuel knows that the cuts will not be pain-free. "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change," he wrote last year (Health Affairs Feb. 27, 2008).

Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else. You know what this means; if you are old it’s not cost effective to keep you alive, the money is better spent on a younger person. In the world of Obamacare no longer will doctors try to keep patients alive, they will be told that a doctor's job is to achieve social justice one patient at a time.

Emanuel believes that "communitarianism" should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).

To defend discrimination against older patients, Emanuel says: "Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years" (Lancet, Jan. 31).

Medicare was started in 1965 and since then seniors' lives have been extended by new medical treatments such as angioplasty, bypass surgery and hip and knee replacements. These procedures have allowed the elderly to lead active lives. But Emanuel criticizes Americans for being too "enamored with technology" and is determined to reduce access to it.

Dr. David Blumenthal is another key Obama adviser; he agrees with Emanuel and recommends slowing medical innovation to control health spending. Blumenthal has long advocated government health-spending controls, though he concedes they're "associated with longer waits" and "reduced availability of new and expensive treatments and devices" (New England Journal of Medicine, March 8, 2001). But he says whether the timely care Americans get is worth the cost is "debatable." (If you or a loved one has cancer, do you think it’s debatable - delay lowers your chances of survival?)

Obama appointed Blumenthal as national coordinator of health-information technology. This is a job that involves making sure doctors obey electronically delivered guidelines about what care the government deems appropriate and cost effective.

In the April 9 New England Journal of Medicine, Blumenthal predicted that many doctors would resist "embedded clinical decision support" -- a euphemism for computers telling doctors what to do.

Betsy McCaughey, founder of the Committee to Reduce Infection Deaths and a former New York lieutenant governor, thinks you need to know who will be involved in your healthcare decisions and provided the information about Drs. Emanuel and Blumenthal, two of the Obama appointees who will be carrying out Obama’s orders to control lives by controlling what medical care people (other than Obama, congress and government bureaucrats) receive.

"Americans need to know what the president's health advisers have in mind for them. Emanuel sees even basic amenities as luxuries and says Americans expect too much: "Hospital rooms in the United States offer more privacy . .. . physicians' offices are typically more conveniently located and have parking nearby and more attractive waiting rooms" (Betty McCaughey - JAMA, June 18, 2008).

The Democrat news media house organs will not tell Americans the thinking behind government health "reform" nor have most people heard about the arm-twisting, Chicago-style tactics being used to force support by Democrat opponents in the House and Senate. In a Nov. 16, 2008, Health Care Watch column, Emanuel explained how business should be done: "Every favor to a constituency should be linked to support for the health-care reform agenda. If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort."

The health bills in the House and Senate will put decision-making about your care in the hands of presidential appointees with the beliefs of Emanuel and Blumenthal who likely reflect what Obama himself thinks. These people will decide what medical insurance plans cover, how much flexibility your doctor will have and what seniors get under Medicare.

This is what we got when voters responded to the clamor for "change" and elected Barack Obama – Obama has showed a willingness to throw folks "under the bus" when it suits him and old folks are no exception.

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Health reformers' Claims Just Don't Add Up

Many extravagant claims have been made on behalf of the various health care "reforms" now emerging from Congress and the White House. But on closer inspection, virtually all prove to be false.

• America has a health care crisis.

No, we don't. Forty-seven million people lack insurance. Of the remaining 85% of the population, or 258 million people, polls show high satisfaction with the current coverage. Indeed, a 2006 poll by ABC News, the Kaiser Family Foundation and USA Today found 89% of Americans were happy with their own health care.

As for the estimated 47 million not covered by health insurance, 20 million can afford to buy it, according to a study by former CBO Director June O'Neill. Most of the other 27 million are single and under 35, with as many as a third illegal aliens. When it's all whittled down, as few as 12 million are unable to buy insurance — less than 4% of a population of 305 million. For this we need to nationalize 17% of our nation's $14 trillion economy and change the current care that 89% like?

• Health care reform will save money.

Few of the plans now coming out of Congress will save anything, says the CBO's current chief, Douglas Elmendorf. In fact, he says, they'll lead to substantially higher costs in the future — costs that will be "unsustainable." As it is, estimates for reforming health care range from $1 trillion to $3.6 trillion. Much will be spent on subsidies to make a so-called public option more attractive to consumers than private plans.

To pay for it, the president has suggested about $600 billion in new taxes, meaning that $500 billion to $2.1 trillion in new health care spending over the next decade will be unfunded. This could push up the nation's already soaring deficit, expected to reach $10 trillion through 2019 without health care reform. Massive new tax hikes will probably be needed to close the gap.

• Only the rich will pay for reform.

The 5.4% surtax on millionaires the president is pushing gets all the attention, but everyone down to $280,000 in income will pay more. Doesn't that still leave out the middle class and poor? Sorry. Workers who decline to take part will pay a tax of up to 2% of earnings. And small-businesses must pony up 8% of their payrolls.

The poor and middle class must pay in other ways, without knowing it. The biggest hit will be on small businesses, which, due to new payroll taxes, will be less likely to hire workers. Today's 9.5% jobless rate may become a permanent feature of our economy — just as it is in Europe, where nationalized health care is common.

• Government-run health care produces better results.

The biggest potential lie of all. America has the best health care in the world, and most Americans know it. Yet we hear that many "go without care" while in nationalized systems it is "guaranteed."

U.S. life expectancy in 2006 was 78.1 years, ranking behind 30 other countries. So if our health care is so good, why don't we live as long as everyone else?

Three reasons. One, our homicide rate is two to three times higher than other countries. Two, because we drive so much, we have a higher fatality rate on our roads — 14.24 fatalities per 100,000 people vs. 6.19 in Germany, 7.4 in France and 9.25 in Canada. Three, Americans eat far more than those in other nations, contributing to higher levels of heart disease, diabetes and some cancers.

These are diseases of wealth, not the fault of the health care system. A study by Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa found that if you subtract our higher death rates from accidents and homicide, Americans actually live longer than people in other countries.

In countries with nationalized care, medical outcomes are often catastrophically worse. Take breast cancer. According to the Heritage Foundation, breast cancer mortality in Germany is 52% higher than in the U.S.; the U.K.'s rate is 88% higher. For prostate cancer, mortality is 604% higher in the U.K. and 457% higher in Norway. Colorectal cancer? Forty percent higher in the U.K.

But what about the health care paradise to our north? Americans have almost uniformly better outcomes and lower mortality rates than Canada, where breast cancer mortality is 9% higher, prostate cancer 184% higher and colon cancer 10% higher.

Then there are the waiting lists. With a population just under that of California, 830,000 Canadians are waiting to be admitted to a hospital or to get treatment. In England, the list is 1.8 million deep.

Universal health care, wrote Sally Pipes, president of the Pacific Research Institute in her excellent book, "Top Ten Myths Of American Health Care," will inevitably result in "higher taxes, forced premium payments, one-size-fits-all policies, long waiting lists, rationed care and limited access to cutting-edge medicine."

Before you sign up, you might want to check with people in countries that have the kind of system the White House and Congress have in mind. Recent polls show that more than 70% of Germans, Australians, Britons, Canadians and New Zealanders think their systems need "complete rebuilding" or "fundamental change."

• The poor lack care.

Many may lack insurance, but that doesn't mean they lack care. The law says anyone who walks into a hospital emergency room must be treated. America has 37 million people in poverty, but Medicaid covers 55 million — at a cost of $350 billion a year.

Moreover, as many as 11 million of the uninsured qualify for programs for the indigent, including Medicaid and SCHIP. But for some reason, they don't sign up. Are they likely to sign up for the "public option" when it's made available?

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26 July, 2009

Heart valve patients recalled after three die from deadly bug infection following operations at same British government hospital

More than 100 heart surgery patients are being recalled for urgent tests after three died from an infection. A further five patients given new heart valves at Nottingham City Hospital face having repeat operations. All were suffering from staphylococcal infection, similar to the antibiotic-resistant MRSA which has killed hundreds of hospital patients in recent years.

Nottingham University-Hospitals NHS Trust says it is sure the infection, which is common and carried on the skin, was not spread via contaminated operating theatres. One of the most likely routes of transmission was via a surgeon who transferred it to patients during surgery, possibly through poor hygiene or contaminated equipment.

The 'precautionary' recall involves all patients who have received heart valve replacements at the hospital's Trent Cardiac Centre since January. The deaths occurred between May and this month. Dr Stephen Fowlie, medical director of the trust, said no other types of heart operations or other surgery have shown any cause for concern.

Results are awaited from checks on a further 28 patients who had very similar operations, with one patient still being sought. In addition, 79 patients who had a different kind of heart valve operation at the heart centre this year are being contacted but they are considered low-risk. All patients are aged between their early 60s and 80s and the deaths happened between May and July.

Dr Stephen Fowlie, medical director at Nottingham University Hospitals NHS Trust, said 'It is with great regret that we confirm that some patients who underwent heart valve operations since January developed an infection with the same bug. 'There have been eight confirmed cases so far, three of whom have died. The other five are receiving treatment and remain stable.

More here




Common Sense May Sink ObamaCare

It turns out the president misjudged the nation’s mood

By PEGGY NOONAN

This is big, what’s happening. President Obama appears to have misstepped on a major initiative and defining issue. He has misjudged the nation’s mood, which itself is news: He rose from nothing to everything with the help of his fine-tuned antennae. Resistance to the Democratic health-care plans is in the air, showing up more now on YouTube than in the polls, but it will be in the polls soon enough. The president, in short, may be facing a real loss. This will be interesting in a number of ways and for a number of reasons, among them that we’ve never seen him publicly defeated before, because he hasn’t been. So we may be entering new territory, with new struggles shaped by new dynamics.

His news conference the other night was bad. He was filibustery and spinny and gave long and largely unfollowable answers that seemed aimed at limiting the number of questions asked and running out the clock. You don’t do that when you’re fully confident. Far more seriously, he didn’t seem to be telling the truth. We need to create a new national health-care program in order to cut down on government spending? Who would believe that? Would anybody?

The common wisdom the past week has been that whatever challenges health care faces, the president will at least get something because he has a Democratic House and Senate and they’re not going to let their guy die. He’ll get this or that, maybe not a new nationalized system but some things, and he’ll be able to declare some degree of victory.

And this makes sense. But after the news conference, I found myself wondering if he’d get anything.

I think the plan is being slowed and may well be stopped not by ideology, or even by philosophy in a strict sense, but by simple American common sense. I suspect voters, the past few weeks, have been giving themselves an internal Q-and-A that goes something like this:

Will whatever health care bill is produced by Congress increase the deficit? “Of course.” Will it mean tax increases? “Of course.” Will it mean new fees or fines? “Probably.” Can I afford it right now? “No, I’m already getting clobbered.” Will it make the marketplace freer and better? “Probably not.” Is our health care system in crisis? “Yeah, it has been for years.” Is it the most pressing crisis right now? “No, the economy is.” Will a health-care bill improve the economy? “I doubt it.”

The White House misread the national mood. The problem isn’t that they didn’t “bend the curve,” or didn’t sell it right. The problem is that the national mood has changed since the president was elected. Back then the mood was “change is for the good.” But that altered as the full implications of the financial crash seeped in. The crash gave everyone a diminished sense of their own margin for error. It gave them a diminished sense of their country’s margin for error. Americans are not in a chance-taking mood. They’re not in a spending mood, not after the unprecedented spending of the past year, from the end of the Bush era through the first six months of Obama. Here the Congressional Budget Office report that a health care bill would not save money but would instead cost more than a trillion dollars in the next decade was decisive. People say bureaucrats never do anything. The bureaucrats of CBO might have killed health care.

The final bill, with all its complexities, will probably be huge, a thousand pages or so. Americans don’t fear the devil’s in the details, they fear hell is. Do they want the same people running health care who gave us the Department of Motor Vehicles, the post office and the invasion of Iraq?

Let me throw forward three other things that I suspect lessen , or will lessen, support for full health-care reform, two of them not quantifiable.

The first has to do with the doctors throughout the country who give patients a break, who quietly underbill someone they know is in trouble, or don’t charge for their services. Also the emergency rooms that provide excellent service for the uninsured in medical crisis. People don’t talk about this much because they’re afraid if they do they’ll lose it, that some government genius will come along and make it illegal for a doctor not to charge or a hospital to fudge around, with mercy, in its billing. People are afraid of losing the parts of the system that sometimes work—the unquantifiable parts, the human parts.

Second, and this is big, some of the bills being worked on in Congress will allow for or mandate taxpayer funding of abortion. Speaking only and narrowly in political terms, this is so ignorant as to be astounding. A good portion of the support for national health care comes from a sort of European Christian Democrat spirit of community, of “We are all in this together.” This spirit potentially unites Democrats, leftists, some Republicans and GOP populists, the politically unaffiliated and those of whatever view with low incomes. But putting abortion in the mix takes the Christian out of Christian Democrat. It breaks and jangles the coalition, telling those who believe abortion is evil that they not only have to accept its legality but now have to pay for it in a brand new plan, for which they’ll be more highly taxed. This is taking a knife to your own supporters.

The third point is largely unspoken but I suspect gives some people real pause. We are living in a time in which educated people who are at the top of American life feel they have the right to make very public criticisms of . . . let’s call it the private, pleasurable but health-related choices of others. They shame smokers and the overweight. Drinking will be next. Mr. Obama’s own choice for surgeon general has come under criticism as too heavy.

Only a generation ago such criticisms would have been considered rude and unacceptable. But they are part of the ugly, chafing price of having the government in something: Suddenly it can make big and very personal demands on you. Those who live in a way that isn’t sufficiently healthy “cost us money” and “drive up premiums.” Mr. Obama himself said something like it in his press conference, when he spoke of a person who might not buy health insurance. If he gets hit by a bus, “the rest of us have to pay for it.”

Under a national health-care plan we might be hearing that a lot. You don’t exercise, you smoke, you drink, you eat too much, and “the rest of us have to pay for it.”

It is a new opportunity for new class professionals (an old phrase that should make a comeback) to shame others, which appears to be one of their hobbies. (It may even be one of their addictions. Let’s stage an intervention.) Every time I hear Kathleen Sebelius talk about “transitioning” from “treating disease” to “preventing disease,” I start thinking of how they’ll use this as an excuse to judge, shame and intrude.

So this might be an unarticulated public fear: When everyone pays for the same health-care system, the overseers will feel more and more a right to tell you how to live, which simple joys are allowed and which are not.

Americans in the most personal, daily ways feel they are less free than they used to be. And they are right, they are less free. Who wants more of that?

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Obama's proposals fail to do anything about rising health costs due to medical advances

Forget the wonkery. Let’s get primeval. Rising health care costs are a stampede of big ugly rhinos. They are trampling your crops, stomping on your children’s play areas and spoiling your hunting grounds. President Obama wasn’t exaggerating when he said this cost onslaught is unsustainable. The rhinos have been roaming unchecked for a generation. We’ve thrown research projects, legislative and corporate reforms at them, all in an effort to tamp down health care inflation. But the rhinos keep coming. They are ubiquitous, powerful, protean and inexorable.

They feed on fuel sources deep in our system: expensive technological progress, the self-interest of the millions of people who make their living off the system, the public’s desire to get the best care for nothing, the fee-for-service payment system and so on. The rhinos are closing off your future. As the White House folks say, health care premiums have doubled over the last decade. The government is saddled with $36 trillion in unfunded liabilities.

So your only question should be: Where do you find a tool or weapon big enough to stop the rhino stampedes? You know the problem is big, and you figure the response had better be gigantic. Then you look on Capitol Hill and you see a bunch of popguns. The politicians describe these big ugly problems, but when it comes time to talk about their remedies they tell you: Don’t worry. Nothing’s going to change. In other words, we’re going to eliminate the biggest, hairiest, most entrenched problem in the country without fundamentally changing the system and without asking for sacrifice from anybody. Good luck.

Then you talk to the health care experts promoting the bills and they are very honest: We don’t know exactly how to slow health care inflation. But we think we have some good ideas. We’re going to put some innovations, information clearinghouses and pilot projects in this legislation, and over the next 10 years we will see what works to really bring down costs. We’re going to go on a voyage of discovery to learn about rhino eradication. And, indeed, some of the ideas do sound good: more information technology, comparative effectiveness research, conducting experiments to bundle hospital payments so they are based on outcomes. Some of the providers that do things right, like the Mayo Clinic, really are getting results.

But some of these ideas have been watered down in the legislation. And you’re not a complete idiot. You know there is a big difference between finding islands of excellence and creating a national system based on them. Besides, you’ve got a bunch of big, evil rhinos stomping around! You want more than some promising ideas to pinpoint waste, fraud and abuse. You want some big heavy hammers to clock those suckers in the head.

Now that the first wave of legislation is bogging down, you want to take the seeds of cost control and you want to do more. You want to eliminate or cap the tax exemption on employee health benefits. This is a big way to crush one of the core drivers of health care inflation. You’re willing to give MedPAC-style technocrats a chance to take control of Medicare spending away from Congressional spendthrifts.

You want to loosen federal regulations so that states have more room to experiment — not tighten them, as the current legislation does, so that states have less. You want reforms throughout the system that will cut down on first-dollar reimbursement in exchange for catastrophic protection. You want to tie Medicare subsidies to income. You want to look at anything that will move us away from a fee-for-service model, the core perversion in the system. You want to change incentives at both ends.

The legislators who drew up the first bills want to change the provider’s incentives. But big cost savings can also come if consumers have choices and incentives to hunt for cheaper coverage. The Wyden-Bennett bill gives people a chance to choose the best option, instead of imprisoning people in existing coverage, as the current legislation does. The Medicare Part D reform has produced impressive reductions by allowing consumers to pocket prescription drug savings. Other proposals would give people tax credits and allow them to go to any trusted community group — like AARP or a union or a religious group — that wanted to compete to offer coverage.

Not everything is compatible with everything else. But the point is that you have rhinos at the door! You’ll try anything that works. You want a political class that no longer perpetuates the myth that people can get everything for nothing. You know that it was political pandering that got us into this mess in the first place. Obama is right. Things will be bad if we don’t tackle the problem this year. Things will be worse if we add to the costs without beating the rhinos.

SOURCE




Stocks Surge as Obamacare Implodes

An interesting comment from economist Larry Kudlow

Hate to say it but Obama’s disastrous press conference last night is a big contributor to today’s roaring stock market. The Dow opened strong and is now up over 200 points, continuing a very bullish rally that is breaking new high ground for shares this year.

Politics is not everything, but I believe that the shrinking probability of a new government insurance plan that would lead to nationalized health care — along with the demise of cap-and-trade that would nationalize energy — is very bullish for stocks.

Hat tip to Bill Kristol for the phrase “docs and cops,” that latter of which were attacked by Obama last night. It looked real bad. In fact his whole garbled, inconsistent, and baffling defense of health care looked real bad. The president’s polls have been falling, especially on his policies. And markets see the possibility that free-market capitalism will live to see another day.

Of course, there are a lot of positives going on inside the economy and markets. Earnings continue to surprise on the upside and a profits bottom following a nasty two-year decline is upon us.

This morning, the weekly jobless-claims figure — a key leading indicator of future employment — did rise 30,000. But that does not erase the near 100,000 downward spike on a four-week moving average. The chart has gone from 660,000 claims to 566,000. It could well mean that businesses cut too many jobs in the first half of the year. Planned layoffs are falling, and the July jobs figure may be better than we think. The unemployment rate might actually level off.

Meanwhile, Ben Bernanke is signaling an accommodative Fed policy for as far as the eye can see. And in the money and bond markets, credit-risk spreads have now fallen back to the pre-Lehman levels of late last summer. Economist Joe LaVorgna thinks stock prices could go back to pre-Lehman levels, too, which would be about 1,250 on the S&P — nearly 30 percent higher than today’s 977 level.

I’m not predicting a return to the all-time S&P high, which was over 1,500. There are still too many government threats to free-market capitalism emanating from Democratic Washington. But the political tide is clearly turning for the better. And so are the economic stats. If the July employment report wipes out some of the negatives of the June report, this market could really roar.

SOURCE




Texas governor raises possibility of states' rights showdown with White House over healthcare

Gov. Rick Perry, raising the specter of a showdown with the Obama administration, suggested Thursday that he would consider invoking states’ rights protections under the 10th Amendment to resist the president’s healthcare plan, which he said would be "disastrous" for Texas. Interviewed by conservative talk show host Mark Davis of Dallas’ WBAP/820 AM, Perry said his first hope is that Congress will defeat the plan, which both Perry and Davis described as "Obama Care." But should it pass, Perry predicted that Texas and a "number" of states might resist the federal health mandate.

"I think you’ll hear states and governors standing up and saying 'no’ to this type of encroachment on the states with their healthcare," Perry said. "So my hope is that we never have to have that stand-up. But I’m certainly willing and ready for the fight if this administration continues to try to force their very expansive government philosophy down our collective throats."

Perry, the state’s longest-serving governor, has made defiance of Washington a hallmark of his state administration as well as his emerging re-election campaign against U.S. Sen. Kay Bailey Hutchison in the 2010 Republican primary. Earlier this year, Perry refused $555 million in federal unemployment stimulus money, saying it would subject Texas to long-term costs after the federal dollars ended.

Interviewed after returning from a trip to Iraq and Afghanistan, Perry spoke out against President Barack Obama’s healthcare package less than 24 hours after the president used a prime-time news conference Wednesday night to try to sell the massive legislative package to Congress and the public. "It really is a state issue, and if there was ever an argument for the 10th Amendment and for letting the states find a solution to their problems, this may be at the top of the class," Perry said. "A government-run healthcare system is financially unstable. It’s not the solution."

Perry heartily backed an unsuccessful resolution in this year’s legislative session that would have affirmed the belief that Texas has sovereignty under the 10th Amendment over all powers not otherwise granted to the federal government. In expressing "unwavering support" for the 10th Amendment resolution by state Rep. Brandon Creighton, R-Conroe, Perry said "federal government has become oppressive in its size, its intrusion into the lives of our citizens and its interference with the affairs of our state." Returning to the "letter and spirit" of the 10th Amendment, he said in April, "will free our state from undue regulations and ultimately strengthen our union."

Perry, in his on-air interview Thursday with Davis, did not specify how he might use the 10th Amendment in opposing the Obama health plan. His spokeswoman, Allison Castle, said that the governor’s first goal is to defeat the plan in Congress and that any discussion of options beyond that would be "hypothetical."

"I don’t think it’s surprising that the governor is taking a stand against it," said Anne Dunkelberg, associate director of the Center for Public Policy Priorities, an Austin-based research organization that supports the House version of Obama’s plan. "Unfortunately, the national dialogue on health reform has been extraordinarily partisan and polarized."

The White House Media Affairs Office, asked to comment on Perry’s statements, did not have an immediate response. In his remarks to the nation Wednesday, Obama restated his midsummer deadline for passage of the bill in Congress, saying it is urgently needed to help families "that are being clobbered by healthcare costs."

Texas has a higher percentage of uninsured people than any other state, with 1 in 4 Texans lacking health coverage. Dunkelberg, whose organization supports policies to help low- and modest-income Texans, said the House version would create a "predictable and comprehensive benefits package" for thousands of struggling middle-income Texans.

Former Rep. Arlene Wohlgemuth of Burleson, a senior fellow for healthcare at the conservative Texas Public Policy Foundation, echoed Perry’s assertion that the Obama plan is the wrong approach and could have disastrous financial consequences for Texas. Under the Senate version of the bill, she said, an expansion of the joint federal-state Medicaid program for the poor could cost Texas $4 billion a year. "There are good solutions" to the country’s healthcare problems, Wohlgemuth said. "This isn’t it."

Perry said the plan is another example of the Obama administration’s "massive takeover of the private-sector economy." "I hope our leaders will look for solutions that don’t dig our country further into debt," he said. Perry called on Texans in the House and Senate to oppose the plan. "I can’t imagine that anyone from Texas who cares about this state would vote for Obama Care. I don’t care whether you’re Democrat or Republican," he said.

Of those Texans who might consider supporting the plan, he said: "This may sound a little bit harsh, but they might ought to consider representing some other state because they’re sure not representing Texas."

SOURCE





25 July, 2009

British swine flu farce

No wonder Britain has the worst incidence of it

I was the first in my house to go down with the H1N1 virus. It was only a matter of time before someone else in the family followed. Seven days after my initial symptoms, my husband woke up with the telltale sore throat, headache and general all-over ennui that signal the start of this virus. By yesterday he was no better, his throat inflamed and his temperature hovering around the 38C mark.

I called the new swine flu helpline. A well-spoken, pre-recorded gentleman gave me a clear explanation of the clinical nature of swine flu. In a passage that reminded me faintly of Mitchell and Webb’s “Remain Indoors” sketch, I was told to stay at home if I or someone I knew was experiencing any of the symptoms, and to visit the website or call this number: 0800 1513100.

Not wishing to drag my husband into the shed that doubles as my office, I decided to try the telephone option. Much to my surprise, I got through quickly and easily to a rather nervous-sounding woman from Scotland. Anxiously, she checked that I was calling from England (this service doesn’t work for Scotland, Wales or Northern Ireland).

Was the person I was calling on behalf of a child? No. Were they with me? Yes. Were they also in England. Er, yes. Asleep or awake? Awake. Could they talk without loss of breath? Yes. She checked again: it’s not a child? No. Are they making grunting noises? What, like the baby in Alice in Wonderland? No, not yet at any rate. Could the patient touch his chin to his chest. Yes.

There was a long silence while this information, clearly the bit of the questionnaire that is designed to weed out meningitis and other serious infections — the work that an actual doctor would normally do — was being processed. She then asked for his date of birth and name, and we proceeded to the meat of the survey — sorry, assessment.

It was at this point that the process became a shade farcical. As the questions progressed, it became clear that not only did the operator have no formal medical training, she wasn’t even familiar with basic health terminology. For example, she struggled to read out the word “Relenza”; When asking if the patient had any other metabolic conditions, the word “metabolic” seemed to baffle her, as did the names of various drugs; and the term “cystic fibrosis” eluded her completely. I really wasn’t expecting any detailed clinical knowledge, but surely basic literacy should be a requirement.

Nevertheless, the computer seemed satisfied, and so I was told that my husband was authorised for a course of antivirals. I was given a number, which the woman stressed I could be told only once (in the manner of that other great British farce, ’Allo ’Allo) and that if I lost, would not be reissued. I was to take this number, along with my ID, to my antiviral collection point.

Meanwhile, in a darkened room somewhere, a friend of mine with early symptoms was on her laptop. By her own admission more likely to be suffering from hypochondria than real flu, she had nevertheless decided she wanted to be on the safe side and secure some Tamiflu just in case. Even with a rudimentary knowledge of all things swine, she managed to tick all the right boxes and rang me, delighted, to say that for her, too, the computer had said yes.

Quite why the Government has taken swine flu away from the medically qualified and franchised it out to some of David Brent’s less sparky colleagues is a mystery. People whose day jobs normally consist of conducting market research surveys should not be in charge of speaking to potentially sick people. That is at the very least the job of nurses. Anything less is a dereliction of duty.

The principal dangers from this virus seems to be with secondary infections: complications arising from the illness. When the person assessing your symptoms can’t even read the questions, it hardly offers much grounds for reassurance. All that will happen is that the genuinely ill will get overlooked, and the wily will get their Tamiflu.

Next stop, eBay.

SOURCE

Another report:

'Are you unconscious?': What happened when the Mail phoned the new swine flu hotline

The National Pandemic Flu Service hotline was caught up in controversy almost as soon as it was launched yesterday. Callers were asked to describe their symptoms by call centre workers with no medical training.

Concerns were raised by doctors and campaign groups as patients were asked a series of bizarre questions including whether they were 'unconscious' or 'unresponsive'.

Launched at 3pm, the helpline and website were intended to dispense antivirals quickly to those at risk and take the pressure off GPs. But thousands of sufferers were given conflicting information by the 2,000 call centre workers with just three hours of experience.

Calls made by the Daily Mail revealed inconsistencies in the advice given.....

More here




Australia: Mother gives high-risk birth at home after being refused admittance by public hospital

A MOTHER has claimed she was forced to give birth on her bedroom floor after being turned away from a Sydney hospital because there were not enough beds. Natasha Ramirez, 27, was bleeding and in labour when she first arrived at Liverpool Hospital last Thursday but said she was told by a nurse, "We don't have enough room tonight". "She told me to go back home because I wouldn't be in labour for another 24 to 48 hours," Ms Ramirez said yesterday.

Five hours later baby Anjelita was born on the bedroom floor at the Ramirez home, The Daily Telegraph reports. The hospital last night refused to comment on the specific allegations.

Ms Ramirez was at her Liverpool unit with her partner Ricardo Hermosilla when she went into labour about 3am. With her mother Diane Burns in Dubbo, Ms Ramirez decided to call a taxi to take her to the hospital. When she arrived she was taken to the birthing unit but claimed she was not seen by a doctor, only a nurse.

At four days overdue, Ms Ramirez was concerned that there might be complications similar to those she suffered in her previous birth when she needed anti-D injections because of her O-negative blood type. "A nurse assessed me and told me to go back home because they were full that night," she said. "I was told all along during my pregnancy that as soon as I went into labour I needed to be assessed and given the injections straight away. "When I got back home I had to lie on the floor I was in so much pain."

She called the hospital again and was told by staff to return. Mr Hermosilla called an ambulance but Anjelita was born before it arrived. "I am angry because something could have happened," she said. Her mother said she was furious her daughter had been put through such an ordeal. "When she got home she rang the hospital and told them she was having contractions and then they said they would make arrangements for a bed," Ms Burns said. "It just makes you wonder why they couldn't do that in the first place."

In a statement last night, a hospital spokeswoman said patients' complaints were taken "very seriously". "Patients who have not yet begun labour, and who are assessed by a doctor and found to have no other clinical needs, are usually sent home to await the full onset of labour," the spokeswoman said.

SOURCE




Governors worried by healthcare bill costs

The nation’s governors, Democrats as well as Republicans, voiced deep concern yesterday about the shape of the healthcare bill emerging from Congress, fearing that the federal government is about to hand them expensive new Medicaid obligations without providing the money to pay for them.

The role of the states in a restructured healthcare system dominated the summer meeting of the National Governors Association here this weekend - with bipartisan animosity voiced against the Obama administration’s plan during a closed-door luncheon Saturday and in a private meeting yesterday afternoon with the secretary of health and human services, Kathleen Sebelius.

“I think the governors would all agree that what we don’t want from the federal government is unfunded mandates,’’ said Governor Jim Douglas of Vermont, a Republican who is the group’s incoming chairman. “We can’t have the Congress impose requirements that we are forced to absorb beyond our capacity to do so.’’

The governors’ backlash creates yet another healthcare headache for the Obama administration, which has tried to recruit state leaders to pressure members of Congress to wrap up their fitful negotiations. In its effort to win support for the health plan, the administration dispatched Sebelius - who was governor of Kansas before she joined the cabinet in April - and the federal Medicaid chief, Cindy Mann, to meet here with the governors. Meanwhile, other administration officials spent yesterday pushing the proposal on television talk shows.

President Obama also plans to address questions about his health plan at a news conference Wednesday.

Although many governors said significant change was needed, they said their deep-seated fiscal troubles made it a terrible time to shift costs to the states. With the recession draining states of tax revenues even as their Medicaid rolls are surging, the National Governors Association projects that states will face aggregate deficits of $200 billion over the next three years.

Because the states and the federal government share the cost of Medicaid coverage for low-income people, any increase in eligibility levels, benefits, or payments to doctors would impose new costs on the states unless Washington agrees to absorb them entirely. In at least one of several bills circulating in Congress, the states would eventually pick up a share of the new costs, and the governors fear they cannot count on pledges in other bills that they will be held harmless.

It was unclear whether the governors’ association would put together a statement expressing its dismay, at least partly because half of the governors did not attend. Many, including the group’s chairman, Governor Edward G. Rendell, a Pennsylvania Democrat, stayed home to deal with budget crises.

Some of the group’s most recognizable names - Arnold Schwarzenegger of California, Sarah Palin of Alaska, Charlie Crist of Florida, Tim Pawlenty of Minnesota, Bobby Jindal of Louisiana, David Paterson of New York, Jennifer M. Granholm of Michigan, and Mark Sanford of South Carolina - were not here.

More here




Health care Never Never Land

In “Sicko,” iconoclastic filmmaker Michael Moore extols the virtue of health care in such liberal “paradises” as the United Kingdom and Cuba. Leaving his audience to wonder where he would choose to go for treatment if he were facing a life-threatening illness — the People’s Hospital in Havana or the Mayo Clinic in Rochester, Minn. — Moore exhibits the same Alice-in-Wonderland delusion that has settled over the Obama administration.

A majority of members of Congress, too, seem to believe that if only enough bureaucracy and taxpayer dollars are thrown at the health care “crisis,” then everyone in the country will have their every medical need met, when they want it, and at much reduced cost. Such a mind set turns Peter Pan’s Never Never Land into a reality show.

For starters, advocates of the House legislation might want to talk to governors of those states, like Massachusetts, that have already implemented “universal” coverage plans. Increasing program costs, coupled with decreased state revenues as a result of the economic downturn, are causing serious fiscal problems and are forcing those states to consider cutbacks in coverage.

However, witnessing the irrational, “gotta-do-this-now” push in our nation’s capitol to pass comprehensive health care “reform” within the next few weeks, it is obvious the proponents of Obama-care are not interested in anyone throwing the cold water of fiscal reality on their parade.

The House version of the legislation, unveiled by Speaker Nancy Pelosi (D-Calif.) last week, includes substantial mandates on American businesses (including a severe, 8 percent payroll tax on any business that fails to offer health insurance coverage to its employees). Still, the Pollyannaish Pelosi claimed (with a straight face) it would “lower costs to businesses.” This is government logic at its finest — you lower the cost of doing business by raising taxes on those businesses.

Pelosi’s obvious inability to grasp even the most basic of economic concepts was further displayed when she claimed that the “costs to consumers,” too, would be lowered. Apparently, this would be accomplished by placing a new surtax on those American consumers whose income exceeded the levels deemed worthy by the legislators.

Analysts of the 1,000-plus page legislation calculate its 10-year cost to exceed $1 trillion. Other experts fear such a figure greatly underestimates its true cost. Even the Congressional Budget Office calculates that the government subsidy for health care coverage will amount to some $6,000 per person within the next decade, which figures to more than $1.8 trillion.

Pelosi’s bill would also create a government-run insurance plan to compete with private insurers. Such a scenario, of course, is never a fair “competition,” because the government “owner” can always print money, spend borrowed money indefinitely, operate without regard for cost-benefit analysis, and threaten legal sanctions for those who fail to comply. None of these remedies are available to businesses (except, of course, for the “new” General Motors).

The smoke-and-mirrors approach is evident also in the fact that high-income taxpayers, who would already be taxed in order to pay for the “universal” coverage for their less-well-off compatriots, would face escalating taxes if the government fails in the years ahead to achieve targeted “savings” in Medicaid and Medicare. In other words, the government will set “savings targets,” but if it fails to meet them, it is taxpayers who will pay the penalty, not those members of Congress or federal bureaucrats who decide how much to spend on the entitlement programs.

Other industries, including pharmaceuticals, will face increased taxes as well, in order to pay for this “reform.” The more successful drug makers will pay a higher percentage tax than their smaller, less successful colleagues. Once again, success in the business arena is punished in the government arena.

Truly, this bill is a monstrosity.

SOURCE




The Left Rejects Free-Market Solutions to Healthcare

Filling in for Keith Olbermann yesterday on MSNBC’s Countdown program, guest host David Shuster chastised Republicans for having no plan “to contain exploding healthcare costs.” So busy was Shuster smirking and sneering (like Olbermann) over the Republicans’ alleged indifference to those costs, that he neglected to mention Congressional Budget Office director Douglas Elmendorf’s recent assessment that the Democrat healthcare plan would increase federal costs “to a significant degree” – because it plainly “raises future federal outlays more than it reduces future federal outlays.”

Neither did Shuster mention that Medicare, the federally funded insurance program for senior citizens, wastes as much as $1 out of every $3 it spends, even as its overall operating costs spiral out of control.

Nor did Shuster point out the legendary economic inefficiency of Medicaid, the government-run insurance program for low-income Americans, which is administered by the states but receives anywhere from one-half to two-thirds of its funding from the federal government. While the program’s costs are projected to rise by more than 100 percent over the next decade, fraud runs rampant; in New York State, for instance, 40 percent of all Medicaid claims are fraudulent.

And neither did Schuster note the similar fiscal inefficiencies or bureaucratic nightmares of SCHIP (the State Children’s Health Insurance Program), which was established 12 years ago to provide medical coverage for children in households with low incomes that nonetheless exceeded Medicaid eligibility.

Leftists like Shuster (and the Democrats in Congress) remain willfully blind to the mountains of evidence demonstrating that government-run healthcare is guaranteed only to raise overall costs, increase the incidence of fraud, and lower the standard of care.

Why do they continue to support it? That’s simple: because they believe in it. The notion that the federal government should control every aspect of people’s lives, regardless of the costs or demerits of such control, is an article of faith for the Left, not a product of reason. Conversely, leftists never offer free-market solutions to problems like healthcare reform because they abjure free markets.

In her landmark book, The Top Ten Myths of American Health Care, author Sally Pipes writes:

[T]rue reform of the health care system requires less government interference—not more. Only with a freer market can we lower costs and achieve quality universal health care. If we have universal choice in health care, we will reach universal coverage—a goal supported by all of us.

Consider Lasik corrective eye surgery. Because most insurance providers including government programs won’t cover the procedure, the market isn’t distorted by excessive regulations. Providers operate in a free market where technology is constantly advancing, price competition is fierce, and the consumer is king. Companies rise and fall according to their ability to provide customer satisfaction.

In the past decade, more than three million Lasik procedures have been performed. During that time, the average price of Lasik eye surgery has dropped nearly 40 percent, from $2,200 to $1,350 per eye.

Unfortunately, Lasik is a rare exception to the general rule. In just about every other area of health care, the government is heavily involved. So the key to lowering costs and expanding coverage is to expand the Lasik model. That means encouraging competition by decreasing government’s role in the health care marketplace.

SOURCE





24 July, 2009

£100m blood filter treatment that stops CJD is ‘too expensive for NHS patients’

Just firing a few of their army of clerks and administrators would enable them to afford it easily

A medical breakthrough that prevents the spread of the human form of mad cow disease via blood transfusions may be denied to NHS patients because it costs too much. More than 60 adults having surgery have received blood free of the risk of variant CJD in trials overseen by the National Blood and Transplant Authority. The advance centres on a filter that can remove the rogue vCJD protein, called a prion, from blood in just 30 minutes - eliminating the patient’s risk of catching the brain disease.

The filter could restore faith in British blood supplies which are proven to be tainted with vCJD after several deaths related to transfusions. But documents reveal it has been branded ‘not cost-effective’ and experts warn it will double the price of producing red blood cells, leaving a bill for an extra £100million.

Donors who do not realise they are carrying the disease, which can have an incubation period of up to 50 years before showing symptoms, risk passing on vCJD when they give blood. It is feared as many as one in 4,000 could be carriers. There is no reliable way of testing stored blood to see if it is infected.

The filter simply clips on to the blood collection bag and red cells are slowly dripped through it into an empty bag underneath. Any prions are captured in a mesh containing resins that are designed to ‘attract’ amino acids found on the surface of vCJD proteins. Animal studies have proved it prevents transmission of the deadly disease through blood transfusions.

But minutes of the advisory committee on the Safety of Blood Tissues and Organs (SaBTO) record: ‘Implementation of prion filtration is not cost-effective under the majority of scenarios modelled for risk.’

One proposal is for filtered blood to be initially given only to under 16s, on grounds of cost, as they are least likely to have been exposed to ‘mad cow’ disease through eating BSE-infected meat.

Estimates from the National Blood and Transplant Authority say the cost to the NHS of producing one unit of blood - about a pint - would double, from £50 to around £100 using the filter, meaning it could cost about £100million to introduce.

However, while declining to give exact figures, manufacturer MacoPharma says its P-Capt filter - which is classed as a medical device and was awarded the European CE quality mark in 2006 - would probably cost the health service half this amount.

Judy Kenny, wife of Deryck Kenny, 69, who died in 2003 after contracting vCJD through a blood transfusion, said: ‘As a nurse, I know there has to be good evidence it is safe and it works. ‘As the wife of someone who died after contracting vCJD through blood, I think cost should not be a reason to stop it being introduced.’

A spokesman for the Health Department said: ‘Cost benefit analysis is carried out on all new measures to assist SaBTO in its decision and is one of several factors it will consider. ‘This does not mean prion filtration will be turned down purely on the basis of cost.’

SOURCE




West Australian public hospital patient waited 'more than 45 hours' for a bed

A WA emergency patient recently waited more than 45 hours for a hospital bed, according to a national report. The report, a snapshot compiled for the Australian College of Emergency Medicine, found WA still had the worst emergency department overcrowding in Australia. The snapshot of 79 emergency departments Australia-wide was undertaken at 10am on Monday, June 1. Eight WA hospitals took part in the snapshot.

WA emergency departments recorded the worst overcrowding in the country. About 35 per cent of patients in WA emergency departments waited longer than eight hours for treatment, with one patient waiting longer than 45 hours. There were nine WA patients who had been waiting longer than 24 hours for a hospital bed.

Queensland had the best record with only 15 per cent of emergency patients waiting longer than eight hours for a hospital bed. Forty-four patients in 22 hospitals included the report had a patient that had waited more than 24 hours for a hospital.

“Half of Australia’s training hospitals have patients waiting for an inpatient bed more than 12 hours after that bed was formally requested,” ACEM president Sally McCarthy said. “Even though politicians and health departments have been shown the facts and even though patients are still dying while waiting for beds, there has been no significant improvement in access block since this time last year.”

All 94 emergency departments accredited for training were contacted, and 79 responded with details of their activity. Associate Professor Drew Richardson, author of the study, said there was no statistically significant improvement in access block compared to last year. “Of the 66 EDs which answered both the 2008 and 2009 surveys, 33 reported an improvement and 33 a worsening of access block: whilst there may be pockets of better practice, the net effect nationwide has been nil.”

WA Health Minister Kim Hames said the emergency department figures were concerning. Dr Hames said the Health Department had started overhauling emergency departments in preparation for the introduction of the four hour rule. Under the rule, 98 per cent of emergency patients must be admitted or discharged within four hours. The state's major tertiary hospitals, like Royal Perth Hospital and Sir Charles Gairdner Hospital, have 18 months to meet the demand. WA is the only state in Australia introducing the scheme.

SOURCE




ObamaCare in Trouble

By KARL ROVE

Polls are turning against President Barack Obama’s health-care plan. The political calendar is, too. On Monday, the Washington Post/ABC poll reported that 49% of Americans approve of his handling of health care while 44% disapprove. What many people missed is that those who strongly disapprove of the president’s approach on health care now outnumber those who strongly approve by 33% to 25%. That presages further decline. Already, 49% of independents disapprove of the president’s approach, up from 30% in April, a staggering shift in 11 weeks.

Mr. Obama is also slipping on the economy. Those who strongly disapprove now outnumber those who strongly approve of his handling of the economy (35% to 29%), of deficits (38% to 19%), and of unemployment (31% to 26%). On Tuesday, Gallup showed Mr. Obama’s personal approval was 55%, down from more than 60% a few weeks ago and lower than the 56% George W. Bush had at this point in his first term.

The polls are crumbling because of a flood of bad news about Mr. Obama’s health-care proposals. One batch of such news came from a July 17 study by the Lewin Group that was commissioned by the Heritage Foundation. It projects that if the House bill becomes law, 83.4 million people—nearly half of those with private coverage—will lose private insurance as employers drop their plans. Mr. Obama’s promise that you can keep your plan is being left on the cutting room floor with nary a peep from the president.

Another batch of bad news came this week as Democratic governors from Colorado, Tennessee, New Mexico and Washington joined GOP colleagues at the National Governors Association summer meeting to blast the administration for plans to shift millions of families into Medicaid. That could stick states with $440 billion in new costs over the next decade.

But the most damaging news came from Congressional Budget Office (CBO) Director Douglas Elmendorf, who said last week that the White House’s health-care proposals would not “reduce the trajectory of federal health spending by a significant amount.” This shattered the central claim Mr. Obama has been making: that his health-care plan controls costs. In a July 17 letter, Mr. Elmendorf added that the House’s health-care bill would result in a “net increase in the federal budget deficit of $239 billion” over 10 years. That’s likely a low-ball estimate because it assumes that Congress will increase taxes by $583 billion over the next decade.

Ways and Means Committee Chairman Charlie Rangel says he’ll pay for the Obama health proposal by raising taxes on Americans making $280,000 a year ($350,000 for couples). Most of those stuck with higher taxes will be small business owners. Even Democrats don’t like that approach: 21 of 39 freshmen House Democrats penned a letter opposing the tax hike. Many are among the 66 Democrats from districts that either Mr. Bush or John McCain carried in recent presidential elections. Mr. Obama shrugged off the letter by saying that the surtax would only force some to pay “a little bit more.”

The Democratic National Committee is now running ads pressuring Democrats to vote for the president’s health-care plans, including new ads in the districts of House Ways and Means Committee Democrats who have raised questions about the health-care bill. It is hard to think of a more obvious sign of weakness than attacking members of your own party.

Team Obama was rushing to pass health care before the August recess out of fear that allowing members to go home for an extended spell before voting on the bill would give them an opportunity to hear from their constituents. They fear that the 300 protestors who showed up at a town hall meeting in Panama City, Fla. held June 30 by Democrat Rep. Allen Boyd shortly after he voted for the cap and trade energy tax) are only the start of a larger backlash.

Democratic leaders, including the president, are now backing away from a vote on health care before August. But that’s not likely to decrease voter angst. Americans for Prosperity and others are already organizing voters to attend public meetings with members of Congress this summer. My guess is that members of Congress are about to hear a lot from their voters on the government takeover of health care, new energy taxes, the failed stimulus, record deficits, and growing joblessness.

SOURCE




What if I don’t want health insurance?

I'm one of the nearly 50 million Americans who don't have health insurance. I don't want it, either. But the bill the House of Representatives is debating would force me to buy it. How good can any product be if Congress compels me to purchase it?

Politicians and interest groups have been trying virtually all my life to foist medical insurance on me. But their proposals rest on mistaken and even insulting assumptions.

First, they presume that everyone wants, needs, and should have abundant medical attention. But I come from a long-lived and healthy family, I've been a vegetarian since childhood because I've never liked the way meat tastes, I don't smoke, and I love to hike – the more miles the better.

I am disgustingly healthy, so much so that the only doctors I see – or try to: I'm near-sighted – are ophthalmologists. Could I be hit by a bus tomorrow when I head out for my daily walk? Possibly. But that's such an unlikely disaster that I've chosen to spend my money on more personally pressing needs than medical insurance.

On the other hand, unlikely disasters do happen. So I might purchase catastrophic coverage if it were reasonably priced – just as I might visit doctors for lesser complaints if their care were reasonably priced.

But the government's meddling is what helped mess-up the medical market to begin with. The federal government perverts costs with its Medicare and Medicaid programs: Recipients of this largess have no incentive to save money since someone else pays their bills.

In fact, the incentives run the opposite way as patients demand more procedures and tests while magnifying problems I resolve out of my medicine cabinet into emergency-room runs. Doctors who get away with charging Medicare hundreds for diagnosing Grandpa's indigestion would charge me the same.

Meanwhile, state governments shackle the insurance industry, mandating that policies cover everything from chiropractic care to hormone replacement. These launch premiums into the stratosphere. I'd much rather pick and choose the coverage I want at a price I'm willing to pay than buy the plan bureaucrats and special interests decree.

But the universal-healthcare crowd thinks it knows better than I do how to spend my money. Why can't they leave me alone? I'm not forcing them to eat flaxseed and bike to meetings instead of hopping into their limousines. It's time for them to return the favor.

Besides, if that bus does hit me tomorrow, I want – and will pay for – top-notch care. And that's not what government-run medical systems dispense. Delays, expedient rather than proper treatment, and double standards of care depending on who you are and whom you know characterize universal-healthcare systems.

Which makes sense. We live in a world of finite resources and infinite desires, where medical care must be "rationed" like all other products and services.

Though we can't choose whether goods are rationed, we can choose how they are. Either the politicians and bureaucrats who bring us long lines at DMVs, failing public schools, and the endless war in Iraq will decide who gets what kind of treatment, or the free market will.

Fans of universal healthcare deride the market: They say it's cold and cruel because we each have to pay for the care we demand. But government healthcare can be far colder and crueler. Its care is inferior: Contrast an inferior, run-down veteran's hospital with a general one. And it's expensive. Dr. Jeffrey Anderson recently wrote in Investor's Business Daily, "Since 1970 – even without the prescription drug benefit – Medicare's costs have risen 34 percent more, per patient, than the combined costs of all health care in America apart from Medicare and Medicaid…."

Absent such meddling, the price of medical care would return to reasonable levels. It benefits no provider of any service to charge such astronomical fees that customers can't afford to patronize him. Then, too, in a market free of the state's stranglehold, doctors and hospitals would compete with one another to lower prices and attract the ill or injured.

That doesn't mean everyone could finally buy all the procedures they wanted or even needed – but that's where private charity would come in. Humanitarians who send inner-city kids to summer camp and volunteer their time or money at soup kitchens would strive to ensure that needy Americans received medical care.

President Obama says, "We have no choice but to fix the healthcare system because right now it's broken for too many Americans." But the only fix we need is for government to get out of medicine.

SOURCE




Fascist healthcare coming

Much of the so-called “debate” over ObamaCare is a diversion. In addition to the technocratic jargon and minute market manipulations being talked about, the Obama Administration is softening up the American public by propagandizing them on the horrors of the current healthcare system. The president has created an entire website that overwhelms people with ObamaTales of Healthcare Terror.

The ObamaTales cast employers, insurance companies, pharmaceutical companies and hospitals as the ogres in the drama. It is essential, therefore, that once people get over the powerful emotional reaction they will have from viewing the sad stories depicted in the videos, they need to consider that the insurance companies, pharmaceutical companies and hospitals portrayed as the bad guys in the ObamaTales are the very entities Obama is presently cutting a deal with behind the scenes to provide the backbone and infrastructure of his government-run system.

“The president refuses to reveal his true preferences for healthcare reform. Will it have a government option to “compete” with private plans; will it have an individual or employer mandate; will it have a rationing board disguised as a board of standards and effectiveness; will it have strict criteria and mandates on private health insurance? No matter what form ObamaCare ultimately assumes after the Congress is finished with its sausage making, it is a certainty that nationalized healthcare in America will have a private-sector facade on it—true to the fascist model Republicans gave us in the Medicare-Part-D prescription-drugs program for seniors—using employers, private insurance companies, private hospitals and pharmaceutical companies essentially as government contractors.

So, just as with the banks in the financial bailout and just like the automotive bailout, nationalized healthcare will end up being more fascist than socialist, a huge “public-private partnership” where the government calls the shots, the private contractors get the goodies, and American citizens pay the tab in higher taxes, more public debt and rationed healthcare. If you think the private companies and employers portrayed in the Obama’s Terror Tales are behaving badly now, just wait until they have the sanction of the federal government behind their delays, denials and rationing of care.

Evidence of the way this saga will end abound. Earlier this week, White House Chief of Staff Rahm Emanuel admitted the prime objective of healthcare reform is to get control of insurance companies. He said, "The goal is to have a means and a mechanism to keep the private insurers honest. The goal is non-negotiable; the path is" negotiable.”

Emanuel specifically mentioned a White House willingness to move away from the “public option” favored by most liberals and adopting instead a version of the fascist Republican model used in Medicare Part D. Obama’s chief of staff said that one of several ways to meet President Barack Obama's goals is to adopt a mechanism under which a public plan is put into effect only if the marketplace fails to provide sufficient competition on its own. This is precisely the trigger mechanism Republicans used when they created a prescription-drug benefit for Medicare in 2003.

Any part of such a deal between the federal government and big insurance companies, of course, would have to entail a guarantee that the insurance companies be sheltered from paying the costs of the plan by shifting them onto healthcare consumers.

And guess who will pay? SENIORS FIRST. That is why it was no coincidence that the $155 billion “cost-saving” deal Obama struck with hospitals entails a decade’s worth of reductions to Medicare and charity-care payments for hospitals.

So there you have it: A stealth government takeover of big insurance companies, pharmaceutical companies, hospitals and even private employers along with more cuts to Medicare. When the government and private industry go into partnership, it is invariably the people who get kneecapped. The fascist healthcare system being teed up in Washington will be no exception.

SOURCE





23 July, 2009

British Hospital to face second inquiry after damning report

An NHS hospital is to be scrutinised in a second official inquiry after a report found that “appalling” emergency care led to patients dying needlessly. Andy Burnham, the Health Secretary, said that current and former staff would be expected to co-operate with the independent inquiry into Stafford Hospital.

In March an investigation by the Healthcare Commission condemned “appalling” and “shocking” standards of care at the hospital, run by Mid Staffordshire NHS Foundation Trust. Between 400 and 1,200 more people died than would have been expected in a three-year period, and a lack of nursing staff was said to have contributed to poor patient care.

Despite two additional Department of Health reviews, campaigners and nursing unions have called for a public inquiry to analyse what part Government targets played in the failings. Mr Burnham said that the new inquiry would be chaired by Robert Francis, QC, a leading clinical negligence lawyer, who will hear evidence from patients and families and identify lessons for the future.

The inquiry was announced as part of measures to tackle “exceptional failures” in foundation trusts, which have a degree of independence from the Department of Health and control most NHS hospitals in the country. The Government said that if the chairman considered it necessary to require witnesses to attend, the Secretary of State would take the necessary steps to ensure this happened.

Andrew Lansley, the Shadow Health Secretary, said that the inquiry would not go far enough. “This independent inquiry could play a part in renewing public confidence but not to the same extent as a public inquiry,” he said. “While I welcome the acknowledgement that individual cases have not been given a sufficient hearing, other critical issues have been sidelined. The terms of reference neither scrutinise the role of the Department of Health nor the impact of the Government’s policies.”

Last week Antony Sumara was appointed as chief executive of Mid Staffordshire NHS Foundation Trust, while Sir Stephen Moss was appointed as chairman. Former chief executive Martin Yeates resigned in March, along with the chairman, Toni Brisby, before the damning report was published. [They should both be prosecuted for murder]

SOURCE




Obama to hit airwaves as health care plan wanes

President Obama will take to the bully pulpit tonight as his signature ambition to remake the health care system reaches a tipping point on Capitol Hill, his poll numbers are slipping, and the health care debate moves into open-throttle political warfare.

A scathing assessment of the House legislation by the Congressional Budget Office has fueled public skepticism and a rebellion among conservative Democrats. The reports pronounced the legislation, produced last week by Speaker Nancy Pelosi, D-San Francisco, and three liberal committee chairmen, to be short on reform and likely to make things worse.

A flurry of negotiations consumed both ends of Pennsylvania Avenue on Tuesday. Obama met with renegade House Democrats while negotiations continued in the pivotal Senate Finance Committee, where a handful of moderate Republicans remain at the table.

Pelosi stuck with her drive toward a full vote in the House next week, brushing aside the deep divisions among her troops. "We're right on course to take up the bill before the break," Pelosi said. "That is our hope. That is our plan."

The Mayo Clinic, which Obama has hailed as an innovative delivery model, welcomed new discussions of an independent Medicare commission focused on reining in cost inflation. House majority leader Steny Hoyer, D-Md., indicated that Democratic leaders are open to other ways to raise revenue besides a 5.4 percent surtax on high-income earners that opponents have slammed as a hit on small business.

Hoyer suggested next week's timetable may slip, too. "If we can get to consensus, we're going to move," Hoyer said. "If we can't get to consensus, we're going to continue to work on creating consensus."

Energized Republicans, calling health care Obama's "Waterloo," are unabashedly maneuvering to send what they call "Obamacare" to the doom that "Hillarycare" met in 1993, followed in 1994 by landslide GOP victories that toppled Democratic House and Senate majorities.

Drawing parallels with the disappointments of the $787 billion stimulus package, Republicans are seeking to brand Obama as a tax-and-spend liberal. Conservative publisher William Kristol reprised his fatal attacks on the Clinton plan, urging Republicans to "go for the kill" against Obama's efforts.

Obama stepped into the Rose Garden to blast the tactics as "a familiar Washington script" by opponents who "would rather score political points than offer relief to Americans who've seen premiums double and costs grow three times faster than wages. They would maintain a system that works for the insurance and the drug companies, while becoming increasingly unaffordable for families and for businesses."

Seeking to avoid former President Bill Clinton's mistakes, when then-first lady Hillary Rodham Clinton spent critical early months of that administration devising a complicated health overhaul behind closed doors only to see congressional Democrats reject it, Obama has left the negotiations to Capitol Hill, much as he did with the stimulus package.

Pelosi and Democratic chairmen spurned many administration recommendations to contain costs and raise revenue.

Now the White House and Democratic leaders are scrambling to address the concerns of conservative "Blue Dog" Democrats from swing districts that gave Democrats their majority. The concerns include budget deficits, low Medicare reimbursement rates to rural physicians and especially soaring health care costs - a concern the White House has made its reason for reform.

Obama's national address arrives as a series of polls this week show waning public confidence in the administration's health care reform efforts, especially among independents. A USA Today/Gallup poll Tuesday, mirroring Monday's Washington Post/ABC News poll, showed half the nation disapproved of Obama's handling of health care.

It is becoming increasingly unlikely that the Senate could complete committee action before Congress leaves for its August recess. The White House fears that postponing action to the fall will only allow the opposition to gather strength.

Sen. Kent Conrad, a moderate North Dakota Democrat and key player on the Senate Finance Committee, downplayed the rush. "We've got plenty of time," Conrad said. "The critical test is: Will it be right? Will it stand the test of history?"

SOURCE




Mayo Clinic calls House plan bad medicine

A world-renowned clinic that President Obama held up as an example of good medicine said Monday that the American people would be "losers" under the House's health care proposal, joining the growing chorus of critics the Obama administration is trying to fend off as the debate intensifies from Capitol Hill to Main Street.

Minnesota's not-for-profit Mayo Clinic, which Mr. Obama has repeatedly hailed as offering top quality care at affordable costs, blasted the House Democrats' version of the health care plan as lawmakers continue to grapple with several bills from each chamber and multiple committees.

The Mayo Clinic said there are some positive elements of the bill, but overall "the proposed legislation misses the opportunity to help create higher quality, more affordable health care for patients."

"In fact, it will do the opposite," clinic officials said, because the proposals aren't [R]patient-focused or results-oriented. "The real losers will be the citizens of the United States."

All day, Republicans took aim at Mr. Obama's weak spot as surveys showed that his poll numbers were slipping on the issue. Republican National Committee Chairman Michael S. Steele charged that the president's plan amounts to a "reckless experiment," dubbing it [JUMP]"socialism."

"He's conducting a dangerous experiment with our health care," Mr. Steele said at the National Press Club as the RNC started an ad campaign, which will run in Arkansas, Nevada and North Dakota using similar language.

In the Senate, Sen. Charles E. Grassley, the Iowa Republican considered key to grabbing some bipartisan support, warned that the House call to raise taxes on wealthier citizens and, therefore, some small businesses to fund the $1 trillion overhaul is a non-starter.

House Speaker Nancy Pelosi, California Democrat, is floating an idea that could make proposed tax increases more palatable to the more fiscally conservative members of her party. She would like to limit income-tax increases to couples making more than $1 million a year and individuals making more than $500,000, Pelosi spokesman Brendan Daly said Monday. The bill passed by the House Ways and Means Committee last week would increase taxes on couples making as little as $350,000 a year and individuals annually making as little as $280,000.

Mr. Obama is going all out to keep the national conversation focused on the need for reform and the political forces at play. He hit back at Sen. Jim DeMint, South Carolina Republican, for suggesting that health care should be the president's "Waterloo."

Without naming Mr. DeMint, Mr. Obama offered the Republican's quote in a brief statement after a visit with health care providers at the Children's National Medical Center in Washington.

More here




Repealing Erisa

If you like your health plan, you won't be able to keep it

One by one, President Obama’s health-care promises are being exposed by the details of the actual legislation: Costs will explode, not fall; taxes will have to soar to pay for it; and now we are learning that you won’t be able to “keep your health-care plan” either.

The reality is that the House health bill, which the Administration praised to the rafters, will force drastic changes in almost all insurance coverage, including the employer plans that currently work best. About 177 million people—or 62% of those under age 65—get insurance today through their jobs, and while rising costs are a problem, according to every survey most employees are happy with the coverage. A major reason for this relative success is a 1974 federal law known by the acronym Erisa, or the Employee Retirement Income Security Act.

Erisa allows employers that self-insure—that is, those large enough to build their own risk pools and pay benefits directly—to offer uniform plans across state lines. This lets thousands of businesses avoid, for the most part, the costly federal and state regulations on covered treatments, pricing, rate setting and so on. It also gives them flexibility to design insurance to recruit and retain workers in a competitive labor market. Roughly 75% of employer-based coverage is governed by Erisa’s “freedom of purchase” rules.

Goodbye to all that. The House bill says that after a five-year grace period all Erisa insurance offerings will have to win government approval—both by the Department of Labor and a new “health choices commissioner” who will set federal standards for what is an acceptable health plan. This commissar—er, commissioner—can fine employers that don’t comply and even has “suspension of enrollment” powers for plans that he or she has vetoed, until “satisfied that the basis for such determination has been corrected and is not likely to recur.”

In other words, the insurance coverage of 132 million people—the product of enormously complex business and health-care decisions—will now be subject to bureaucratic nanomanagement. If employers don’t meet some still-to-be-defined minimum package, they’ll have to renegotiate thousands of contracts nationwide to Washington’s specifications. The political incentives will of course demand an ever-more generous “minimum” benefit and less cost-sharing, much as many states have driven up prices in the individual insurance market with mandates. Erisa’s pluralistic structure will gradually constrict toward a single national standard.

Yet a computer programming firm, say, and a grocery store chain have very different insurance needs, and in any case may not be able to afford the same kind and level of benefits. Innovation in insurance products will also be subject to political tampering. Likely casualties include the wellness initiatives that give workers financial incentives to take more responsibility for their own health, such as Safeway’s. Some politicians will claim that’s unfair. High-deductible plans with health savings accounts are also out of political favor, therefore certain to go overboard. If you have one of those and like it, too bad.

The new Erisa regime will be especially difficult to meet for businesses that operate with very slim profit margins or have large numbers of part-time or seasonal workers. They may simply “cash out” and surrender 8% of their payroll under the employer-mandate tax. A new analysis by the Lewin Group, prepared for the Heritage Foundation, finds that some 88.1 million people will be shifted out of private employer health insurance under the House bill. If those people preferred their prior plan, well, too bad again.

The largest employers—though not all—may clear the minimum bar, at least at first. But in addition to the “health choices” administrative burden, the cost of labor will rise because the House guts another key section of Erisa. Currently, lawsuits about employee benefits are barred under the law, allowing large employers to avoid the state tort lotteries in disputes over coverage. No longer. As a gratuity to the trial bar, Democrats will now subject businesses to these liabilities in the name of health “reform.”

So when Mr. Obama says that “If you like your health-care plan, you’ll be able to keep your health-care plan, period. No one will take it away, no matter what,” he’s wrong. Period. What he’s not telling the American people is that the government will so dramatically change the rules of the insurance market that employers will find it impossible to maintain their current coverage, and many will drop it altogether. The more we inspect the House bill, the more it looks to be one of the worst pieces of legislation ever introduced in Congress.

SOURCE




The fatal conceit of health care reformers

It’s easy to get distracted by the details and crushing cost estimates of “health-care reform” while losing sight of the key question: Can a handful of congressmen, most of whom probably have never even run a small business, design an entire market for medical services and insurance?

A few moments’ thought should be enough to see is the answer. Markets are unbelievably complex, and the details are beyond the grasp any individual. They consist of hundreds of millions of people making countless judgment calls, tradeoffs, and transactions with respect to a huge array of services and products. Each person makes these choices within his personal situation, which no one can know as well as that particular person can. Providers of medical services, insurance, and products undertake those activities after calculating that such work is their best opportunity for income and other forms of satisfaction.

Given this complexity, only someone lusting for power or incredibly conceited would presume to design a market. An appalling ignorance of economics is also a prerequisite for such a conceit.

As a way to coordinate supply and demand, economize resources, and create wealth, markets are simply unmatched. They do so well precisely because they use the critical knowledge scattered among all the participants. This is one reason central planning never works. No planning board could possibly know what everyone put together knows. Individuals contribute their partial knowledge to the market process through their decisions about what to buy, how much to buy, and what not to buy. Those decisions, based on subjective often unarticulated information, send signals through the price system, guiding entrepreneurs who buy resources and turn them into usable products and services according to consumer demand.

The process constantly rewards those who serve consumers well and penalizes those who don’t. That is the economic function of profit and loss.

When politicians arrogantly attempt to design a market — specifying services, setting terms, controlling prices — they undermine precisely those features that make markets perform effectively. Planning a market is a contradiction in terms. When it’s the medical market that’s being designed, the politicians are playing with people’s lives. The philosopher and economist F.A. Hayek called the belief that institutions such as markets can be consciously planned “the fatal conceit.” In the case of the medical market, the term is highly appropriate because those who vote to overhaul the medical industry rather than let the market work spontaneously will be responsible for the death and suffering of a great many people.

But, the advocates of “reform” say, people are dying and otherwise suffering now because of the deficiencies of today’s medical system. That is no doubt true, but it is not the free market that is doing it. There is no free market in medical care. On the supply side government controls the production of medical services and insurance through licensing and comprehensive regulation. On the demand side, more than 80 cents of every dollar spent on care is paid for by government — Medicare and Medicaid — or employer-based insurance, which most people neither choose nor pay for directly. The upshot is that most people’s medical care, even routine services, seems to be paid for by someone else. As a result, they do not act like cost-conscious consumers, which is key to efficient markets. (Unlike other medical services, the price of elective services not covered by insurance, such as cosmetic surgery, has been falling.)

In contrast, people in a free market would typically buy high-deductible catastrophic insurance to protect themselves financially in case of serious illness, while paying for cheaper routine services out of savings. The analogy with homeowner’s insurance is obvious.

Competition and innovation, unmolested by bureaucrats, would bring down the price of medicines and medical devices, as they have brought down the price of cell phones and computers.

What about low-income people? This question dissolves when one understands that it’s government that inflates prices by stifling competition and stimulating demand. In a free market and an ever more prosperous and generous society, no one need go without medical care. If the egotistical medical czars on Capitol Hill get their way, lots of people will go without. I predict the politicians won’t be among them.

SOURCE





22 July, 2009

Gun and car crash victims face long ambulance ride to new British trauma units

British ambulance response times are already erratic .... And time is of the essence in many cases of serious injury

FOUR "super" accident and emergency units designed to treat gun crime and car crash victims in London are to be given the green light today. The most seriously ill patients will be fast-tracked to the major trauma centres for life-saving emergency care. But campaigners said lives will be put at risk as the centres are not spread evenly across London, meaning those on the outskirts face long journeys.

A joint committee of all London's primary care trusts is set to approve the hospital centres which will be set up at the Royal London in Whitechapel, King's College in Denmark Hill, St George's in Tooting and St Mary's in Paddington. The units will be open by the end of next year. NHS body Healthcare for London, which is developing plans for the trauma centres, insisted every Londoner will be a maximum of 45 minutes by ambulance away from one. [That eats up a lot of the "golden hour" (first hour after injury) during which some seriously injured persons can be saved]

But Geoff Martin, chairman of London Health Emergency, said: "Millions of Londoners on the outskirts will now face a dangerously long journey to the centre to access emergency trauma care. We think the 45-minute maximum journey time is optimistic and with only one air ambulance this whole scheme represents a massive gamble with life or death services."

There are also concerns that none of the centres is near Heathrow. Mr Martin added: "It defies belief. That leaves the UK's major airport dangerously exposed and we are demanding an urgent rethink before these plans are cast in stone."

But a spokeswoman for Healthcare for London said most major trauma incidents, such as stabbings, shootings and car accidents, happen in central London. She added: "The important thing is to get the right treatment, even if it means spending an extra 10 minutes in an ambulance."

The trauma centres will be staffed by a consultant at all times and specialists in every discipline, including trauma, orthopaedic and neuro-surgeons. The units will cost £14million a year to run, and the money will come from PCT budgets. Matt Thompson, clinical director for trauma services in London, said: "These patients are some of the most seriously injured patients that any hospital will ever see. It is vitally important that they have access to the right expertise and services if their lives are to be saved and disabilities reduced. "The proposed new trauma system - made up of major trauma centres linked to local trauma centres - would rival the best in the world. It is a fantastic opportunity for London to improve the care of these patients."

The PCT committee is also expected to approve plans to create eight specialist centres for stroke victims at Charing Cross, King's College, Northwick Park, Queen's, St George's, the Princess Royal, the Royal London and University College hospitals. These will provide specialist care for the first 72 hours after a stroke or until a patient is stabilised. They will open by summer 2011 and cost around £23million a year. Patients will be taken to the units within 30 minutes. But acute services in other hospitals are expected to be closed as part of the process. Campaigners fear the Royal Free in Belsize Park will lose its emergency stroke unit.

Dr Nick Losseff, interim clinical director for stroke services in London, said: "Patients and their families can be assured these will save lives and prevent disability."

SOURCE




Support for Obama on healthcare slips - poll

Public support for President Barack Obama's handling of healthcare reform, the pillar of his legislative agenda, has fallen below 50 percent for the first time, a Washington Post-ABC News poll released on Monday said.

Obama and his Democratic allies in Congress have run into stiff opposition this month as they try to pass legislation to restructure the $2.5 trillion U.S. healthcare industry through the creation of a government-run health insurance program. Republicans and some fiscally conservative Democrats argue the plan, with an estimated cost of more than $1 trillion, could hurt small businesses, add to budget deficits and reduce the quality of medical care for many Americans.

Those concerns may be having an impact on the public, according to the poll, which showed 49 percent of respondents approving of Obama's stand on the issue compared to 57 percent in April. Those saying they disapproved rose to 44 percent from 29 percent during the same period.

Obama and the White House have gone on the offensive to drum up support for the plan, which would compete with private insurers, provide cover to many of the 46 million uninsured and try to stem runaway medical costs. With time running out to pass a bill in Congress this year, the battle is shaping up as a major test of Obama's presidency. Delaying legislation until 2010, a congressional election year, could give Republicans and critics in the healthcare sector more time to galvanize opposition to the plan.

But Obama remains more trusted than Republicans in Congress to do a better job on healthcare reform, the poll showed, with 54 percent of respondents putting their faith in the U.S. leader versus 34 percent in favor of Republican lawmakers. His overall approval rating also remains high at 59 percent despite some slippage in approval ratings for his handling of the economy, the federal budget deficit and other leading domestic issues, according to the poll.

It surveyed 1,001 adults randomly by telephone between July 15-18, 2009. The results from the full survey have a margin of error of plus/minus three percentage points.

SOURCE




Inside the Monstrous Obamacare Bureaucracy



If you think government is too big and too costly, wait until Obamacare kicks in. The Congressional Budget Office put the price tag of the House Democrats' health care takeover plans at $1.5 trillion over 10 years. But the CBO's fine print included a telltale caveat:

"We have not yet estimated the administrative costs to the federal government of implementing the specified policies, nor have we accounted for all of the proposal's likely effects on spending for other federal programs."

You don't need an accounting degree or clairvoyant powers. The administrative costs and spillover spending effects will be astronomical. Look at existing federal programs. In 1966, the Office of Management and Budget put the total taxpayer costs for Medicare at $64 million. In 2011, Medicare costs are expected to balloon to nearly $500 billion. Medicaid cost $770 million in 1966. By 2011, that program will cost taxpayers an estimated $264 billion. The Virginia-based Council for Affordable Health Insurance estimated that the administrative expenses of both programs last decade were 66 percent higher than those of private sector health insurance companies.

And we ain't seen nothing yet. House Republicans on the Joint Economic Committee sifted through their opponents' 1,018-page health care bill and released a dizzying flow chart detailing the Byzantine bureaucracy Obamacare would create. Washington would become the home of at least 31 new federal programs, agencies and commissions to oversee the government-run health insurance regime.

Because 32 "czars" isn't enough, the Democratic plan would add another overlord to the Obama administration. The new "Health Choices Commissioner" would helm the new "Health Choices Administration" (section 141 of the bill) -- separate from the already existing Department of Health and Human Services, Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration), the Veterans Health Administration and the Indian Health Service.

Because the government has done such a boffo job managing the near-bankrupt Social Security and Medicare Trust Funds, the Democrats have proposed creating a "Public Health Investment Fund" and a "Health Insurance Exchange Trust Fund." The latter would create a "transparent and functional marketplace for individuals and small employers to comparison shop among private and public insurers."

No matter that state insurance departments already operate such systems. Health care must be "fixed." The federal cure is redundancy.

The Obamacare bill also creates a new "Bureau of Health Information" (not to be confused with the already existing National Center for Health Statistics) within the department of Health and Human Services. A new "Assistant Secretary for Health Information" will lead the BHI. The new assistant secretary will coordinate with the recently created "National Coordinator for Health Information Technology" -- who is responsible for monitoring the $19.5 billion in the stimulus law to implement "a nationwide interoperable, privacy-protected health information technology infrastructure."

New bureaucracies always have old special interests to appease. The Bureau of Health Information will house its own "Office of Civil Rights" and "Office of Minority Health." The information czar will be required to collect health statistics in the "primary language" of ethnic minorities -- and, thus, the need for a new "language demonstration program" to showcase their efforts. Obamacare will also ensure "cultural and linguistics competence training" and establish "a youth public health program to expose and recruit high-school students into public health careers." The government health care juggernaut must be fed and staffed, after all.

Providing more stimulus for taxpayer-funded jobs, the Democrats' bill would add a new "Senior Advisor for Health Care Fraud" and require the Attorney General to appoint a "Senior Counsel for Health Care Fraud Enforcement." There's already a national Health Care Fraud and Abuse Control Program, but who's counting?

To coordinate all the new bureaucrats, Obamacare would create a new "Health Care Program Integrity Coordinating Council" to "to coordinate strategic planning among federal agencies involved in health care integrity and oversight."

To make sure all the existing local and state environmental public health agencies don't feel lonely, the Democrats' plan creates a new "Coordinated Environmental Public Health Network" to "build upon and coordinate among existing environmental and health data collection systems and create state environmental public health networks."

A new "National Health Care Workforce Commission" will be "tasked with reviewing health care workforce and projected workforce needs." New funding will be available for a "demonstration program to improve immunization coverage" that would enable government busybodies to send reminders or recalls for patients or providers, or make home visits.

Who'll be looking out for you? The House bill creates a "public plan ombudsman" and a "special health insurance exchange inspector general" to police spending and guard against waste, fraud and abuse. Given the sad fate of aggressive watchdogs in the age of Obama, however, these positions will end up like every other new agency, commission, task force and office created to serve the federal health care beast: black holes.

SOURCE




The “public option” health care scam

Some statements are inherently unbelievable. Such as: "I am an official of the government of Nigeria, and I would like to deposit $60 million in your bank account." Or: "I'm Barry Bonds, and I thought it was flaxseed oil." And this new one: "I'm Barack Obama, and I favor more competition in health insurance."

That, however, is the claim behind his support of a government-run health insurance plan to give consumers one more choice. The president says a "public option" would improve the functioning of the market because it would "force the insurance companies to compete and keep them honest."

He has indicated that while he is willing to discuss a variety of remedies as part of health insurance reform, this one is non-negotiable. House Democrats, not surprisingly, included the government plan in the 1,000-page bill they unveiled Tuesday.

It will come as a surprise to private health insurance providers that they have not had to compete up till now. Nationally, there are some 1,300 companies battling for customers. Critics say in many states, one or two insurers enjoy a dominant position. But market dominance doesn't necessarily mean insufficient competition.

Microsoft's dominance of software didn't prevent the rise of Google, and Google's dominance of search engine traffic didn't prevent Microsoft from offering Bing. If a few health insurance providers were suppressing competition at the expense of consumers, you'd expect to see obscene profits. But net profit margins in the business run about 3 percent, only slightly above the median for all industries.

There are reasons, though, to think that the president's real enthusiasm is not for competition but for government expansion. Free-market advocates want to foster competition by letting consumers in one state buy coverage offered in other states. If WellPoint has more than half the business in Indiana, why not let Indiana residents or companies go to California or Minnesota to see if they can find options that are cheaper or better?

But the administration and its allies show no interest in removing that particular barrier to competition. Maybe that's because it would reduce the power of state regulators to boss insurance companies around.

Nor does Obama believe in fostering competition in other health insurance realms—such as existing government health insurance programs. John Goodman, head of the National Center for Policy Analysis, suggests letting Americans now enrolled in Medicare, Medicaid and the State Children's Health Insurance Program (SCHIP) select a voucher to buy private coverage if they want. Don't hold your breath waiting for the administration to push that idea.

Supporters of the "public option" think it can achieve efficiencies allowing it to underprice existing insurers. But efficiency is to government programs what barbecue sauce is to an ice-cream sundae: not a typical component. Nor is there any reason to think Washington can administer health insurance with appreciably lower overhead than private companies.

Medicare supposedly does so, but that is partly because it doesn't have to engage in marketing to attract customers, which this program would. It also spends less than private companies combating fraud and unwarranted treatments—a type of monitoring that spends dollars while saving more.

As the Congressional Budget Office has pointed out, "The traditional fee-for-service Medicare program does relatively little to manage benefits, which tends to reduce its administrative costs but may raise its overall spending relative to a more tightly managed approach." False economies are one reason Medicare has done a poor job of controlling costs.

But a public program of the sort Democrats propose doesn't have to control costs, because in a pinch it can count on the government to keep it in business. Competition is healthy, but how are private companies supposed to compete with an operation that can tap the Treasury?

Students of the Obama economic policy will also note a curious consistency in its approach to economic issues. Some problems, like the near-collapse of General Motors and Chrysler, came about because competition worked very well at serving consumers and punishing poorly run companies. Some problems, such as high health insurance premiums, came about because competition allegedly didn't work so well. In both cases, the administration proposes the same solution: more federal spending and a bigger federal role.

Will introducing a government-run insurance program work? After all, that Nigerian financial scam works. Just not necessarily the way you hope.

SOURCE




Are the lights on?

How can the hostile takeover of health care businesses and workers by the federal government be okay? Blissful ignorance is one thing, but this is worse. It has to be willful ignorance.

Is there really anybody out there who doesn’t understand that there are a whole lot of people who will over-use free health care service? If asked to think about it, does anyone really expect there are an infinite quantity of heart bypasses and new hip joints sitting in a warehouse somewhere just waiting to be handed out to anyone who wants one?

If they do conclude that health care is a finite good, then are they ready for the next half of the conclusion, that their lovely free universal health care will turn those goods, services and the people who provide them from private to government? Are they ready to have their least favorite politicians deciding who gets care and when?

What other choice is there?

Of course there is the fairyland option where perfect people make perfect decisions. Are there really people out there who have experience with perfect people attaining positions of power?

As we run full speed downhill into the abyss, I am amazed at some of the decisions the politicians get away with. Piles of mistakes are buried under mountains of stupidity. Covering it all is an ocean of greed and corruption.

It seems so obvious to me now, and has for so long that I have to work to understand how anyone can think this is good or even okay. What kind of people think this can work out? I suppose I have to admit that thinking is not involved and belief is the operable word.

SOURCE





21 July, 2009

Another disastrous NHS hospital

And the boss escapes without any retribution

Deaths at Broadmoor high security hospital and other institutions will be linked to management failures in a highly critical report this week. Executives at West London Mental Health NHS Trust failed to investigate promptly “serious untoward incidents”, including patient suicides, meaning that staff were unable to learn lessons that might have prevented further deaths, an inquiry by the Care Quality Commission (CQC) is expected to conclude.

The trust’s chief executive, Simon Crawford, left on Friday to take up a job at the health authority NHS London.

Services at the trust have been under scrutiny since 2004 when Peter Bryan, a cannibalistic killer awaiting trial for murder, was transferred to a medium-security ward, where he killed Richard Loudwell, another inmate.

That incident is the subject of another report, to be published next month. The report into the West London Mental Health NHS Trust was triggered after complaints from families and patient groups. An official risk assessment report by NHS London issued West London Mental Health Trust with a “red” alert rating over its governance last month.

NHS London said of Mr Crawford’s move: “Discussions have taken place between Simon Crawford and the trust and they both agreed that the time was right for Simon to move on and it would be helpful for his own development to have experience in another sector.”

His departure echoes those at Mid Staffordshire and Maidstone and Tunbridge Wells hospital trusts, where executives left before critical findings were published. Katherine Murphy, of the Patients Association, said that it was disgusting that chief executives appeared to be “jumping before they were pushed”. “This is a reward for failure approach,” she said. “Poor and sloppy governance of trusts leads to appalling patient care and unnecessary deaths.”

In a separate report, the CQC reported on how patients detained under the Mental Health Act in England were treated. The review, published on behalf of the former Mental Health Act Commission, found evidence of “worrying and poorly documented practices” surrounding control and restraint, patients at risk of suicide being left unmonitored and under-18s and women being transferred inappropriately to adult or mixed-sex units.

SOURCE




NHS is a bottomless pit for taxpayer funds

More and more bureaucrats have to be fed

The National Health Service is facing “the biggest financial crisis in its history” requiring tax rises or large cuts to other government departments just to maintain its budget, a report predicts. Spending on the NHS has doubled in a decade to more than £106 billion for next year, but the NHS needs to brace itself for a funding freeze that could last for six years, two leading think-tanks say.

The report, by the King’s Fund and Institute for Fiscal Studies (IFS), suggests that even under the most optimistic funding scenario, the NHS will struggle to meet people’s healthcare needs without significantly increasing its productivity after 2011.

Both Gordon Brown and David Cameron have promised “real-terms growth” in NHS funding, or at least no cuts to the health budget in real terms if they win the next election. But these promises would inevitably result in hard decisions, such as cuts to other Whitehall budgets or an increase in tax over the period to 2017, the report says.

Over the next spending review period, from 2011-12 to 2013-14, the budget across all spending departments, including the NHS, could reduce in real terms by an average of 2.3 per cent each year, according to the IFS. These cuts could be restricted if taxes were increased, the authors of the report say. Limiting other departmental cuts to 2 per cent a year, while freezing the NHS budget over the next spending review period would require additional revenue of about £10.6 billion — equivalent to an extra £340 per family.

If, as seems likely, the NHS has at least three or four years of low or zero growth, it will be the first time in its history that it has had to go for such a long period with rising demand and little or no new money, the report says. But even if the NHS budget is not cut in real terms, future funding is likely to fall short of the population’s healthcare needs by more than £30 billion.

John Appleby, chief economist at the King’s Fund, said: “Everybody knows that the financial forecast is going to be bad, but we’ve tried to put some numbers on this and figure out where the cuts might come. Our analysis shows that the NHS is facing the most significant financial challenge in its history.”

In 2002, Sir Derek Wanless published a landmark report that set out the funding projections needed to maintain “solid progress” in the NHS, Mr Appleby said. The projections assumed improvements in health-related lifestyle behaviour and increased productivity in the NHS. “But even if spending is maintained or increases slightly, funding would still fall short of the solid progress mark by between £6.4 billion and £32.4 billion by 2016-17 at today’s prices,” he said. “This is equivalent to between 6 per cent and 31 per cent of the entire NHS budget.”

Part of the shortfall could, in principle, be filled by increasing productivity in the NHS. To do this, over the period from 2011-2017, the NHS would need to make gains of between £3.9 billion and £8.2 billion per year. This is equivalent to improvements of 3.7 to 7.7 per cent per year.

But the Office for National Statistics estimates that average productivity between 1997 and 2007 has fallen each year by 0.4 per cent on average, while private sector productivity growth averages about only 2 per cent a year.

“The service has enjoyed unprecedented increases in funding since the turn of the century, but those days will soon be over,” Mr Appleby said. “That is why it is crucial that the service does all it can over the next two years to prepare itself for the financial freeze that will take hold over the two coming spending review periods.”

Niall Dickson, the chief executive of the King’s Fund, said: “The scale of what is about to hit the healthcare system is unprecedented. It would be a grave mistake to underestimate the challenge ahead.”

SOURCE




A Reckless Congress

Democrats want to ram through one of the greatest raids on private income and business in American history



Say this about the 1,018-page health-care bill that House Democrats unveiled this week and that President Obama heartily endorsed: It finally reveals at least some of the price of the reckless ambitions of our current government. With huge majorities and a President in a rush to outrun the declining popularity of his agenda, Democrats are bidding to impose an unrepealable European-style welfare state in a matter of weeks.

Mr. Obama's February budget provided the outline, but the House bill now fills in the details. To wit, tax increases that would take U.S. rates higher even than most of Europe. Yet even those increases aren't nearly enough to finance the $1 trillion in new spending, which itself is surely a low-ball estimate. Meanwhile, the bill would create a new government health entitlement that will kill private insurance and lead to a government-run system.

Hyperbole? That's what people said when we warned about this last fall in "A Liberal Supermajority," but even we underestimated the ideological willfulness of today's national Democrats. Consider only a few of the details:

A huge new income surtax. The bill's main financing comes from another tax increase on top of the increase already scheduled for 2011 under Mr. Obama's budget. The surtax starts at one percentage point for adjusted gross income above $350,000 in 2011, rising to two points in 2013; a 1.5 point surtax at incomes above $500,000, rising to three in 2013; and a whopping 5.4 percentage points in 2011 and beyond on incomes above $1 million.

This would raise the top marginal federal tax rate back to roughly 47% or 48%, if you include the Medicare tax and the phase-out of certain deductions and exemptions. With the current top rate at 35%, this would be the largest rate increase outside the Great Depression or world wars.

The average U.S. top combined state-federal marginal tax rate would hit about 52%. This would be higher than in all but three (Denmark, Sweden, Belgium) of the 30 countries measured by the OECD. According to the nearby table compiled by the Heritage Foundation, taxpayers in at least five U.S. states would pay higher marginal rates even than Sweden. South Korea, which Democrats worry is stealing American jobs, would be able to grab even more as its highest rate is a far more competitive 38.5%.

House Democrats say they deserve credit for being honest about the tax increases needed to fund their ambitions. But then they also claim that this surtax would raise $544 billion in new revenue over 10 years. America's millionaires aren't that stupid; far fewer of them will pay these rates for very long, if at all. They will find ways to shelter income, either by investing differently or simply working less. Small businesses that pay at the individual rate will shift to pay the 35% corporate rate. When the revenue doesn't materialize, Democrats will move to soak the middle class with a European-style value-added tax.

Phony numbers. Democrats will have to come up with something, because even the surtax puts their bill at least $300 billion short of honest financing. The public insurance "option" doesn't even begin until 2013 and the costs are heavily weighted toward the later years, but the tax hikes start in 2011. So under Congress's 10-year budget window, the House bill is able to pay for seven years of spending with nine years of taxes. Andy Laperriere of the ISI Group estimates the bill would add $95 billion to the deficit in 2019 alone.

Then there's yesterday's testimony, from Congressional Budget Office (CBO) Director Doug Elmendorf, that ObamaCare's cost "savings" are an illusion. Mr. Obama claims government can cover more people and pay less to do it. But Mr. Elmendorf told the Senate Finance Committee that "In the legislation that has been reported we don't see the sort of fundamental changes that would be necessary to reduce the trajectory of federal spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health-care costs."

Further on the public plan: "It raises the amount of activity that is growing at this unsustainable rate."

No matter, Speaker Nancy Pelosi is whisking the bill through House committees even before CBO has had a chance to score it in detail. As Wisconsin Republican Paul Ryan put it to us, "We will not have read it, and we will not have a score of it, but we will have passed it out of committee."

A new payroll tax. Unemployment is at 9.5% and rising, but Democrats will nonetheless impose a new eight percentage point payroll tax on employers who don't provide health insurance for employees. This is on top of the current 15% payroll tax, and in addition to a new 2.5-percentage point tax on individuals who don't buy health insurance. This means that any employer with more than $400,000 in payroll would have to pay at least 25% above the salary to hire someone. Result: Many fewer new jobs, with a higher structural jobless rate, much as Europe has experienced as its welfare states have expanded.

Other new taxes, including an as yet undetermined levy on private health plans. This tax, which Democrats say could raise $100 billion or so, would make it even harder for private plans to compete with the government plan, which would already benefit from government subsidies and lower capital costs. For good measure, the House bill also gets the ball rolling on tax increases on foreign-source corporate income.

We could go on, and we will in coming days. But the most remarkable quality of this health-care exercise is its reckless disregard for economic and fiscal reality. With the economy still far from a healthy recovery, and the federal fisc already nearly $2 trillion in deficit, Democrats want to ram through one of the greatest raids on private income and business in American history. The world is looking on, agog, and wondering why the United States seems intent on jumping off this cliff.

SOURCE




Health bill would deliver pre-Reagan tax rates

Small-business owners are warning that the economy would suffer under a health care bill proposed by House Democrats, which would drive tax rates for high-income taxpayers to levels not seen since before President Reagan's tax reform of 1986.

The top federal income tax rate, which Mr. Reagan and a bipartisan Congress lowered from 50 percent to 28 percent, would reach 45 percent in 2011 if Congress and President Obama enact the surtaxes that are part of the health care reform plan that House Democrats announced Tuesday.

Small-business owners, who would take a direct hit from the surtaxes, expressed dismay over the proposal, saying it would force them to curtail hiring and reduce wages amid the worst recession in a generation. "If they institute a 5 percent surtax on income, it will have a severe impact on small businesses that are already hurting," said Michael Fredrich, whose Wisconsin company, MCM Composites, molds plastic parts. "We run maybe three days a week, sometimes four days a week, sometimes zero days," he said. "I can tell you that at some point, people ... running a small business are just going to say, 'To hell with it.' "

Not everybody is worried about the proposed tax's impact on business. "Most small businesses are small and would be completely unaffected by the surtax on high-income people," said Chuck Marr, director of federal tax policy at the liberal Center on Budget and Policy Priorities (CBPP).

Polls show most Americans support raising taxes on the rich. However, the last time Democrats pursued that agenda in 1993, when they raised the top federal income tax rate from 31 percent to 39.6 percent, they lost their congressional majorities in both chambers the next year. The current top federal income tax rate, established under President George W. Bush, is 35 percent.

Throughout his presidential campaign, Mr. Obama pledged to restore President Clinton's top income tax rates of 36 percent and 39.6 percent. About 2.2 percent of filers with small-business income would be affected by this proposal to allow the top two marginal tax rates to return to pre-Bush levels after 2010, when the 2001 tax cuts are scheduled to expire, Mr. Marr said.

More here





20 July, 2009

ALG Calls for End to Congressional Exemption from Obama Health Care

Americans for Limited Government president, Bill Wilson, today called upon members of the House of Representatives to adopt a resolution (H. Res. 615) stating that "Members who vote in favor of the establishment of a public, Federal Government run health insurance option are urged to forgo their right to participate in the Federal Employees Health Benefits Program (FEHBP) and agree to enroll under that public option."

The measure is sponsored by Congressman John Fleming and currently has 42 cosponsors. On his website, Fleming writes, "Under the current draft of the Democrat healthcare legislation, members of Congress are curiously exempt from the government-run health care option, keeping their existing health plans and services on Capitol Hill. If Members of Congress believe so strongly that government-run health care is the best solution for hard working American families, I think it only fitting that Americans see them lead the way."

"What's good for the goose is good for the gander," said ALG's Wilson. "If members of the House are expecting everyone to be a part of this government-run system, then they should be taken off the Federal Employee Health Benefits Plan and put on to this so-called public 'option' since they like it so much."

Currently, members of the House and Senate are covered by a health care plan offering a wide variety of options, including private coverage, according to the Federal Employee Health Benefits Plan website, "Federal employees, retirees and their survivors enjoy the widest selection of health plans in the country."

As participants, members of Congress can choose from "Consumer-Driven and High Deductible plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts and lower premiums, or Fee-for-Service (FFS) plans, and their Preferred Provider Organizations (PPO), or Health Maintenance Organizations (HMO) if you live (or sometimes if you work) within the area serviced by the plan."

"It's time for Washington to stop acting like an aristocracy, where Congress treats itself to luxuries and forces everybody else into convoluted, inefficient, and low-quality so-called 'options,'" said Wilson.

"Members of Congress know that the system they are proposing will be much, much worse than the health options they currently have," Wilson added. "What they need to acknowledge is that it will also be much, much worse than the options the American people currently have."

Wilson also called upon the House Committees on Education and Labor, Ways and Means, and Energy and Commerce to adopt a binding measure that would require all members of Congress to enroll in the government-run health insurance option if lawmakers adopt one.

A similar provision, proposed by Senator Tom Coburn (R-OK), has already been adopted in the Senate version of the bill. In order for it to be included in the House version, the "three-in-one" committee currently considering the legislation needs to add it in.

The Coburn amendment passed by a vote of 12-11 in committee with Senators Chris Dodd (D-Conn) and Ted Kennedy (D-Mass) voting with Senators John McCain (R-Ariz), Orrin G Hatch (R-Utah), Richard Burr (R-NC), Lamar Alexander (R-Tenn), Tom Coburn (R-Okla), Pat Roberts (R-Kan), Judd Gregg (R-NH), Johnny Isakson (R-Ga), and Mike Enzi (R-Wyo) in favor.

In committee, Senator Coburn said, "Let's demonstrate leadership—and confidence in the system—by requiring that every member of Congress go into it." 11 Democratic members voted no, including Senator Jeff Bingaman (D-N.M.), who said, "I don't know why we should require ourselves to participate in a plan that no one else needs to participate in."

"Senator Bingaman is still sticking to the big lie that the public 'option' will at all be optional," said Wilson. "The unfortunate impact of this government-run health care proposal will be to crowd out private options, leaving Americans in the end with no other option but to use the Orwellian, abominable, government-run plan that will burden taxpayers with an insurmountable level of debt. This will be the largest government entitlement in human history, and it will break the public treasury," Wilson concluded.

The above is a press release from Americans for Limited Government. Contact Alex Rosenwald at (703)383-0880 or at arosenwald@getliberty.org for further information




DEM HEALTH RX A POI$ON PILL IN NY

Congressional plans to fund a massive health-care overhaul could have a job-killing effect on New York, creating a tax rate of nearly 60 percent for the state's top earners and possibly pressuring small-business owners to shed workers. New York's top income bracket could reach as high as 57 percent -- rates not seen in three decades -- to pay for the massive health coverage proposed by House Democrats this week.

The top rate in New York City, home to many of the state's wealthiest people, would be 58.68 percent, the Washington-based Tax Foundation said in a report yesterday. That means New York's top earners, small-business owners and most dynamic entrepreneurs will be facing new fees and penalties. The $544 billion tax hike would violate one of President Obama's ironclad campaign promises: No family will pay higher tax rates than they would have paid in the 1990s.

Under the bill, three new tax brackets would be created for high earners, with a top rate of 45 percent for families making more than $1 million. That would be the highest income-tax rate since 1986, when the top rate was 50 percent. The legislation is especially onerous for business owners, in part because it penalizes employers with a payroll bigger than $400,000 some 8 percent of wages if they don't offer health care. But the cost of the buy-in to the program may be so prohibitive that it will dissuade owners from growing their businesses -- a scary prospect in the midst of a recession.

Obama took to the airwaves yesterday with ads and TV interviews promoting the need to reform health care. As a Senate health committee passed a different version of a health-care reform bill - a milestone for the issue - Obama said on NBC, "The American people have to realize that there's no such thing as a free lunch." And in a Rose Garden speech, he said the "status quo" on health care is "threatening the financial stability of families, of businesses, and of government. It's unsustainable, and it has to change."

Asked if Obama supports the surtax on wealthiest Americans even though it would break a campaign pledge, White House spokesman Robert Gibbs said only, "It's a process that we're watching."

Republicans in Washington and small-business defenders in New York said the House legislation would effectively place a stranglehold on businesses while running off top earners. "Placing a big tax burden on the small-business community would rob them of the resources they need to create the jobs that will lead us out of the recession," said Tom Donohue, president of the US Chamber of Commerce. "If there's one sure way to kill the goose that lays the golden egg, this is it."



Richard Lipsky, a lobbyist for small stores and businesses in New York City, warned that "in the middle of a recession, it's a very strange way to legislate." "According to what we've read, the House health-insurance plan would have a job-crippling impact on neighborhood stores and other small businesses because they put mandates on these businesses that would prevent them from hiring people because of the cost of the plan," Lipsky said.

Under the House plan, businesses with payrolls of $400,000 or more would pay an 8 percent penalty for uninsured workers, while companies with payrolls between $250,000 and $400,000 would pay slightly smaller penalties. Adding to this burden, said Michael Moran of the State Business Council of New York, is that New York is already a high-tax state. "Any additional taxes make New York even less competitive," he said. New York would become the third-most-hostile place for top earners to live under the proposed new surtaxes supported by House Democrats and championed by Rep. Charles Rangel (D-NY).

Also hit would be individuals earning $280,000 annually and families making $350,000 a year. The profits from small businesses would also be taxed on the back end. Kathryn Wylde, president of the Partnership for New York City, an umbrella organization representing the city's major businesses, said that the estimated top marginal tax rate of 57 percent for New York actually underestimates the potential impact on businesses. That's because it doesn't include the city's burdensome unincorporated-business tax, which snares many entrepreneurs. "It could be between 62 and 63 percent," she said.

If the House plan passes, Wylde said, "There literally, at this point, is very strong reason to relocate your family and your business outside New York." A lot of small businesses would be hit with the penalties for not insuring workers and get hit with the surtaxes, Moran warned. "Many small businesses file their business taxes under personal income," he said. "That's the way the tax law is written. Small business, which is really where most of the job creation takes place, could be hit hard.

According to the city's Department for Small Business Services, there are some 220,000 small businesses in the five boroughs. The agency does not keep track of how many offer health insurance. "It's something that's going to kill jobs. That's the result," said Stephanie Cathcart, spokeswoman for the National Federation of Independent Businesses. Among the most egregious provisions of the House proposal, she said, is a requirement that businesses pay the cost of 72.4 percent of individual health plans and 65 percent of family plans. Those that don't hit the mark would face the payroll tax penalty.

SOURCE




NHS heart treatment ‘among worst in West

TREATMENT for heart disease in Britain is worse than almost anywhere else in the western world, despite pledges by Labour to improve services. A new study reveals that fewer NHS patients have access to defibrillators, pacemakers and heart surgery than in most neighbouring nations. In some parts of Britain, such as the northwest, up to a third of patients are failing to receive life-saving operations.

Doctors are demanding a public debate on how to tackle the growing pressure on heart services. One in three people in Britain are destined to suffer from heart disease.

The study, Access to Cardiac Care, has been commissioned by the British Heart Foundation, the British Cardiovascular Society and a coalition of 41 charities and voluntary groups. The report predicts that demand for heart treatment will double by 2020, yet there is no clear indication that funds will be available to pay for it.

The forecast is in stark contrast to the ambition shown 10 years ago by Alan Milburn, then the health secretary, when heart disease claimed 140,000 lives annually. In a newspaper article at the time, Milburn said: “Tackling heart disease is one of the keys not only to a healthier nation but to a fairer nation.” However, the number dying from heart disease has since increased to 198,000, with one in three victims under 75.

The study, carried out by Oxford Healthcare Associates, showed startling regional variations in cardiac services, with “overprovision” of treatment in affluent cities and the shires.

Roger Boyle, the heart czar, said heart operations had increased by 59% since 2000 and that deaths from cardiovascular disease had fallen by 44% in the past decade.

SOURCE




Australian public hospital clown caused fatal catastrophic bleeding, court told

There was blood everywhere in theatre and what did the clown prescribe? Blood THINNERS -- thus worsening the bleeding. He was already under scrutiny for incompetence but they didn't act soon enough to stop him. I blogged on this back in 2006. I am glad he is finally facing the music. There is a picture of him below, sitting up like Jackie, quite proud of himself



A Brisbane doctor has faced court accused of killing one of his patients when he allegedly improperly inserted a surgical drain which later caused extensive blood loss and multiple organ failure. Mother of two Nadia Annette Cvitic was 30-years-old when she died in 2002 following a radical hysterectomy performed by Dr Bruce Gordon Ward, a specialist in gynaecology oncology.

Mrs Cvitic underwent the surgery due to cervical cancer on February 11 but died in Brisbane's Mater Hospital on February 21. The cause of her death was determined as multiple organ failure caused by inadequate blood flow to vital organs as a consequence of blood loss.

On the first day of a trial in the Queensland Supreme Court in Brisbane, Dr Ward pleaded not guilty to manslaughter. Crown prosecutor David Meredith, in his opening to the jury, said Dr Ward was accused of criminal negligence when he operated on Mrs Cvitic and when he failed to take competent post-operative care of her.

Mr Meredith said post-surgery, on 14 February, a surgical drain which had been inserted into Mrs Cvitic's pelvic area was removed and this caused "catastrophic bleeding." This happened because it had been inserted in such a way that the drain's exit point damaged a vein and blood vessels at the top of her leg, he said. "The prosecution says it was dangerous for the life and health of the patient to finish an operation with a drain in that manner," he said.

Using a medical mannequin and several tubes, Mr Meredith demonstrated how and where the drain was inserted into Mrs Cvitic. Mr Meredith said another element of Dr Ward's negligence was that he did not order blood tests which would have revealed a drop in haemoglobin levels which may have alerted medical staff there was internal bleeding. "No such tests were done," he said.

The trial is set to continue for eight weeks with dozens of medical staff to be called to give evidence. Three reserve jurors have been empanelled in the case, which is being heard by Justice Henry Fryberg.

SOURCE





19 July, 2009

CBO: Health care reform to increase federal cost

Report threatens Obama overhaul plan

Congress' budget watchdog warned Thursday that Democrats' health care bills would not lower skyrocketing costs and would drive up government spending, undermining one of President Obama's chief arguments for the overhaul.

Congressional Budget Office (CBO) Director Douglas Elmendorf said the plans already released by the House and Senate would keep costs rising at an unsustainable pace, fueling criticism from Republicans and some conservative Democrats that the overhaul will bankrupt the country.

"Today's CBO testimony should be a wake-up call," said Senate Minority Leader Mitch McConnell, Kentucky Republican. "Instead of rushing through one expensive proposal after another, we should take the time we need to get things right - especially at a time when hundreds of thousands of Americans are losing jobs every month."

Meanwhile, a bipartisan group of senators on the Finance Committee ended negotiations for the week without a piece of legislation, putting the aggressive timetable sought by Mr. Obama and Senate leaders in doubt.

House Speaker Nancy Pelosi, California Democrat, criticized the CBO analysis for not calculating the savings from prevention and wellness measures in the bill that proponents say would promote a healthier population.

Still, she said, Congress will look for more ways to keep down costs, which White House officials predicted will alleviate the budget director's assessment.

"I think we can bend the curve more. I think that we definitely can," she said. "And that is what I think we should try to do."

The verdict from CBO, Congress' nonpartisan accountant, also underscored objections from the House's conservative Blue Dog Democrats, whose break with Democratic leaders last week over the high cost of the plan stalled attempts to quickly advance the bill.

Democratic leaders are struggling to placate the faction, which has enough members on the Energy and Commerce Committee to kill the measure.

The Blue Dogs, a group of more than 50, issued a joint statement Thursday pledging its commitment to health care reform but putting Democratic leaders on notice that it is watching every penny.

More here




Public wealth won’t cure public health

The statist establishment would love a single-payer health-care system like Canada's if it were politically achievable. Barack Obama said that if we were starting from scratch, single payer is what he'd back. But, thankfully, Americans are still libertarian enough to cringe at turning the medical system entirely over to government.

So with single payer out of reach, the fans of government control have grabbed for second best: the "public option." This would be government-run health insurance that would "compete" with private insurance. (It wouldn't compete fairly because it could do something no private firm can do: milk the captive taxpayers.) But the public option is proving hard to get. Even some Democrats are nervous about it.

What's a statist to do? Leading Democrats in the Senate say the answer might be nonprofit health cooperatives. Sen. Charles Schumer wants some method "to keep the companies honest," and if the "public competitor" can "do those things in a co-op form, I think we're open to it."

One sign that this may be the way things are heading is that the New York Times, the mouthpiece of the statist establishment, ran a front-page article last week that begins with glowing praise for a co-op where doctors have lots of time to spend with patients because of its "collaborative model of primary care." Among the media it's an article of faith that the "collaborative model" is more consumer friendly than a profit-seeking business.

The Times connects the dots in case anyone missed the point. "On Capitol Hill, those innovations have made Group Health a prototype for a political compromise that could unclog health care negotiations in the Senate and lead to a bipartisan deal. ... [T]he Senate Finance Committee seems poised to propose private-sector insurance cooperatives ... as its primary mechanism for stoking competition and slowing the growth of medical costs."

Give me a break. Since when is government needed to stoke competition? Competition is what happens when government lets people alone. I defy anyone to give me an example of lack of competition that doesn't have its roots in government intervention.

Since co-ops are nonprofit organizations owned by their members, the Times' story subtly implies that the profit motive is responsible for the absence of competition and higher medical costs. But that's ridiculous. In a free market without government barriers to entry, it's the quest for profit that produces competition and lower costs.

If health cooperatives were really more efficient and innovative, wouldn't they be copied all over the country? That's how the market works. When someone comes up with an innovative way of doing business, it is quickly imitated and improved on. But buried late in the Times story is the revealing fact that the co-op is "a rare survivor among the hundreds of rural health insurance cooperatives."

Hello? Don't the Times editors see the disconnect? If co-ops worked well, today there would be thousands of them. Why should taxpayers fund a method of delivering health care whose success is "rare"?

The newspaper story made another point that is a favorite of the policy elite: Preventive care will save tons of money. If that's true, there is nothing (but government) to keep people from implementing that principle. But is it true?

This seems to be one of those things we know that isn't so. I take Lipitor. The drug may extend my life. But this doesn't lower my health-care costs. Years of pill-taking increases costs. If the pill works, I may live long enough to get an even more expensive disease. And maybe I, like millions of others, take Lipitor unnecessarily because we would never have had heart attacks. We then spend more, not less, on health care.

Health-care expert John Goodman of the National Center for Policy Analysis says there are "literally hundreds of studies from over the past 40 years that show preventive medical services usually increase medical spending ... Contrary to popular belief, checkups for children and adults do not save the health care system money."

If the policy elite really wanted cost-cutting competition, they would deregulate medicine. No one has ever found a better way to stimulate competition than freedom.

SOURCE




The truth about health care reform

Hidden within the language of the House Democrats’ Health Care Bill is a provision that would effectively destroy the market for private health insurance:

It didn’t take long to run into an “uh-oh” moment when reading the House’s “health care for all Americans” bill. Right there on Page 16 is a provision making individual private medical insurance illegal.

When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.

It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of “Protecting The Choice To Keep Current Coverage,” the “Limitation On New Enrollment” section of the bill clearly states:

“Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day” of the year the legislation becomes law.

So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.

In other words, if this bill passes, you would be able to keep your current health insurance as Obama promises, but you wouldn’t be able to make any changes to it beyond adding or deleting new dependents, and the insurance company wouldn’t be able to increase premiums for specific risk groups without raising everyone’s premiums by the same amount, and they won’t be able to accept any new customers under the existing plan. Insread, they’d have to offer plans that comply with the rules set forth in the Democrats’ bill.

You can read the language for yourself, just go page 16.

Ed Morrissey is spot-on in describing what the impact of this part of the legislation would be:

[It] will have the effect of forcing millions of people into the public plan whether they want it or not. Even worse, if insurers get barred from attracting new customers — which this clause outlaws — then they will eventually see their rolls drained, thanks to the natural flow of the market as employers drop plans and skip the expense of offering medical insurance. It won’t take long at all for insurers to exit the market and leave the field for just the public plan, which will automatically get the customers of each individual insurer as they close up shop.

Does this bill outlaw private insurance? Literally, no, but in practical terms, it makes it an endangered species and creates an American single-payer system by default.

The good news ? It looks like the Blue Dog Democrats are joining Republican efforts to fight the worst parts of Obamacare:

Centrist Democrats are threatening to oppose their party’s healthcare legislation unless House Speaker Nancy Pelosi (D-Calif.) accepts changes that make the bill more to their liking.

Seven Blue Dogs on the House Energy and Commerce Committee have banded together to draft amendments that they’ll co-sponsor in the committee markup, which starts Thursday. Rep. Mike Ross (D-Ark.), the Blue Dogs’ point man on healthcare, says if those changes aren’t accepted, they’ll vote down the bill.

“We cannot support the current bill,” Ross said. “Last time I checked, it took seven Democrats to stop a bill in Energy and Commerce.” …

Blue Dogs think the bill fails to do enough to reduce healthcare costs, jeopardizes jobs with a fee on employers that don’t provide health insurance, and would base a government-run healthcare plan on a Medicare payment system that already penalizes their rural districts.

Here’s hoping that they can stop this monstrosity because, if it passes, it’s game over.

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A sign of things to come?

Remember when Massachusetts overhauled its health care system? It wasn’t too long ago. Two thousand and six (AD) to be precise. Well, the utopian project is now forcing its passengers to brace for impact as it experiences potentially terminal turbulence due to out of control costs associated with the massive entitlement program.

The Commonwealth’s Medicaid program, called MassHealth, is what America’s government-run health care could look like if the administration gets its wish and the new America’s Affordable Health Choices Act, introduced yesterday by Speaker Pelosi and other top House Democrats, passes Congress.

We’ll know sometime this fall—most likely October if things go according to Mr. Obama’s plans—whether or not the trail of red ink leading out of 1600 Pennsylvania Avenue becomes a fully-paved road. In the meantime there are some staggering vitals you should know about the pending legislation’s microcosm.

The Bay State’s landmark health care bill enactment has caused more headaches than breakthroughs. At the root of the plan are tax hikes, employee and employer mandates, a council that makes decisions on benefits, community rating mechanisms to determine care and a full-fledged Trojan Horse public-option.

The result: MassHealth is adding sharply to the Commonwealth’s budget shortfall. As Alexander Green of the Examiner points out,

“While the commonwealth brags about ‘closing the $5 billion budget gap,’ doing so involved $305 million in Medicaid cuts. Even worse, the vast majority of that money came in federal reimbursements, so the Commonwealth’s net savings are only $119 million, or 39% of the lost benefits.”

And that’s only for starters. Green adds,

“Even less impressive is the fact that $1.657 billion needed to “close the gap” came from the federal government’s American Recovery and Reinvestment Act.”

Now, as reported by the New York Times, Boston Medical Center, a hospital that patients thousands of Massachusetts’ poverty-stricken residents, sued its employer yesterday, charging that

“[i]t’s costly universal health care law is forcing the hospital to cover too much of the expense of caring for the poor.”

But rapidly rising costs have caused centers such as the BMC problems beyond repair. For instance, as the report indicates, the state employer only reimburses BMC 64 cents for every dollar it spends on treating the poor. Although the number of uninsured patients is now down to 10% (levels were at 20% pre-enactment), many more of the hospitals patients are insured through Medicaid or Commonwealth Care, the state-subsidized insurance program for low-income residents. BMC has accumulated a $38 million deficit for the 2009 fiscal year, its first loss in five years. And,

“The suit says the hospital will lose more than $100 million next year because the state has lowered Medicaid reimbursement rates and stopped paying Boston Medical ‘reasonable costs’ for treating other poor patients.”

The report makes no mention of the rationing of care—no doubt precursive to the losses—that has since taken place, but one can grimly imagine. But some, like Elaine Ullian, the hospital’s CEO, still hold out hope.

“We filed this suit more in sorrow than in anger. We believe in health care reform to the bottom of our toes, but it was never, ever supposed to be financed on the backs of the poor, and that’s what has happened in Massachusetts.”

Reading between the lines it is rather clear what Ms. Ullian is trying to say: that the deal was suppose to put the burden on the rich folk. But Ms. Ullian misses the boat completely. Mounting deficits go hand in hand with such a system. One needs to look no further than the whalesharks of the Great Society, Medicare and Medicaid. Thus, it might not be long before the Massachusetts’ experiment crashes.

If so, don’t say we didn’t warn advocates of ObamaCare.

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18 July, 2009

Patient sues NHS after having terminal cancer wrongly diagnosed

When Philip Collins was told that he had cancer and had just six months to live, he quit his job, cashed in his pension and bought himself a powerful motorcycle. He was determined to enjoy the time left to him. When he was still alive a year later his doctors conducted a re-examination and admitted that there had been a mistake. The inoperable “tumour” on his gall bladder was a relatively harmless abscess.

Far from being delighted at his unexpected reprieve Mr Collins, 59, was devastated. He had spent his life savings and the powerful drugs that the doctors prescribed to keep him alive as long as possible had destroyed his health. Mr Collins, now 61, had even planned his own funeral. As well as buying the Triumph motorcycle, he had bought his wife Isabel a new car so that she would have transport after he had gone. The couple spent an emotional “last” Christmas together.

Two years later Mr Collins is seeking compensation from the NHS for his ordeal, which he said had left him “an absolute wreck” due to the quantity of drugs he had needlessly taken. Mr Collins, of Yetminster, Dorset, said: “When they told me I had cancer I knew I had a chance to do everything I wanted. I was a fit man and a keen motorcyclist. I still had a lot of working life left in me.

“When they told me I did not have cancer, it knocked me off balance. Now I cannot do anything. I’m an absolute wreck. If you have spent two years thinking you are going to die, then you are told you are not, it knocks you backwards.”

Mrs Collins, 62, said that the couple were delighted that the original diagnosis was a mistake, but added that it had ruined her husband’s life. She said: “We just don’t understand how it could have happened. They obviously didn’t look at the tests closely enough. I never used to believe in suing or compensation or anything like that.”

Mr Collins’s ordeal began when he lost his appetite suddenly and suffered weight loss and anaemia. He was given a scan at Dorset County Hospital in Dorchester that revealed he had an abnormal gall bladder and liver. Further tests led doctors to believe that he had cancer and they told the the couple that he had only six months to live.

Mrs Collins said: “He was bitter and tearful but he took the news that he was going to die calmly. We took £18,000 out of a pension and he bought the Triumph motorbike, which had always been his dream. He even told me he wanted his coffin to be carried on the back of it at his funeral, which he had arranged.”

After a grim “last Christmas” his 60th birthday came and went. Three weeks after a second CT scan doctors told Mr Collins that although he still had cancer, it was not terminal. Two weeks later he was told that he was suffering not from cancer, but from an abscess.

Dorset County Hospital’s chief executive, Jan Bergman, has written to Mr Collins disclosing that the initial diagnosis was made before all the test results had been examined. He said that practices had been reviewed to ensure that surgeons looked at all information before reaching a conclusion. Mr Collins is now being treated at Yeovil District Hospital. A spokesman for Dorset County Hospital said: “We have been in contact with Mr and Mrs Collins about the conclusions of our investigation.”

SOURCE




NHS: £286m to help terminally ill to die at home ‘lost in system’

Millions of pounds of extra funds pledged by the Government for the care of terminally ill patients are failing to reach frontline health services, The Times has discovered. Nine out of ten local health authorities cannot identify their share of the £286 million promised last year to help people who want to die in their own homes, rather than in hospital.

Alan Johnson, then Health Secretary, announced the spending over two years last July as part of the End of Life Care strategy, claiming that it would honour Labour’s manifesto pledge to double investment in specialist palliative care by 2011. Hospice directors say, however, that the money is being lost on the NHS balance sheet or spent on other services because it has not been ring-fenced.

Research by the charity Help the Hospices, seen by The Times, shows that of a sample of 28 NHS primary care trusts, only three could provide evidence of extra investment in palliative care this year. At least six of the trusts surveyed — in Blackpool, Bury, Cumbria, Devon, North Lancashire and West Essex — said that there was no extra money for end-of-life care because of financial pressures and the need for savings. Others were unable to identify a specific sum for end-of-life care, or said that no new money had appeared in their annual baseline allocation.

Only one in five deaths in England — most of which follow chronic illness such as heart disease, cancer or dementia — occurs in the home, although two thirds of people say that is where they would prefer to die. By comparison, 58 per cent of people die in hospital. Families complain that a lack of support, local hospice beds or pain management services leaves them no alternative.

A review of end-of-life care published yesterday by the Department of Health painted a quite different picture, claiming that the £286 million programme had made a good start and was set to deliver real service improvements. Mike Richards, the department’s national director for cancer, added that while some funds had gone directly to trusts, money was also being held by the department “for national work”.

The ten-year strategy aims to shift public attitudes to death and dying, invest in local workforce training and create “rapid response” nursing teams to provide care and support to those who wish to die in a hospice or at home.

David Praill, chief executive of Help the Hospices said: “This is a tragic indictment of the system. PCTs have been given a substantial amount of money to improve end-of-life care, and it simply isn’t good enough that, one year on, many don’t know where it is.”

The pressure on local hospices — three quarters of which are funded by local charities rather than by the NHS — is rising, with more than 100,000 patients using services last year.

Adult hospices in England receive on average only 31 per cent of their funding from the Government, and the gap between what they spend on NHS patients and what the NHS contributes to that care is estimated at £200 million a year, and widening. Help the Hospices is concerned that the extra funding will be diverted to hospital-based care rather than the voluntary sector.

Richard Cowie, chief executive of St Clare Hospice, in Harlow, Essex, said that many local charitable organisations had not seen money being passed on by local NHS managers. “We have a decent working relationship with our local PCT, but their key statement is that they have to make cost-savings on existing budgets and that there is no new money,” he said.

SOURCE




President Obama’s top five health care lies

President Barack Obama walked into the Oval Office with a veritable halo over his head. In the eyes of his backers, he could say or do no wrong because he had evidently descended directly from heaven to return celestial order to our fallen world. Oprah declared his tongue to be "dipped in the unvarnished truth." Newsweek editor Evan Thomas averred that Obama "stands above the country and above the world as a sort of a God."

But when it comes to health care reform, with every passing day, Obama seems less God and more demagogue, uttering not transcendental truths, but bald-faced lies. Here are the top five lies that His Awesomeness has told--the first two for no reason other than to get elected and the next three to sell socialized medicine to a wary nation.

Lie One: No one will be compelled to buy coverage.

During the campaign, Obama insisted that he would not resort to an individual mandate to achieve universal coverage. In fact, he repeatedly ripped Hillary Clinton's plan for proposing one. "To force people to buy coverage," he insisted, "you've got to have a very harsh penalty." What will this penalty be, he demanded? "Are you going to garnish their wages?" he asked Hillary in one debate.

Yet now, Obama is behaving as if he said never a hostile word about the mandate. Earlier this month, in a letter to Sens. Max Baucus, D-Mont., and Ted Kennedy, D-Mass., he blithely declared that he was all for "making every American responsible for having health insurance coverage, and making employers share in the cost." But just like Hillary, he is refusing to say precisely what he will do to those who want to forgo insurance. There is a name for such a health care approach: It is called TonySopranoCare.

Lie Two: No new taxes on employer benefits.

Obama took his Republican rival, Sen. John McCain, to the mat for suggesting that it might be better to remove the existing health care tax break that individuals get on their employer-sponsored coverage, but return the vast bulk--if not all--of the resulting revenues in the form of health care tax credits. This would theoretically have made coverage both more affordable and portable for everyone. Obama, however, would have none of it, portraying this idea simply as the removal of a tax break. "For the first time in history, he wants to tax your health benefits," he thundered. "Apparently, Sen. McCain doesn't think it's enough that your health premiums have doubled. He thinks you should have to pay taxes on them too."

Yet now Obama is signaling his willingness to go along with a far worse scheme to tax employer-sponsored benefits to fund the $1.6 trillion or so it will cost to provide universal coverage. Contrary to Obama's allegations, McCain's plan did not ultimately entail a net tax increase because he intended to return to individuals whatever money was raised by scrapping the tax deduction. Not so with Obama. He apparently told Sen. Baucus that he would consider the senator's plan for rolling back the tax exclusion that expensive, Cadillac-style employer-sponsored plans enjoy, in order to pay for universal coverage. But, unlike McCain, he has said nothing about putting offsetting deductions or credits in the hands of individuals. In other words, Obama might well end up doing what McCain never set out to do: Impose a net tax increase on health benefits for the first time in history.

Lie Three: Government can control rising health care costs better than the private sector.

Ignoring the reality that Medicare--the government-funded program for the elderly--has put the country on the path to fiscal ruin, Obama wants to model a government insurance plan--the so-called "public option"--after Medicare in order to control the country's rising health care costs. Why? Because, he repeatedly claims, Medicare has far lower administrative costs and overhead than private plans--to wit, 3% for Medicare compared to 10% to 20% for private plans. Hence, he says, subjecting private plans to competition against an entity delivering such superior efficiency will release health care dollars for universal coverage.

But lower administrative costs do not necessarily mean greater efficiency. Indeed, the Congressional Budget Office analysis last year chastised Medicare's lax attitude on this front. "The traditional fee-for-service Medicare program does relatively little to manage benefits, which tends to reduce its administrative costs but may raise its overall spending relative to a more tightly managed approach," it noted on page 93. In short, extending the Medicare model will further ruin--not improve--even the functioning aspects of private plans.

Lie Four: A public plan won't be a Trojan horse for a single-payer monopoly.

Obama has repeatedly claimed that forcing private plans to compete with a public plan will simply "keep them honest" and give patients more options--not lead to a full-blown, Canadian-style, single-payer monopoly. As I argued in my previous column, this is wishful thinking given that government programs such as Medicare have a history of controlling costs by underpaying providers, who make up the losses by charging private plans more. Any public plan modeled after Medicare will greatly increase this forced subsidy, eventually driving private plans out of business, even if that weren't Obama's intention.

But, as it turns out, it very much is his intention. Before he decided to run for office--and even during the initial days of his campaign--Obama repeatedly said that he was in favor of a single-payer system. What's more, University of California, Berkeley Professor Jacob Hacker, who is a key influence on the Obama administration, is on tape explicitly boasting that a public plan is a means for creating a single-payer system. "It's not a Trojan horse," he quips, "it's just right there."

But even if Obama wanted to, it is simply impossible to design a public plan that could compete with private insurers on a level playing field and without "feeding off the public trough" as Obama claims.

At the very least, such a plan would always carry an implicit government guarantee that, should it go bust, no one in the plan would lose coverage. This guarantee would artificially lower the plan's capital reserve requirements, giving it an unfair edge over private plans. What's more, it is simply not plausible to expect that the plan wouldn't receive any start-up subsidies or use the government's muscle to negotiate lower rates with providers. If it eschewed all these things, there would be no reason for it to exist--because it would be just like any other private plan.

Lie Five: Patients don't have to fear rationing.

Obama has been insisting, including during his ABC Town Hall event last week, that the rationing patients would face under a government-run system wouldn't be any more draconian than what they currently confront under private plans. This is complete nonsense.

The left has been trying to address fears of rationing by trotting out an old and tired trope, namely, that rationing is an inescapable fact of life because every system rations whether by price or fiat. But there is a big difference between the two. If I can't afford caviar and champagne every night, any rationing involved is metaphoric, not real. Genuine rationing occurs when someone else controls access--how much of a particular good I can consume.

By that token, Obama's stimulus bill has set in motion rationing on a scale unimaginable in the land of the free. Indeed, the bill commits over $1 billion to conduct comparative effectiveness research that will evaluate the relative merits of various treatments. That in itself wouldn't be so objectionable--if it weren't for the fact that a board will then "direct financing" toward approved, standardized treatments. In short, doctors will find it much harder to prescribe newer or non-standard treatments not yet deemed effective by health care bureaucrats. This is exactly along the lines of the British system, where breast cancer patients were denied Herceptin, a new miracle drug, until enraged women fought back. Even the much-vilified managed care plans would appear to be a paragon of generosity in comparison with this.

Obama has repeatedly asked for honesty in the health care debate. It is high time he started showing some.

SOURCE




Let’s can the public plan

President Barack Obama wants to sign a health “reform” bill by October. Democratic congressional leaders are doing their part to satisfy the president, promoting bills that threaten to government’s role, at the expense of patients and doctors Apparently, though, they didn't consult the American public.

It's not that ordinary Americans aren't looking for reform. They simply don't want what the Democrats have effectively proposed – a government take-over of their health care. Just look at the results of a recent survey from prominent pollster Frank Luntz. Half of Americans are put off by "healthcare rationing." A third is not in favor of "one-size-fits-all health care." But under the Democratic plan, rationing and one-size-fits all coverage are exactly what the American people are going to get.

Take, for instance, the Democrats' plan to expand Medicaid, the joint federal-state health program for the poor, to any American making up to 150 percent of the federal poverty line. This is an incredibly inefficient way to expand coverage. Medicaid costs are already ballooning out of control. The Department of Health and Human Services estimates that the program's expenditures will increase by about 8 percent every year until 2017 – well above the expected rate of inflation. In the four decades since its creation, Medicaid's share of the national health budget has fattened from 5 percent to nearly 20 percent. Expanding Medicaid would push the program even closer to insolvency.

Worse, Medicaid is already a prime reason for the increasing cost of private insurance. Because Medicaid routinely underpays doctors and hospitals – by about 43 percent and 33 percent, respectively – prices for everyone else have gone up. Such cost-shifting inflates private premiums by an estimated 15 percent.

Medicare shifts costs, too – not only to private payers but to our children, as well. Despite this, the Washington politicians seek to create a so-called “public insurance plan” (actually a swamp of new, bloated government agencies) to “compete” directly with private insurers. Proponents of the idea claim that a "public option" would keep private insurers honest by forcing them to cut down on administrative waste and reduce premiums. In truth, though, the new plan would eventually crowd out all choice of health insurance.

A government-run insurance program would immediately go to the front of the line for perpetual taxpayer bailouts – a luxury that private insurers (which pay higher taxes than most other businesses, because of state insurance laws) don’t have. As more Americans who prefer private coverage suffer the increasing taxes required to feed the beast, many will have to give up the unequal struggle, and fall into its maw.

According to the Lewin Group, an economic consulting firm, a government-run insurance program would motivate two-thirds of Americans to drop the private coverage they already have. That certainly won't help reduce the number of uninsured.

A third plank in the Democratic plan is the implementation an employer mandate, under which employers would be forced to either buy insurance for their workers or pay a tax. Given the state of the economy, it's astounding that lawmakers would even consider such a move, saddling businesses with a job-killing tax at a time when many are struggling to stay afloat. Obama opposed the idea during the presidential campaign for just this reason.

Instead of spending and regulating with impunity, legislators should grant Americans greater control over their healthcare dollars. One way of doing so? Allow Americans to buy insurance policies across state lines. After all, there's no reason a 26-year old man in New York should have to pay four times as much as a 26-year old man in Indiana for a similar policy.

Lawmakers should also permit all workers to purchase insurance tax free, just like businesses do. Americans lack choice in health benefits because the government forces us to get health “benefits” dictated by our companies’ HR departments. Level the tax treatment would solve this problem. Personalized health care, lower prices, and increased consumer choice -- that's what the American people really want.

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17 July, 2009

A 9-month wait for NHS arthritis treatment: Delay can mean a lifetime of agony for victims

Thousands of rheumatoid arthritis sufferers face a lifetime of agony because they are not being treated quickly enough, a report says. Guidelines state that patients should receive treatment within three months of the first symptoms appearing. But the average wait is nine months - and GPs are not trained well enough to know what help to offer.

There is no cure, but experts say that if arthritis is diagnosed in the first three months, drugs can be given which limit its progression. This means the disease will not be as painful as it would have been if the condition was diagnosed later. The study by the National Audit Office found that patients do not know enough about the condition, and therefore delay going to see their GP. Between half and three-quarters of people with symptoms wait more than three months before seeking medical help, and about a fifth delay for a year or more.

GPs lack the specialist knowledge required to diagnose the condition quickly, and on average it takes four visits before a patient is referred to a specialist for diagnosis and treatment, the report adds. Its author, Chris Groom, said: 'This is a nasty disease, a progressive auto-immune disease, which attacks otherwise healthy joints. Early symptoms are joint pain and stiffness and it leads to inflammation and loss of strength. 'It also affects other parts of the body, such as the heart and lungs, and is also associated with increased risk of cardiovascular disease.'

The report found that the average length of time from the onset of symptoms to treatment has not improved in the past five years. Mr Groom said that services needed to be better coordinated and designed around people's needs, including helping them remain in work.

Three-quarters of sufferers are of working age when diagnosed, meaning delays cost the economy almost £2billion a year - about £560million a year in NHS healthcare costs and £1.8billion in sick leave and work-related disability. 'Once people fall out of the job market with this disease, it is very hard to get back in', Mr Groom said.

The report also found that 50 per cent more people have rheumatoid arthritis than was previously thought. Mr Groom added: 'We estimate that 580,000 adults in England have the condition, which is higher than existing estimates of 400,000 for the UK, and that there are 26,000 new cases each year in England, compared to estimates of 12,000 for the UK.'

Neil Betteridge, chief executive of the charity Arthritis Care, said: 'The report echoes what people with rheumatoid arthritis have been telling Arthritis Care for years. 'Early diagnosis and referral for suitable treatment is crucial as it can stop this debilitating condition in its tracks. 'We applaud the audit's recommendations that the Department of Health and Primary Care Trusts replace their often scattergun delivery with joined-up services.'

Tory MP Edward Leigh, chairman of the Commons public accounts committee, said the NHS needed to improve support services for people with arthritis.

Health minister Ann Keen said: 'We welcome this report and will consider it carefully before responding.'

SOURCE




Your regulators will protect you (NOT)

Some charming reports from California about its "caring" nurses. And nobody cares about the abuses

Nurse Owen Jay Murphy Jr. twisted the jaw of one patient until he screamed. He picked up another one – an elderly, frail man – by the shoulders, slammed him against a mattress and barked, "I said, 'Stay in bed.' " He ignored the alarms on vital-sign monitors in the emergency room, shouted at co-workers and once hurled a thirsty patient's water jug against the wall, yelling, "How do you like your water now?" according to state records.

Murphy's fellow nurses at Kaiser Permanente Riverside Medical Center finally pleaded with their bosses for help. "They were afraid of him," a hospital spokesman said. Under pressure, Murphy resigned in May 2005. Within days, Kaiser alerted California’s Board of Registered Nursing: This nurse is dangerous.

But the board didn't stop Murphy from working elsewhere, nor did it take steps over the next two years to warn potential employers of the complaints against him. In the meantime, Murphy was accused of assaulting patients at two nearby hospitals, leading to convictions for battery and inflicting pain, board and court records show. Even Murphy, who has since taken classes to curb his anger, was surprised the board didn't step in earlier. "The nursing board is there to protect the public from me," he said in an interview.

The board charged with overseeing California's 350,000 registered nurses often takes years to act on complaints of egregious misconduct, leaving nurses accused of wrongdoing free to practice without restrictions, an investigation by The Times and the nonprofit news organization ProPublica found.

It's a high-stakes gamble that no one will be hurt as nurses with histories of drug abuse, negligence, violence and incompetence continue to provide care across the state. While the inquiries drag on, many nurses maintain spotless records. New employers and patients have no way of knowing the risks.

Reporters examined the case of every nurse who faced disciplinary action from 2002 to 2008 – more than 2,000 cases in all – as well as hundreds of pages of court, personnel and regulatory reports. They interviewed scores of nurses, patients, families, hospital officials, regulators and experts.

Among the findings:

* The board took more than three years, on average, to investigate and discipline errant nurses, according to its own statistics. In at least six other large states, the process typically takes a year or less.

"It's really discouraging that when you do report people . . . they don't take action," said Joan Jessop, a retired chief nursing officer in Los Angeles who filed multiple complaints with the board during her 43-year career. "What is so frightening to me is that these people will go on and do it to somebody else."

* The board failed to act against nurses whose misconduct already had been thoroughly documented and sanctioned by others. Reporters identified more than 120 nurses who were suspended or fired by employers, disciplined by another California licensing board or restricted from practice by other states – yet have blemish-free records with the nursing board.

* The board gave probation to hundreds of nurses – ordering monitoring and work restrictions – then failed to crack down as many landed in trouble again and again. One nurse given probation in 2005 missed 38 drug screens, tested positive for alcohol five times and was fired from a job before the board revoked his probation three years later.

* The board failed to use its authority to immediately stop potentially dangerous nurses from practicing. It obtained emergency suspensions of nurses' licenses just 29 times from 2002 to 2007. In contrast, Florida's nursing regulators, who oversee 40% fewer nurses, take such action more than 70 times each year.

In interviews last week, the board's leaders and other state officials defended its record. "We take what we do – protecting the public – very, very seriously," said Executive Officer Ruth Ann Terry.

Terry, at the helm for nearly 16 years and on staff for 25, acknowledged that the pace of the disciplinary process has "always been unacceptable" and said the system was being streamlined. But she blamed other parts of the state bureaucracy for delays and was vague about what changes would be made.

Later, the state Department of Consumer Affairs, which oversees the board, sent reporters a three-page list of "process improvements." Many were mundane or incremental adjustments – such as revising disciplinary guidelines or planning expert witness training. Others seemed more directly aimed at reducing delays: adding staff, meeting with investigators about stalled cases and using computer systems to better track complaints.

Patricia Harris, acting chief deputy director of the department, stood behind the board. "I think they do a good job," she said.

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Health reform would tax the rich and near-rich

Americans would face new requirements to obtain health insurance or face hefty tax penalties as part of a $1.5 trillion health care reform plan introduced by House Democrats on Tuesday that will be paid for, in part, by a new 5.4 percent tax on the wealthiest Americans.

Employers would have to provide coverage to employees or face penalties of their own under the 1,018-page bill, released by Democratic leaders and chairmen of three committees that share jurisdiction over health care. It would also create a public health insurance program and impose a series of new regulations on the insurance industry, including a ban on denying coverage of pre-existing conditions.

"This is a defining moment for our country," said Rep. Henry A. Waxman, California Democrat and chairman of the House Energy and Commerce Committee. "We are about to undertake what has eluded so many presidents and Congresses for far too long and that is the objective of getting good quality, affordable health care insurance to every American."

The health care reform bill, which was praised by President Obama for creating new competition for insurance companies, would reshape the country's focus on health care coverage as a right of all Americans and a responsibility of the government.

The bill's release was met with enthusiasm by health care advocates but slammed by the industry and other business groups. A "pay or play" mandate on businesses drew condemnation as a job killer from a group of more than 30 trade associations, including the U.S. Chamber of Commerce, the Business Roundtable and the National Retail Federation. "We believe that some of the approaches under consideration in the House legislation would not improve the system, but in fact would jeopardize the parts of the system that currently work," the groups said in a letter to members of the House.

The Pharmaceutical Research and Manufacturers of America (PhRMA), the trade group of the pharmaceutical industry, said it won't support the bill because of changes in the Medicare Part D benefit, which it said would constitute a tax increase on seniors.

The bill was praised by various health care advocacy groups such as AARP. Families USA Executive Director Ron Pollack said the bill would "ensure that virtually all Americans have access to high-quality, affordable health coverage and care."

The bill still faces opposition from factions of the Democrat caucus and has already prompted widespread criticism from Republicans. A group of fiscally conservative "Blue Dog" Democrats stalled the release of the bill last week over concerns that it be deficit neutral, control costs and include stronger protections for small businesses and rural patients. The group said it plans to incorporate more cost cutting measures into the bill.

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Universal Health Care Isn't Worth Our Freedom

What would Thoreau have made of the current debate?

People who seek the services of auto mechanics want car repair, not "auto care." Similarly, most people who seek the services of medical doctors want body repair, not "health care."

We own our cars, are responsible for the cost of maintaining them, and decide what needs fixing based partly on balancing the seriousness of the problem against the expense of repairing it. Our health-care system rests on the principle that, although we own our bodies, the community or state ought to be responsible for paying the cost of repairing them. This is for the ostensibly noble purpose of redistributing the potentially ruinous expense of the medical care of unfortunate individuals.

But what is health care? The concept of reimbursable health-care service rests on the premise that the medical problem in need of servicing is the result of involuntary, unwanted happenings, not the result of voluntary, goal-directed behavior. Leukemia, lupus, prostate cancer, and many infectious diseases are unwanted happenings. Are we going to count obesity, smoking, depression and schizophrenia as the same kinds of diseases?

Many Americans would willingly pay for insurance to protect them against the exorbitant cost of treating their own leukemia. But how many Americans would willingly pay for insurance to protect them from the expenses of treating their own depression?

Everyone recognizes that the more fully we wish insurance companies to defray our out of pocket expenses for our car repairs, the higher the premium they will charge for the policy. Yet foregoing reimbursement for trivial or unnecessary health-care costs in return for a more suitable health-care policy is an option unavailable under the present system. Everyone with health insurance is compelled to protect himself from risks, such as alcoholism and erectile dysfunction, that he would willingly shoulder in exchange for a lower premium.

The idea that every life is infinitely precious and therefore everyone deserves the same kind of optimal medical care is a fine religious sentiment and moral ideal. As political and economic policy, it is vainglorious delusion. Rich and educated people not only receive better goods and services in all areas of life than do poor and uneducated people, they also tend to take better care of themselves and their possessions, which in turn leads to better health. The first requirement for better health care for all is not equal health care for everyone but educational and economic advancement for everyone.

Our national conversation about curbing the cost of health care is crippled by the vocabulary in which we conduct it. We must stop talking about "health care" as if it were some kind of collective public service, like fire protection, provided equally to everyone who needs it. No government can provide the same high quality body repair services to everyone. Not all doctors are equally good physicians, and not all sick persons are equally good patients.

If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price. We will become the voluntary slaves of a "compassionate" government that will provide the same low quality health care to everyone.

Henry David Thoreau famously remarked, "If I knew for a certainty that a man was coming to my house with the conscious design of doing me good, I should run for my life." Thoreau feared a single, unarmed man approaching him with such a passion in his heart. Too many people now embrace the coercive apparatus of the modern state professing the same design.

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16 July, 2009

NHS tries to avoid treating patients with swine flu

For one mother, the NHS's swine flu response is scarily unresponsive. Dealing with swine flu is confusing and - with the news of the deaths of apparently healthy people - scary. That was brought home by this message I got from a mother trying to negotiate the NHS for her family. She writes:

Yes, more children will probably die in the swine flu epidemic. And it may well be partly because senseless bureaucracy is stopping child victims getting urgent medical help...

It was Saturday morning. My children had been taking Tamiflu for a couple of days, after our GP had diagnosed swine flu on the phone. Now both my husband and my younger son were looking worse. My husband has asthma and my son suffers from recurrent croup (for which he has been hospitalised twice). So I rang Out of Hours Urgent Care, who transferred us to NHS Direct. Surely, I thought, as probable swine flu victims my husband and son would be treatment priorities?

An arrogant telephone operative at NHS Direct told my asthmatic husband he probably didn’t have swine flu and had nothing to worry about. No treatment was offered. So I took my son to the NHS Walk-In Centre. There, when I mentioned Tamiflu, we were ushered into a separate room and then told we would not be seen by a doctor and must leave the building. Because we had swine flu. We should ring NHS Direct for help. I explained why that had failed, whilst my son’s coughing grew more ominous.

I refused to leave, I pleaded, I lost my temper. My child is sick, he is getting croup, he needs to be seen. Children die of this. At length, a kindly nurse arranged a GP Home Visit. We returned home to wait, but within two hours my son was struggling to breathe. A 999 call, ambulance, blue lights, hospital, steroids, oxygen. An emergency that could well have been avoided with the right medical treatment quicker. Admittedly, we got help quickly because I broke the rules given at the time of diagnosis: I rang for an ambulance myself rather than joining the queue for NHS Direct, as I’d been told to do in emergency. I wonder how long I would have waited in a telephone queue whilst my son struggled to breathe.

And my husband? Oh, he ended up in hospital too, for a couple of hours, after the Home Visit GP looked at his condition and recommended I drive him straight to Casualty. He explained that it was breaking the rules, but that my husband needed a nebuliser quickly, and if he tried to arrange it the procedure would take hours, because there were so many protocols for dealing with swine flu patients.

I wish my story was unusual. But a friend in the same village – on the same day – broke the rules too. They’d been diagnosed in hospital that Friday, immediately quarantined and sent home with a helpline number to ring for medicine. They tried for twenty-four hours to get through. They spent thirty pounds on fruitless telephone calls. Then he took his rapidly worsening son back to Casualty.

Leaving him in the car to prevent infection, he went inside and demanded to see a doctor. His treatment was worse than mine. When I lost my temper the Walk-In Centre took me seriously. When he raised his voice, they called the police. He was kept in a private room whilst his sick son was left alone in the car outside. “It’s the lack of compassion that gets me,” he said. “It was like they didn’t care about a sick child.”

He got the medicine, eventually. After breaking the rules and kicking up a fuss. But Tamiflu is only effective if taken at the very beginning of an illness. That twenty-four hour delay in getting medication could have killed my friend’s child. So could untreated croup.

Of course no one wants to spread infection unnecessarily. It is sensible to self-quarantine and ask for home visits. But at the moment Britain’s panic about swine flu has created senseless barriers that are stopping very ill young children getting the treatment they need.

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Obama’s tax flip-flop on health benefits

The campaign ad was ominous: "John McCain would make you pay income tax on your health insurance benefits. Taxing health benefits for the first time ever." So warned candidate Barack Obama less than a year ago. In ads and speeches, Obama went on to predict the horrific fallout of McCain's proposal: financial hardship and millions dumped from employer-provided health plans. Today, spokesmen for President Obama are saying a tax on employer-provided health benefits wouldn't be such a bad thing after all.

Roughly 163 million Americans receive health insurance through their employer. While actually a form of compensation, the value of the employer's contribution to that insurance is not taxed under the federal income or payroll taxes. This exclusion is a solidly middle-class tax benefit. More than 70% of middle-income, nonelderly Americans have employer-based health coverage. And about half of people with employer-based coverage have family income of less than $75,000.

Now, in a desperate search for $1 trillion to $2 trillion to pay for Obama's medical insurance reform plan, congressional Democrats are considering proposals to limit or repeal this tax exclusion. And the Obama administration says it may go along.

This reversal is far more than a simple case of hypocrisy or jettisoning a campaign promise once it becomes inconvenient. The McCain proposal that candidate Obama so viciously attacked was part of a plan to shift the overall system toward market-based individual coverage. While it was true that McCain would have eliminated the exclusion for employer-provided health benefits, letting them be taxed like ordinary income, he would have given workers a tax credit for purchasing health insurance on their own or through an employer. The result would have been that most workers would pay the same or less in taxes, with health markets more efficient and coverage more portable.

The proposals now discussed are nothing more than a naked grab for more tax money. There would be no offsetting tax credit. Workers would simply pay more taxes — a lot more taxes. For example, if the income-tax exclusion were repealed, it would impose a $2.3 trillion tax increase over 10 years. On average, employers pay $8,824 for a worker's insurance. Assuming tax rates of 10% to 38%, that means workers could expect to pay from $882 to $3,353 annually in additional taxes. Those with more expensive health plans, such as unionized auto workers, would face even bigger tax hikes.

Rather than fully repealing the exemption, Congress likely will put a cap on the tax exclusion. It would eliminate the income and payroll tax exclusion only for insurance plans with an above-average value or for workers with incomes above a certain level. The problem is that, while more politically palatable, such a partial repeal of the exclusion wouldn't raise nearly enough money to pay for medical insurance reform. Eliminating the exclusion only for insurance plans with an above-average value would raise only $165 billion over 10 years.

And all this is only one of the middle-class tax increases Congress is considering to pay the enormous cost of the president's plan. Payroll tax hikes, a value-added tax, income tax surcharges, even taxes on beer and soft drinks are all on the table. In the words of humorist P.J. O'Rourke: "If you think health care is expensive now — just wait until it's free."

Congress seems determined to pass medical insurance reform no matter what the price. And if the president has to break a few campaign promises and tax the American middle class, the path he is on indicates he is willing to pay up. Whether middle-class Americans are is a different story.

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Wal-Mart has let the side down

The word leadership tends be thrown around a lot in Washington. We see it used endlessly in political campaigns, newsrooms…even by trade associations. It seems everyone wants to lead. But not everyone has what it takes.

With health care reform looming in Congress, everyone is clamoring to claim their corner on the big debate, and the stakes have never been higher. The Obama administration seems to have taken to the notion that reform for reform’s sake is better than nothing at all. What they must fail to realize is that a misstep on health care could quickly push our economic recovery back decades.

One of retailers’ biggest concerns in the health care debate is the idea of an employer mandate provision, which would be catastrophic for our industry. Mandates would drive up costs for retailers while doing nothing to address waste, inefficiencies and lack of competition. Ultimately, employers forced to spend more on insurance would have little choice but to reduce payrolls or raise prices – and that’s the last thing retail employees or shoppers need right now. NRF’s Employee Benefits Counsel has been participating in health care reform discussions behind the scenes for years, working with Congress, associations and businesses alike to arrive at a compromise.

When Wal-Mart sent a letter to President Obama two weeks ago supporting government mandates on businesses as a part of reform, the retail industry was astonished. Seeing the company in lock-step with the unions on this issue was troubling to say the least. Although the move may provide a short-term public relations boost to Wal-Mart, it could have long-lasting, devastating consequences to retailers throughout the country.

This stunning turn of events left NRF with a decision to make. We could stand idly by and allow Wal-Mart to tip the scales on the health care debate, cower and release an innocuous statement that would neither support nor condemn their decision, or stand up for all retailers and come out swinging.

The truth is the decision wasn’t all that difficult. In fact, there was never really any choice. NRF is the retail industry’s association, which means we represent all retailers – large and small – not just a select few. (Wal-Mart is not a member of NRF and, after this dispute, I’m not expecting a dues check from them anytime soon.)

We knew that going up against Wal-Mart would raise some eyebrows – and it did. But, simply put, we could not condone the decision of one retailer, even the largest retailer in the world, if it would come at the expense of everyone else. So, we spoke up.

In the last few weeks, NRF executives have spent quite a bit of time speaking with reporters – from CNBC to the Wall Street Journal to Fox News – expressing our disappointment with Wal-Mart’s decision. On Capitol Hill, we have been working closely with legislators to spell out in no uncertain terms the serious ramifications employer mandates would have on our economy. On top of that, our CEO Health Care Task Force continues to work diligently on real solutions that would help fix our health care system by laying out steps to encourage competition on cost and quality, rather than creating a $2 trillion bill for future generations to pick up.

To truly lead on the health care debate, it is imperative that businesses, associations, and politicians take a stand when it counts and not shy away from deal-breakers like employer mandates. That’s the difference between leadership and lip service. And I think, by now, we’ve all had quite enough of the latter.

If you have any thoughts on NRF’s stance on health care and employer mandates, please let me know.

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Weasel language from an Australian government health bureaucracy

A missive from Queensland Health director-general Mick Reid reminding staff about how important it is to be honest with the public now that the Right to Information laws have begun:

Special Broadcast 1/07/2009 6:43 pm

All staff of Queensland Health need to be aware that the Right to Information Act 2009 and the Information Privacy Act 2009 commenced today.

Both of these Acts are key components of the Queensland Government’s Right to Information policy that is aimed at promoting a culture of openness, accountability and transparency, balanced with appropriate protections for certain information, including personal information. In practice, this means that information will be released unless, on balance, its release is contrary to the public interest.

All of the Queensland Public Service need to be aware that the objectives of the Right to Information reform process mean we operate on a presumption of disclosure of government information.

To this end could all staff please note the contents of the attached Statement of Right to Information Principles For the Queensland Public Service issued by the Premier of Queensland.

SOURCE

I think comment would be superfluous





15 July, 2009

America already has a system of socialized medicine. It's already being abused and it's already costing taxpayers a bomb

A homeless alcoholic nicknamed Ricky Ricardo, swigs cheap vodka by day at his favorite corner in Washington Heights, then calls an ambulance to chauffeur him to the hospital for a free meal and a warm place to sleep, courtesy of taxpayers who fund his Medicaid benefits. For a chronic caller like Alardo -- who phones 911 four or five times a week -- the annual medical bill can be as high as $300,000. Over 13 years, the length of time he has been abusing the emergency room, he has cost the medical system an estimated $3.9 million.

In Midtown, another bum, Robert, has faked emergencies to get food and shelter in ERs about 40 or 50 times in the past three years -- and taxpayers pick up his tab, too. Ricky and Robert are among the dozens of "frequent fliers" who clog the 911 system, tie up city ambulances, crowd emergency rooms and burn through Medicaid money. An ambulance ride alone can run as much as $800, and an ER visit can cost, conservatively, $400 a pop, according to estimates from medical experts.

City officials don't track frequent fliers or the costs associated with their transport and hospital care, but anecdotal numbers from ER and EMS workers suggest there are dozens throughout the city. "We have a system that is extremely dysfunctional. We have no place to put these people," an EMS medic said.

A paramedic working downtown said some frequent fliers think they'll get faster treatment if they arrive at an ER by ambulance, rather than walk in. "They know what to say to our call takers," he said. Or they'll tell a bystander, "Oh, I have chest pains," the medic said. Alardo, 53, phones 911 so regularly, medics know which calls are likely his. "When Ricky passes on, I'll probably even go to his funeral," said one medic who works in Washington Heights. "I've seen him almost every day for the last 13 years."

An inebriated Alardo lauded the medics last week, saying they "treat me like a king." A few hours later, he called for an ambulance to pick him up on Bennett Avenue. He went into the hospital at about 4 p.m. and slept for hours.

His fellow frequent flier Robert said he has called 911 as many as 50 times since becoming homeless three years ago. He said he would tell the 911 operator he had chest pains or was suicidal. But, he confessed last week, "I'm not really suicidal." Robert, 40, said he was looking for a place to sleep, get a meal and get the medications he takes for depression. He said he stopped his 911 habit after an ambulance driver "chewed him out." "I haven't called an ambulance for about a month," Robert said.

By law, EMS workers cannot refuse to treat or transport any patient. And ERs have to at least evaluate and stabilize homeless patients. The drain on the city's strapped medical system is huge. Medicaid reimbursements don't come close to covering the costs of frequent-flier visits. Medicaid pays just $175 for a basic ER visit and only $186 for the cost of an $800 advanced-care ambulance.

At a minimum, ERs give vitamins, showers, hot food and a bed to their homeless patients. But those who come in with underlying medical conditions require X-rays, cardiograms and medicines that can push the cost of an ER visit well above the average $400. "They take space. They take nursing resources. They're a drain on the staff's energy level and emotions," said Dr. Jeffrey Brenner, of Camden, NJ, who has studied the issue. "They're costing the system in both direct and hidden ways."

Brenner's research found Medicaid paid $46 million for the top 1 percent of Camden's frequent fliers, or 1,035 patients, during a five-year period. A pilot program at Bellevue Hospital has cut ER visits by 67 percent among "high-cost" Medicaid patients by finding them their own doctors, housing and even cellphones to keep in touch with their doctors, according to a recent report by the United Hospital Fund. But it will be hard to break the habit of vagrants who view the ER as their personal retreat. "It's not always easy to pick up these guys and take them in," one medic said. "But our policy is: 'You call, we haul.' We have no other choice."

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'Rationing' is GOP weapon against health reform

In political combat, there are few more potent weapons than a single word or a catchy phrase that can be used to target a proposal and drive it into the ground. For Republicans, "rationing" could be that poison-tipped arrow for the Democratic-led health care bill, much as "amnesty" was the club with which conservatives beat President Bush's attempt at immigration reform into a bloody pulp in 2007.

"Governments ration care to control costs, and we've got stories from other countries where disabled children wait up to two years for wheelchairs. We've got a story that we found: a 76-year-old retiree pulled out their own teeth," said Rep. Dave Camp, Michigan Republican and the ranking member on the House Ways and Means Committee. "Government rationing is a scary proposition," he said.

Sen. John Cornyn of Texas, chairman of the National Republican Senatorial Committee, echoed this point during a conference call Wednesday, warning that the government could get into the business of rationing health care, deciding how much Americans can get or can spend on it and denying people health care that exceeds some rationed amount. "The rationing problem is very real in all this and I think that as the American people learn more and more about the proposals as we are now being allowed more time for them to engage on this issue, they are very, very much concerned," he said.

But Democrats say the insurance companies are already rationing care and that the reforms they want would cover all those who are being denied coverage under the current system, as well as keep down costs through an intensive focus on which medical procedures and products deliver care most effectively.

Republicans say that under a government-run system, which they argue will result from the proposed option to buy insurance from the government, cost will come to be the dominant factor that defines "efficient care," and thus Americans will be denied care with no recourse.

House Democrats plan to introduce their health care overhaul measure Monday and consider amendments later in the week. On Sunday's talk shows, there was disagreement on whether Congress will finish work on the bill before adjourning for the August recess.

Sen. Judd Gregg, New Hampshire Republican, said on CNN that meeting the deadline was "highly unlikely" because the Senate Finance Committee had not completed a draft. Sen. Jon Kyl of Arizona, the Senate Republican whip, said flatly there was "no chance."

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Why Britain should fear American health care reform

Tucked away in a piece about possible end runs around NICE, the health care rationing body, is something of a scary paragraph:

Pharmaceutical companies are reluctant to launch new drugs in the UK at low cost because 25% of the global market is influenced by the UK price.

No, not that one sentence, although it helps explain why this next one is scary:

It comes at a time when other countries are actively considering setting up equivalents to Nice. First among them, and most important for the pharmaceutical industry, is the US. President Obama is known to be interested in some sort of cost-effectiveness scrutiny of medicines, which is bitterly opposed by the industry.

What all too few seem to understand is that medical innovation is hugely driven by what happens in the US market. The only market that is largely free from price controls. We can see from the first sentence that price controls do indeed retard innovation but of course there is no outcry about this for we don't normally see it. Who does take note of cures that aren't invented, aren't launched, because price controls mean there is no profit in their being so?

The great release from this problem for European health care systems has been that the US market, by far the largest in the world, is not subject to such price controls. Thus 300 million of the richest people on the planet underwrite, through the prices they pay for new treatments, the developments that we get years later as prices drop.

If the US does indeed bring in some form of NICE equivalent, some form of price rationing, then medical innovation will fall....no, not cease completely, simply there will be less of it than there would otherwise have been. Thus people who could or might have been cured will not be and they will die.

Reform of the US system might still be worthwhile, something like NICE might even still make sense: but don't anyone believe that such changes will be costless, they will indeed cost lives.

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NHS 'obsession with breastfeeding is putting bottle-fed babies at risk'

Thousands of mothers who bottle feed are accidentally putting their babies' health at risk, says a study. They were found to be using too much formula milk powder and timing feeds wrongly. Frequent overfeeding can put babies at risk of long-term obesity and conditions associated with it, such as heart disease.

The problem is blamed on the Health Service's obsession with breastfeeding. It is accused of failing to provide enough information to new mothers on the alternatives. Cambridge University experts reviewed studies involving more than 13,000 mothers. They found that many mothers felt guilty or thought they were a failure for bottle feeding, while many were angry about not being able to breastfeed.

Others thought midwives were more interested in helping breastfeeding mothers than those who used bottles. Ministers are keen to get more mothers to breastfeed because of mounting evidence that it improves children's immunity to disease and helps brain development. It is also thought to reduce a mother's chance of heart attack.

The research, published in the Archives of Disease in Childhood journal, involved 23 studies. The authors found that some NHS midwives mistakenly thought they were forbidden from giving advice to bottle-feeding mothers, even after the baby was born. 'When women do not get information from healthcare professionals, they are reliant on friends and family, and incorrect practices are likely to be handed down from one generation to the next,' the researchers said.

They found that many mothers mistakenly put too much formula powder with the water. 'In addition to the short-term issues of hygiene and safety, it is possible that errors in the measurement and over concentration of bottle feeds may contribute to overfeeding, rapid infancy weight gain and later obesity,' they said.

The World Health Organisation code on infant feeding says only limited information on bottle feeding should be given before the baby is born - and after birth, instruction on bottle feeding should be given only after the mother has decided against breastfeeding. The study also noted that parents often changed the brand of formula they used if their baby was regurgitating it, in the belief the child might have a food intolerance. However 'it was possible that the reason for this symptom may not have been intolerance but overfeeding', the researchers said. 'There was a risk that infants would wrongly be labelled as having an intrinsic abnormality with longterm consequences to their health.'

An Infant Feeding Survey from 2005 showed that while 78 per cent of mothers in England initiate breastfeeding, only 45 per cent of babies were exclusively breastfed aged one week, dropping to less than 1 per cent when they were six months. The authors said that while it was known that breast milk is best for baby, mothers who choose to bottle-feed or who have failed with breastfeeding should be supported. They added: 'Inadequate information and support for mothers who decide to bottle feed may put the health of their babies at risk.'

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14 July, 2009

One Reason Our Healthcare System is in a Mess: Trial Lawyers

OK, my headline is admittedly too simplistic. In fact, the whole medical malpractice milieu is sorely in need of a fix. We have unnecessarily large awards to aggrieved patients, crushing insurance costs to doctors to cover malpractice, a situation where defensive medicine drives up costs, and an entire industry of lawyers whose job it is, apparently, to rape the system and cause it to be burdensome for all of us. On top of that, we have a national party in the Democrats assisting these very destructive lawyers to do just that. This is a part of our medical system that truly needs reform.

We can start by getting Democrats to stop doing everything they can to bend over backwards for the John Edwards’ of this world — ambulance chasers extraordinaire. Democrats are the reason this has gotten so bad. And imagine, we are trusting to Democrats to “fix” what they, themselves broke with the greedy assistance of the trial lawyers.

Last month, I wondered aloud if Obama was going to cut these medical vultures off at the knees? I asked if Obamacare would mean that medical malpractice law will take a hit?

Currently doctors pay outrageous premiums for malpractice insurance. A CBS report from 2004, for instance, revealed that some OB-GYNs then paid as much as $90,000 a year for malpractice insurance. Today it is likely closer to $200,000. These outrageous premiums mean that a doctor must take in something like $400,000 a year to be able to afford the insurance premiums and still make a living worth going through the decades of training and schooling required to become a doctor.

Others are also wondering about Obama’s plans for medical malpractice reform. But it doesn’t look like Obama is really much interested in telling his trial lawyer backers to tone it down. There won’t be any “shared sacrifice” for trial lawyers if Obama has any say in the matter.

Richard Epstein also tackled this topic in The Wall Street Journal on June 30. Epstein compared our medical malpractice arena to that of other countries and the results prove that our trial lawyers and their Democratic Party patrons have created a mess for US in comparison.

Litigation in the U.S. has at least four distinctive procedural features that drive up malpractice costs. The first is jury trials, which can veer out of control and in any case introduce significant uncertainty. The second is the contingency-fee system, which allows well-heeled lawyers to self-finance litigation. The third is the rule that makes each side bear its own costs. This induces riskier lawsuits than are undertaken in most other countries, such as Canada, England and most of Europe, where the loser pays the legal costs of the winner. The fourth is extensive pretrial discovery outside the direct supervision of judges, which occurs far more readily here than elsewhere.

Epstein identifies several other problems with our legal practices re medical malpractice and ends up finding that we burden ourselves with waste and abuse beyond measure.

A study led by David Studdert published in the 2006 New England Journal of Medicine concluded that the administrative expenses of the malpractice system were “exorbitant.” And worse, it found errors in jury verdicts in about a quarter of the litigated cases. Juries denied compensation properly due in 16% of the cases, and awarded it about 10% of the time when it was unwarranted. These error rates don’t include damage awards set at improper levels.

And here is one where Canada does do a far better job than we do. Epstein tells us that according to a 1992 study by Donald Dewees and Michael Trebilcock in the Osgood Hall Law Journal, Canada’s medical malpractice caseload was about the same as that of the U.S., but they incur about 10% of the total cost of ours. This is a travesty.

Epstein has several suggested correctives to our system, but he is reticent, it seems, to put the blame where it belongs: the Democrat Party. It is they who’ve passed laws that coddle trial lawyers looking for big payoffs and get rich quick schemes. And, as I said, we are unfortunate enough that it is they that folks are looking to for a healthcare fix.

For Democrats, with the trial lawyer backers in tow, there will be no fix of medical malpractice unless voters force the issue. If Barack Obama truly wanted reform, a major part of his healthcare policies would revolve around fixing the medical malpractice system we are currently suffering under.

Unfortunately, Barack Obama is not interested in reform. He only wants power.

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The Massachusetts Health Mess

Massachusetts shows how ObamaCare would really work

In a rational world, the prognosis for ObamaCare would wait on the evidence in Massachusetts, given that the commonwealth's 2006 program closely resembles what Democrats are trying to do in Washington. If the results were widely known, it might be dead on arrival.

The Massachusetts law, which was championed by former GOP Governor Mitt Romney, imposed an individual mandate, requiring nearly all residents to buy health insurance or else pay a penalty. (The exceptions are those who qualify for the state's public program.) This was supposed to cover everybody and save money too. We've written before about how costs have exploded, but it also turns out that consumers have other ideas.

For 15 years Massachusetts has also imposed mandates known as guaranteed issue and community rating -- meaning that insurers must cover anyone who applies, regardless of health or pre-existing conditions, and also charge everyone the same premium (or close to it). Yet these mandates allow people to wait until they're sick, or just before they're about to incur major medical expenses, to buy insurance. This drives up costs for everyone else, which helps explain why small-group coverage in Massachusetts is so much more expensive than in most of the country. Mr. Romney argued -- as Democrats are arguing now -- that the individual mandate would make that problem disappear, since everyone is always supposed to be covered.

Well, the returns are rolling in, and a useful case study comes from the community-based health plan Harvard-Pilgrim. CEO Charlie Baker reports that his company has seen an "astonishing" uptick in people buying coverage for a few months at a time, running up high medical bills, and then dumping the policy after treatment is completed and paid for. Harvard-Pilgrim estimates that between April 2008 and March 2009, about 40% of its new enrollees stayed with it for fewer than five months and on average incurred about $2,400 per person in monthly medical expenses. That's about 600% higher than Harvard-Pilgrim would have otherwise expected.

The individual mandate penalty for not having coverage is only about $900, so people seem to be gaming the Massachusetts system. "This is a problem," Mr. Baker writes on his blog, in the understatement of the year. "It is raising the prices paid by individuals and small businesses who are doing the right thing by purchasing twelve months of health insurance, and it's turning the whole notion of shared responsibility on its ear."

Mr. Baker is right, though he underestimates the extent to which it is rational for people to do this, considering the government-mandated incentives. To one degree or another all insurance pools require the younger and healthier to subsidize the older and sicker, though part of the risk-sharing bargain is the hedge against unanticipated or future health problems -- i.e., true insurance. The combination of guaranteed issue and community rating actively encourages parts of the healthier population to forgo coverage and thus blow up voluntary risk pools. No doubt our politicians will conclude that the solution is to raise the penalty for going uninsured, though it would be easier and more rational to let insurance markets function without mandates.

For many Democrats, none of this is really a surprise, or even important. Their Rube Goldberg rules are meant to transfer the costs of health care away from individuals and onto someone else -- private companies like Harvard-Pilgrim in the short term, and over time onto taxpayers. Why lobbyist Karen Ignagni is still putting the health-insurance industry's head on the Washington chopping block is a mystery for the ages.

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Democrats Hoodwink the Health Lobby

America's health-care CEOs are being taken for a ride by Congress and their own lobbyists

When Democrats recall their HillaryCare defeat, they like to decry those Harry & Louise ads. What they choose not to recall so publicly is the help they got -- and are getting again -- from folks like Karen Ignagni [President and CEO of America's Health Insurance Plans].

The left today gets mileage out of claiming it was a unified private health sector that killed the 1993-94 Clinton health plan. It's a clever historical rewrite, offering not only an excuse for their prior defeat, but a bogeyman for today's health-care battle. It's also allowed them to obscure the real lesson they took away from HillaryCare. Namely that, handled properly, industry groups can be played like banjos. Democrats are employing the same tactic this time -- only more deftly and with more muscle -- and the titans of the private sector are rambling straight into the ambush.

The old hands of the Clinton health fight know there never was uniform opposition to the government plan. Plenty of bigger players figured they could craft the regulations for bigger profits. In 1993 a number of insurance giants cut ties with their trade group, the Health Insurance Association of America (HIAA). Prudential, Cigna and others were salivating over Clinton proposals to pay for insurance for millions of uninsureds. The giants were in line to suck up these customers. They didn't appreciate the grousing of smaller association members who opposed regulations that would crowd them out.

Representing many HMO biggies was a one-time AFL-CIO employee named Karen Ignagni. While the rump HIAA was running its Harry & Louise ads, others like Ms. Ignagni were running with the Clintons to craft a regulation to the big insurers' liking.

The insurers have today reunited under a group called America's Health Insurance Plans. Its CEO? Ms. Ignagni. She, along with Billy Tauzin, head of the Pharmaceutical Research and Manufacturers of America, the American Hospital Association's Rick Umbdenstock, and others are back in Washington convinced they can outsmart, or at least outrun, the politicians. Democrats are happy to let them think so.

The industry's calculation is that by cutting deals, it can set the terms of its contributions to "reform" and even wangle upsides. The insurers came first, promising to squeeze $2 trillion in costs out of the system. Democrats are letting Ms. Ignagni believe that in return she'll get a mandate to require all Americans to carry insurance (which her members will supply), and be spared a public option (which would decimate her industry).

Mr. Tauzin came along, pledging that drug makers would cough up $80 billion to narrow a gap in Medicare drug coverage. He's been led to think Washington will forgo its plans to allow drug reimportation or give him a hand on generics. The hospital groups this week agreed to $150 billion in future Medicare and Medicaid cuts, in return for assurances it wouldn't be worse. The doctors are next, also seeking guarantees on Medicare payments.

Democrats have complemented their smiling encouragements with behind-the-scenes threats. After retaking the House in 2006, the party made clear that companies that did not hire Democratic lobbyists would not get a hearing in Washington. The ruling party is now seeing the fruits of its bullying. These days, a meeting of health-care lobbyists is better described as a reunion of Senate Finance Chairman Max Baucus's former aides. Health-care lobbying has been turned on its head: The new cabal of Democratic lobbyists does not exist to protect the industry from Congress. It exists to present Democratic ultimatums to business.

When Senate Republicans last month hosted a meeting to discuss reform ideas, Mr. Baucus's office called in a block of these Democratic lobbyists to deliver a message. "They said, 'Republicans are having this meeting and you need to let all of your clients know if they have someone there, that will be viewed as a hostile act,'" reported one attendee to the Baucus caucus. Message to companies that don't agree with their Beltway lobbyist: Pull a Rick Scott (the former hospital executive running ads critical of ObamaCare), and you'll be sorry.

All these actions -- the White House meetings, the strung-out negotiations, the muzzling -- have been taken with one aim: To buy silence. President Barack Obama is committed to a public option. Liberal Democrats intend to make the private sector fund their plans. They figure by the time they drop a bill that contains odious elements, it'll be too late for any industry player -- big or small -- to cut a Harry & Louise ad.

Industry players this week got a glimpse of how they will be treated. House Energy and Commerce Chairman Henry Waxman dismissed the $80 billion drug deal, claiming it did not have House support, and moreover that the White House "told us they're not bound to that agreement."

Mr. Waxman detailed his own demands, which, needless to say, made $80 billion look piddling. The Obama administration is already backing off the pharma and hospital deals. An anonymous White House official claimed this week that neither were set in stone, and, for the record, had been inked solely with Mr. Baucus. That's the same Mr. Baucus who has been losing clout with each day this process goes on.

The question is just how long it is going to take for America's health-care CEOs to realize they are being taken for a ride, both by Congress and their own lobbyists. Americans are wary enough about ObamaCare to maybe appreciate some straight talk from corporate America. If only corporate America can find the smarts to give it.

SOURCE




Everyone in Britain will soon get untested vaccine against swine flu -- courtesy of the NHS and "regulators" who have dropped the ball

This seems amazingly precipitous. The reasoning is clearly that MOST people will be OK and damn the minority. I think I would rather take my chances with the flu rather than risk Guillain-Barré syndrome

The NHS is preparing to vaccinate the entire population against swine flu after the disease claimed the life of its first healthy British patient. A new vaccine is expected to arrive in Britain in the next few weeks and could be fast-tracked through regulatory approval in five days. As many as 20m people could be inoculated this year. Ministers have secured up to 90m doses, and the rest of the population is likely to be offered vaccinations next year.

A man from Essex was confirmed on Friday as the first person without underlying health problems to have died from the virus. The health department said most people with the virus had only mild symptoms.

Peter Holden, the British Medical Association’s lead negotiator on swine flu, said GPs’ surgeries were ready for one of the biggest vaccination campaigns in almost 50 years. “If this virus does [mutate], it can get a lot more nasty, and the idea is to give people immunity. But the sheer logistics of dealing with 60m people can’t be underestimated,” he said. The health department said a vaccination programme would be drawn up based on expert advice.

The path of a popular medicine from the laboratory to the chemist or doctor’s surgery can involve years of clinical trials on a select group of patients. When the new vaccine for swine flu arrives in Britain, regulators said this weekend, it could be approved for use in just five days.

Regulators at the European Medicines Agency (EMEA) said the fast-tracked procedure has involved clinical trials of a “mock-up” vaccine similar to the one that will be used for the biggest mass vaccination programme in generations. It will be introduced into the general population while regulators continue to carry out simultaneous clinical trials.

The first patients in the queue for the jab - being supplied to the UK by GSK and Baxter Healthcare - may understandably be a little nervous at any possible side effects. A mass vaccination campaign against swine flu in America was halted in the 1970s after some people suffered Guillain-Barré syndrome, a disorder of the nervous system.

However, regulators said fast-tracking would not be at the expense of patient safety. “The vaccines are authorised with a detailed risk management plan,” the EMEA said. “There is quite a body of evidence regarding safety on the trials of the mock-up, and the actual vaccine could be assessed in five days.”

The UK government has ordered enough vaccine to cover the entire population. GPs are being told to prepare for a nationwide vaccination campaign. Dr Peter Holden, the British Medical Association’s lead negotiator on swine flu, who has been attending Department of Health meetings on the outbreak, said GPs’ surgeries were prepared for one of the biggest vaccination campaigns in almost 50 years.

He said although swine flu was not causing serious illness in patients, health officials were eager to start a mass vaccination campaign, starting first on priority groups. First, the jabs would reduce the chances of a shortage of hospital beds because of people suffering from swine flu. Second, it would reduce the effect on the economy by ensuring workers were protected from the virus. “The high-risk groups will be done at GPs’ surgeries. People are still making decisions over this, but we want to get cracking before we get a second wave, which is traditionally far more virulent.”

Holden said it was likely the elderly would be given their seasonal flu jab as well as the swine flu vaccination. The new vaccine is likely to require two doses.

Details of the inoculation plans emerged after the death of a patient, reportedly a middle-aged man, at a hospital in the Basildon area of Essex. The victim had no underlying health problems, but officials say there is no evidence the swine flu virus had mutated into a more dangerous strain.

Holden said it would be the biggest campaign in response to an outbreak since mass vaccination against smallpox in 1962. He said surgeries would be aiming to inoculate about 30 people an hour in a “military-style operation”. The Department of Health said it had still not finalised which groups would be vaccinated first, but children, frontline health workers, people with underlying illnesses and the elderly are likely to take priority.

The European Commission is also identifying population groups which it believes should get priority. It is keen to ensure that countries such as the UK, which had ordered supplies of the vaccine in advance, do not cause inequities in treatment elsewhere in Europe. It warned health ministers in a note circulated last month that if the vaccines were more readily available in some countries it could cause “vaccine tourism/shopping in other member states”.

About 15 people have died of swine flu in Britain, but most of those infected get only mild symptoms. According to the latest figures from the Health Protection Agency, the UK has had 9,718 confirmed cases of the disease.

SOURCE





13 July, 2009

The Health Care Fight is On!

President Obama’s government-run, abortion-promoting health care plan hasn’t gone away. Although there have been bigger headlines in the news this week, we cannot forget the ongoing fight in Congress against a proposed government health care scheme that would go against the consciences of hundreds of thousands of Americans by providing abortions with taxpayer money nationwide.

Reuters continued to report today that the bill has seen considerable resistance in the House from the “Blue Dog Democrats;” fiscally conservative Democrats who oppose the plan based on its impending negative impact for “hospitals, doctors, and patients.” We also cannot forget the fabulous 19 pro-life Democrats, including Kathy Dahlkemper (PA-3), who sent a letter to Speaker Nancy Pelosi last week refusing to support the proposed plan unless it explicitly excludes abortion.

While these developments are promising, now is not the time to slacken our efforts to defeat this bill. Back in 2008, in his speech to the Planned Parenthood Action Fund, President Obama stated that in his mind "reproductive care is essential care, basic care, so it is at the center, the heart of the [health care] plan that I propose." When asked for clarification later, an Obama spokesman said that reproductive care included abortion. If this bill passes, Americans will be forced to pay for abortions nationwide for years to come! The damage to the pro-life cause will be nearly impossible to undo for years to come.

Don’t forget to tell your Representatives to ban the funding of abortion as they work through this bill. Abortion hurts American women and kills 1.3 million baby Americans in the womb each year. Tell Congress you don’t want tax dollars to pay for abortions!

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Do we need state control of medical care?

Government-run health care cannot eliminate scarcity

The notion that the political classes “should never waste a good crisis” has extended not only to the de facto nationalization of domestic auto companies and the financial sector, but also to medical care. It is treated as inevitable that the government will demand to control all the money that comes into the medical sector, thus effectively nationalizing it.

President Barack Obama recently expressed faux surprise that anyone would oppose his latest proposal, a government-run insurance company that will offer coverage in competition with private insurers. The president’s surprise came in the form of asking why people would claim that government cannot operate efficiently, yet simultaneously run an insurance company that would be a lower-cost producer than private firms.

While seemingly clever, President Obama’s point is irrelevant. The question is not about the “efficiency” of insurance plans, but rather the simple fact that government schemes are responsible for driving up the cost of medical care to consumers. From the huge regulatory burdens (with accompanying paperwork) on medical people to the third-party payments, government actions on all fronts have turned medical care into something akin to a Rube Goldberg cartoon.

Talk to any doctor and he or she will tell you that they spend many hours per week doing paperwork, almost all of it required by government and insurers. The government paperwork is especially pernicious because errors or disagreements on billing – even innocent ones – can lead to criminal charges. The legal aspect of medical care has turned into a minefield for the providers, and that has to impact overall costs.

The main issue, however, is quite simple, yet also profound: Medical care is a scarce good and thus is subject to the laws of economics. All too often, we hear that medical care is not like other goods and services and is set apart from economic laws. All we can say in return is, “Not so fast, my friend.”

Application of economic theories does not discriminate between the kinds of goods and services rendered. If something is scarce, the same laws apply whether we speak of brain surgery or pork bellies. Such words are disconcerting to people who believe that medical care should be a right that should be provided to everyone regardless of one’s personal wealth. Unfortunately, all government interventions – all of them –carrying out this “rights” mandate only serve to make medical care less available (and less effective) for everyone.

Think of a simple supply-and-demand example. If anything increases the cost of providing something, the supply curve shifts to the left, making the good less available and higher-priced. There is no exception to that point for anything that is scarce.

So, let us think of the ways that government makes it more difficult to provide medical care. First, and most important, government sets huge barriers in the path of people seeking to engage in medical occupations, especially through licensing and strict regulations. In other words, government purposely limits the supply of medical providers to protect the incomes of doctors.

It is the equivalent of the government’s forcing all of us to purchase a BMW or Cadillac instead of letting us choose between a high-end and lower-end vehicle. If such restrictions existed in the auto industry, we would have demands for “cost containment” in autos.

Second, as previously noted, the legal side of medical care forces doctors and nurses to spend time doing paperwork rather than providing care. Furthermore, the constant threat of criminal and civil action forces medical care providers to play defense, which further limits the supply of their services.

Last, the third-party payment system that dominates medical care further separates the consumers from their choices. If we had the same system to pay for food and automobiles, we would have “cost crises” in those markets as well.

Most people cannot fathom decoupling government control and medical care, as though cost-raising controls actually improve medical service. Yet if we wish to have innovative and affordable medical care, that is precisely what must be done.

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Democrats' Health Care "Reform": The Next Job Killer

There they go again. Democrats have controlled the White House and both chambers of Congress for less than six months, yet already their tax-and-spend ways are hurting America’s economy – and taking away jobs.

Their first act of business was to pass a so-called “stimulus” package they promised would save or create 3.5 million jobs and keep the national unemployment rate below eight percent.

Instead, last week the rate jumped to 9.5 percent, its highest level in more than 25 years.

Rather than reversing course, however, Democrat leaders continued down this perilous path by forcing through the House a climate change bill that would be properly described as a “cap-and-tax” scheme. Experts say its carbon-trading rules will kill millions of jobs in an economy that desperately needs them.

Of course, this wasn’t enough to convince Democrats of the error of their ways.

Next up is health care, which is in dire need of attention. But – perhaps unsurprisingly – the projected effects of Democratic proposals on business and jobs are dismal.

Take small business, for example. It’s often called the engine of the U.S. economy because it employs approximately one out of six Americans and provides $1.7 trillion in annual wages.

If we leave it to the Democrats, that engine will break down. A national mandate on small business to provide health care would eliminate 1.6 million jobs over a five-year period according to a study by the National Federation of Independent Business Research Foundation. Two out of three of those 1.6 million jobs lost in five years would be shed from small businesses.

Other studies have painted an even more troubling picture of the Democrats’ planned government takeover of our health care system. Based on a model developed by Council of Economic Advisors Chair Christina Romer, it is estimated that some 4.7 million jobs could be lost as a result of taxes on businesses that cannot afford to provide health insurance coverage.

Make no mistake: The Democrats’ proposal is a government-run health program and something that absorbs tax revenue rather than creates it, which will contribute to a prolonged recession.

The plan also will take away the health care plans millions of Americans already have. A June study by the independent Lewin Group found that 114 million Americans would be forced out of their current private health coverage under the House Democratic plan. So much for the President’s assurance that “if you like your health care plan, you’ll be able to keep your health care plan, period.”

Sponsors of the Democrat plan seem all too willing to ignore the fact that we can’t pay for the government-funded health care programs we already have. Consider Medicare: Its trustees recently reported that the Great Society program’s funds will be depleted by 2017. That’s two years earlier than the date they projected last year – largely because of the recession that Democrats seem to keep fueling.

Add to that dire prediction the new spending of their government-run health care plan – not to mention the equally troubled Medicaid and Social Security systems. You don’t have to have a Ph.D. in economics to see that our children and grandchildren will be paying for these programs for the rest of their lives.

Republicans have serious reservations about the Democratic health plan. And we have developed solutions we believe can get the job done.

In fact, we think we can contribute to meaningful change of our health care system in this decade just as we spearheaded welfare reform in the 1990s and the tax code in the 1980s. Some of our Republican proposals to change health care in America include:

• Creating opportunities for small businesses to pool their resources to offer higher quality coverage.

• Providing tax credits to help small businesses cover the administrative costs of establishing and maintaining health coverage.

• Giving incentives to states to redesign insurance laws to make health care coverage more affordable to their residents.

• Cutting regulations so insurance companies can compete for your business, which allows you to shop around for the best coverage and price that fits your needs.

• Allowing tax deductions to offset the cost of purchasing individual insurance.

• Fixing medical liability rules that make trial lawyers rich at the expense of patients and doctors.

These are just some of the many ideas my fellow Republicans and I have proposed to improve health care in the United States. You can check out more at www.gop.gov.

If this recession is going to end, Democrats need to focus on creating jobs – not killing them. The American people deserve no less.

SOURCE




Canada's health care system has problems, say Canadians

The Health Council of Canada recently published a report in which they reiterated Canada’s universal, publicly funded health care system is widely viewed as an essential part of a social safety net and a reflection of Canadians’ core values. But they also found that the cost of the system is a constant concern, and many fear that public health care is unsustainable.

Negative discussion about health care in Canada tends to focus on a persistent set of problems: access, wait times, and shortages of health care providers. This has been the case in times of good economy and during economic crisis.

The 10th annual Health Care in Canada survey confirms that wait times and the shortage of doctors top the list pf concerns voiced by Canadians in 2008. Other issues of concern were timeliness and access to care and environmental health issues such as air and water pollution.

Although some Canadians say they have never waited for medical services, complaints about long waiting times have lead virtually every provincial government to publish data on wait times for specific procedures in their province.

In 2004 the federal government and all the provincial governments entered into a 10 year plan to achieve significant reductions in wait times for 5 priority areas:

Cancer
Heart
Diagnostic imaging
Joint replacement
Sight restoration (cataract surgery)

By 2007, despite government promises and billions of dollars funneled into the Canadian health-care system, "the average patient waited more than 18 weeks between seeing their family doctor and receiving the surgery or treatment they required," said Nadeem Esmail, director of Health System Performance Studies at the independent Fraser Institute.

It is difficult to talk about waiting times across the board because of differences in provincial reporting. Waiting times did increase in 7 provinces: Alberta, Manitoba, Ontario, Quebec, Nova Scotia and Newfoundland and Labrador.

But 4 provinces, British Columbia, Saskatchewan, New Brunswick and Prince Edward Island., showed marked decreases in waiting time. The differences between the provinces may to some extent account for the widely differing opinions expressed by Canadians about their health care system.

The shortage of doctors and other health care professionals is the second most problematic issue for Canadians. The lure of more lucrative salaries led to a "brain drain" of professionals to the United States in recent years. Although overall emigration has been relatively small, health care professionals constitute a significant proportion of the public sector workers who have chosen to leave Canada for employment in the United States.

Canadian nurses have expressed particular dissatisfactions with the health care system in recent years. They have consistently recommended increasing the number of nurses, improvements in education, and maximizing the scope of practice of nurses.

SOURCE





12 July, 2009

Fury as NHS trust says only women between 39.5 and 40 years old can have IVF

Which, aside from anything else, makes it most likely to be futile. You wonder if it's human beings who are making these decisions. It shows you how low bureaucratically-run medicine can sink

Infertile women have been told they can only have IVF treatment if they are aged between 39 and a half and 40. The 'cruel and bizarre' restrictions were put in place by NHS managers in North Yorkshire struggling to deal with a huge deficit at their health trust. It could mean women with severe fertility problems to wait years for one cycle of IVF treatment. Between the age of 35 and 40, the chance of conception for women halves - and the heart breaking delays will further reduce the chance of having a baby for dozens of women.

The rules were greeted with incredulity by charities. Susan Seenan, from Infertility Network UK, said: 'This policy really is one of the worst we have ever encountered amid the postcode lottery for IVF. 'We have seen some bad policies in other parts of the country, but this is not just cruel, it is bizarre, and it flies in the face of the medical evidence that the best treatment for fertility is to start early.' 'If you seek fertility treatment, and you are told to wait until you are almost 40, at a point when your chances of conception will be massively diminished, if there is any way you can manage to pay for it, you will seek private care. 'The tragedy is for those couples who do not have that option.'

The severe restrictions were put in place by NHS North Yorkshire and York in order to cut its spending. Two couples said they were forced to go private because the health trust would not fund the IVF. They had their treatment at Leeds General Infirmary, alongside couples who lived in a neighbouring primary care trust area who received their treatment for free.

One couple from Harrogate, who now have a three-week-old daughter, following private infertility treatment, said they were 'incredulous' when their consultant explained why they could not receive NHS treatment. The man, aged 40, and his wife, who is now 33, said that even their GP was not aware of the policy. Guidance from the National Institute for health and Clinical Excellence says women should be offered three cycles of IVF treatment free on the NHS, if they have had fertility problems for three years, are aged between 23 and 39, are not obese and do not smoke. The cost of three cycles is around £15,000.

But around three quarters of primary care trusts are providing less IVF treatment. Many reduce to pay for IVF treatment to women below the age of 30. But none are as restrictive as North Yorkshire and York primary care trust, where just 16 women were given IVF treatment in the last year. The PCT said the vast majority of those cases involved women aged between 39 years and six months and 40, but said it was possible for younger women to be granted the treatment if their circumstances were deemed to be 'exceptional'. Managers would not define exceptional, although families in North Yorkshire said it only covered occasions where one of the prospective parents was terminally ill.

NHS North Yorkshire and York PCT said decided to stop routinely funding IVF treatment in May 2007, as part of a plan to tackle its financial problems. All women who were on the waiting list for treatment at the point it was frozen have now been scheduled to have IVF by September of this year. The trust said it was currently reviewing its policy covering women referred since May 2007, and future patients. It said it aimed to ensure that by next April it could remove its age restrictions on treatment, and offer all couples one cycle of treatment.

PCT strategy director David Cockayne said: 'As part of our financial recovery plan, which began in early 2007, the PCT's board had to take some very difficult decisions on what clinical priorities it would pursue.'

Of the 32,000 people who have fertility treatment each year, around three-quarters pay privately for the treatment, which has a success rate of around 25 per cent per cycle.

SOURCE




Blue Dog Democrats negative on Nationalized Health Care

There's blue blood in the water. Congressman Mike Ross (D-AR-CD4), chairman of the Blue Dog Health Care Task Force, dropped a bombshell yesterday on Barack Obama and Nancy Pelosi's plans to implement a so-called public "option" for health care. Ross stated that if the House Majority brings their bill to the floor as proposed, an "overwhelming majority" of his 52 member coalition would vote against it. As well they should, a group that claims that their "top priority will be to refocus Congress on truly balancing the budget and ridding taxpayers of the burden the national debt places on them."

Congressman Ross' statement is encouraging, but it needs to be backed up by action to defeat any proposal that threatens to bankrupt the nation by creating another unsustainable entitlement. With the national debt now soaring above $11.4 trillion, unfunded liabilities in Medicare and Social Security totaling $104 trillion, a proposed annual budget of $3.6 trillion, and a projected deficit of $1.8 trillion this year alone, a vote in favor of a trillion dollar government-run health care plan would decidedly be against Blue Dog, fiscal conservative principles.

And with legislation moving through Congress at a frightening speed this year—trillion dollar "stimulus," carbon energy taxes, nearly a $4 trillion dollar budget, and now healthcare—with only 178 House Republicans, the only chance at saving privately-provided health options will be if Democrats vote against their leadership, and against this legislation.

But that will only happen if pressure is brought to bear on each and every member of the Blue Dog coalition and beyond. They must hear from the more than 201.7 million constituents who possess privately-provided health care as of 2007—and would undoubtedly like to keep it and not be forced to trade it in for a substandard government plan. For, unless the users of health care defend what is rightly theirs, the so-called public "option" will take over the entire system, devouring all other options.

What's worse is the exact details are not yet publicly known of the plan. And it is moving swiftly: House Democrat leaders plan on unveiling it today, and committee votes are expected as early as next week. Only there's just one small problem. They have not even shown it to their Blue Dog colleagues yet.

"We've just got a lot of questions and the top of the list would be how to pay for it," said Congressman Marion Berry (D-AR-CD1). That, of course, is an excellent question, since the only way to pay for any new spending programs with the country in such a steep deficit will be to borrow more cash from overseas, raise taxes, or print more dollars.

And in all of the above financing alternatives, the American people will wind up paying more. Borrowing too much leads to higher interest rates as U.S. debt becomes less attractive of an investment. Raising taxes obviously takes more money away from Americans to purchase their own health options. And firing up the printing presses leads to inflation, which will mean higher prices on just about everything, including health care, thus fueling the bottom line of whatever proposal is enacted.

But that may not even be the worst of it. An even more fundamental question to be answered about the so-called public "option" is: Who will qualify? If it is truly to be an option for all Americans, then in principle everyone would qualify. And if that's the case, say goodbye to private health care, as everyone starts lining up for government freebies.

Advocates of the public "option" claim that it will be "cheaper" than private care. That they want to cut health care costs—which in reality means price controls that unfortunately always lead to shortages. It will also put private insurers who attempt to compete out of business, since they cannot borrow trillions of dollars to stay in the black.

As a result, even if government does not issue free health care outright, and just heavily subsidizes individuals and employers to switch to the government plan, the net effect will still be a state-run monopoly that crowds out private options, long lines at the doctor's office, and a declining quality of care as doctors are forced to take pay cuts and yet work even longer hours.

So, the Blue Dog Democrats really ought to consider the 201.7 million American people who like the quality of their privately-provided health care that is unparalleled anywhere in the world. Because they do not need "more time" to consider this plan. They need to know that there's somebody in Congress who is going to fight to help them keep their options.

SOURCE




There's No Such Thing as Free Health Care

The costly truth about Canada's health care system

President Obama says government will make health care cheaper and better. But there's no free lunch. In England, health care is "free"-as long as you don't mind waiting. People wait so long for dentist appointments that some pull their own teeth. At any one time, half a million people are waiting to get into a British hospital. A British paper reports that one hospital tried to save money by not changing bedsheets. Instead of washing sheets, the staff was encouraged to just turn them over.

Obama insists he is not "trying to bring about government-run healthcare." "But government management does the same thing," says Sally Pipes of the Pacific Research Institute. "To reduce costs they'll have to ration-deny-care."

"People line up for care, some of them die. That's what happens," says Canadian doctor David Gratzer, author of The Cure. He liked Canada's government health care until he started treating patients. "The more time I spent in the Canadian system, the more I came across people waiting for radiation therapy, waiting for the knee replacement so they could finally walk up to the second floor of their house." "You want to see your neurologist because of your stress headache? No problem! Just wait six months. You want an MRI? No problem! Free as the air! Just wait six months."

Polls show most Canadians like their free health care, but most people aren't sick when the poll-taker calls. Canadian doctors told us the system is cracking. One complained that he can't get heart-attack victims into the ICU.

In America, people wait in emergency rooms, too, but it's much worse in Canada. If you're sick enough to be admitted, the average wait is 23 hours. "We can't send these patients to other hospitals. Dr. Eric Letovsky told us. "Every other emergency department in the country is just as packed as we are."

More than a million and a half Canadians say they can't find a family doctor. Some towns hold lotteries to determine who gets a doctor. In Norwood, Ontario, 20/20 videotaped a town clerk pulling the names of the lucky winners out of a lottery box. The losers must wait to see a doctor.

Shirley Healy, like many sick Canadians, came to America for surgery. Her doctor in British Columbia told her she had only a few weeks to live because a blocked artery kept her from digesting food. Yet Canadian officials called her surgery "elective." "The only thing elective about this surgery was I elected to live," she said.

It's true that America's partly profit-driven, partly bureaucratic system is expensive, and sometimes wasteful, but the pursuit of profit reduces waste and costs and gives the world the improvements in medicine that ease pain and save lives. "[America] is the country of medical innovation. This is where people come when they need treatment," Dr. Gratzer says. "Literally we're surrounded by medical miracles. Death by cardiovascular disease has dropped by two-thirds in the last 50 years. You've got to pay a price for that type of advancement."

Canada and England don't pay the price because they freeload off American innovation. If America adopted their systems, we could worry less about paying for health care, but we'd get 2009-level care-forever. Government monopolies don't innovate. Profit seekers do.

We saw this in Canada, where we did find one area of medicine that offers easy access to cutting-edge technology-CT scan, endoscopy, thoracoscopy, laparoscopy, etc. It was open 24/7. Patients didn't have to wait. But you have to bark or meow to get that kind of treatment. Animal care is the one area of medicine that hasn't been taken over by the government. Dogs can get a CT scan in one day. For people, the waiting list is a month.

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The misrepresentation of healthcare reform

In the debate over medical reform, everyone can find a public-opinion poll to support his or her position. Robert Reich, who favors deeper government involvement in health care than we already have, wrote recently, “In the most recent Wall Street Journal/NBC News poll, 76% of respondents said it was important that Americans have a choice between a public and private health-insurance plan. In last week’s New York Times/CBSNews poll, 85% said they wanted major health-care reforms.”

Yet Catherine Rampell, economics editor for nytimes.com, reports there has been “no sea change in public opinion” about healthcare reform. She cites Nolan McCarty of Princeton University, who shows that public support for a government overhaul of the medical industry was higher in 1993, when the Clinton plan failed, than it is today.

Of course, we always have reason for suspicion about public opinion polls, since pollsters can get the results they want by how they frame the questions, especially the all-important preliminary questions. People aren’t laboratory rats, and some respondents may be as interested in impressing the pollster as in speaking their minds. Definitive proof of the case for suspicion was provided some years ago by an episode of the satirical BBC television program Yes, Prime Minister, the key scene of which is here. So What?

But let’s not stop there. We may grant that “the public” want (as the British would say) the government to set up an insurance program to compete with private insurers and are even willing “to pay higher taxes so that all Americans have health insurance that they can’t lose no matter what.” So what? By asking this question, I am not displaying naïveté. Politicians of course will use a favorable poll for cover when they do what they want to do anyway.

I mean something else: Why should the people get something through government–that is, at the point of a gun–simply because they want it? We make that assumption reflexively, but why? Fifty-seven percent may be willing to pay higher taxes for universal health insurance, but let’s not overlook what else they are willing to do: tax the 37 percent who aren’t willing to pay higher taxes. (Six percent don’t know if they are willing or not. Sigh.)

H. L. Mencken long ago defined democracy as the “the theory that the common people know what they want, and deserve to get it good and hard.” The problem is that those who don’t want it get it, too. When it comes to government programs, there’s no opt-out provision. Alas, what distinguishes “free” from unfree countries is the freedom to speak out, not to opt out. In the latter respect, all are unfree.

What about that 37 percent who would be ignored? If they don’t count, they needn’t have had their time wasted by the pollster. As Bruno Leoni wrote, “[I]n assuming that 51 voters out of 100 are ‘politically’ equal to 100 voters, and that the remaining 49 (contrary) voters are ‘politically’ equal to zero (which is exactly what happens when a group decision is made according to majority rule) we give much more ‘weight’ to each voter ranking on the side of the winning 51 than to each voter ranking on the side of the losing 49.” (See my article “The Crazy Arithmetic of Voting.”)

Well, it might be said, in our system the majority rules. Standing alone, this principle sounds rather ominous, so the speaker usually hastens to add, “but the rights of the minority are protected.” But really now, which is it? Do the majority rule or are the rights of the minority protected? I really don’t see how you can have it both ways. Our “representatives”–more aptly, our “misrepresentatives”–are supposed to sort out all this complicated stuff, but don’t bet on their squaring the circle any time soon.

The upshot is that they will decide what kind of healthcare system we will have. To the extent they take into consideration what some of the people whom they “represent” want, it is only because they are looking to the next election.

All of which leads me to the question of why we even see these decision-makers as our representatives rather than as our rulers. Think about this: The average congressional district has a population of well over 600,000 people. In Montana, one congressman allegedly represents the state’s entire population of 967,440. The populations of the states range from about half a million (Wyoming) to 36.7 million (California).

Honestly now, who really believes that anyone can actually represent such large and diverse groups of people? (Credit the Antifederalists, or anti-Rats, with another legitimate concern about centralized power.) Are we playing games when we talk about representation under those circumstances?

The Fiction of Representative Government

What got me thinking about this the other day is an essay by the highly respected historian Edmund Morgan, emeritus professor of history at Yale University and prolific author of books on America’s colonial and revolutionary era. His latest book is a collection of previously published papers with the self-explanatory title American Heroes: Profiles of Men and Women Who Shaped Early America. (Hat tip: Jeffrey Rogers Hummel.) But Morgan departs from that theme in a couple of chapters, including Chapter 15, “The Founding Fathers’ Problem: Representation.”

Morgan begins by noting that all governments rest on consent; specifically, the governors are few and the governed are many and thus potentially more powerful than the governors. Therefore the governed must be persuaded to believe that obeying the government is the right thing to do. This is the role ideology plays: It constitutes “opinions to sustain their consent.”

“The few who govern take care to nourish those opinions, and that is no easy task, for the opinions needed to make the many submit to the few are often at variance with the facts,” Morgan writes. “The success of government thus requires the acceptance of fictions, requires the willing suspension of disbelief, requires us to believe that the emperor is clothed even though we can see that he is not.” (Emphasis added.)

In democratic countries such as the United States, those fictions include the idea of representation, as well as the idea that our “representatives” are mere members of the governed like the rest of us. It doesn’t take a lengthy visit to Washington, D.C., or even a state capital, to be disabused of that latter fiction.

Fictions endure only as long as they are useful, and the one regarding representation is quite useful. Morgan writes, “And just as the exaltation of the king could be a means of controlling him, so the exaltation of the people can be a means of controlling them. …In locating the source of authority in the people, they ["the men who first promoted popular government"] thought to locate its exercise in themselves. They intended to speak for a sovereign but silent people, as the king had hitherto spoken for a sovereign but silent God.”

Morgan is unequivocal: “Representation from the beginning was a fiction. If the representative consented [to the king's taxes or laws], his constituents had to make believe that they had done so.” The problem was not only that often a perfect stranger deigned to represent individuals he knew little about, but also that he had a conflicting mandate: to represent his district while also looking out for the welfare of the whole country. This second part was useful in making representative bodies into modern aristocracies. (We leave aside the further problem that for much of the history of representative government, many people were not allowed to vote.)

“The sovereignty of the people was an instrument by which representatives raised themselves to the maximum distance above the particular set of people who chose them,” Morgan adds. “In the name of the people they became all-powerful in government, shedding as much as possible the local, subject character that made them representatives.”

Morgan connects these considerations to the American Revolution, the Articles of Confederation, and the goals of the Constitutional Convention. But bear in mind that he is not a radical critic of the American political system. He’s no anti-Rat. Yet he concedes that centralization of power under the Constitution was intended to restore representation to its fictive status, since it had become more real in the small legislative districts within the states during the Confederation period. As he writes, “The fictions of popular sovereignty embodied in the federal Constitution may have strained credulity, but they did not break it.”

Alas, that topic must be left for another time. For now, as the Senate and House of “Representatives” deliberate whether to give even more control over your health care to bureaucrats, ask yourself what taxation with representation has wrought.

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11 July, 2009

When public health becomes a public nuisance

The bizarre advice given to British doctors on how to deal with swine flu confirms that top-down scaremongering is destroying medical practice

The combination of speculative scaremongering by Britain’s health authorities and increasingly absurd directives to general practitioner (GP) surgeries in response to the current flu outbreak confirms that public health has become a public nuisance.

On 3 July, the UK health minister Andy Burnham (the fourth since the last General Election) announced that the swine flu pandemic could no longer be contained and that there could be 100,000 cases a day by the end of August. In response to the suggestion from a TV interviewer that this could mean 40 deaths a day, the chief medical officer Liam Donaldson agreed that this was possible, and that it could be higher.

Burnham conceded that his figure was ‘a projection’, not a fact - he meant that it was a speculation based largely on ignorance, similar to previous (unfulfilled) predictions of catastrophic mortality from AIDS, mad cow disease and bird flu. Though leading public health authorities cling to the belief that proclaiming nightmare scenarios is useful in raising public awareness of disease, in reality this provokes anxiety out of all proportion to benefit.

On the same day we received in our GP surgery, by fax and email (and no doubt shortly also by post), the latest of the almost daily pandemic flu briefings from the local primary care trust (PCT). The headline barks: ‘PPE procedures to be used for every patient.’ The bulletin continues in the now familiar tone of an exasperated infant school teacher spelling things out for children who suffer from a combination of learning difficulties and attention deficit hyperactivity disorder (though it never goes so far as to explain that PPE stands for ‘personal protective equipment’):

‘GPs are reminded that on seeing a patient with flu-like symptoms they need to follow all guidance on PPE, including wearing a surgical mask, gloves and apron.’

This is the sort of advice that could only be given by somebody who has never set foot in a GP surgery, certainly not since the onset of the great swine flu scare. The simple fact is that many patients who have been alarmed by the pandemic propaganda take no notice of the advice to stay at home and come to the surgery (and bring their children) and - quite understandably - expect to be seen. So, after they have sat in the waiting room for hours, coughing and spluttering, we are then expected to scrub and gown up as though we were performing open-heart surgery - and then repeat this procedure for the 20 other patients in the queue? Dream on.

I am torn over what has been the most useful guidance we have received from on high. Is it the diagram showing a cross-section of the nasopharynx illustrating how to take a throat swab? Or is it the picture of the container showing how to package the swab for transport to the laboratory? It was also very helpful to receive ‘real examples’ of ‘what not to do’ detailing just how stupid some local GPs have been in misinterpreting simple guidelines. It is shocking to hear that some GPs have even confused World Health Organisation (WHO) pandemic alert algorithm S5a (for dealing with suspected cases) with algorithm S5b (for sporadic cases). Is it any wonder that the pandemic is out of control? Can revalidation come a moment too soon?

GPs who were instructed - as I was - by the Health Protection Agency (HPA) to visit a suspected case of swine flu solely to do a throat swab may be alarmed by the proposals for home visiting in the grand pandemic flu contingency plan. This anticipates that 28.5 per cent (note the decimal place precision) of a predicted 30million cases in the UK (based on a 50 per cent ‘clinical attack rate’) will require visiting at home. By my humble calculations, assuming a four-week period (and assuming, improbably, no GP absenteeism), this would mean about 10 visits a day for every GP working seven days a week. Whether or not this would be of any benefit to these patients, it would certainly bring primary care services to a halt. But, if the epidemiologists want swabs, why not ask patients to do their own? (They could be sent pictures to help them locate their noses and throats.) We do this already with suspected cases of measles and mumps, so why not for flu? Patients are quite capable of doing their own genital swabs for chlamydia. Indeed this suggests another role for the ‘flu friend’: why not ask them to do your chlamydia swabs as well and get even friendlier?

The unfolding swine flu fiasco raises some hypothetical questions. What if the WHO, the HPA, the Department of Health and the rest had declared an embargo on press conferences and public statements? What if they had encouraged the virologists to concentrate their energies in the laboratories (where their achievements have been impressive) and stay away from the TV studios (where their pronouncements have often been ill-judged and alarmist)?

What if the PCTs had simply let GPs respond in the familiar way to cases of flu apparently occurring in an unfamiliar season? Given the evident mildness of the vast majority of swine flu cases (often milder than seasonal flu), it is difficult to believe that this approach would have resulted in any higher morbidity or mortality. It would certainly have led to less anxiety, to a much lower number of confirmed cases and to a vastly lower consumption of marginally effective anti-viral drugs. It would also have prevented much distress to patients, and much disruption to schools and workplaces (not to mention to surgeries, out-of-hours services, and hospitals).

Ah yes, but it could have been worse, comes the doomsday chorus from WHO, HPA, and all the rest. No doubt, the H1N1 virus could mutate to become the most virulent strain since the 1918 flu pandemic that killed 20million people. It could even be worse than the Black Death of 1348 that reduced the population of Europe by a third. Or maybe not. The public health authorities appear to have become incapable of distinguishing between sensible contingency planning and scaremongering propaganda. But instead of quietly admitting at the outset that very little was known about H1N1 and discreetly getting on with the job of preparing a vaccine and testing drugs, they reached for the megaphone. Better, according to the official mantra of twenty-first century risk aversion, ‘to prepare for the worst and hope for the best’. But even if swine flu had turned out to be a more serious illness, it is difficult to see how scaremongering, swabbing, PPE and Tamiflu would have made much difference.

The ascendancy of public health over primary care revealed in the swine flu scare is an ominous trend. The statements of both national and local public health practitioners confirm attitudes of condescension, even contempt, for the individuals traditionally regarded as being at the centre of primary care - patients and GPs. For public health specialists, our patients are merely people committed to unhealthy lifestyles. Their risk factor epidemiology repackages old prejudices: people get ill because they are idle, promiscuous, gluttonous, drunken, and as the spread of swine flu confirms, dirty. They regard GPs as sadly lacking in the moral fervour required to transform the deviant behaviour of our patients.

The outlook of public health would not be of much consequence were it not for the fact that it has, over the past 20 years, acquired a growing influence over primary health care. This is confirmed by the prominent role of public health specialists, who often have little knowledge or experience of General Practice, in primary care trusts. It is also reflected in the shift in the focus of primary care away from the diagnosis and treatment of the illnesses presented by patients towards the attempt to manage the health-related behaviour of the practice population. The burgeoning activities of check-ups and screening are resulting in what might be called an epidemic (perhaps not yet a pandemic) of overdiagnosis and overtreatment particularly in relation to cancer, heart disease and diabetes.

The moralising propaganda of public health has a generally demoralising effect on society, encouraging fear and anxiety - and attendant sentiments of stigma and blame. It has a degrading effect on medical practice and is corrosive of good relations between doctors and their patients. As the swine flu scare confirms, it is also disruptive of day-to-day medical practice.

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Insuring you won’t cut costs

Health care "reformers" keep talking about getting us more health insurance. Then they talk about cutting costs. This is contradictory nonsense. Insurance, whether private or a government Ponzi scheme like Medicare, means third parties pay the bills. When someone else pays, costs always go up.

Imagine if you had grocery insurance. You wouldn't care how much food cost. Why shop around? If someone else were paying 80 percent, you'd buy the most expensive cuts of meat. Prices would skyrocket. That's what health insurance does to medical care. Patients rarely even ask what anything costs. Doctors often don't know. Often nobody even gives a damn. Patients rarely ask, "Is that MRI really necessary? Is there a cheaper place?" We consume without thinking.

By contrast, in areas of medicine where most patients pay their own way, service gets better, while prices fall. Take plastic surgery and Lasik eye surgery: Because patients shop around and compare prices, doctors work hard to win their business. They often give customers their cell-phone numbers. Service keeps increasing, but prices don't. "In every other field of medicine, the price is going up faster than consumer prices in general," says John Goodman of the National Center for Policy Analysis. "But the price of Lasik surgery, on average, has gone down by 30 percent."

This shouldn't be a surprise. What holds costs down is patients acting like consumers, looking out for themselves in a competitive market. Providers fight to win business by keeping costs down and quality up. Yet politicians keep telling us the solution is more insurance. And they mean insurance not just for catastrophic diseases that could bankrupt us but also for routine treatments.

The politicians are so oblivious to reality that they are on course to make things worse. Obama would force every business to either give workers health insurance or pay a fine into the public system. Why is that something we should want employers to do? Premiums come out of our salaries, but insurers are accountable to our bosses, not to us. Why not just have a free market where people can buy whatever kind of health insurance they want? Competition would then bring prices down.

Obama and his Senate allies would limit competition by requiring insurers to cover everyone for the same "fair" price. No "cherry picking," the president says. No charging healthy people less.

They call this "community rating," and it sounds fair. No more cruel "discrimination" against people who have a preexisting condition, obese people or smokers. But such simple-minded one-size-fits-all rules take from insurance companies their best price-dampening tool: Risk-based pricing encourages people to take better care of themselves, just as car-insurance companies reward good drivers. With one-size pricing your car-insurance company must give the town drunk the same deal it gives you. Insane, but the health-insurance industry is playing along. Insurers say that if government forces everyone to have insurance, they will accept all customers regardless of preexisting illnesses.

They also offered to stop charging higher premiums to sick people. They're even giving up on gender differences. Sen. John Kerry huffed, "The disparity between women and men in the individual insurance market is just plain wrong, and it has to change." The president of the industry trade group, Karen M. Ignagni, agreed that disparities "should be eliminated."

Give me a break. Women pay more than men for health insurance for good reason. Despite being healthier than men, they incur higher costs because they go to doctors more often, and they take more medicine. Kerry is pandering. I don't recall him demanding that men be protected from higher life-insurance and auto-insurance premiums.

"Community rating" hides the cost of health care. It's as destructive as ordering fire insurance companies to charge identical premiums for wood frame and stone houses. Universal health insurance with "no discrimination" pricing will make health care costs rise even faster. When politicians interfere with free markets, unintended consequences harm everyone, except the companies that lobby hard enough to protect themselves. Is it too much to expect our rulers to understand this?

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Health care is not a right

Amidst all the health care debate, there is one underlying assumption that hardly anyone challenges: the notion that people have a right to health care. The truth is that it’s a nonsensical notion. People no more have a right to health care than they have a right to education, food, or clothing.

After all, what does a right to health care mean? If I have a right to something, then doesn’t that mean that you have a correlative duty to provide it? If you’re a doctor, then it means that you are required to serve my needs, like it or not. If I need an operation, then you cannot say “no” because that would be denying me my right to health care.

Thus, isn’t the right to health care actually a power to force doctors to provide people with medical services?

Now, the proponent of health care as a right might say, “That’s not what I mean. Why, to force doctors to provide health care services to others would be akin to slavery, especially if it’s for free. I think that doctors deserve to be paid for their services.”

Fair enough. But then doesn’t the right to health care entail the power to force someone else to pay for it? Let’s assume, for example, that I need hip-replacement surgery that will cost $25,000 and that I don’t have the money to pay for it. Since I have a right to health care, that means that I have a right to get the money from you to pay for my operation. It also means that you can’t say no because that would be interfering with my right to health care.

Thus, the right to health care entails the power of everyone to get into the pocketbooks of everyone else. That’s not only a ridiculous notion of rights but also a highly destructive one. Since obviously people can’t go and take the money from others directly, it inevitably entails converting government into an engine of seizure and redistribution. Or to paraphrase Bastiat, such a concept of rights converts government into a fiction by which everyone is doing his best to live at the expense of everyone else.

Meanwhile, while everyone is using government to get into everyone else’s pocketbook to pay for his health care expenses, he is simultaneously doing his best to protect his own income and assets from being plundered by the government to fund everyone else’s health care bills.

Over time, it is easy to see how such a system devolves in everyone’s warring against everyone else. It is also easy to see that such a system obviously does not nurture friendly and harmonious relations between people. This is especially true when these types of “rights” expand to such areas as education, food, clothing, and housing.

The true nature of rights — the type of rights the Founding Fathers believed in — involved the right of people to pursue such things as health care, education, clothing, and food and that government cannot legitimately interfere with their ability to do so.

Thus, the right to life, liberty, and the pursuit of happiness, as described in the Declaration of Independence, doesn’t mean that someone else is forced to provide you with the means to sustain or improve your life. It means that government cannot enact laws, rules, or regulations that interfere with or infringe upon your right to pursue such things.

When Americans began looking upon rights as some sort of positive duty on others to provide them with certain things, that was when the quality of health care in America began plummeting. That was what Medicare and Medicaid were all about — the so-called right of poor people and the elderly to health care. It is not a coincidence that what began has the finest health care system in the world has turned into a system that is now in perpetual crisis.

There is one — and only one — solution to America’s health care woes — and it lies not in a government takeover of health care. In fact, the solution is the exact opposite: It is the end of all government involvement in health care — a total separation of health care and the state. That would entail not a reform or improvement of Medicare and Medicaid but rather their total repeal.

At its core, the solution to America’s health care crisis lies in the abandonment of the notion that health care is a right. Once people reach this fundamental realization, as our American ancestors did, the nation can get back on the road toward to a healthy, prosperous, and harmonious society.

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10 July, 2009

NHS nurse mocked frail old lady as 'drama queen'

By the time Ann McNeill was admitted to Edgware Hospital, in North London, her legs were raw and covered in bandages. The 71-year old grandmother had been diagnosed with the superbug MRSA, and the infection Clostridium difficile at nearby Barnet General Hospital following a succession of major operations.

Having spent decades working as a nurse, Mrs McNeill hated to bother the staff during the 10 months she spent in both hospitals before she died. When the stench of dried urine from a neighbouring bed in her ward in Barnet became overpowering, it was her husband Richard, who asked if it could be cleaned.

When a nurse told the frail pensioner that she "would never be going home" Mrs McNeill said nothing, only weeping later, when her husband visited. In October 2007 she was transferred to Edgware Hospital. The skin on her legs was raw, and partly covered with bandages, both to protect her wounds, and the fragile skin surrounding them.

As a night nurse roughly hoisted her into bed, knocking her legs, Mrs McNeill gasped in pain. "Oh, we've got a drama queen here," laughed the nurse, leaving the pensioner in agony, as blood slowly soaked the sheets. On many occasions, she was left in her own faeces.

Her widower recalls: "She hated disturbing the nursing staff, but she was totally compos mentis and she hated the indignity of it. She would plead with them to change her, but the answer was always firm: 'We will get to you when we have time". Mr McNeill was not convinced that time pressures were the problem. "Often I would wait at the nursing station, for perhaps five minutes, to ask for help for Ann. "They would keep chatting about this and that and I didn't want to interrupt them, I wanted to be polite. "But then when they got to the end of their conversation, they would go off, as though I wasn't there at all. I remember once I felt so desperate, I said to them, 'Are we invisible?'"

On another occasion, he arrived at Edgware hospital to find his wife sitting in a chair, her clothes covered in vomit. He was unable to find a nurse. In the next bed, the heavy breaths of an old woman, whose oxygen mask had fallen off, appeared to go undetected by staff.

On Monday 15 October 2007, less than a week after her surgeon said Mrs McNeill was recovering well, she died of bronchopneumonia, a condition which is closely linked to MRSA.

Her widower, now 75, says: "I know there is nothing I can do to bring Ann back, but it destroys me to think of what she went through, even with me trying my best for her every step of the way."

A spokesman for Barnet and Chase Farm Hospitals trust, which runs Barnet General Hospital, extended their apologies to Mrs McNeill's family for additional distress caused by the circumstances surrounding her death. He said the patient was in the hospital's care for an extended period of time, and that the trust would be happy to meet with her widower to hear his concerns. He added: "We are anxious to take the opportunity to make any improvements in the quality of care we provide."

Barnet primary care trust, which runs Edgware Community Hospital, said it worked to maintain high standards of health care and had not received any complaints about Mrs McNeill's care.

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This is the sort of nut that the NHS can unleash on you

NHS nutritionist gave 'dangerous' food advice to diabetic patients

An NHS nutritionist told diabetic patients to eat a range of bizarre and trendy foods, including some that were 'dangerous', a disciplinary panel heard yesterday. Katie Peck, 32, recommended dandelion tea, kelp granules, milk thistle, flax seed oil and chromium supplements - all apparently without any clinical reason. She also allegedly recommended expensive vitamin supplements, including co-enzyme Q10, for which there is no evidence of any benefit.

A colleague at the Coxheath Centre Diabetes Clinic, near Maidstone in Kent, told a hearing most of the advice was baffling but harmless - but in the cases of two diabetic patients it was 'dangerous'. One, known as ES, who was on insulin and was also being treated for a thyroid condition, was told to take granules of kelp seaweed - a rich source of iodine. Sally Norris, a specialist diabetes dietician, told the Health Professions Council that extra iodine could dangerously interfere with both conditions. 'There would be a safety issue,' she said.

Another diabetic patient, KA, who was awaiting kidney dialysis and had high potassium levels, was told to eat half a large green banana - even though the fruit is known to be rich in potassium. Mrs Norris told the panel: 'What does that mean? Why does the banana have to be green? 'And I would certainly not expect somebody with high potassium levels to be recommended to eat bananas because it would be dangerous.'

Miss Peck also allegedly forbade some patients from eating grapes or drink coffee, and said one should eat cottage cheese - but never with pineapple. She banned mashed potato and alcohol and said red meat should not be eaten more than once a fortnight. Her other directions included that water must be filtered, eggs must be free-range and the dried fruit on one patient's daily porridge had to be organic, the panel heard.

Mrs Norris said there was no reason for that and it would cost the patients more.

She also said to have inappropriately recommended specific brands of products, including Rachel's probiotic yoghurt, Tilda brown basmati rice and Alpro soya milk.

Miss Peck was hired by West Kent NHS Primary Care Trust to cover for Mrs Norris when she went on maternity leave in 2005. When she returned to work in 2007 she sat in on one of Miss Pecks' consultations and was immediately concerned when Miss Peck tried to measure a patient's waist 'in the wrong place completely'. Mrs Norris then went through files and found dozens of examples of peculiar advice, which she reported to managers. She said: 'I was very concerned that things had been written down that didn't seem to have any explanation behind them and I could not see any clinical reasoning. 'There was no evidence that I could see that was behind what was being recommended.'

Miss Peck faces disciplinary charges in relation to 27 patients. John Harding, for the HPC, said: 'The allegation is that Katie Peck's fitness to practise is impaired by reason of lack of competence. 'It will be seen that in relation to each patient there is a common theme that develops - that the note-keeping was in a poor state and that recommendations made by Katie Peck were without any obvious reasons.'

Miss Peck denies any wrongdoing. The hearing in South London continues.

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In Obama's America you are going to have to be rich to get good health care

The Obama administration might like to "spread the wealth around," but its proposed "health care reform" wouldn't spread consumer choice around. Rather, it would constrict consumer choice substantially — except for the very rich. That's the great irony of President Obama's ambitious health care agenda: His administration, which seems to feel little empathy for the rich, is paving the way to a two-tiered system in which only the very rich would have a choice.

Under ObamaCare, the rich would continue to get the care they want — whether here or abroad — by paying for it out of their own pockets. The rest of us would stand in line and wait for rationed care.

Most Americans want consumer freedom. They want to be able to shop for health care value — for the best care, at the best prices. They'd like to have a lot more freedom to shop for such value than they currently have. That's why Democrats are couching their proposed expansion of government-run health care in the language of competition and choice.

Listen to the president as he pitches the centerpiece of that agenda — a "public option," a form of Medicare for all. He says it's merely a way to give Americans another choice: People can buy private health insurance, just like now, or they can instead choose the government option. But millions of middle-class Americans who are happy with their employer-provided insurance would soon find the choice isn't theirs to make. The government would make it cheaper for employers to contribute to the government-run option than to keep providing private insurance. Millions of employers would do the math and pick the government option. The "public option" would provide a choice — for millions of employers, against the wishes of millions of employees.

The Lewin Group, a prominent consulting firm, estimates that a widespread "public option" with Medicare-like reimbursement rates would result in 118 million Americans losing their private insurance and being forced into government-run care. Meanwhile, private insurance wouldn't be able to compete on the uneven playing field that Congress would establish.

In its competition with FedEx and UPS, the Post Office at least has to provide a service. But the "public option" would merely use government's coercive powers to dictate prices and availability of services provided by others — by doctors, nurses, hospitals, etc. Private insurance can't similarly fix prices and would be run out of business.

Lower reimbursement rates, coupled with a dwindling pool of private insurers to whom to pass on costs, would mean lower incomes for medical professionals. The eventual result would be fewer people entering the medical profession.

A two-tiered system would then emerge: The very rich would take their spots like first-class passengers on the Titanic, paying for fine care and not asking the price. The rest of us would take our spots in steerage class, awaiting the inevitable collision between government-run health care and the iceberg of budgetary disaster.

White House budget director Peter Orszag recently opined that "the deficit impact of every other fiscal policy variable" is "swamped" by the deficit-threat posed by Medicare and Medicaid. Obama's solution? A massive new Medicare-like program! Medicare may not pay much to doctors, but taxpayers pay plenty to Medicare. As my recent Pacific Research Institute study shows, since 1970, Medicare's costs have risen 34% more, per patient, than the costs of all health care in America apart from Medicare and Medicaid. Medicare's costs have risen $2,511 more per patient.

Across nearly four decades, government-run health care has been far more expensive than privately run care. It comes down to a simple comparison and an obvious verdict: Privately run care offers choice and is cheaper. Government-run care denies choice and is more expensive.

But the particular losers under Obama-Care would be the middle class. The uninsured poor would largely benefit, although they might benefit even more — while hurting others far less — from fixing the unfairness in the tax code and giving them the health care tax-break that millions of insured Americans already enjoy.

The truly rich would be largely unaffected, as they never really needed private insurance anyway. They would continue to pay for the care they want, because they can.

Middle-class Americans wouldn't enjoy that freedom. They would lose their employer-provided insurance and be left with only the government-run "option." And, under a government monopoly, they would get rationed care. And every April 15, they would get a higher tax bill for their troubles, which just might make them feel sick enough to get back in line.

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Medicare’s mythical administrative cost savings

by Megan McArdle

The title of this post is going to make some of my readers very angry. Medicare has lots of administrative cost savings, they will say. This may be so. But I mean mythical in another sense: there's ultimately no way to prove or disprove these amazing savings. The problem is indeterminate.

Jon Cohn, who I respect greatly, spends a lot of time on the money and time that insurance companies put into denying claims. This is undoubtedly true. But I have two caveats. First, some of that effort is a good thing: without it, there would be fraud. No, not the automatic denials so many insurers are fond of, and I'm not defending. But Medicare should probably spend a lot more effort rooting out excessive billing. And I don't know what percentage of claims denial consists of refusing to line the pockets of doctors and labs.

But the more important point is that I doubt this is the majority of their administrative costs, or even the difference between their administrative costs and Medicare's. I'm not trying to justify the bullshit automatic claims denial, but that's not actually a very costly process: a hospital submits a bill, they deny it, you yell at them. Nor is refusing to cover people with pre-existing conditions, or any of the other multifarious complaints of single-payer advocates.

Rather, private insurers have costs that Medicare doesn't have within the agency. Private insurers bill. Medicare does too, but the IRS has its own budget--hell, its own courts--which don't show up on Medicare's balance sheet. Private insurers negotiate with suppliers. Medicare does too, but most of the negotiation takes place between lobbyists and Congressmen who again, do not show up on Medicare's balance sheet. The Federal government has all sorts of these little items which relieve government agencies of reporting certain costs. But the costs remain.

My guess would be that these explicit costs are still lower than Medicare's. But then there are implicit costs to government fiat that markets don't have. As Tyler Cowen points out, taxation has deadweight losses, and Medicare is a tax on employment, which is something we are particularly anxious not to suppress right now.

The final point is that while people commonly think of administrative costs as "wasted", in fact, they are an important part of the market system. As Alex Tabarrok points out, and I have myself from time to time, many of the arguments in favor of national health care are literally socialist. And no, I am not using that term to apply to "anyone who is in favor of redistribution" or "government programs". But consider the following common arguments:

* National health care will be cheaper because we will reduce administrative overhead

* National health care will reduce wasteful competition in the form of me-too drugs

* National health care will reduce wasteful competition in the form of advertising and other marketing expenses

* National health care will allow us to rationally distribute care to where it does the most good rather than the current messy, wasteful hodge-podge

* National health care will use resources for production instead of profits

* National health care will achieve economies of scale in purchasing and record-keeping

* People will not overuse free goods because there are hard limits to desired consumption

These were all arguments advanced in favor of socialism. Contrary to popular conservative belief, socialists were not unfamilier with either the incentive problems of communism (people will not work hard if there's no benefit to doing so) or the Hayekian argument about the value of prices, aka the Socialist Calculation Problem. Rather, smart socialists thought that they could overcome these problems with a combination of status competitions (Hero of the Soviet Union, Second Class) and massive efficiencies gained by wringing all that fragmented, wasteful competition out of the system. Economists who would be ashamed to make these sorts of arguments about Proctor and Gamble or the used car market suddenly start parroting these things as if they hadn't been thoroughly discredited by the last seventy years.

But why were they discredited? That list looks really, really good on paper, even to my jaded libertarian eyes. A lot of the answer lies in the reason that we don't like monopolies--even though that list is just as true of monopolies as it is of the government. Monopolies, government or private, are risk averse, slow to innovate, and generally run things for the benefit of themselves rather than their customers. Hamstringing them with regulations can limit measurable outcomes, like excess profit-taking, but not unmeasurable ones, like the people who might have been cured by a drug the system didn't invent. And the political system introduces its own problems. As Robert Heinlein pointed out years ago, systems that have only positive feedback loops tend to fail catastrophically.

My critics will want me to explain why, then, Europe can do it cheaper. The answer is threefold. First, most European nations have better governance than we do--the American political system is a Public Choice disaster. Second, they pay people less money in a way that's hard to replicate here (and even if it wasn't, would be a one time savings that wouldn't check the rate of growth). Third, we're still driving quite a bit of product innovation. Our messy, organic, wasteful, unfair, irrational system allows experimentation, and they cherry pick the best results. If we stopped doing this, their system would stop looking so good.

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9 July, 2009

British tumour patient was treated in corridor

As Barbara McVernon was wheeled to the operation for brain surgery, she broke into song: "Wish me luck, as you wave me goodbye..." It was a typical gesture from an exuberant, sociable woman, who at the age of 76 was showing no signs of slowing down. If the keen artist and charity fund-raiser from Wokingham was fearful about the surgery to remove a tumour from her eye socket and temple, she was determined not to show it, recalls her daughter Lynne.

After the surgery, at the John Radcliffe Hospital, Oxford, in April 2006, Mrs McVernon remained in good spirits, laughing and joking with family and friends. However, further tests revealed that the growth – as well as pains in Mrs McVernon's hips, which her local hospital, the Royal Berkshire in Reading, had mistaken for arthritis – was in fact caused by multiple myeloma, cancer of the bone marrow. Nonetheless her specialist was optimistic: if the will was there, the pensioner could survive five years.

Soon after Mrs McVernon was transferred back to the Royal Berkshire, one of her hips broke. She was sent to a specialist NHS hospital, The Nuffield Orthopaedic Centre, in Oxford, for surgery the following month. It went well. Yet in the days following the operation, the outgoing, lively woman became increasingly confused and depressed.

Amid repeated concerns raised by her family, staff insisted her behaviour was normal – until 11 days after the operation, when a doctor diagnosed diabetes. An investigation found staff had made a "critical error" when the elderly woman was admitted to the hospital, by keeping her on a high dose of steroids which should have lasted for just four days. The findings, which included an admission that the mistake could have caused the onset of diabetes, reached Lynne on the day her mother died.

In her last few weeks, the increasingly weak pensioner had been transferred back to the Royal Berkshire Hospital, soon after her family found out that she was suffering from MRSA, which she had already been carrying before treatment at the Nuffield.

Hours after the transfer, her daughter found her being treated in a corridor, before a bed could be found. As the quality of her life deteriorated, and amid chaotic care, Mrs McVernon lost the will to continue, says her daughter. "She was having hourly blood tests because of the diabetes, her hands were caked with blood, she had bed sores, she was upset, confused and disorientated because her blood sugar levels were see-sawing. "It was hard to believe Mum was the same woman who had been singing on her way to surgery."

On June 22, Mrs McVernon died of pneumonia, multiple myeloma and MRSA.

A spokesman for Nuffield Orthopaedic Centre Trust said patient safety was its top priority, and that it regretted that the McVernons' experiences did not fulfil its usual standards. It said the trust had been open about the findings of its investigation, and learned lessons from the case. The Royal Berkshire trust said it was "deeply disappointed" that the family had not raised any concerns since Mrs McVernon's death, so that any failings could be investigated.

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NHS units exposed over unacceptable conditions

This is a total whitewash. What they say about the food tells you that. British hospitals are notorious for inedible food

At least a dozen NHS units in England are treating patients in poor or unacceptable conditions, an official report says today. A national survey of 1,265 medical sites found that the vast majority of facilities scored either “excellent” (24 per cent) or “good” (60 per cent) for standards of cleanliness, decoration, linen, furniture and general state of repair. But of the rest, more than one in six sites (15 per cent) had only “acceptable” working conditions, while nine sites were rated “poor” by the local Patient Environment Action Team (PEAT) assessments.

Three sites — all rehabilitation units for mental health patients — were rated “unacceptable” for their environment: Windmill House in Bushey, West Hertfordshire; Norfolk Lodge, in Colliers Wood, South London; and Lodge Causeway, in Bristol.

The National Patient Safety Agency, which publishes the scores, said that poorly-performing sites would be followed up by the regional health authorities or the Care Quality Commission, the NHS regulator, to make sure standards were improved.

The PEAT programme was established in 2000 to assess all NHS hospitals with more than ten beds every year on a range of standards including food and whether patients were treated with dignity and privacy. The assessment teams consist of NHS staff, including nurses, matrons, doctors, catering and domestic service managers, executive and non-executive directors, dietitians and estates directors. Most also include patients and members of the public.

A total of 94 per cent of sites scored ‘excellent’ or ‘good’ ratings for levels of privacy and dignity, which examined the quality of their sleeping accommodation as well as toilet and bathroom facilities.

But Thorneywood Unit, a child mental health clinic run by Nottinghamshire Healthcare NHS Trust, and Norfolk Lodge, part of South West London and St George’s Mental Health NHS Trust were rated unacceptable.

On food, 95 per cent of sites achieved an "excellent" or "good" ratings for quality, choice and availability of their menus [By British hospital standards, maybe]. Just one unit, Ogden House in Ramsgate, a mental health inpatient unit, was rated unacceptable for its food.

Ann Keen, the Health Minister, said that the increase in trusts achieving good results was “great news for NHS staff and patients”. “Cleanliness is a top patient priority and these results show that the measures we have in place are working. We are also delighted to see such high scores in the area of privacy and dignity.” Ms Keen said that she expected to see further improvements in next year’s results after a drive to eliminate mixed-sex accommodation in the NHS.

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More poison, not an antidote: Mandating employer health insurance

President Obama is either misinformed or lying about health care. He said the “free market has not worked perfectly.” There’s a market, but it’s not free. It’s infested with harmful political meddling. One example is government’s favoring employer-provided insurance, a poison to affordable medical care and insurance.

But unions and Congressional Democrats want to intensify the dose with a “pay or play” employer mandate. This would penalize employers for not buying medical insurance for their employees. This is not “reform;” it just entrenches flawed policies. It would violate rights, lower wages, and threaten jobs of minority single moms

Government’s favoring employer-sponsored insurance is the problem, not the solution. When your employer buys your insurance, it’s a non-taxable corporate expense. Employers save by “paying” you with insurance instead of higher wages.

This tax policy coddles insurance companies. They need only please your employer, not you. Most employers offer just one or two plans. Want more choices? If you prefer one of the many plans available at eHealthInsurance.com, you face a stiff tax penalty. Or try changing jobs. Insurers know you’re essentially stuck with your employer’s plan, so why should they please you?

Tax-discounted insurance has turned insurance into prepaid health care. If car insurance worked this way, it would cover predictable expenses like oil changes and replacement tires. You wouldn’t price compare or consider whether services were really necessary. Rather, you’d ask if “it’s covered.” Costs would soar. This has happened with medical care.

The tax bias for employer-sponsored insurance punishes those who incur medical conditions and then lose their job. A pre-existing condition can make them uninsurable.

This can create “job lock,” which stifles entrepreneurship. As Business Week describes: “fear of losing coverage keeps people at jobs … so many workers will keep hanging on to jobs they hate. … One single mom in New York, for example, is sticking with her graphic design job solely to retain the health coverage for herself and her son. … Her wish? To start a business doing bath and body products. ‘I feel stuck,’ she says.”

An employer mandate would further stifle entrepreneurs and destroy jobs. It would require a growing business to provide insurance when hiring its 10th or 20th employee. Since the additional employee would impose a huge cost, it might not hire anyone.

In response to an employer mandate, employers would shift this cost to employees by lowering wages. It’s worse for those with near-minimum wage jobs. These workers are “at substantial risk of unemployment if their employers were required to offer insurance,” write economists Katherine Baicker and Helen Levy. Employees “most harmed by mandated employer-paid healthcare are…more likely to be a minority, a single parent, and unmarried.” The employer mandate surely wouldn’t threaten union jobs, as unions support it.

An employer mandate would also violate our rights. Employers create jobs, and hence have the right to hire on terms mutually acceptable to both employer and employee. Politicians should not interfere with this private matter between consenting adults.

Tax-favored employer-sponsored insurance has created enough problems. Mandating it makes them worse. Politicians should not dictate whether you buy insurance directly from an insurer, through a membership group (like AAA), or through your employer. Legislators should both eliminate the tax exemption and decrease tax rates commensurately.

Second-best would be to make all medical insurance and expenses tax-exempt. This would remove tax bias toward excessive insurance coverage. Health Savings Accounts are a step in this direction, but they should be eligible to everyone, regardless of their insurance plan. Such “Large HSAs” would allow consumers to buy medical care and insurance with tax-free earnings.

Removing the tax code’s bias for employer-sponsored insurance can alleviate problems with job lock and pre-existing conditions. While some employers would offer insurance to attract employees, more people would buy policies directly from insurers when still healthy. Customers could choose — as many already do — a guaranteed-renewable policy, so the insurer cannot terminate coverage or raise premiums because you get sick.

The rigorous competition of a free insurance market could yield innovative products that protect against pre-existing conditions. For example, “health-status insurance” would pay for increases in your insurance premiums should your health status change, and you’d retain the freedom to buy a policy from insurers competing for your business. To learn more, look up “‘Health Status Insurance’ Provides Real Alternative to Universal Care.”

Mandating employer-sponsored insurance is wrong. It’s not a cure, but more of the disease: government’s bias for employer-provided insurance. This just benefits unions and politicians at our expense.

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Obama’s job-killing health care tax

On June 15th, the Congressional Budget Office issued a crushing blow to President Barack Obama’s health care plan, placing a $1 trillion price tag on the Senate Health, Education, Labor and Pensions (HELP) committee’s draft legislation. And what did Americans get for their $1 trillion in new debt? A measly16 million net decrease in the number of people uninsured. Liberals in Washington decried the CBO’s findings, complaining that they had scored an incomplete version of the bill.

So this past Friday the CBO released a fuller scoring of HELP’s legislation, and indeed, the overall impact on our nation’s debt is lower: a mere $597 billion would be added to federal budget deficits over the 2010-2019 period.

How did HELP lower the bill’s budget busting total? Did they “bend the curve” on health care costs? Did they weed out administrative costs? Eliminate waste? Nope. The Washington Post reports:

Committee staffers reworked the bill — and added a new provision requiring most employers to contribute to the cost of health insurance — to arrive at the lower estimate. Under the new proposal, any business with more than 25 workers would be required to offer coverage or pay a $750 penalty per employee.

In other words, the HELP committee wants to pay for their health care plan in classic “tax-and-spend” liberal fashion: by instituting a crippling new tax on our nation’s businesses. And not just any new tax. A tax directed like a heat seeking missile at job creation: an employer mandate. But don’t take our word for it. President Obama’s White House National Economic Council Director Larry Summers wrote in 1989:

Mandated benefits are like public programs financed by benefit taxes… There is no sense in which benefits become ‘free’ just because the government mandates that employers offer them to workers. … [Minimum] wages cannot fall to offset employers’ cost of providing a mandated benefit, so it is likely to create unemployment.

And the HELP committee bill is still incomplete. Even its most current incarnation still would cover just 39% of uninsured Americans. So the Obama administration is also pushing for a further expansion of Medicaid. Add those costs into the mix and the final price tag shoots back up to $1.3 trillion. Wonder who the administration plans to tax to make up for that final trillion?

Defending his administration’s economic performance on ABC’s This Week, Vice President Joe Biden told George Stephanopolos: “There was a misreading of just how bad an economy we inherited.” The Obama administration can not blame President Bush forever. They can’t run around threatening to enact a $400 billion tax on employment and then blame others for double-digit unemployment rates. There is an alternative to government run budget busting health care. Some of which the Obama Administration even supports like removing the tax benefit of employer-sponsored health care coverage which will untie Americans health care coverage from their employers and help move the country towards a truly market based consumer driven health care model. Health care coverage can be expanded in a cost-efficient manner, but only by empowering Americans to make health care decisions with their doctors.

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8 July, 2009

Diary of despair of old lady who died in 'zoo' NHS hospital after 'catalogue of blunders by staff'

A horrifying journal of the neglect a great-grandmother suffered in hospital has been published by her family. Betty Dunn, 79, was admitted with a routine stomach problem but died six weeks later after a string of medical errors. During this time her relatives compiled the diary detailing her ordeal in a ward they grimly nicknamed the 'zoo'. The dossier tells how Mrs Dunn was:

* Given medication containing penicillin - despite warnings that she was allergic to it;

* Forced to sleep on a bare mattress;

* Made to wait 40 minutes for a bedpan;

* Treated by staff who could barely speak English;

* Made to eat a food substitute against medical advice.

At one stage, the mother- of-four's children became so desperate that they called the police for help but were told nothing could be done. In a final insult, the news that Mrs Dunn was dying was broken to her daughters in a busy corridor in front of other visitors.

The wartime Land Girl was being treated on a mixed-sex ward divided into bays at Tameside Hospital, in Ashton-under-Lyne, near Manchester. Labour had pledged to scrap this type of patient accommodation.

'The ward where mum was treated was like a zoo, and we called it that afterwards,' said her daughter, Liz Degnen, 49, today. "It was manic and chaotic with people running around like headless chickens. 'It doesn't matter if you're 79, 29, or 109, the way the hospital treated her was disgraceful. Every aspect of her care was just terrible. The staff did their best but there were not enough of them to cope. It's a scandal that hospitals can operate like this in this day and age.'

Mrs Dunn, a former dinner lady from Gamesley, near Glossop in Derbyshire, was admitted to Tameside on January 4 with complications from a stomach bug. 'On the night she was admitted for treatment mum was waving and blowing kisses and saying "See you, love",' said Mrs Degnen, a teaching assistant. 'Yet when we left for a few hours we came back to find her slumped across a bedside trolley. Her eyes were at the back of her head, rolling about.'

Her children responded by keeping a round-the- clock vigil and documenting the care she was given. They noted that one nurse even refused to change a faulty drip because she was about to go off duty. A few days later came the mix-up over the penicillin. 'At this point we were in tears,' one of the sisters wrote in the diary.

'Mum had yet again missed another dose, this was the final straw.' Mrs Degnen said yesterday: 'We didn't feel like they were listening to us. They were making blunder after blunder in our face. 'We could see there were other patients not being cared for. We tried to communicate with the staff but some of them couldn't even speak English'

Mrs Dunn's condition appeared to stabilise but on January 21 her family were told she had contracted C. diff. They had nursed her themselves without being offered protective gloves or aprons to guard against such infections. She recovered sufficiently however to be transferred to a local hospital only to deteriorate again and be moved back to Tameside. Five days later she died from complications caused by the hospital bug.

The hospital insists doctors were right to prescribe antibiotics containing penicillin as it was felt that the benefits would outweigh any minor side-effects. A spokesman said: 'We acknowledged and apologised for the shortcomings in Mrs Dunn's care. We would reiterate the apology here.' Staff have been sent for retraining or are having their performance monitored.

In 2006, a coroner condemned the hospital after four elderly patients died in agony following what he called 'despicable and absolutely chaotic' treatment.

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British man died of heart attack while cowardly paramedic stood outside and conducted a "risk assessment"

An open door frightened him!

A grandfather died of a heart attack while an emergency paramedic stood outside his home for 16 minutes, making a risk assessment. The family of Roy Adams, 60, claimed yesterday that he might have survived if the paramedic had entered immediately. London Ambulance Service said that it had begun an investigation into the circumstances of the delay.

Mr Adams, a chauffeur for the Metropolitan Police, dialled 999 complaining of breathing problems and chest pains just after midnight on June 29. He was told by the operator to leave his front door open so an ambulance crew could get to him quickly.

However, a paramedic who arrived six minutes later and saw the door open feared that the property was being burgled. He stayed on the doorstep carrying out a “risk assessment exercise” before calling police for support. When he entered the property, 16 minutes after arriving, he found Mr Adams in the front room of his home in Morden, South London. Mr Adams was not breathing and was dead when he reached hospital.

His daughter, Sarah Adams, 23, said: “It makes me feel sick to think that the paramedic waited outside for 16 minutes. They thought he was having a heart attack but didn’t go in. He was told to leave the door open, so I can’t understand how it was a surprise for the medic. The delay might have made all the difference. “I don’t understand what health and safety worries meant this man couldn’t help my dad. He was dying.”

Ms Adams said that the family was planning to sue the ambulance service. “No one has apologised to us for what has happened,” she said. “I would at least expect a letter or something like that — but I still want to take them to court.”

A spokesman for London Ambulance Service said that two “single responders” had been sent to the address in cars, an ambulance crew and a duty officer. “The first member of our staff to arrive carried out a full on-scene risk assessment and requested police assistance due to safety concerns,” the spokesman said. “He then took the decision to enter the property alone, while maintaining telephone contact with our control room. “We are looking into the incident and are in the process of contacting Mr Adams’s family to discuss things further.”

Concerns have been raised about the increasing use of solo paramedics as two-person crews were split up before the introduction of new government targets in April last year. Under the new targets, three quarters of the most serious emergencies have to be met within eight minutes of a 999 call being answered.

Ben Bradshaw, then a junior health minister, denied in December 2007 that “single responders” would put patients at risk. He said they could help to free resources and that emergency calls would be responded to more quickly.

Miss Adams added: “Why would you stand outside carrying out this risk assessment when you know an old man is inside with a serious medical emergency? My dad had been instructed to put the doors on the latch by the operator. Vital minutes were wasted. He might well have survived if the medic had gone in and treated him as soon as he arrived.”

The ambulance service spokesman described the risk assessment as a “mental checklist” which included considering the safety of the scene, types of risk and whether extra help or equipment was required. “We have a duty of care to treat patients but we also have to look after our staff,” he said. “In this case the medic conducted the assessment, had safety concerns and decided to call for back-up.”

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Australian Feds trying to reduce government support for IVF

As the father of an IVF son, I wholeheartedy endorse the views below. I took no notice of the money cost of my heroic wife going through 10 IVF treatment cycles in a private clinic and have no clue what that cost was, but not everyone can afford to take that attitude

WHY are we paying the $5000 baby bonus to anyone who can get themselves knocked up, but taking money away from those who really want a baby, but can't conceive naturally? That's right. The Federal Government is planning to restrict Medicare funding for IVF, which could put the fertility treatment out of the reach of ordinary Aussies.

Most IVF users are devoted couples who deserve what the rest of us take for granted - a baby. I have watched many of my friends struggle - sometimes for years - to become parents. I have shared with them the highs, the lows, the pain, and the joy of IVF and other fertility treatments. Most have got there eventually - sometimes naturally after years of invasive medical treatments.

Others have had cycle after cycle of IVF and conceived only when they were on the verge of giving up - a miracle of medicine that has turned a couple into a family, and made them feel whole. Just one kid is enough to allow them to enter the magical world of parenthood - the trips to the park, the school days, the Friday night family dinners, cheering at sports matches, the school soccials, the children and the grandchildren.

It's a reminder that although my kids get me down at times, I know I am very lucky to have them. With three kids in 5 1/2 years, our fertility is a family joke. But our kids are a blessing for which I am grateful every day, and I want others to have the same chance. Surely having a baby is a basic right worth fighting for?

Why, then, would we ever think of restricting access to IVF just to those who can afford it? I hope this message gets across loud and clear in this week's Senate hearings on the issue. Let's not forget what the Federal Government change is estimated to do - triple the price of IVF, and thus put it out of reach of most middle-income Aussies. According to IVF rights campaigner Sandra Dill, from Access Australia, out-of-pocket expenses per cycle could be $3000 - up from $1000 at the moment. When you consider most people need two or three cycles to become pregnant, it's just not affordable.

I don't think fertility treatment is something that should just be the preserve of the rich, and not the rest. We'd end up like the US where the rich pay hundreds of thousands to buy a baby, rent a womb or choose the sex of their offspring, and the rest can barely afford to see a GP, let alone a fertility expert.

Federal Health Minister Nicola Roxon - herself a mother - says the Government is trying to crack down on doctors overcharging patients. But why not focus on the doctors rather than penalise the patients? We mustn't forget that IVF isn't just another medical procedure curing ingrown toenails or broken arms. And so we must fight for the right of 11,000 babies to be born every year to parents who desperately want to have kids, but can't for medical reasons.

After all, IVF is now mainstream - 3 per cent of all births are by assisted reproduction these days. Forget the Wacko Jackos and rent-a-womb Hollywood superstars. The "right to IVF" debate should instead be about the couple next door, and their right to have the baby they've always wanted.

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The forbidding arithmetic of healthcare reform

THE FUZZY math behind the Massachusetts universal healthcare law is starting to add up - just as Washington studies the law as a possible model for the nation.

Because of a recession-related drop in state revenues and a surge in enrollment by the recently unemployed, the truth is emerging at an inconvenient time. Massachusetts doesn’t have enough money to pay for the coverage envisioned by the law. In June, state officials announced they are cutting $100 million from Commonwealth Care, which subsidizes premiums for needy residents. The poorest residents, along with the newest - legal immigrants - will take the hit.

This outcome is not surprising, but it is instructive as President Obama pushes for a national healthcare plan. On the day that Republican Governor Mitt Romney, for once, made Bay State Democrats happy, by signing the sweeping new healthcare bill into law, the Globe headline said it all: “Joy, worries on healthcare. As Romney signs bill, doubts arise about revenues.’’

In Massachusetts, the numbers never added up, as everyone involved in crafting the new law understood. But for a variety of reasons, ranging from Romney’s presidential aspirations to Senator Edward M. Kennedy’s longstanding commitment to healthcare reform, everyone smiled for the cameras and hoped for the best out of this noble experiment.

Today, the current governor, Deval Patrick, a Democrat, is skeptical about the end product. Asked during a televised town hall meeting in March if he believes national healthcare legislation should be patterned after the Massachusetts plan, he said, “I don’t know. I had real misgivings about it as a candidate. . . . I’m proud of it, but I don’t know if it’s a model for the nation.’’

The foundation of the Massachusetts law is the so-called individual mandate. That means everyone must have health insurance. From that perspective, the Massachusetts experiment is a success. The percentage of residents without insurance was down to 2.6 after two years. But, the law never provided an absolute way to pay for the expanded coverage, and it never addressed how to reduce costs. “They decoupled the access issue from the cost issue,’’ said Philip Johnston, chairman of the Blue Cross Blue Shield of Massachusetts Foundation, which played a key role in expanding healthcare coverage here. “The lesson is, there needs to be a dedicated revenue source to support health reform.’’

An even bigger lesson is that to make health reform happen, all the players must be invested from the start - and must stay invested. “Getting it done is politics. That means dealing with all the elements that are necessary for near-universal access and cost management, but not overreaching in any one area, so that major stakeholders turn from supporting the effort to opposing it,’’ said John Sasso, who represented Partners Healthcare, the largest healthcare provider in Massachusetts, and Blue Cross Blue Shield, the state’s largest insurer, during the reform process. The stakeholders are still at the table, trying to make the numbers work better, he points out.

It’s true that Massachusetts built a dream house of a healthcare plan, without knowing the exact cost or how to pay for it. But that doesn’t mean it should be dramatically downsized, as state Treasurer Timothy P. Cahill proposes as he positions himself for a gubernatorial run.

A recent report by the Massachusetts Taxpayers Foundation, a business-funded group that advocated for the healthcare law, found that state spending increased by about $88 million annually since it was implemented. Is that too much to absorb, within the context of a $28 billion state budget?

As Patrick also said about the state’s healthcare law at that town hall meeting, “The great story about Massachusetts is instead of waiting for the perfect solution . . . or doing nothing . . . we tried something.’’

Washington can’t be as adventurous. Costing out a national healthcare plan, and figuring out how to fund it, is the current fault line for Obama. The president insists he can overhaul the healthcare system without adding to the deficit. He should take this final lesson out of Massachusetts: Be honest about cost in the good times and make sure you can cover it in the bad.

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7 July, 2009

British patient lived with cancer for 50 years before dying of bedsore in an NHS hospital

Cancer patient Pamela Goddard battled against cancer for 50 years before she died of an infected bedsore during a stay in hospital. The treatment for the cancer appeared to be working, but the bedsore continued to get worse.

Pamela Goddard had great faith in the NHS. It had, after all, kept her alive for more than half her 82 years. The piano teacher first contracted breast cancer in the 1960s and had survived a series of recurrences of the disease over the years. So when it returned last year, this "completely vital" woman, who was still working up to 30 hours a week, was fully expected survive. The cancer did not kill her, but a bedsore did.

What appeared to be the start of one was noted on her back as she was admitted for radiation treatment in September and it was allowed to gradually develop into a "raging sore" which left Mrs Goddard moaning in pain. During four weeks of what her family describe as "torture" in a bed in East Surrey Hospital, the sore resulted in a fatal blood infection and she died on October 27.

Her son Adrian Goddard, who lives in the US, said: "She survived cancer for 40 years, then died from a bedsore. "It is just beyond belief that they could let a bedsore develop to the point where it actually kills someone from septicaemia." He said the nurses seemed largely unconcerned by the growing size of the sore and his mother's increasing pain. "The bedsore was painful. There were various procedures that should have been done. You are supposed to debride the thing, clean it, treat it. "She was supposed to be lifted and moved so there's not constant pressure on it," Mr Goddard said.

"There were explanations like 'there was only one nurse and it wasn't possible to do it or the equipment was broken'... just a series of excuses. "Most of the time there were [enough nurses]. None of them struck me as being frantically busy to put it mildly. "There were lots of conversations about last night's activities in the pub, a lot of strolling around, looking at charts without doing anything. "The level of crisis that attracts their attention has to be very high for them to put down their biscuits. I guess they get inured to it, the moaning, the fact my mother was in great pain."

The first sign Mrs Goddard was unwell came early in 2008 when she suffered from back pain. She went to Barts Hospital in London but the recurrence of cancer which was the cause of the pain was not diagnosed until she broke her leg in June. The treatment for the cancer appeared to be working, but the bedsore continued to get worse despite attempts to treat it with "maggot therapy" in which maggots are used to clean out the wound.

On October 11, Mr Goddard said a doctor told him that "she was recovering well, except there was something in the blood work, which suggested an infection". "If it didn't go away, he said he would give her penicillin or something," Mr Goddard said. "It never occurred to him this by now raging bedsore was the source of the infection."

Mr Goddard said he and other members of the family had tried to persuade nurses and doctors to take more action, but said the "inertia was extraordinary, the worst sort of institutional dysfunction".

Mr Goddard said anyone in a similar situation should "do what you need to do to find some sort of private care for them". "She certainly wasn't ready to die. To the extent she realised it was happening, she must have been horrified," he said. "The thing that makes me most angry was she had such faith in the system and it let her down so badly. "She was basically in torture over a four-week period. Then she was drugged up and left to die. "It's unconscionable, very sad."

Surrey and Sussex Healthcare NHS Trust Director of Nursing, Mary Sexton, said: "We offer our sincere condolences to the family of Pamela Goddard on the loss of their mother. "We are committed to providing high quality patient care and are sorry that on this occasion the family feel that that standard has not been met. "We have received a formal complaint, which we have responded to, but are carrying out further investigations at the request of the family.

"The presence of pressure sores is associated with a twofold to fourfold increased risk of death, but this is because pressure sores are a marker for underlying disease severity and other co-morbidities. "Mrs Goddard was receiving complex treatment for a number of medical conditions from a number of health care organisations at the time of her death."

SOURCE




11 serious errors a day in NHS surgery

Eleven people are seriously harmed during NHS surgery every day, it emerged yesterday. The number of major errors has risen by 28 per cent in five years, with more than 4,000 patients hurt in 2007/08. Mistakes include objects such as scalpels and coils being left inside patients, organs being punctured, and the wrong dosage of drugs being given.

A total of 722 objects were left inside patients during surgery last year – one every two and a half days. That number has soared by 13 per cent in the five years to 2007/08.

The figures were revealed just days after a damning MPs' report found that many hospitals are routinely covering up such mistakes. The Commons health select committee warned that another hospital disaster like the one at Stafford, where up to 400 people died, could not be ruled out – because managers were putting Whitehall targets and cost-cutting above patient safety. Government policy 'too often' gave the impression that hitting waiting list targets, achieving financial balance and attaining elite foundation trust status were more important than patient safety. 'This has undoubtedly, in a number of well documented cases, been a contributory factor in making services unsafe,' the report said.

The MPs added that many mistakes were not reported by the NHS – raising the possibility that the recorded number of medical mishaps is just the tip of the iceberg.

The latest figures were uncovered by the Liberal Democrats in a parliamentary answer. Health spokesman Norman Lamb said: 'These figures raise serious concerns and call into question the Government's claim to be making patient safety a priority. 'There really is no excuse for leaving objects inside people. Far too many avoidable mistakes are still being made. 'Many doctors and nurses are under enormous amounts of pressure to meet Government targets. We have to ensure that patient safety isn't being compromised to satisfy the whims of Whitehall. 'If we really want to raise standards in the NHS then we need to give local people the power to hold their health services to account.'

The figures show that there have been a total of 17,921 errors during surgery over the past five years. The number of cases every year has shot up by 28 per cent to 4,161 in 2007/08 – 11 a day.

Most of the cases involve people having organs mistakenly punctured, which can lead to haemorrhaging. Over the last five years, the organs of 12,125 patients were punctured, with the annual figures soaring 33 per cent to 2,817 in 2007/08.

Hundreds of other surgical mistakes were reported, including not removing or inserting tubes properly, using wrongly-matched blood, forgetting to give drugs on time, and not sterilising equipment properly. Failure to sterilise is a key method by which superbugs such as C. Diff and MRSA can spread.

There were also dozens of reports of the catch-all 'performance of inappropriate operations'. The total uncovered by the LibDems represents only a fraction of the mistakes made in the NHS every year, as it only covers errors during operations. Overall, there are around 250,000 mistakes causing harm to patients reported across the Health Service every year. More than 3,600 of those affected die as a result.

SOURCE




Medical arrogance

During his ABC infomercial last week, President Obama continued to insist that the type of reform he has in mind would reduce the cost of health care, improve its quality, and enable people to keep their current insurance policies and doctors. He is wrong on all counts.

Very little in the Democratic bills making their way through Congress would do anything to reduce costs, while the new subsidies their authors envision would increase costs. That is why the Democrats are talking about both explicit and disguised tax increases. During the ABC special, the president hinted that reform would give doctors and hospitals new incentives to avoid unnecessary care. But since government cannot reliably distinguish between the necessary and the unnecessary, all it can do is encourage less care — and leave it to doctors and other health-care workers to administer the rationing. Obama would be well-advised, for his political health, to do no more than hint at this prospect.

Obama wants to establish a government-run insurer. Because it could pass along its costs to its private-sector competitors, that insurer would quickly come to dominate the market, regardless of its quality. (All estimates agree that many millions of people would lose their existing coverage.) It would thus strengthen the government’s ability to reshape health care to its specifications. Obama seems entirely too confident that it could do so intelligently.

The better course would be to make it easier for people to buy insurance policies for themselves and their families, so that they would not have to rely on either the government or their employers. Under such a system people would run less of a risk of being denied care that they want, and would also have an incentive to keep an eye on costs. And in a market less fragmented on the basis of employment status, individuals would be better able to buy renewable insurance policies that they could keep even after getting sick.

President Obama could easily get such a plan through Congress if he wanted it and were willing to face the wrath of the Left. By pursuing his political and ideological ambitions, he is risking getting no bill at all — or, worse, one that takes America in the wrong direction.

SOURCE




Obamacare: Do or die for America

With so much coverage of the current debate on Barack Obama’s attempt to impose nationalized healthcare on America, it may seem that little else can be said on the subject. Yet it needs to be discussed, and its manifold dangers explained to the American people. It is impossible to overstate the significance of this battle. If successful in establishing this pinnacle of his socialist agenda, Obama will unleash a “change” on the country from which it may never recover.

Clearly, he is aware of the governmental power he has the potential to accrue with the passage of this single atrocious new entitlement. His lust for that power is evident in the ferocity with which he is striving to ramrod his plan through the congress and onto America. The stakes are far too great for him to do any less. Ultimately, the zeal with which he is pressing forward should be the greatest indication to Americans of the long-term perils that await them if he succeeds.

While it may seem odd to draw comparisons between the healthcare “debate” and the recent uprisings in Iran, certain disturbing parallels indeed exist. America and the world witness the tragedy of an oppressed people yearning to be free, and the manner in which the Iranian government is scrambling to regain its iron-fisted control of the situation. Central to this effort is their disinformation campaign. And while nobody in our country is being slaughtered over health care controversies, the situation is rife with ominous signs of a government/media propaganda blitz that rivals anything ever concocted by Tass or Pravda.

Furthermore, though the violence in Iran is not likely to be recounted in our communities, particularly with respect to medical care, ominous patterns of governmental coercion, and suppression of all opposition are already beginning to unfold here. And if the poisoned seeds of impending tyranny are any indication, it is chilling to ponder the bitter fruit that they may bear if not immediately checked.

It is not necessary to delve into ideological parallels between Obama and the ruthless Iranian leadership. Clearly, his Cairo speech revealed an appalling willingness to laud the Islamic world in a manner that he never proffers on behalf of America and the rest of Western Civilization. Anyone who doubts this need only to contrast that speech against the venom and anti-American hatred of the “Reverend” Jeremiah Wright, under whose spiritual leadership Obama willingly sat for more than two decades.

Still, with respect to healthcare, the underlying ideology is a secondary issue. It makes no difference why Obama and his kind are so intent on lowering the quality of American healthcare to levels reflective of nightmarish and dysfunctional Euro-socialist states. Their willingness to employ fraud and overreaches of power speaks volumes in itself. The results of this approach are entirely predictable. Any program that is implemented through such thuggish tactics cannot possibly redound to the benefit of America’s greatness or the former freedoms enjoyed by its people.

Pivotal to the onset of unrest among Iranian citizens was the obvious tampering of election results, ensuring the reelection of Islamist puppet Mahmoud Ahmadinejad. On the Iranian street, it was a given that Ahmadinejad’s rival, Mir Hossein Mousavi, was far more popular. Yet the “election” results painted a completely different picture, and predictably, one that the “religious” autocracy had intended from the beginning.

Of course nothing like that could happen here in America, or could it? On June 20, just in time for Obama’s big healthcare propaganda blitz, an “independent” CBS News/New York Times poll was released which claims that an amazing 72% of Americans are in support of putting their medical care under the complete control of the government. Apparently, the monstrosity of a socialist bureaucracy enjoys even more popularity on mainstreet than Ahmadinejad does in Tehran.

However, on closer examination, it turns out that, by a two to one margin, participants chosen for the poll were Obama supporters. By resorting to such absurdly skewed “sampling” pollsters can easily manufacture “overwhelming” public support or opposition on any topic they choose. Thus has CBS/New York Times revealed its willingness to sway public opinion by generating the illusion of political momentum.

Equally significant is that, in this role, CBS/New York Times is clearly disseminating misinformation in concert with the agenda of Obama and the Democrats. These formerly respectable establishments of the press have abdicated their time-honored role of protecting liberty and national integrity by keeping the public informed. Instead, they have assumed the dark mantle of demagogues and propagandists for the state. Joseph Goebbels would be proud.

Much worse is yet to come. At least CBS/New York Times still felt compelled to do their dirty deed under the guise of an objective poll. In comparison, the actions of ABC “News” vastly eclipse any previous sellout of the public trust by the press. Not content to merely parrot the Obama/Democrat party line, on Wednesday June 24, ABC News conducted a government “healthcare” infomercial from inside the White House. Comically denying any partiality, this broadcast was clearly crafted to advance Obama’s socialist cause, denying any opposing viewpoint from being presented, even during paid commercials.

In a sad post-mortem on the demise of the American Republic, CBS News/New York Times, along with ABC News, would not be memorialized as principled martyrs who lost a valiant fight to keep spreading truth among the people of the country. Rather, descending to the point of becoming ideological brothels from which any “informational” service can be purchased for the right price, these once great institutions willingly abandoned their rightful purpose, and now publicly strut their wares for the right bidder.

Despite all of this, the path to a takeover of the medical system is far from certain. Obama’s own desperation, revealed in such antics as the ABC News publicity stunt, stand as evidence that huge obstacles remain before Americans will consign their physical well being to the insipient madness of liberal bureaucracies. In response, Obama has been driven to mimic the tactics of those Iranian Ayatollahs who feel their grip on power slipping away. While insisting that the plan is a “done deal,” he demeans any who oppose it as “not logical.” In doing so, he demeans himself and the office he holds.

Next week, this country will be celebrating the two hundred and thirty third anniversary of its founding. Those courageous individuals who crafted and signed the Declaration of Independence birthed a nation on principles so wise and noble that it has since risen to the pinnacle of civilization. But if such ideals are abandoned, it cannot exist forever on the mere momentum of its glorious founding.

It seems wholly unlikely that Americans may ever face the prospect of blood running in the streets of their cities. But the specter of a government run healthcare system, and the sinister manner in which it is being advanced, represent a dangerous departure from the nation’s former greatness.

SOURCE





6 July, 2009

A deadly organ-donor system

by Jeff Jacoby

RIGHT ON THE HEELS of the recent news that Apple CEO Steve Jobs underwent a liver transplant came the speculation that he had somehow gamed the organ donation system in order to jump to the head of the waiting list. It was widely noted that Jobs's transplant took place at a hospital in Tennessee, some 2,000 miles from his home in California. That suggests he had registered with more than one regional transplant center. Multiple registrations aren't against the rules but they can be an expensive proposition, since the patient must be able to travel at a moment's notice when the organ becomes available, and since insurance companies generally won't pay for evaluations at more than one hospital. Jobs, a billionaire, may thus have benefited, frets USA Today, from "a loophole that favors the rich."

Had Jobs traveled to Tennessee to consult a highly sought-after medical specialist, or to acquire a piece of cutting-edge medical equipment, or to undergo a rare and difficult brain operation -- or to buy a Smoky Mountains mansion, for that matter -- nobody would be grumbling about loopholes or wondering whether rules had been manipulated. When it comes to doctors' services or medical technology or surgical procedures -- or real estate -- people understand that suppliers generally charge what the market will bear.

The same economic system that generally makes good health care available to all does price certain products and services high enough that only the wealthy can afford them. It isn't news that the world's finest surgeon commands a high fee, or that the latest "miracle" drugs tend to be expensive, or that billionaires can afford things that mere mortals can't.

Yet when it comes to the donation of human organs, countless people believe that the market must be prevented from functioning.

Under current law, an organ may be transplanted to save a patient's life only if it was donated for free. Federal law makes it "unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation." The surgeon who performed Jobs's liver transplant, the hepatologist who diagnosed him, the anesthesiologist who managed his pain, the nurse who assisted during the procedure, the medical center that provided the facilities, the pharmacy that supplied his medications, even the driver who brought him to the hospital -- all of them were paid for the benefits they rendered. Only the organ donor (or the donor's family, if the liver came from a cadaver) could receive nothing except the satisfaction that comes from performing an act of kindness.

That, many say, is as it should be: Organs should be donated out of goodness alone; otherwise the rich might exploit the poor. Others flatly oppose any hint of commerce in human organs. Opening the door to "financial incentives," declared the Institute of Medicine in 2006, could "lead people to view organs as commodities and diminish donations from altruistic motives."

Unfortunately, altruistic motives aren't enough. I carry an organ donor card and think everyone should, but only 38 percent of licensed drivers have designated themselves as organ donors. Thousands of organs that could be used to save lives and restore health are lost each year, buried or cremated with bodies that will never need them again.

No one would dream of suggesting that medical care is too vital or sacred to be treated as a commodity, or to be bought and sold like any other service. If the law prohibited any "valuable consideration" for healing the sick, and allowed doctors to practice medicine only if they did so for free, the result would be far fewer doctors and far more sickness and death.

The result of our misguided altruism-only organ donation system is much the same: too few organs and too much death. More than 100,000 Americans are currently on the national organ waiting list. Last year, 28,000 transplants were performed, but 49,000 new patients were added to the queue. As the list grows longer, the wait grows deadlier, and the shortage of available organs grows more acute. Last year, 6,600 people died while awaiting the kidney or liver or heart that could have kept them alive. Another 18 people will die today. And another 18 tomorrow. And another 18 every day, until Congress fixes the law that causes so many valuable organs to be wasted, and so many lives to be needlessly lost.

SOURCE




Lack of NHS cash puts British bottom of league for fertility treatment

Couples in the UK have less chance of IVF treatment than those in Montenegro

Poor NHS funding of IVF means that infertile British couples are among the least likely in Europe to receive the treatment they need to start a family, new official figures have shown. The latest European league table of access to fertility treatment has placed Britain 11th of 13 countries providing data for 2006, with only Germany and Montenegro providing fewer cycles of IVF in proportion to their population.

Infertile couples in Denmark and Belgium, which finish first and second in the table, are more than three times more likely to have IVF than those living in Britain, the new figures collected by the European Society of Human Reproduction and Embryology show. While Denmark conducts 2,337 IVF cycles per million inhabitants and Belgium conducts 2,187, Britain conducts just 729.

The UK’s performance reflects a lack of funding for IVF on the NHS. While the National Institute for Health and Clinical Excellence (NICE) recommends that primary care trusts should offer three free cycles of treatment to most infertile couples, only a quarter meet this standard. In 2006 only nine of the 161 trusts in England and Wales offered three free cycles. Many trusts also impose further restrictions, such as refusing to fund treatment when people have children from a previous relationship, and the NHS will only pay when women are under the age of 40. In Denmark and Belgium, up to six cycles of IVF are reimbursed by the state. Other leading performers in the league table, such as Iceland, Finland and Sweden, also offer more generous funding than the UK.

Clare Lewis-Jones, chief executive of the patient group Infertility Network UK, said: “We are angry that although the UK pioneered infertility treatment, we are still among the lowest providers in Europe, and these figures show that availability in the UK is less than one third of that in Denmark. “To be so far behind other countries in Europe in the provision of fertility treatment is totally intolerable. “Although there has been an improvement recently in the provision of treatment by some PCTs, there still remains considerable variation in the criteria used to determine whether or not couples can access treatment.”

Anders Nyboe Andersen, of Copenhagen University Hospital in Denmark, who led the research and presented it today at the ESHRE conference in Amsterdam, said that while funding was a major explanation for different countries’ performance, it was not the only one.

More here




Top doctor in Western Australia claims that colleagues operated 'without proper qualifications'

And another bullying Health Dept. that tries to get back at whistleblowers

A top surgeon at WA's biggest [government] hospital claims two doctors were conducting critical surgery without proper qualifications, The Sunday Times has discovered. Cardiothoracic surgeon John Manuel Alvarez has lodged an internal complaint in which he claims last year he warned bosses at Sir Charles Gairdner Hospital that he feared two of his peers were underqualified for the major surgery they were performing. The Sunday Times understands that some of the concerns related to whether or not the two doctors had passed specialist examinations. Both doctors are no longer at the hospital. One has left WA.

Dr Alvarez himself is being investigated by the Health Department over misconduct allegations. The Health Department started investigating him in July last year after he raised doubts about the ability of the two doctors. The Sunday Times understands that Dr Alvarez believes the inquiry is a witch hunt and was not properly conducted.

Dr Alvarez filed a writ last week seeking to restrain the Health Department from continuing with an investigation and publishing or acting on its findings of misconduct against him. He also wants to stop any future investigation of him by the department. Dr Alvarez named WA Health Minister Kim Hames as the first defendant and Kenneth John Trainer as the second defendant in the action which was filed last Friday. Mr Trainer was the independent investigator hired by the Health Department. Dr Alvarez wants damages for breach of contract with the writ alleging the investigation breached his employment contract dated July 28, 2005.

A SCGH spokeswoman confirmed that Dr Alvarez had made complaints about the quality of some of his peers who were conducting critical surgery last year. She said the hospital was unable to comment specifically on the investigation into Dr Alvarez as the matter was before the courts.

SOURCE




Healthcare Reform: Will Obama Let You Into His Lifeboat?

Tough luck for the elderly, smokers, big alcohol drinkers and people who don't exercise. If you are any of those, think carefully about your vote next year

The term “lifeboat ethics” is used to describe ethical issues that arise in situations involving the allocation of limited resources. It originally came out of a landmark 1974 article by philosopher Garrett Harden in connection with ethical questions surrounding the issue of providing food aid to underdeveloped nations. He pictured wealthier nations as being like so many lifeboats---all with limited capacity, of course---afloat in a sea surrounded by many swimmers who need saving: the residents of poorer nations. His discussion there concerned the ethical guidelines that ought to govern who, if anyone, should be picked up and saved by those in the lifeboats.

The picture of the lifeboat is, quite obviously, an analogy. And from a logician’s perspective, an analogy is a tool used in a particular type of argument. If I am using an analogy to convince you of something, then I am arguing that two things, A and B, are alike in certain important respects, hence they should be seen as being alike in at least one more relevant respect: that which represents the conclusion of my argument. As a logical tool, an analogy works where it works. Its applicability is not necessarily tied down to only one situation or ethical position.

The lifeboat analogy has surfaced in several ways in the Health Care community and is relevant to the current debate over Health Care Reform. Here we are also dealing with the allocation of limited resources.

Perhaps the most legitimate use of this analogy in health care situations concerns triage decisions in disasters, both natural and man-made [what used to be called “Terrorist Incidents”]: “During overwhelming disasters, health systems must be considered lifeboats with insufficient capacity to minister to all, and thus decisions regarding who is best served by the lifeboat must be made.”

These “high-consequence event” situations have something in common with the original analogy that is so obvious it may easily be overlooked. The lifeboats and the individual swimmers are in the water because a disaster has just occurred; a ship has slipped beneath the waves. Sometimes I think that using lifeboat ethics type cases as if they should furnish us with generally applicable moral guidelines is a little like bringing up the experience of the Donner Party to introduce a discussion about whether cannibalism should be seen to be more acceptable morally than is generally recognized.

Lifeboat ethics cases do not provide us with examples for general moral guidance but instead present situations that are so extreme that they force us to raise questions about whether, in them, some generally accepted moral guidelines and ordinary standards of professional ethics may justifiably be suspended. Indeed, the Homeland Security study mentioned above recognizes this:

“The threshold for what constitutes life-sustaining care could also be lowered if staff degradation and or physical plant damage prevent the delivery of advanced acute and critical care therapies. Depending on the scope, magnitude, and duration of the disaster, sufficiency of care could mean little more than providing intravenous fluids or ventilator-assisted breathing.”

The translation of the above is that under the extreme circumstances it finds itself in, the staff will just have to do the best it can with what resources it has and cannot morally or reasonable be expected to do much more.

But not everyone agrees with my view that Lifeboat Ethics cases are best used to discuss exceptions to general moral guidelines rather than to set the guidelines themselves. And since Obama has insisted on many occasions in the past, especially when running in the primaries against Hillary Clinton, that it is his health care plan we are considering when we discuss the plan soon to be presented to Congress, it is I think reasonable to now ask relative to some important situations, whether Obama would let you into his lifeboat.

Situation One: Are you over 70 years old? If so, then you have real reason to worry about whether he will let you in. Developers of his plan understand that the bulk of the nation’s health care resources are used by senior citizens and they are looking for ways to ration care to the elderly.

In our last article we looked at an argument they favor which would ration care to the elderly and terminally ill based on a Cost-Benefit Analysis. Another plan now being seriously considered here and in Great Britain is to set an arbitrary age cap on receiving health benefits. This hearkens back to an idea originally espoused as far back as 1987 by Daniel Callahan, that humans have an average expected life span (figures of 70 yrs. to 85 yrs. have been mentioned in discussions of this point) and persons who have lived up to this age have no right to expect that we extend them medical care beyond it.

In other words, we are not here talking about a situation where, for example, if two patients, a 75 year old and a 25 year old were competing for the same donated liver, then the relative age of the patients would be one factor health care workers could take into account when making the decision as to who gets the organ. This proposed policy would instead use age alone as the sole criterion for denial of care. And it would not be health care workers but government who would exclude the 75 year old by setting a standard which would deny him/her from receiving health benefits on the basis of age alone!

A point made in these discussions is that such a person has put in enough innings in the game of life and its time to pull them out of the game and put another younger person in, whether they want to come out or not. They will thus not be brought on board the lifeboat of health care.

Situation Two: Are you ill as the result of a lifestyle choice? For example, have you been a heavy smoker or drinker and now things have caught up with you? You should have serious worries about whether Obama will let you into his lifeboat, even if you are not now at an advanced age. Hershel Elliot, an ardent supporter of Harden’s work, succinctly summarized its relevance to healthcare rationing by lifestyle in a 2003 article when he said, “You are unlikely to learn to take care of your health, if you are free to abuse your body by overeating, lack of exercise, and dangerous behavior while society must pay the costs of restoring your health. When individuals are free to damage their own health and society has to pay the costs of curing them, medical costs can spiral out of control.”

Of course, his conclusion is that since these individuals’ health situations came about as a result of their own behavior arising from their lifestyle choices, then society has no moral responsibility to bring them aboard the lifeboat of healthcare and is justified in leaving them alone in the water to suffer the consequences of their choices. Not only will care be rationed on the basis of lifestyle choices in the proposed Obama plan, but government bureaucrats will use the threat of denial of care as the basis for meddlesome intervention into people’s private lifestyle choices. If the government is picking up the bill, either in whole or in part, then these choices are not private anymore!

Curiously, the one application of Garrett Harden’s Lifeboat analogy that his followers judiciously choose to leave out when they apply his views to healthcare, but which might be the most relevant, is the one he himself made in his original article in connection with our moral obligation to supply food aid to poor nations. And that point, which is just as applicable to healthcare, is that Marxist-inspired, redistributionist ethics won’t work. If we apply the Marxist principle of “to each according to his needs” and bring 100 additional needy swimmers out of the water into a nearly full lifeboat that only holds 60, then the lifeboat sinks and everyone loses out.

And sadly, this could be the impact of the Obama, socialist-inspired, universal healthcare plan: it will either sink the US healthcare system lifeboat or drain the economy that keeps it afloat.

SOURCE





5 July, 2009

British doctors punished over appointment times by patient survey

This is British bureaucracy at its most moronic. Doctors will just reduce the number of patients they see if this goes through. Britons will end up having as much trouble finding a doctor as they already do in finding a dentist. In Britain, an NHS doctor has a "list" and you have to be on his list to be treated by him. If this goes through, doctors will close their lists and, as the elderly who take most of a doctor's time drop off the list through death, he will soon have a smaller list and be able to see all of them promptly. Nobody wants to work for nothing, which is what the new system imposes. Socialist bureaucracy will be as destructive as usual.

People with no doctor will then flood hospital emergency rooms and then what will become of the bureaucratic "targets" there? Will 4 hour waits transmogrify into 4 day waits? Bureaucracy will have made the problem worse instead of better -- as usual. Another possibility is that doctors will spend less time with each patient, thus causing things to be missed and allowing problems to develop -- with the patient ending up severely ill in hospital when that could have been avoided. Once again the strain on the already overburdened hospitals will be increased

Family doctors will lose millions of pounds in funding because of complaints from patients over the waiting times for appointments. Most general practices around the country are expected to suffer losses — some as much as £25,000 — when the results of a survey are released today.

The GP Patient Survey, the first to financially penalise doctors who receive negative responses, is expected to cost practitioners more than £10 million and in the worst cases could force cutbacks such as staff redundancies.

The estimated cost to surgeries in Birmingham has been calculated at more than £1 million, while those in Northern Ireland and Wales are likely to lose similar sums. In Greater Manchester, about half of GP practices have been told they will lose up to £10,000.

The system, designed to encourage a better service from GPs, has been widely criticised for punishing some practices that need more help. Doctors have also raised concerns about being judged on a small number of responses and queried why just two of the survey’s 49 questions — concerning access to a GP in 48 hours and more advanced appointments — carried all the financial penalties.

In Scotland, where patient responses were processed last month, some practices serving more than 10,000 patients were hit with five-figure penalties as a result of the responses of only 50 patients.

Laurence Buckman, chairman of the British Medical Association’s GPs’ committee, said that the lengthy survey did not encourage responses, and a few negative patients could skew the perception of a good practice. This was particularly likely in inner-city areas, where high numbers of patients could not be bothered to respond. “Some practices are going to be very badly hit with huge amounts of money on the say-so of very small numbers of patients,” Dr Buckman said. “We know in England that there are going to be similar results as there were in Scotland. “If you reduce money, you are reducing the services, not improving them. Because of the way payment is geared you can only have the money taken away. We will be looking at thousands of practices that will be adversely, and in some cases, unfairly hit.”

Describing the survey’s flawed methodology, Dr Buckman said that most questions were angled negatively to seek out underperformers while none covered simple issues such as “how good is your doctor?” He said that the process “was so long that most people would just get worn out and give up”.

Practices that receive less than 60 per cent of positive responses to the two key questions would sacrifice all the money available as part of the Quality and Outcomes Framework, which pays doctors for achieving service targets. The BMA predicted an average-sized practice could face losses of £7,500, while larger lists could lose more than £10,000. Hundreds of practices are expected to appeal.

In Glasgow, 170 of 270 practices will appeal. GPs’ leaders in Scotland said that few practices had escaped losses entirely.

David Stout, the Primary Care Trust network director at the NHS Confederation, said that money taken from GP budgets would be reinvested by trusts in other services. He said that PCTs had discretionary powers to reduce the penalties if they felt that a practice had been treated unfairly.

“If it’s over-zealous then [the Government] will want to look at that in the cold light of day and if it needs to be re-examined it will.”

A Department of Health spokesman denied that the survey was flawed, adding that it had been agreed by stakeholders and would be an accurate reflection of patient perceptions.

SOURCE




Alice in Healthcareland

Most political and media discussions of medical care have an air of unreality reminiscent of Alice in Wonderland. There is an abundance of catch-phrases but remarkably few coherent arguments. Let's start at square one. Why is there alarm about American medical care? The most usual reason given is because its cost is high and rising.

That is certainly true. We were not spending nearly as much on high-tech medical procedures in the past because there were not nearly as many of them, and we were not spending anything at all on some of the new pharmaceutical drugs because they didn't exist. This general pattern is not peculiar to medical care. Cars didn't cost nearly as much in the past, when they didn't have air-conditioning, power steering and high-tech safety features. Homes were cheaper when they were smaller, had fewer bathrooms and lacked such conveniences as built-in microwave ovens.

We would like to have all these things without the rising costs that come with them. But only with medical care is such wishful thinking taken seriously, with government regarded as a sort of fairy godmother who will give us the benefits without the costs.

A cynic is said to be someone who knows the price of everything and the value of nothing. If so, then it is political cynicism to point to other countries that spend less on medical care, including some countries where there is "universal health care" provided "free" by their governments. Just as medical care, houses and cars were all cheaper when they lacked things that they have today, so medical care in other countries is cheaper when they lack many things that are more readily available in the United States.

There are more than four times as many Magnetic Resonance Imaging units (MRIs) per capita in the United States as in Britain or Canada, where there are government-run medical systems. There are more than twice as many CT scanners per capita in the United States as in Canada and more than four times as many per capita as in Britain. Is it surprising that such things cost money?

The cost of developing a new pharmaceutical drug is now about a billion dollars. Neither political rhetoric nor government bureaucracies will make those costs go away.

We can, of course, refuse to pay these and other medical costs, just as we can refuse to buy air-conditioned homes with built-in microwave ovens. But that just means we pay attention only to prices and not to the value of what we get for those prices. We can even refuse to pay for so many doctors. But that just means that we will have to wait longer to see a doctor— as people do in countries with government-run medical systems.

In Canada, 27 percent of the people who have surgery wait four months or more. In Britain, 38 percent wait that long. But only 5 percent of Americans wait that long for surgery. Surgery may well cost less in countries with government-run medical systems— if you count only the money cost, and not the time the patients have to endure the ailments that require surgery, or the fact that some conditions become worse, or even fatal, while waiting.

A recent report from the Fraser Institute in Canada shows that patients there wait an average of ten weeks to get an MRI, just to find out what is wrong with them. A lot of bad things can happen in 10 weeks, ranging from suffering to death.

Politicians may talk about "bringing down the cost of medical care," but they seldom even attempt to bring down the costs. What they bring down is the price— which is to say, they refuse to pay the costs. Anybody can refuse to pay any cost. But don't be surprised if you get less when you pay less. None of this is rocket science. But it does require us to stop and think before jumping on a bandwagon.

The great haste with which the latest government expansion into medical care is being rushed through Congress suggests that the politicians don't want us to stop and think. That makes sense, from their point of view, but not from ours.

SOURCE




Public medicine looks a lot like public school

With our son approaching school age, my wife and I are considering a variety of options: charter, private, homeschooling. Just about the only option not on the list, even though we're forced to pay for it anyway, are public schools. We're not only unimpressed with the results achieved by local public schools, but we also don't like their one-size-fits-all structure. As things stand, we're concerned that, a few years from now, we'll face a similar situation with health care, forcing us to pay for coverage that we don't want in addition to care that we actually choose.

That's the big problem with government-sponsored versions of anything. No matter the quality of the ultimate product, everybody has to pay for it, even if it doesn't suit their personal needs and preferences. Just imagine if dining out was a state-provided service. Given popular preferences, at best, we'd end up with reasonably decent steak and burger joints from sea to shining sea -- and that's it. Good luck to vegetarians and fanciers of exotic ethnic foods.

Of course, at worst, you'd be forced to pay for the food quality of a high school cafeteria mixed with the service you've come to love at the Department of Motor Vehicles.

That worst-case scenario came to pass in Canada, where the country's Supreme Court ruled in 2005 that the quality of medical care provided by the state system in Quebec was so terrible that the province's law against private health insurance couldn't be allowed to stand. While the ruling doesn't apply elsewhere, private -- and arguably illegal -- clinics are springing up around the country to provide care to people who'd rather pay for medicine twice than accept the government's prescription.

Private medicine is legal in the United Kingdom, where about 11.5% of Britons (up from 5% in 1980) carry private insurance in addition to the taxes they pay for the National Health Service. Government-provided dentistry is such a shambles that people have fled the system, and dentists now make more from private-pay patients than from the state system.

But if other country's medical systems have troubles, so does the American system. After all, The World Health Organization gave America's health care a miserable 37th-place ranking out of 191 countries, right?

Well ... not so much. Actually, when economist Glen Whitman looked at WHO's rankings, he concluded:

The WHO rankings depend crucially on a number of underlying assumptions—some of them logically incoherent, some characterized by substantial uncertainty, and some rooted in ideological beliefs and values that not everyone shares.

The analysts behind the WHO rankings express the hope that their framework "will lay the basis for a shift from ideological discourse on health policy to a more empirical one." Yet the WHO rankings themselves have a strong ideological component. They include factors that are arguably unrelated to actual health performance, some of which could even improve in response to worse health performance.

Basically, WHO front-loaded its ratings with criteria that guaranteed high rankings to tax-supported systems, and low rankings to systems where people pay for their own care. Said Whitman, "To use the existing WHO rankings to justify more government involvement in health care--such as via a single-payer health care system--is therefore to engage in circular reasoning because the rankings are designed in a manner that favors greater government involvement."

Plenty of people share WHO's biases -- many Canadians and Europeans are happy with what they get, and lots of Americans say they want the same thing. But plenty of people don't share WHO's biases. If you implement a state-sponsored health care system, everybody gets drafted into the one-size-fits-all scheme, without consideration for their personal preferences.

Actually, "draft" is the right word. Since state-supported schemes are supported by taxes picked from all our pockets, they're basically conscription with limited -- or expensive -- opportunities for conscientious objectors (and sayonara to voluntary alternatives). That's true of public schools, and it may soon be true of health care.

Right now, President Obama and his allies in Congress say they have no plans to displace private medicine, only to create a public plan that would compete with and "discipline" private insurers.

Right. What do you think would happen to Burger King if McDonald's not only ran its own restaurants, but also had the power to charge everybody for Big Macs whether they ate under the golden arches or not, and could regulate all fast-food joints? That's the sort of "discipline" you get from a government plan.

I expect that, in years to come, my wife and I will be looking at our options for escaping not just public education, but also public medicine. And, as it already is for Britons and Canadians, that choice will be expensive and limited by a government that doesn't put a lot of value on personal choice.

SOURCE




Obama healthcare poison pill

In his crusade to bring health care - one-sixth of the country's economy - under government control, President Obama is asking Americans to swallow a huge and potentially poisonous policy pill.

Just as many Canadian politicians and their families have, hypocritically, come to the U.S. when they prefer our advanced, private health care over their own socialized system, President Obama got caught last night in a "do as I say not as I do" moment. In a special broadcast on ABC, the president refused to pledge that he'd limit his own family to the tests and treatments that the general public would have to confine themselves to under his proposed health care "public option" restrictions.

Obama dismisses as "fear tactics" charges that his program amounts to "socialized medicine" similar to Canada, the United Kingdom and Sweden. Yet, ironically, Canada, the United Kingdom and Sweden are all beginning to open their socialized systems to private care due to citizen protests that critical treatments are delayed or denied. The past president of the Canadian Medical Association says that in Canada, "¦a dog can get a hip replaced in under a week but a human may wait two to three years."

None of this deters Obama from his insistence on government-run health care. And while he bases the need for reform on cost savings and universal coverage, the Congressional Budget Office recently estimated that Obamacare would increase the federal deficit by more than $1.6-trillion over ten years even while leaving 30 million people uninsured.

This week, Obama is leading a charge to use Democrats to ram through draft health reform legislation in the Senate, excluding Republican input. Obama's rush to pass health care reform by August 1 is the centerpiece of his plan to do a "community reorganization" of America by putting more of the private sector under government control and tying the middle class to government with the major entitlement of health insurance.

But according to Michael Cannon, writing in National Review, "there aren't enough Americans earning more than $250,000 to finance [Obamacare] reform would mean higher taxes for the middle class, violating another promise Obama made during the presidential campaign." Further, "if Congress used Medicare's payment rates and opened the new program to everyone, it could pull 120 million Americans out of private insurance more than half of the private market" and boost the government rolls by an even larger number. Two-thirds of Americans would depend on government for their health care, compared with just over one-quarter today. That would strike a historic blow against even the possibility of limited government."

The public's worries are growing about Obama's overreach. A new Washington Post-ABC News poll finds that "Most respondents are 'very concerned' that health-care reform would lead to higher costs, lower quality, fewer choices, a bigger deficit, diminished insurance coverage and more government bureaucracy." When those polled find out that government-funded health care could put many private insurers out of business because of an inability to compete with Uncle Sam, support for government control sinks to 37 percent.

Medicare and Medicaid illustrate the potential for Obamacare to bankrupt individual states en route to bankrupting the nation and transforming the country into a welfare continent like Europe. Medicare and Medicaid waste, fraud, mismanagement and runaway costs threaten the financial viability of many states, including California and New York. Just as with Obamacare, Medicare and Medicaid use ostensible cost controls mandated by Big Government. But the result has been that patients, hospitals, doctors, pharmaceutical companies and the government itself game the crazy incentives of the system to overuse and overprescribe medicine while stifling more cost efficiency and innovation in medical care.

Obama is selling his health care plan as a way to reform all that. But what he's not telling you is that the price you'll pay (when you're not paying it in higher taxes) includes rationing: of medical procedures, patient-doctor choices, and access to cutting edge new drug" which will all be restricted by government bureaucrats.

Contrary to Obama (and his echo chamber in the mainstream news media), there are alternative health care plans that can be emulated -- using the private economy. In the June 19 Wall Street Journal, Kimberly Strassel wrote about tens of thousands of Safeway employees enjoying quality, cost-effective health care in a program championed by CEO Steve Burd who "blew up the company's existing health care structure and replaced it with one that embodied market principles -- choice, responsibility, competition and price."

The FOX Forum and others, including the Center for Medicine in the Public Interest, are providing outlets for citizens to debate what kind of health care they prefer.

The antidote of public scrutiny is needed. Otherwise, Obama's health care poison pill could kill the private system that makes American medicine the world's best.

SOURCE





4 July, 2009

Is ObamaCare the end of Roe v. Wade?

Talk about the law of unintended consequences. Stated or unstated, a driving force behind modern liberalism takes root in the 1973 Supreme Court decision Roe v. Wade, in which abortion was legalized. The Court found a "right to privacy" guaranteed by the due process clause of the 14th Amendment, saying that a woman had a constitutional right to abort her child up until the "point at which the fetus becomes viable." The Court quite specifically defined viability as the point at which a fetus is "potentially able to live outside the mother's womb, albeit with artificial aid. Viability is usually placed at about seven months (28 weeks) but may occur earlier, even at 24 weeks."

Quite aside from the political acrimony the Roe decision has generated from the day it was issued, the hot debate over President Obama's health care proposal alters the abortion debate in a fashion quite unintended. If passed, ObamaCare could instantly set up a legal confrontation between the principle behind President's health care system -- and the principle undergirding Roe v. Wade. Which in turn would launch a political battle royal between proponents of government health care and abortion rights.

Why? A reading of the Roe decision leaves no doubt whatsoever of what abortion advocates have claimed ever since the opinion was handed down. To quote the Supreme Court decision directly:

"We repeat, however, that the State does have an important and legitimate interest in preserving and protecting the health of the pregnant woman, whether she be a resident of the State or a nonresident who seeks medical consultation and treatment there, and that it has still another important and legitimate interest in protecting the potentiality of human life."

If, as Roe clearly states, "the State does have an important and legitimate interest in preserving and protecting the health [emphasis mine] of the pregnant woman" -- why doesn't it have "an important and legitimate interest" in protecting the health of the rest us? Like, say, the President's own late grandmother? Or U.S. Senator Arlen Specter? Or you?

According to the President himself in his recent health-care infomercial with ABC News, his late grandmother was "somebody who contracted what was diagnosed as terminal cancer. There was unanimity about that. They expected that she'd have six to nine months to live. She fell and broke her hip. And then the question was, does she get hip replacement surgery, even though she was fragile enough that they weren't sure how long she would last, whether she could get through the surgery."

Stop the tape. What if the diagnosis of his grandmother's terminal cancer had been wrong?

The U.S. Senate's newest Democrat, Pennsylvania's Arlen Specter, has vividly written of his own diagnosis with Hodgkin's disease, Stage IVB. Specter's doctor informed him that he should get his affairs in order because his time was short -- Specter was going to die and soon. A stunned Specter decided instead to get a second opinion. By his own account, this decision saved his life and (to the irritation of all sorts of people in both parties) Arlen Specter is still here years later famously running for re-election on the cusp of 80. This was not the case of Obama's grandmother, but a misdiagnosis like Specter's is something that happens all across America every day.

If you don't think so, just check in with those longtime stalwarts of the modern Democratic Party -- medical malpractice lawyers. Indeed, a random visit to the website of lawyers advertising their services as medical malpractice attorneys highlights the fact in detail. Their practice is based on patients who have received a "misdiagnosis" from a physician. Specifically, the law practice seeks clients who have received a misdiagnosis for heart attacks, stroke, and cancer. In the case of cancer patients who have been misdiagnosed, the list of misdiagnosed diseases handled is quite specific: "Breast Cancer, Cervical Cancer, Prostate Cancer, Colon/Rectal Cancer, Skin Cancer." Also listed is "Prenatal Misdiagnosis" resulting in "Cystic Fibrosis, Down Syndrome, Fragile X Syndrome, Sickle Cell Disease, Spina Bifida/Neural Tube Defects, Thalassemia."

Got that? It is the self-appointed job of these entrepreneurial lawyers to go to every length available to prove the doctor in question simply didn't do enough to correctly diagnose and correctly treat the diseases listed by the lawyers themselves. The lawyers are thus at one with patients who believe (as did Arlen Specter) that one more test, one more opinion correctly done -- a second or third or a fourth -- is the one that would have resulted in eventually restoring the patient to health. A health that Roe v. Wade quite specifically says is "an important and legitimate interest" of the State.

Yet here is the President on ABC (with anchor Charlie Gibson) responding to the notion at the very core of the medical malpractice profession and, indeed, of most Americans: that Americans want the freedom -- indeed have the right -- to seek the best health care that exists for themselves and their families. Says the President in the transcript provided by ABC News:

OBAMA: I think families all across America are going through decisions like that all the time. And you're absolutely right that, if it's my family member, it's my wife, if it's my children, if it's my grandmother, I always want them to get the very best care. But here's the problem that we have in our current health care system, is that there is a whole bunch of care that's being provided that every study, every bit of evidence that we have indicates may not be making us healthier.

GIBSON: But you don't know what that test is.

OBAMA: Well, oftentimes we do, though. There are going to be situations where there are going to be disagreements among experts, but often times we do know what makes sense and what doesn't.

Let's parse. The "problem" says the President, "is that there is a whole bunch of care that's being provided that every study, every bit of evidence that we have indicates may not be making us healthier." In other words, the President has just said it that his health care plan, what we will call here ObamaCare, intends to insert a third party -- the government -- between you and your doctor. Why? Because the President, a third party, believes "a whole bunch of care...may not be making us healthier." This is in direct conflict with Roe, which says:

"The right of privacy, whether it be founded in the Fourteenth Amendment's concept of personal liberty and restrictions upon state action, as we feel it is, or, as the District Court determined, in the Ninth Amendment's reservation of rights to the people, is broad enough to encompass a woman's decision whether or not to terminate her pregnancy."

A "woman" as defined in Roe is a person, as in someone who, along with all other Americans of both genders, is entitled to "the Ninth Amendment's reservation of rights to the people" and the 14th Amendment's "concept of personal liberty." She may be pregnant, something not doable for men, but that both men and women are "people" is not in dispute. And whatever else one may say of abortion, it is precisely a medical procedure just as everything from brain surgery to stitches.

According to the principle laid down in Roe, every American (except, of course, the unborn) has the constitutionally protected right to have our health care decided on by ourselves and our doctors, without disapproving courts, legislatures, presidents or health care bureaucrats getting in the way. (In the case of Roe, the third party was the state of Texas.) Roe specifically forbids third parties interfering in the patient-doctor relationship. To say, as the President has said, that "every study, every bit of evidence" produced by some third party (an ObamaCare medical bureaucrat, for example) is somehow relevant to the treatment of a patient -- and that it will be mandatory to heed -- is a direct contravention of the two-party patient-doctor relationship legalized by Roe on the grounds of "personal liberty" and the "right to privacy." The President's ambition is simply to insert the federal government into the role played by the state of Texas in the original Roe decision.

Roe is quite specific as well that "the State does have an important and legitimate interest in preserving and protecting the health of the pregnant woman." In that one partial sentence every American becomes a pregnant woman, their health protected for the same reason as the pregnant woman's -- because the Court found a constitutional protection that does so. If there's any doubt about the sacredness Roe attaches to this principle, which in political and constitutional shorthand has become known as "the right to privacy," Roe restates it a second way. The State, says Roe, has still another "important and legitimate interest in protecting the potentiality of human life." Which it proceeded, to much controversy, to define as the "point at which the fetus becomes viable."

So in ruling out the unviable life -- the fetus -- as worthy of protection, the Court left no doubt whatsoever that "viable" human beings must be protected as the State has a "legitimate interest in protecting the potentiality of human life." Read those phrases again: "viable" and "protecting the potentiality of human life." If you are reading this, you are a "viable" human being as specifically defined by Roe v. Wade. If you have plans for five minutes from now, we are talking about your potentiality for human life.

Whatever else is said about Roe and the argument over the unborn, there is not the slightest doubt whatsoever that the born -- until their last breath is drawn -- meet exactly Roe's standard of "the potentiality of human life." Your beloved spouse, parent, child, relative, friend has at the minimum a potential for something as long as they live. That something could be a Michael Jackson-style 50-concert extravaganza or your 90-year-old mother bringing joy to life by simply holding your hand. Both are physical manifestations of the "potentiality of human life" as specifically defined by Roe. The much publicized exertions to save Michael Jackson are emblematic of the point, and in fact such ministrations go on all across America every single minute of the day. The entire point of frantic efforts to save a life -- Michael Jackson's, yours, your spouse's or the life of someone you have never heard of -- is because of the fundamental belief in that person's "potentiality" in human life.

As long as that question can be answered with any response that implies breathing by a born human, it is very clear that Roe, citing the 14th and 9th Amendments, protects not just the health of a woman but the health of us all. It gives every American with a beating heart a "right to privacy" to make exactly the medical choices they wish to make with their own bodies. Or, in the blunt words of a feminist blogger (the bloggers stylistic phrasing and caps included) over at one very typical liberal site called progressivesonline.com:

Keep Your Hands Off My Body!

I'll make it simple for everyone.

MY BODY belongs to ME

I make decisions alone (or with the help of my family, my doctor, my God) for MY BODY

KEEP YOUR GOVERNMENT HANDS OFF MY BODY!

OK, then! Are we clear?

Well, apparently the President is not.

More here




Canada Sees Boom in Private Health Care Business

Private for-profit clinics are a booming business in Canada -- a country often touted as a successful example of a universal health system. Facing long waits and substandard care, private clinics are proving that Canadians are willing to pay for treatment.

"Any wait time was an enormous frustration for me and also pain. I just couldn't live my life the way I wanted to," says Canadian patient Christine Crossman, who was told she could wait up to a year for an MRI after injuring her hip during an exercise class. Warned she would have to wait for the scan, and then wait even longer for surgery, Crossman opted for a private clinic.

As the Obama administration prepares to launch its legislative effort to create a national health care system, many experts on both sides of the debate cite Canada as a successful model. But the Canadian system is not without its problems. Critics lament the shortage of doctors as patients flood the system, resulting in long waits for some treatment.

"No question, it was worth the money," said Crossman, who paid several hundred dollars and waited just a few days.

Health care delivery in Canada falls largely under provincial jurisdiction, complicating matters. Private for-profit clinics are permitted in some provinces and not allowed in others. Under the Canada Health Act, privately run facilities cannot charge citizens for services covered by government insurance. But a 2005 Supreme Court ruling in Quebec opened the door for patients facing unreasonable wait times to pay-out-of-pocket for private treatment.

"I think there is a fundamental shift in different parts of the country that's beginning to happen. I think people are beginning to realize that they should have a choice," says Luc Boulay, a partner at St. Joseph MRI, a private clinic in Quebec that charges around $700 for most scans.

Yet advocates looking to preserve fairness claim that private clinics undermine the very foundation of the country's healthcare system. "Private clinics don't produce one new doctor, nurse, or specialist. All they do it take the existing ones out of the public system, make wait times longer for everybody else while people who can pay more and more and more money jump the queue for health care services," said Natalie Mehra, member of the Ontario Health Coalition.

Canada spends $3,600 per capita on health care -- almost half of what is spent in the U.S. And while some in Washington look to its northern neighbor for ideas, the Canadian system is still changing. "One can understand that this is evolving and a mix of private and public seems to be favorable in some context. On the other hand, we need to be really careful that we're not treating health care the way we treat a value meal at McDonalds," Dr. Michael Orsini from the University of Ottawa told FOX News.

Provincial governments now face the difficult job of finding a balance in meeting the country's health care needs -- reducing wait times and maintaining fair access without redefining the universal ideals at the core of Canada's health care system.

SOURCE




Obama's "Progressive" vision for healthcare goes back to Hegel, not Jefferson

President Obama has one distinguishing feature. He is a man of rigid self-discipline. Politicians are a lot like actors: they tend to be vain; and, more often than the rest of us, they are presented with the temptations to which the vain are prone. Many--one thinks of Bill Clinton, John Edwards, John Ensign, and Mark Sanford--succumb. If, however, in his personal life as an adult, Barack Obama has strayed from the straight and narrow, we have heard nary a word.

It is, in fact, a sign of his astonishing self-discipline that we know next to nothing about his life apart from what he chose to impart in the two autobiographies he published. For a long time now, for longer than we can perhaps imagine, every move he has made has been carefully calculated, calibrated, and choreographed. In this regard, he is in the fullest sense what every politician aims to be: a self-made (one might even say a self-invented) man. It is easy to see why someone like Evan Thomas should think him a god.

Once in a while, however, when Obama gets separated from his teleprompter, the mask slips a tad. On the hustings, Joe the Plumber caught the candidate off guard and got him to admit the truth about his plans to effect a redistribution of wealth. Something of the sort happened again last week--when, at a carefully staged rally for the administration's health care proposal, to which the flacks who run ABC News tellingly invited no one who regards the current healthcare arrangement as even remotely satisfactory--President Obama responded to a question by acknowledging that his plan aimed to reduce medical costs by aligning "incentives" in such a fashion as to discourage the sick and the dying from undergoing "additional tests" or taking "additional drugs that the evidence shows is not necessarily going to improve care."

Obama's choice of words was, as always, soothing. But anyone familiar with the healthcare debate will immediately recognize what he left unsaid. We all know that, wherever there is socialized medicine, there is rationing. Cutting costs is, in fact, its rationale, and this end is achieved by a refusal on the part of the government to pay for care that the bureaucrats judge uneconomic. Already now, in the semi-socialized system to which we have been made subject, those consigned to HMOs come up against gatekeepers charged with shaving costs by restricting care.

Why, we might ask, should one have to wait months or even years for a hip-replacement operation? Why should one be denied a cataract operation if one is over a certain age? What business is it of Barack Obama's whether I choose to spend my own hard-earned money on procedures thought to have only a limited chance of success? What gives him--or, for that matter, anyone else--the right to make decisions that are for me a matter of life and death?

Defenders of Obama's proposal will reply that I am misrepresenting his proposal. No one, they will say, will be forced to give up the health insurance they have. Technically, of course, this is true. But what President Obama calls the "incentives" will be structured in such a way that employers will no longer have to offer coverage, and to save themselves the expense (which is considerable), they will seize the opportunity to opt out, and then we will have no choice.

Perhaps we will then be left free to spend as we see fit the money left to us after we have paid for the government-run insurance program. Perhaps we will be able to go into the private market and pay for a hip-replacement operation, a cataract operation, or for tests and procedures that our doctor recommends but that the government-run insurance program refuses to pay for.

Here is where Obama's "incentives" reappear. The government-run insurance program will, for all practical purposes, be a monopsony--the sole purchaser. It will be in a bargaining position enabling it to dictate the price that it will pay, and, of course, it will pay very little. You, as an individual purchaser, will have no leverage at all; and, like those not covered by employer-sponsored insurance plans today, you will have to pay through the nose. Unless you are filthy rich, you may well have to wait your turn for that hip-replacement operation, forego that cataract operation, or do without those expensive tests and procedures. In sum, you will not be in the driver's seat.

To grasp what is at stake, one must step back and consider what sort of thinking underpins the drive for what is called "health care reform." There was a time in the United States when we lived under a regime of individual rights, and as individuals we assumed responsibility for our own welfare. We worked; we saved; and we took pride in looking after ourselves. Many of us still think in this fashion, but this is not the manner in which our masters now think. We may be the heirs of the men who adopted the Declaration of Independence; those who rule us are the offspring of the Progressives, and men of this temper have dominated our political life for almost a century now.

Back in 1912, when Woodrow Wilson successfully ran for the presidency, he told his compatriots, "We are in the presence of a new organization of society." Our time marks "a new social stage, a new era of human relationships, a new stagesetting for the drama of life," and "the old political formulas do not fit the present problems: they read now like documents taken out of a forgotten age." What Thomas Jefferson once taught is now, he insisted, quite out of date. It is "what we used to think in the old-fashioned days when life was very simple." Above all else, he hoped to persuade his compatriots to get "beyond the Declaration of Independence." That document "did not mention the questions of our day," he told them. "It is of no consequence to us. It is an eminently practical document, meant for the use of practical men; not a thesis for philosophers, but a whip for tyrants; not a theory