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31 March, 2007
Single payer: is there anything it can't do?
Americans are a litigious people. We love to sue each other. We’re so eager to take our neighbors to court that, sometimes, we’ll file suit even when we don’t have a case. Doctors and hospitals are prime targets of the lawsuit industry. Hey, they cut people open on purpose at hospitals. It’s their job. Mistakes – real and imagined – can happen.
Some of us think this is driving up the cost of health care. Every lawsuit against a doctor or hospital means cost – legal fees, time lost, etc. A lost case or a settlement means the defendant has to pay the damages, or, more likely, the defendant’s insurance has to pay. Both defendant and insurance have to make a profit. Thus, the cost of lawsuits is reflected in the cost of health care. So. Tort reform. Lawsuit reform. Bringing some sanity to the legal system. Making it harder to pursue frivolous cases. Putting limits on punitive damages. Given the unrelenting wailing and gnashing of teeth over the state of American health care today, these are all legitimate ideas.
But the Tomah Journal takes it even farther. Instead of just reforming the legal system, they opine, let’s remove it from the equation entirely: "There’s a better approach: Join the rest of the industrialized world and establish single-payer universal health care. Billions of dollars worth of lawsuits would suddenly evaporate if lawyers could no longer haggle over million-dollar medical bills." That’s an interesting suggestion. Or, at least, an original one. They’re right: make it a single-payer system, and suddenly there’s nobody to sue. Your insurance company doesn’t have to pick up the tab for somebody else’s mistake.
Sure, there’d still be pain and suffering. Lost wages. That sort of thing. I’m sure the government would take steps to protect itself from lawsuits. Heck, they already do. When it’s the government being sued, suddenly limits on damage awards are in the public interest.
I’ll do the Journal one better: let’s nationalize all industry in the country. Because if government owns industry, “billions of dollars” of product liability lawsuits would “suddenly evaporate,” too. Anyone who’s been following the story of Walter Reed Army Medical Center – the veterans’ hospital that is treating its patients worse than the Marines at Gitmo treat their prisoners – knows just how well the government handles big things like health care. If that’s not enough, consider Great Britain’s National Health Service – an actual example of nationalized health care. Childbirth mortality has grown by 21% over the past three years.
"Record numbers of women are being harmed or dying as a direct result of childbirth in what doctors are labelling a "crisis" in maternity care.
…
The UK now has one of the highest rates of maternal mortality in Europe, with 13 deaths per 100,000. Britain ranks below countries including Poland and Hungary, and is above Bulgaria, Bosnia, Belarus, Romania, Armenia and Albania."
And the Tomah Journal may want to read this part (emphasis added):
"The scale of the maltreatment has led to soaring medical negligence claims from mothers. The bill to the NHS has hit 1 billion pounds for the past five years. Two-thirds of the 100 largest payouts by NHS trusts for medical negligence are now to women who have suffered traumatic childbirth experiences…"
Yep, sounds like socialized, nationalized, single-payer health care is just the answer we need.
Nobody claims our system of delivering health care is perfect. It’s not. But expecting government to make the imperfect perfect is like expecting Randy Moss to make the Packers a playoff team. You’re just exchanging one set of problems for another. Over time, our government will expand on the services covered by a nationalized health care plan. Little by little by little, every time another tragic tale of an uncovered illness or injury emerged, the program will get that much bigger.
And as more and more people realize they can go to the doctor as much as they want for free, they’ll start doing just that. Which means more bills piling up for the single payer – government – us - to pay. Which leads to government trying to contain costs. Which leads to…well, read that story in The Independent again. It all leads to that.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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30 March, 2007
NHS crisis is forcing cuts to maternity care, charity warns
Support for pregnant women is being cut because of the NHS's financial troubles, a healthcare charity has warned. The National Childbirth Trust (NCT) says it is receiving "increasing reports" that NHS antenatal classes, breastfeeding services and postnatal visits are being cancelled.
NHS antenatal classes have been cut or suspended in at least 10 areas in England and Wales, according to the NCT. These are Romsey in Hampshire; Worcestershire; Newham in London; Watford; Gwent in south Wales; south-west Kent; Nottinghamshire; Gloucestershire; Hemel Hempstead in Hertfordshire; and Wiltshire.
The NCT said it also understood that postnatal home visits have been stopped or are facing cuts in Wiltshire and in east and north Hertfordshire, which would mean new mothers have to travel to a clinic in order to receive after-birth care. An NCT spokeswoman said: "These cuts in maternity services may reflect a more widespread pattern. "The NCT is concerned that these short-term measures to ease financial deficits are having a negative effect on new parents and parents-to-be, preventing them from getting the information and support they need at this important stage in their lives."
The Department of Health (DoH) said it expected local NHS trusts to follow guidelines set down in the children's national service framework which says good antenatal care will include access to parenting education and preparation for birth "as classes or through other means".
A DoH spokesman said: "The soon-to-be-published maternity strategy will set out how we will achieve services that provide real choice and support for women in all settings, from antenatal care through to the early child years."
Source
IMPOSSIBLE TO INSURE EVERYONE AGAINST EVERYTHING
There's a gazillion ways the body can break down, and some folks want every last one of them covered by insurance. And if that weren't enough, we're seeing pressure to cover things that don't threaten health. Such things as birth control, fertility treatments, Viagra, abortions, sex change operations, cosmetic surgery; what folks once called non-essentials and electives. Expanding the number of things covered by insurance increases demand.
All of which redounds to this: EVERYONE with health insurance is going to be filing a claim. That's a hyperbole of course, as there are a few genetically blessed individuals who neither get sick nor need sex change operations. But the statement is close enough for government work. And it is a violation of the basic laws of the insurance business.
But wait. It gets better. There's a movement afoot to insure EVERYONE. We're talking about adding 46.6 million souls to the insurance rolls. Many of the uninsured are either unemployed or unemployable, and those who are employed have employers who cannot afford to pay for their health insurance. So it will fall to the taxpayer to pick up the tab. Life expectancy continues to rise, which means we have more time in which to file claims. And California governor Schwarzenegger wants to insure illegal aliens.
Bottom line: We have "unlimited" demand for a product in limited supply-and someone else is supposed to pay for it.
HOW can the health insurance business survive?
Well, it's not supposed to. At least that's the position of the political left, which wants to nationalize healthcare. The left doesn't like the baggage that comes with "national healthcare" and "socialized medicine". They prefer to talk about "universal healthcare", "single-payer", "social insurance", or some other softer-sounding thing. But it's all the same thing.
NYTimes columnist Paul Krugman posits the "starve the beast" strategy of the right. But there's a leftist analog: "ride the beast into the ground". That is, load up so many mandates and requirements on the beast-the health insurance business-that it collapses and folds. Then the socialists step into the breech like white knights and save the day with their government system. The reason one might believe such a conspiracy theory is because the socialist reformers aren't putting forth any serious proposals to keep costs down, and without such the beast will indeed buckle, collapse, and go out of business.
Part of the solution to the problem of escalating healthcare costs is simple-reduce demand. Get healthy, so you don't have to use the healthcare system. Change your "lifestyle", go on a diet, start exercising, stop smoking, moderate your drinking, and give up the drugs. Indeed, if America were to have a universal single-payer healthcare system, wouldn't it be everyone's duty to get healthy so that we can get healthcare costs down? But are the healthcare reformers going to demand that folks do the right thing and start taking care of themselves so that healthcare costs don't spiral further out of control? They aren't-because they can't. And that is the dirty little secret of the reformists.
The government can't be constantly monitoring everybody, making sure they eat their spinach, and walk their 5 miles a day. It would involve a mammoth bureaucracy. Besides, people have a right to be unhealthy. They have a right to eat whatever the heck they want, and in super-sized portions. They have a right to gorge on trans-fats, swill booze, smoke cigs, dip snuff, or whatever, and to their hearts' content, and if it ruins their health-tough. Folks aren't going to change their "lifestyle" just so some utopian universal healthcare system can be made feasible. And if the feds try to take away the sole pleasures in our dreary little lives, there'll be hell to pay and a nice revolution to boot. People have a right to be irresponsible, as long as it doesn't hurt anyone else. But what the utopian reformists don't understand and won't accept is that the rest of us-the tofu-eating, jogging, responsible rest of us-shouldn't have to subsidize irresponsibility and bad behavior by paying the medical bills of the slobs. Escalating healthcare costs due to self-inflicted diseases and imprudent "lifestyle" are going to "run the beast into the ground".
Are there any conservatives out there?
The new universal healthcare plans enacted in Massachusetts and proposed in California require individuals to purchase health insurance. Despite what they tell you, this is not analogous to requiring auto insurance; folks can choose not to drive, and some are unable to drive or are not allowed to. No, this requirement is of a different order altogether; it's worse than a poll tax-it's an existence tax. But if government can demand that individuals buy health insurance for themselves as well as pay taxes for those who can't afford to buy it, shouldn't government at least be able to demand that individuals improve their "lifestyle" and habits so that those who are paying won't have to pay so much? We've been down this road before, during Prohibition. Is America really ready for it again? Just what kind of fascist police state are you willing to put up with?
So it appears that universal healthcare is going to require the responsible, prudent, taxpaying adults amongst us, who delay gratification and regularly save and invest for the future, to subsidize with their taxes behavior they would never countenance in themselves. The reformers think folks should be able to lead a life of dissipation and then check in at the nearest hospital saying, "fix me", and that you should pay for it. But aren't the socialists forcing the taxpayer to take part in immorality? It seems a bit much to ask.
And another thing: Just how "comprehensive" is universal healthcare supposed to be? Are those getting a free ride supposed to get the very same healthcare as those who pay? Is every unemployed, homeless cirrhotic wino supposed to get a liver transplant? And will they be put at the back of the waiting list? How much are we willing to pay for the psychiatric care for the drug-addled underclass? What are the healthcare reform grandees going to require of these people to keep costs down? These are the kinds of the questions that must be answered by the reformers.
Entitlements:
David Walker, the U.S. Comptroller General, the nation's top accountant, is horrified by the actuarial nightmare imposed by entitlements. Walker told Steve Kroft of CBS News: "the real problem, Steve, is health care costs. Our health care problem is much more significant than Social Security." Walker assures us that our present course with entitlement spending is unsustainable and immoral. But socialists want more.
Entitlements account for an ever-growing share of the federal budget; way over half. Entitlements, after having "run the beast into the ground", will run the federal government into the ground. In trying to make government a cornucopia, the reformers simply lack the ability to say "no". Instead of throwing yet more money at this problem, we should instead institute a "freeze" or a budget cap on entitlements. Which could involve means testing or cross-the-board cuts. We should also institute a mechanism that requires all redemptions of federal "trust fund" treasuries to come only out of general fund surpluses (if any), which this writer has urged here.
The federal government, including its entitlement programs, operates entirely on a cash-flow basis. Incoming revenue is immediately spent. If there's a surplus, the feds must spend it as well; e.g., by retiring debt. Medicare isn't amassing reserve funds for your next round of chemotherapy; the money will come from future tax revenue. The federal government has no legal mechanism to save money. The so-called "trust funds" are full of nothing but IOUs.
But corporations and individuals can't operate like the feds; they must set money aside. Folks who don't trust the feds to be there for them, or who are offended by the way the feds operate, or who want to be assured that funds will be waiting for them when they need it, should be allowed to opt out of federal programs....
More here
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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29 March, 2007
British man denied "too expensive" heart surgery
Health insurance that isn't
A seriously ill man has been told he cannot have a potentially life-saving operation on the NHS because his local primary care trust will not pay for it. Paul Carter, 66, of Malvern, was told by a specialist he needed biventricular pacing fitted for his enlarged heart. But Worcestershire Primary Health Care Trust has refused, saying the advanced pacemaker surgery would cost 8,000 pounds. It said it could not afford the 400,000 pounds it would cost each year to provide the surgery to patients.
The primary care trust's Dr Richard Harling said: "Any funding would have to come from other services. "For the PCT to justify introducing (biventricular pacing) we would have to be sure that it was a better use of this money than our other local services."
Mr Carter's wife Marjorie said: "We are very upset. Working all your life and having to face an operation and then you can't get it done is a bit distressing."
The National Institute for Health and Clinical Excellence (Nice), which offers guidance to primary care trusts over whether a treatment is cost effective, is due to make a decision over the treatment in July. The Department of Health said, until Nice's guidance was published, the final decision on funding lay with individual trusts.
Source
Wonder drug NHS bosses can't afford to offer cancer victims
CASH-strapped NHS bosses are denying thousands of Midland kidney cancer patients two new 'wonder drugs' that could prolong their lives. A Birmingham oncologist has likened the scandal surrounding Sutent and Nexavar to that of breast cancer treatment Herceptin, which was denied to sufferers until a public outcry last year. Professor Nicholas James revealed that Midland health chiefs are refusing to fund some of his patients with the kidney cancer treatments, licensed for use in Britain last August.
Trials have shown that Sutent and Nexavar can offer patients a dramatic improvement in quality of life - and increase life expectancy by two years. That compares favourably to Interferon-alpha, the kidney cancer treatment currently available on the NHS, which lengthens lives by just five months on average.
But Sutent and Nexavar cost 3,000 pounds a month to fund, and have not yet been approved as 'cost-effective' by the National Institute for Clinical Excellence (NICE). As a result, funding decisions are currently being taken by individual Primary Care Trusts (PCTs), who are said to be rejecting most NHS patients. Kidney cancer sufferers are so desperate to experience the drugs' life-extending benefits that they are cashing in pensions and selling homes to fund the treatment themselves.
Prof James, a clinical oncology expert from Birmingham University's Wellcome Institute, said: "Around 6,000 people in Britain are diagnosed with kidney cancer every year, and it kills up to 4,000 people every 12 months. "Initially, you can be treated with radiotherapy, chemotherapy and surgery. But, until August last year, if it came back there was no hope. "The approval by the Medicines and Healthcare products Regulatory Agency (MHRA) of Sutent and Nexavar, licensed last August, has changed all that.
"It was a big step forward in terms of treatment options for kidney cancer patients. "But although the drugs had been approved by the Agency, NICE has not yet given them the go-ahead as being cost-effective for NHS patients. "This is where our problem lies. We have drugs available to treat our patients, but they are not routinely available on the NHS because they have not been approved by NICE. "This means I have some patients who were involved in the trials for these drugs who can continue treatment. "But others have to rely on decisions of their individual PCTs to see if they will fund them.
"When this happened with Herceptin, there was a huge uproar. NICE eventually approved the drug. "Up to 40,000 women are diagnosed with breast cancer each year in Britain, so the numbers affected were far greater and they could kick up a bigger fuss. "Meanwhile, there are thousands of kidney cancer patients who could benefit from these new drugs, but who are finding it difficult to make their voices heard."
Two men for every woman is diagnosed with kidney cancer, which tends to affect those aged from 30 to 60. Prof James added: "It's a ridiculous situation. If a drug is approved by the MHRA, it should automatically be approved by NICE. "It is unfair that some patients can have access to the drugs, which have proved to be highly effective at prolonging life and improving life quality, yet others aren't.
"It is a ghastly decision for the PCT to have to make. "There are several Midland patients who can't afford the drugs, while others have remortgaged their homes and cashed in their pensions so they can be treated."
Radio presenter James Whale, who has kidney cancer, is backing the campaign to have Sutent and Nexavar offered free to NHS patients. "In the past, people with advanced kidney cancer had little hope," he said. "Now, drugs like Sutent and Nexavar are their only chance of precious extra months of life."
A Department of Health Spokesman said: "Our guidance makes it clear to NHS organisations that they should not refuse to fund a treatment simply because NICE guidance does not yet exist. "Until NICE has issued final guidance on a treatment, NHS bodies should continue with local arrangements for the managed introduction of new technologies, taking into account all the available evidence."
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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28 March, 2007
Democrat’s strange healthcare mathematics
As I was reading about the Democratic candidates forum in Nevada yesterday, I realized that both Bill Richardson and John Edwards need some math help. Both claimed that for between $90 and $120 Billion dollars a year they can provide “universal health care” for America. Now, the WaPo and www.americansforrichardson.org website don’t make it clear if that price is for all 320 million of us, or just the 46 million without health coverage. Either way, these guys need to look at their numbers, and to give them the benefit of the doubt, I’ll use the premise they are only talking about the uninsured. If I speculated that they were going to cover all of us then it becomes too funny to think about.
Back to the math, if either or both are only talking about the 45 million or so without coverage, that means that they are going to get Medicare to cover them for about $2600 per year. Currently Medicare covers just over 30 million people with a budget of $300 Billion. That comes out to $10,000 per year per person covered. How exactly are they going to get that number cut by 75%?
And, if it’s possible to do that, why not just lower the cost for everyone covered? Using their claimed numbers from yesterday we should be able to cut the Medicare budget by 1/3 from it’s current level and still cover the 76 million uninsured and elderly who would be eligible.
Universal health care polls great. Folks love the idea of everyone being covered, and no worries about health care. The truth is though, universal coverage isn’t going to come cheap, and it’s not going to come easy.
More here
Strange NHS priorities
Tom and Donna (not their real names) are professional shamen. They teach classes in shamanism at a “foundation”, where you can learn “soul retrieval healing”, help the dead “continue their journey into the Hereafter”, and investigate “the Fairy Kingdom”. These soul retrievers and Fairy Kingdom investigators also work for the NHS — where, according to Tom’s foundation profile, they “use complementary therapies to help those with mental health difficulties”.
Shaman therapies are not the only unorthodox treatments for which the NHS will gladly pay. Taxpayers are also subsidising Emotional Freedom Technique (EFT) “therapy”, in which, according to one NHS trust, “subtle energies” are reordered via “tapping with the fingertips to stimulate certain meridian energy points while the client is ‘tuned in’ to the problem”. The inventor of EFT notes on his website that he “is not a licensed health professional”, which doesn’t stop him promoting it as an effective treatment for diabetes — unsurprising, since it works for “just about every emotional, health and performance issue you can name”.
If EFT doesn’t do the job, an NHS foot massage might help. Reflexologists believe that each part of the foot maps to a different organ, and that massaging a particular point can treat that organ. Medical doctors think it’s absurd. This is not to say that the NHS doesn’t have a sceptical side — even it is dubious about homeopathy, pointing out that “no evidence has been found” to support the key homeopathic principle that water retains a “memory” of molecules that have been filtered out of it, and that pure distilled water is an effective treatment for a host of conditions.
Since the NHS believes that the entire basis of homeopathy is “contrary to scientific knowledge”, the obvious question becomes: why is it funding five homeopathic hospitals? Most depressing of all for the rational taxpayer is the NHS Directory for Alternative and Complementary Medicine, which aims to promote “dowsers”, “flower therapists” and “crystal healers”.
We’ve just learnt that some hospitals are removing every third light bulb to save money, and that nurses are being paid half the minimum wage — or being asked to work for nothing — at others. That’s how bad the financial crisis has become. Meanwhile, the National Health Service is employing shaman fairy enthusiasts as psychological counsellors, enthusiastically providing treatments invented by “an ordained minister and a personal performance coach” who thinks tapping your body can cure diabetes, promoting dowsers and crystal healers and spending vast amounts on therapies that can’t be scientifically supported.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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27 March, 2007
Whose life is it anyway?
University of Virginia student Abigail Burroughs died of head and neck cancer at age 21 on June 9, 2001. She died while fighting to gain access to promising experimental anti-cancer drugs recommended by her oncologist at Johns Hopkins University Hospital. Her father, Frank Burroughs, founded the Abigail Alliance for Better Access to Developmental Drugs and sued the Food and Drug Administration, arguing that terminal cancer patients have a constitutional right to try to gain access to developmental medicines that the agency has not yet approved.
In May 2006, the Alliance won its case before the U.S. Court of Appeals for the District of Columbia which ruled that "barring a terminally ill patient from the use of a potentially lifesaving treatment impinges on this right of self-preservation." The Appeals Court sent the case back to District Court to consider if the protected liberty interests of terminally patients outweigh the FDA's interest in insuring the provision of safe and effective drugs. Yesterday, March 1, the full Appeals Court reheard the case at the request of the FDA.
Earlier this week, the Food and Drug Law Institute held a colloquium, "Whose Life Is It Anyway?," on the issue. Scott Ballenger, the lawyer who is representing the Abigail Alliance before the Appeals Court, noted that the legal question before the court is what standard should apply to the case. Is trying to gain access to potentially life-saving medicines unapproved by the FDA a fundamental right or merely an economic right subject to regulations established by political authorities? Can the government properly assert that it has a compelling interest to deny dying patients access to potentially life-saving drugs?
Ballenger compared the situation to self-defense. "Self defense is the most obvious and self-evident rights of men," he asserted. "No state can deny someone self-defense in the face of an attack." Ballenger argued that if the law recognizes that people have the right to defend themselves from attack by a bear or infectious bacteria, then surely they have the right to defend themselves against a rogue cancer cell.
At the colloquium, food and drug lawyer Richard Cooper agreed that the issue is whether some rights are so fundamental that we do not entrust them to decisions made by elected officials. Until recently, establishing agencies to regulate the safety and efficacy of drugs was thought to be within the purview of Congress. "I doubt that most people thought that they had a constitutional right to buy investigational drugs," said Cooper. "It's a wholly new, unheard of right with no antecedents in Anglo-American law." If people want to change the way the FDA regulates patient access to investigational drugs, Cooper argued, they can petition the FDA and Congress and eventually vote out members of Congress who refuse to change the regulations.
Cooper noted that the Supreme Court ruled in 1979 that cancer patients did not have a constitutional right to access the cancer treatment laetrile. The court reasoned that access to the drug might be restricted on the grounds that laetrile had not passed the hurdle of FDA safety testing. However, the Alliance argues that this ruling does not apply because it is asking only for the same right of access enjoyed by those terminally ill patients who are lucky enough to be enrolled in an FDA-approved efficacy trial.
Ballenger continued that federal courts have recognized a number of fundamental rights and not all of them deal with life and death issues, including the right to teach your children German, educate them in private school, live with family members under one roof, view pornography at home, and engage in homosexual sodomy. Some other fundamental rights recognized by federal courts are the right to interracial marriage, to use contraception, to worship, and to obtain abortions.
University of Pennsylvania bioethicist Arthur Caplan pointed out that it was difficult to figure out who qualifies for the category "terminally ill." He also asked wyhy terminal illness in and of itself should give a patient a privilege or a right. After all, a patient who has exhausted standard treatments for some kind of severe disability, say, Parkinsonism, macular degeneration, or dementia, could argue that they have a right to access potentially better drugs that the FDA has not yet approved.
Scott Gottlieb, who has just stepped down as deputy commissioner at the FDA, thinks that "terminal patients should have access to experimental drugs after exhausting other treatments" He noted that FDA bureaucrats are concerned that opening access to investigational drugs to terminal patients might imperil the agency's ability to collect good data on drug safety and efficacy. They think that they are balancing individuals' interests in getting cutting edge treatments now against society's interest in obtaining more information in order to get more drugs to more people eventually.
Gottlieb noted that there is a marketplace issue. Companies have a disincentive to offer access outside of clinical trials. Why? Because side effects or other adverse events would be reported from patients who had not met the criteria for clinical trials. The companies fear that an already hyper-cautious agency would use such adverse event reports from outside of clinical trials as a justification for slowing the approval of a drug. Gottlieb told the colloquium that many inside the FDA believe that it is more important and better for society in the long run to gain good clinical data about a drug than it is to try to save the lives of individual patients. "I don't think the choice is that stark," said Gottlieb. "The FDA could pursue both goals."
Gottlieb asserted that the FDA is failing to use its authority to strike a balance on this issue. He suggested that the agency could start to develop alternatives to randomized placebo controlled clinical trials, perhaps incorporating Bayesian techniques. The FDA could also develop and validate surrogate clinical endpoints so that results can be known sooner than the results from trials that rely on long term survival rates. Gottlieb pointed out that new cancer drugs are rarely held up on safety grounds, so research should focus more quickly on efficacy. He does worry that the agency has begun to refuse to approve drugs that have fewer side effects but are less efficacious than earlier more brutal treatments. The agency fears that patients would trade off a higher risk of dying for fewer side effects. Why mentally competent people in consultation with their physicians should not be allowed to make such tradeoffs is not at all clear.
Mark Gately, a Baltimore attorney who defends pharmaceutical firms, pointed out another big issue in this debate -- the fact that federal law forbids a patient using experimental drugs from waiving negligence. Gately litigated the case involving patients enrolled in clinical trials for the drug GDNF, developed by Amgen to control Parkinsonism. The clinical trial did not find the drug to be efficacious, but many patients, who believed that they did benefit from it, sued the company demanding continued access to it. The company refused because it was worried by research that showed that the drug caused some brain damage in monkeys. According to Gately, a Kentucky judge asked the lawyer who represented two of a clinical trial participants, "What happens when one dies?" The lawyer answered, "They know what they are getting into. There will be no lawsuit." The judge replied, "This is America. If one dies, there will be a lawsuit." The bottom line for Gately: "Drug companies will be hard pressed to provide these drugs unless they are provided some protection from legal attacks."
For Frank Palumbo, who is the executive director of the University of Maryland's School of Pharmacy Center on Drugs and Public Policy, the central question is: "If patients are allowed access to these investigational drugs for the purpose of treating terminal illness, how can they afford them?" Newer cancer therapies are very expensive, some costing $10,000 per month.
After the somewhat dispassionate presentations of the panelists, representatives from the Abigail Alliance made themselves heard during the question and answer period. Steve Walker, the chief advisor to the Alliance explained what had happened to Abigail. She had exhausted all of the approved therapies. Her oncologist believed that the then-investigational anti-cancer therapy, Erbitux, being developed by ImClone might work for her because the drug was targeted against the EGFR receptor that encourages cancers to grow. Abigail's cancer had a very high EGFR expression. Despite preliminary evidence that it was an effective treatment for head and neck cancer, she did not qualify for clinical trials which were being run at the time only for colon cancer. The FDA approved the drug for treating head and neck cancer in March 2006. Erbitux boosts average head and neck cancer survival rates by about 2 years.
Walker noted that the current clinical trial system was devised 50 years ago in an era of medical ignorance. Today, researchers use genomic information to develop targeted drugs. Walker pointed to a current clinical trial involving a drug that early trials show works "unbelievably well" against metastatic kidney cancer. According to Walker, the FDA is insisting on randomized placebo controlled trial for approval. "Everyone knows the drug works," said Walker. So the end result is that the cancers in patients enrolled in the placebo end of the trial will have gotten worse by the time the FDA approves the drug in the next 4 or 5 months.
Ballenger pointed out that the American Society of Clinical Oncology (ASCO) had actually made the argument in its amicus brief in the current Abigail Alliance suit that terminal patients are desperate so they can't give informed consent, yet somehow ASCO also argues that such desperate patients can give informed consent to participate in clinical trials. Is ASCO willing to sacrifice patients who might benefit from investigational treatments in order to maintain a pool of research subjects? Ballenger said, "I do not think that this is an ethical line of argumentation."
Ballenger added, "I am more than happy to concede that the FDA has a compelling state interest to protect medical progress if the FDA can prove that expanded access to investigational drugs will imperil clinical trials. The fact is that most trials are over enrolled and that most people asking for expanded access don't qualify for the trials anyway. Standing in the way of expanded access is just perverse."
Abigail's father Frank Burroughs wrapped up the presentation for the colloquium participants. "Every drug that we've pushed for early access to over the past six years--all are now approved by the FDA." Thousands died waiting for the FDA bureaucracy to let cancer drugs that would have lengthened and perhaps even saved their lives onto the market. Perhaps finding that mentally competent terminal cancer patients do have a fundamental right to access investigational drugs will finally spur the FDA to stop clinging to an outdated mid-20th century cancer clinical trial system and embrace one more suited to the 21st century science. The millions of us who will one day develop cancer had better hope so.
Source
Australia: Amazing bureaucracy stymies vital checks on foreign doctors
Since overseas-trained doctors, mainly from India, have done great harm to Australian patients (including deaths) this is a matter of considerable importance
Plans to establish a national system to rigorously assess the competence of overseas-trained doctors have stalled after the NSW Government rejected a range of measures backed by the other states and territories. The recommendations include standardised supervision guidelines for all overseas-trained doctors and the creation of an independent body to assess doctors' qualifications and clinical skills.
"All the jurisdictions have signed off on the improved standards to assess doctors trained overseas, bar one," said Australian Medical Association president Mukesh Haikerwal. "I don't know why NSW is dragging its feet."
The Council of Australian Governments announced in July last year that new nationally consistent guidelines to assess doctors would replace the ad hoc state-based systems. Overseas-trained doctors working in Australia are normally assessed by the Australian Medical Council. However, doctors who come from countries with similar medical systems to Australia's can enter the country on temporary visas and are not required to take the AMC's examinations if they agree to work in an area of need.
A report commissioned by the Howard Government, but never released, found more than 3500 doctors enter Australia every year on temporary visas and are given jobs without having their competence assessed by the AMC. The report recommends that all overseas-trained doctors should undergo a standardised assessment process before commencing work in this country.
Lesleyanne Hawthorne, associate dean international of the University of Melbourne's faculty of medicine and author of the report, warned that it was unlikely all the states would agree on how doctors should be evaluated. "The idea of getting uniform screening standards that every state will sign up to is a pipedream, because the states are competing with each other to attract overseas-trained doctors," Dr Hawthorne said.
The NSW Department of Health would not explain why it opposed the changes. "The commonwealth and the states are still in discussion on the matter to develop final proposals for agreement by health ministers," the department said in a statement. "NSW continues to work closely with other states and territories to ensure doctors from countries which have been assessed as having equal standards to Australia do not face unnecessary restrictive barriers to employment."
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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26 March, 2007
Increased Canadian government health-care spending not helping
The federal government has provided provinces with an extra $36 billion in transfers for health care since 1997, yet Canada's health care system is in worse shape now than it was 10 years ago, according to a new report by the Fraser Institute. Consider:
* Between 1980 and 1997, federal transfers for health care spending were relatively stable, and from 1988-89 to 1997-98, the average annual growth rate in federal health care transfers was 1.4 per cent.
* But starting in1997-98, spending ballooned to 12.9 per cent, when just 3.1 per cent would have been required to keep pace with population growth and inflation.
* In total, the federal government has provided the provinces with $234.5 billion in cash transfers for health since 1980-81, but more than half that amount -- $115.7 billion -- has come since 1997-98.
Meanwhile, says the Institute:
* In 2006, the average Canadian could expect to wait 17.8 weeks from the time of a referral from a General Practitioner to the time a specialist delivered the treatment required, compared to 11.9 weeks in 1997; a nearly 50 percent increase.
* Total wait time for treatment was the result of a 72.5 per cent increase in the wait time to see a specialist after referral by a general practitioner, and a 32.4 percent increase in the wait time to receive treatment after an appointment with a specialist.
* The wait time for a CT scan increased from 4.1 weeks to 4.3 weeks between 1997 and 2006 while the wait time for an MRI scan went from 9.6 weeks in 1997 to 10.3 weeks in 2006 -- indicating that additional funding has not improved technology.
Source: "Canadian health care system shows little improvement despite extra $36 billion in federal transfers since 1997," CNW Group, March 13, 2007.
Source
Australia: New mothers badly treated in government hospitals
A CRISIS in Queensland's maternity service is leaving one in three mothers traumatised and endangering the health of their babies. A Sunday Mail investigation has revealed shocking lapses in care in overcrowded maternity units, with mothers going into labour in corridors and others pressured into having unnecessary caesarean deliveries. Poor post-natal care has led to some women needing emergency hysterectomies after developing avoidable infections.
A new study by Jenny Gamble, state president of the Australian College of Midwives, has found 30 per cent of mums experience symptoms of psychological stress after giving birth in Queensland hospitals. Lobby group the Maternity Coalition said overcrowding was now a problem statewide following the closure of 38 maternity units. In rural Queensland, a different study shows five women a week give birth before reaching a hospital with specialised maternity care.
The State Government was warned of the appalling state of maternity services two years ago, but midwives say it has so far failed to help frontline staff or their patients.
A Sunshine Coast couple have launched a court action against Queensland Health, alleging their son was born with cerebral palsy as a result of an emergency caesarean. On Thursday, an inquest was told that a young Brisbane mother suffered a fatal brain haemorrhage after another caesarean delivery.
Maternity Coalition president Joanne Smethurst said Australia's standard of care was almost "Third World". "The health of mothers and babies is suffering every day, but the Government has wasted two years doing nothing," she said, adding that hospitals were encouraging women to be induced and undergo caesareans because of a shortage of midwives and beds. Queensland has a caesarean rate of 32 per cent. The World Health Organisation recommends 10-15 per cent. Dr Gamble, who also runs the midwifery program at Griffith University, wants a community midwife scheme introduced: "We know what the problems are, we just need the Government to get on with it."
Since 1995, Queensland Health has received 20 reports on the state of its maternity services. The most recent, presented by the department's maternity services steering committee, said action was needed to improve care for women in rural areas and called for the introduction of post-birth care for all. In the past two years, the steering committee has spent almost $1 million on paperwork to prepare for the creation of yet another committee on the crisis. Steering committee chairwoman Cherrell Hirst said State Cabinet still had to approve the second committee and would make a decision by the end of the month.
She said it could be four years before any improvements in care were seen. "Stage one was setting up the interim committee, ahead of establishing the second committee," she said.
Opposition health spokesman John-Paul Langbroek said the situation was outrageous. "We get review after taskforce after investigation, and meanwhile services suffer," he said. A spokeswoman for Queensland Health said "moves are under way" for change. The Gold Coast Health Service District Birthing Centre, opened in May 2006, offers an "alternative model of care for birthing", but nothing has been rolled out state-wide
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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25 March, 2007
Republican Rx: GOP alternatives to HillaryCare
It's been mostly doom-and-gloom days for Republicans--a lost majority, Iraq, U.S. attorneys, soul-searching over just what happened to the party of Reagan. So it's worth noting a new intellectual debate that's rumbling to life in the party wings, one that could signal whether the GOP is capable of rediscovering its free-market principles.
That debate is about the future of health-care reform, and it got some momentum this week when Oklahoma Sen. Tom Coburn released a big-ideas blueprint for restructuring the entire health-care system--the tax code, Medicare, tort liability, insurance laws--along free-market lines. Dr. Coburn's plan builds on the White House's own bold proposal in January to revamp tax laws so as to put consumers back in control of their health-care decisions. Both plans are about fundamental, bottom-up health-care reforms, cast in the language of markets, consumers and individual control.
They're also the polar opposite of the health-care "reforms" that won GOP Govs. Arnold Schwarzenegger and Mitt Romney media huzzahs this past year, and have thus captivated no small few in the Republican party. The state plans are heavy on regulation, wrapped in red tape, and happy for taxes, though much of the bad has been squeezed behind a few fig leaves of market reform. This is mini-me Republicanism, but it has also allowed its creators to boast that they are offering "universal coverage"--a phrase that polls fabulously.
Which side wins? Who knows. But what is clear is that the scrap has come at a crucial moment. Americans are howling for relief for spiraling health-care costs and companies are drowning in doctor bills. Yet until recently, Democrats have been alone in offering a comprehensive answer to the problem: government-run health care. These liberals never offer details about the extraordinary costs, the miserable service, the wait lines, the Walter-Reed-like facilities, but then again, they don't have to. They have an easy-to-describe "plan," which is more than can be said of the other party.
This has led to some glumness in conservatives ranks, and a feeling that the debate has already been lost. That pessimism helps explain the Schwarzenegger and Romney programs, both of which ape the left's mantra of "universal coverage." Yet all that underestimates just how much intellectual progress conservatives have made since 1993 and the HillaryCare debate, when they were forced to start thinking seriously about health issues.
Conservative health-care guru John Goodman remembers going to Washington in the early 1990s to get Republicans interested in individual health savings accounts, and "only about five guys would even meet with me," he recalls. Now, HSAs "are a religion" among the right, he notes, and Republicans used their last years in the majority to significantly expand access to these accounts. In the past 15 years, the GOP has also planted the roots of Medicare reform, looked at interstate trade in health insurance, and got behind competitive Medicare reforms in their states.
The recent White House and Senate proposals are meant to package these ideas into a more unified, free-market whole. Mr. Coburn, like the White House, would remove the subsidy corporations get for health care, and instead give the money to individuals--putting them in charge of their health expenditures. It would expand HSAs, and allow consumers to buy insurance from any state, thereby avoiding costly regulations. It would modernize Medicare, allowing workers to invest their payroll taxes into a savings account and control their care in their retirement years. It would free up the states to inject Medicaid with new flexibility and competition.
There's plenty of big ideas in these new proposals over which conservatives can argue. Do they get behind tax rebates (… la Coburn) or tax deductibility (… la President Bush)? Do you leave medical liability to the states, or intervene with federal legislation to set up state "health courts"? Or do they write all this off as too hard a political sell, and run for the Schwarzenegger "universal coverage" cover?
The important thing is that debate equals education, which equals understanding, which equals precisely what the GOP needs right now. The Heritage Foundation's Mike Franc says Republicans are still too preoccupied with health-care small-ball--which procedures should be covered by Medicare, how much should generics cost--to get their heads around the broader subject. "This is still outside their intellectual comfort zone, and Republicans never do well in that situation," he says. "But to win this debate--the defining issue of the next 40 or 50 years--they're going to have to address it forcefully, head-on, and with every bit of their intellectual firepower."
You'd have thought the right would have figured this out by now, given its success at reframing other policy issues. When Republicans railed about welfare queens, they were viewed as the heartless party. When they turned the debate into one about the vicious cycle of dependency and poverty that welfare causes, they captured voters' imagination--they captured even Bill Clinton's imagination--and pushed through entitlement reform. Today, even the left agrees welfare-recipients should work.
Americans similarly tuned out the GOP's gripes about federal education spending, and reasonably so. All parents knew was that their kids were failing, and that Democrats were warning that fewer dollars would make things worse. Only when the GOP reframed the debate, and explained that this was a question of competition, of accountability, of greater parental choice, did they tap into long-held American ideals. Flowering charter schools and vouchers are one result. Ted Kennedy's admission that standards matter is another.
Those on the free-market side are starting to understand the need for a new language, especially if they are to coax more nervous elements of their party into embracing radical change. When President Bush unveiled his health-care tax overhaul in the State of the Union, he stressed that health-care decisions needed to be made by "patients and doctors," not government or insurance companies. Mr. Coburn's bill summary is littered with the words "choice," "empowerment," "competition," "flexibility," "control"--which is not only an honest assessment of what his proposal would provide, but one with which Americans can identify.
With Democrats running the show, Republicans now have the quality time to hash through this debate, and if they're smart, that'll be a priority. The left is so confident it owns the health-care issue, and so bereft of creative ideas, it risks squandering its advantage--just as the GOP lost its own credibility on fiscal restraint. But first, Republicans need to figure out what they believe.
Source
THAT FABULOUS SOCIALIST "PLANNING" IN ACTION
Long claimed as why socialism is superior to "chaotic" private enterprise
NHS planning has been a disastrous failure, leading to an uncontrolled boom in the workforce followed by a bust in budgets, a report by MPs says. The health service set out in 1999 to recruit 20,000 more nurses by 2004 but hired 67,878 - 340 per cent over target. It also recruited twice as many GPs as planned and 69 per cent more health professionals, such as physiotherapists. As the inflated workforce had to be paid, hospitals and trusts plunged into deficit, the Commons Health Select Committee report says. Now posts are being left empty or lost, and a few NHS workers are being made compulsorily redundant. More than half of newly qualified physiotherapists have failed to find work in the NHS.
The MPs are scathing about the failure to maintain a link between staff numbers and the money available to pay them. Instead of raising productivity to meet targets, the NHS "threw new staff into the task rather than consider the most cost-effective way of doing the job", the report says. It calls the staff expansion "reckless and uncontrolled" and says that funding increases were often seen as a blank cheque for recruiting new staff. There is also criticism of generous contracts. "Large pay increases were granted without adequate steps being taken to ensure increases in productivity in return," it said. The committee urged the Government to make workforce planning a priority [When will they ever learn?], and for an end to constant health service reorganisation.
Stephen O'Brien, the Shadow Health Minister, said: "Top-down workforce targets imposed by Labour have created confusion amongst NHS staff. Patients are bewildered about where all the money has gone, and hard-working staff are losing confidence by the day in Labour's stewardship of the NHS."
The British Medical Association did not entirely endorse the report, however. Sam Everington, its deputy chairman, said: "While agreeing wholeheartedly that integrated workforce planning must be a priority... we do not agree that the expansion of the medical workforce was reckless and uncontrolled and that pay increases for doctors have not seen a return in productivity. "The UK is still critically short of doctors and the BMA has always believed that government goals to increase doctor numbers were too low."
Andy Burnham, the Health Minister, said: "While the pay contracts cost more than we or the trade unions and professional associations first anticipated, we must remember that we were setting right an NHS system with widespread recruitment difficulties. We have been able to eliminate these and reward hard-working professionals with the pay they deserve."
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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24 March, 2007
Dirty NHS hospital kills patient
And a coverup fails. How many more deaths from negligence is this hospital concealing?
A father of three died after he contracted an infection from a hospital shower on the day that he was due to be discharged after successful treatment for leukaemia. The hospital had failed for many years to act on guidance about the safety of its ageing hot water system, a court was told. The failure led to Daryl Eyles, 37, contracting legionnaires’ disease from a dirty shower head. He had just been told that he was in complete remission after enduring months of chemotherapy. At Bath Magistrates’ Court, the Royal United Hospital (RUH) in Bath admitted two charges of failing to act on safety warnings.
Jennifer Gunning, chairwoman of the bench, said: “Guidance was available for more than ten years, but this was blatantly not followed. The RUH management was inadequate. Mr Eyles died as a result of those failings and many other vulnerable patients were put at risk.” Referring the case to Bristol Crown Court for sentencing, she said: “We believe this to be so serious that our sentencing powers are not sufficient.”
Mr Eyles, a security guard at Bath University, had leukaemia diagnosed in August 2003 after developing a painful abscess while on holiday in Cyprus. The cancer went into remission after his first course of chemotherapy, but he was told that he needed two more sessions to make sure that it did not come back. He spent Christmas at home with his family before returning to the hospital for his final session in January 2004.
His wife, Andrea, 31, had previously told how her husband was desparate to get home and had tried to discharge himself early but was advised to wait a few days. She said: “I saw him after he finished his chemotherapy and he just wanted to come home. He felt fine and was looking forward to getting back to work. “He said he had more chance of catching something in hospital than he did at home, but the doctors advised him to stay in hospital.”
On February 7 Mr Eyles took a shower at the William Budd Oncology Unit, where he was being treated. He became ill and was prescribed antibiotics, but they failed to prevent his death a week later. Doctors initially told Mrs Eyles that her husband had died of pneumonia and septicaemia. She discovered the true cause only after taking legal action. An investigation found that the shower head was contaminated with Legionella bacteria. She said: “I just wanted to know the truth about what happened and I’m furious that it took legal action to get it.” The couple, from Bath, had two children: Georgina, 10, and Mitchell, 8. Daryl also had a son, Christopher, 14, from a previous relationship.
After the hearing Mark Davies, the chief executive of the Royal United Hospital Bath NHS Trust, said: “The RUH took this incident extremely seriously and we have learnt from this very sad case. “We were all shocked by the sudden death of Daryl Eyles in February 2004. The trust accepted liability in October 2004 and has since reached a settlement in response to the family’s claim. At the time the trust fully cooperated with the Health and Safety Executive and has complied with all its recommendations to minimise further risk of Legionella.” The hospital trust will be sentenced on March 29.
Source
Mixed-sex wards fury in Australia too
It's a big issue in British government hospitals
QUEENSLAND Health has been accused of robbing patients of their dignity by forcing men and women to share hospital wards. Doctors say the practice has become widespread across the state because of the chronic bed shortage in public hospitals. The state has fewer beds than it did 10 years ago - even though its population has grown by one million.
One nurse who protested over the opening of a mixed-sex unit at her regional hospital said: "The patients don't like it, but many of them are elderly and don't like to complain. "Vulnerable patients rely on us for care but the system has no respect for them. "It astounds me that anyone could ever think this was acceptable."
A 45-year-old female patient said she was appalled to be placed with two men in a four-bed bay when she was admitted to the Royal Brisbane and Women's Hospital. "A friend of mine had discharged herself when she was put in a mixed ward," she said. "I thought it couldn't be that bad - until I was put in one myself. One of the men had dementia and kept getting out of bed and undressing in front of me. "It was embarrassing for me and demeaning for him. "I'm no prude, but mixed-sex wards cannot be justified."
Dr Ross Cartmill, a urologist at Brisbane's Princess Alexandra Hospital and a spokesman for the Australian Medical Association, said: "The problem occurs at every hospital with a bed shortage - which is most hospitals. "Patients growl about it, but most think it's just better to have a bed than none at all."
Opposition health spokesman John-Paul Langbroek warned that mixed-sex wards could open patients to allegations of voyeurism and inappropriate behaviour. Chief Health Officer Jeannette Young said it was more efficient to place patients in mixed wards if they required specialist treatment, such as cardiac and neurological care. "All hospitals understand the need to be sensitive to their patients whilst being flexible, so that they can provide a bed for every individual who needs one," Dr Young said.
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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23 March, 2007
National health insurance: A medical disaster
Affordable health care has become one of the most important social issues of our time. Every news broadcast seems to have a special report on “America’s health care crisis” or a politician demanding “universal health insurance.” Evidence cited for the need for immediate and drastic government action includes:
High medical costs. The United States reportedly has the highest per capita medical expenditures of any country in the world. According to Insight magazine, U.S. citizens spent an average of $2,051 on health care in 1990, compared to $1,483 for Canadians and $1,093 for West Germans.
Rapid increase in medical expenditures. The average American now spends 11.1 percent of his income on medical care. If current trends continue, health care will consume over 17 percent of the Gross Domestic Product within 15 years.
High administrative costs. In the U.S., administrative costs consume nearly 12 percent of health dollars compared to one percent under Canada’s socialized system. More than 1,100 different insurance forms are now in use in the United States.
Americans without insurance coverage. At any given time, over 13 percent of Americans have incomes that are too high to qualify for Medicare or Medicaid, but are too low to pay for medical insurance themselves.
The free market in health care, we are told, has failed. The solution offered by a growing chorus of commentators and candidates is universal, mandatory, national health insurance; in other words, socialized medicine. Is socialized medicine the answer, or will it only make things worse?
How Well Has Socialized Medicine Worked Elsewhere?
Most of the developed countries of the world presently have some form of socialized medicine. How well has it worked?
Great Britain. Great Britain adopted socialized medicine in 1948, with the creation of the National Health Service (NHS). The political rhetoric in Britain exhorting the adoption of nationalized health insurance is similar to what we are heating in the U.S. today. In 1942, Prime Minister Winston Churchill declared:
The discoveries of healing science must be the inheritance of all . . . . Disease must be attacked whether it occurs in the poorest or the richest man or woman, simply on the ground that it is the enemy . . . . Our policy is to create a national health service, in order to secure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal Opportunities to benefit from the best and most up- to-date medical and allied services available.
With the adoption of national health insurance, Labour Minister Dr. David Owen predicted, “We were going to finance everything, cure the nation and then spending would drop.” Unfortunately things didn’t work out exactly as planned.
The first problem with Britain’s National Health Service was skyrocketing demand. With health care paid for entirely by the government, there was no reason not to go to a doctor. Why take aspirin or wait out a cold, when professional medical care is free? As Michael Foot observed, within months “the demand [for health care] was exceeding anything [its creators] had dreamt of.” First-year operating costs of NHS were 52 million pounds higher than original estimates.
NHS soon found itself in direct competition for funds with national defense, pensions, and all other governmental functions. Budget cuts for NHS quickly followed. British economists John and Sylvia Jewkes estimated that between 1950 and 1959 the United States spent six times more per capita on hospital construction than England. As a result, there was a steady deterioration in the quality of British medical care.
By 1977, British general practitioners rarely had any medical instruments except for stethoscopes and blood- pressure meters. They had to send their patients to hospitals even for such routine procedures as X-rays and blood tests. The waiting time for routine, non-emergency surgery had increased to years. By the mid-1970s, more than 700,000 English men, women, and children were on hospital waiting lists at any given time. The average British doctor now has over 3,000 patients, compared to 500-600 for the average American doctor. NHS doctors spend an average of less than five minutes with their patients, who usually wait hours to see them.
In 1975 Bernard Dixon, then editor of the British magazine New Scientist, provided this summary of the state of National Health Insurance:
The plight of Britain’s Health Service conflicts desperately with the avowedly utopian ideals of its founders. For most of us, it is only when we join a year-long hospital waiting list, or have to take an injured child to a hospital casualty department, that we realize just how threadbare and starved financially the service really is. Not only is there an acute shortage of resources, but the expertise and facilities that are available are all too often dispensed via a conveyer-belt system which can at times be positively inhuman.
As a result of widespread public dissatisfaction, in 1989 the British government began dismantling its National Health Service, and reintroduced mar-ket-based health care competition.
Canada. What of the Canadian National Health System, which many U.S. politicians are now championing as a less expensive and more efficient alternative to our supposed free market system?
Canada has had socialized medicine for 20 years, and the same pattern of deteriorating facilities, overburdened doctors, and long hospital waiting lists is clear. A quarter of a million Canadians (out of a population of only 26 million) are now on waiting lists for surgery. The average waiting period for elective surgery is four years. Women wait up to five months for Pap smears and eight months for mammograms. Since 1987, the entire country spent less money on hospital improvements than the city of Washington, D.C., which has a population of only 618,000. As a result, sophisticated diagnostic equipment is scarce in Canada and growing scarcer. There are more MRIs (magnetic resonance imagers) in Washington State, which has a population of 4.6 million, than in all of Canada, which has a population of 26 million.
In Canada, as in Britain under socialized medicine, patients are denied care, forced to cope with increasingly antiquated hospitals and equipment, and can die while waiting for treatment. Canada controls health care costs the same way Britain and Russia do: by denying modern treatment to the sick and letting the severely ill and old die.
Despite standards far below those of the United States, when variables such as America’s higher crime and teenage pregnancy rates are factored out, and when concealed government overhead costs are factored in, Canada spends as high a percentage of its GNP on health care as the United States. Today a growing chorus of Canadians, including many former champions of socialized medicine, are calling for return to a market-based system.
The Worldwide Failure of Socialized Medicine
Throughout the world the story is the same: socialized medicine results in skyrocketing demand for nominally “free” health care, doctors are overburdened, medical services steadily deteriorate, and there are endless waiting lists for health care. In the Soviet Union before the collapse of Communism, anesthetics, painkillers, and most drugs were rationed; 57 percent of hospitals had no hot running water; and it was standard practice to clean needles with steel wool and reuse them. In New Zealand, which has a population of just 3 million, there is a waiting list of 50,000 for surgery.
Socialized medicine doesn’t even fulfill its promise of equal access to treatment regardless of ability to pay. For example, in Canada “a small child with a skin rash is 22 times more likely to see a dermatologist if the child is living in Vancouver [a major city] than in the East Kootenay district [a remote rural area].” In Brazil, “residents of urban areas experience nine times more medical visits, 15 times more related services, 2.7 times more dental visits and 4.5 times more hospitalizations,” than do rural dwellers.
Throughout the world, there are more and more refugees from socialized medicine. Middle-class Canadians flock across the U.S. border to avoid waiting months or years for routine procedures. In England a system of private, quasi-legal clinics has developed to care for patients who can no longer tolerate the abysmal medical services provided by national health insurance. In Russia, desperate patients bribe doctors and secretly visit them after hours to get decent treatment and scarce drugs.
Socialized medicine, like all forms of socialism, has been a world-wide failure. As people throughout the world from the Soviet Union to South America are learning, socialism cannot work. Socialism is fundamentally incompatible with human nature.
Socialism fails bemuse it denies and degrades our essential humanity by treating us as objects. Socialized medicine takes away our control over our own health and body, and gives that power to the state. Under a socialized medical system, the government, • not you or your doctor, decides what treatments, doctors, and drugs you get. If you don’t like the service the government gives you, your only alternative is to flee to another country or to break the law and bribe a doctor. Under socialized medicine, the exercise of free choice becomes a crime.
Even after it destroys quality health care and individual liberty, socialized medicine still cannot achieve equal treatment for all. When planners try to make all people equal, they confront the inescapable paradox of equality: Abolishing inequality requires massive government power. But power by its nature is unequal: there are those that have it and those that do not. Giving government the power to make everyone equal necessarily creates the worst form of inequality: that of master and subject. In practice under socialized medicine, those with more money and friends in the government get vastly better health care than those without power and connections.
Socialized medicine will not work any better in the United States than it has in England, Canada, Russia or elsewhere. Consider just the economics of socialized medicine in the U.S. Medicare and Medicaid costs are already skyrocketing out of control. State governments cannot afford the 20 percent of theft budgets that Medicare and Medicaid now consume. Where will government get hundreds of billions of dollars more for national health insurance? A complete Canadian-style national health insurance system for the U.S. would initially cost over $339 billion and require that payroll taxes be nearly doubled, or require a new, national 10 percent business tax.
Socialized medicine does not work, but has the free market failed as well? If freedom works, why is American health care now in crisis?
Government Intervention and Health Care Costs
The answer is that America does not have a free market in health care, and in fact has not had one for 50 years. What we have had is a half century of mounting government encroachment upon medical freedom, leading to more and more health care problems.
Over 42 percent of funds spent on American medical care are now controlled by government. Over 700 state laws, some hundreds of pages long, govern all health care providers and institutions. According to some estimates, for every man-hour of health services provided by doctors, two hours are spent by clerks filling out government paperwork. Dr. Francis A. Davis estimated in the March 1991 issue of Private Practice that government regulations have already increased the cost of medical care by up to 50 percent!
Government regulations and controls now intrude upon virtually every area of health care in America. These regulations increase tremendously the cost of health care. Here are some examples:
The War on Drugs. U.S. federal drug certification requirements are the most burdensome in the world. It presently can cost $231 million and takes 12 years to develop, test, and certify a single new drug in the U.S. The introduction of many drugs, which have been thoroughly studied and used safely in Europe, has been delayed for years or even decades in the U.S. by the Food and Drug Administration. FDA delays in the introduction of just one drug, the beta-blocker propranolol, used to treat angina and hypertension, caused at least 30,000 avoidable deaths in the U.S.
Literally hundreds of thousands of Americans have died in the last two decades, and millions have suffered needless pain and expense, as a result of government drug regulations. Further, the prohibition of marijuana, heroin, and cocaine has created a growing public health crisis in America.
Consider the medical implications of the government’s ban on marijuana. On September 6, 1988, Drug Enforcement Administration (DEA) Administrative Law Judge Francis L. Young stated: “The evidence in this record clearly shows that marijuana has been accepted as capable of relieving the distress of great numbers of very ill people, and doing so with safety under medical supervision. It would be unreasonable, arbitrary and capricious for DEA to continue to stand between those sufferers and the benefits of this substance in light of the evidence in this record.”
Judge Young concluded that many classes of patients could potentially benefit from medicinal use of marijuana, including sufferers from glaucoma, chemotherapy, multiple-sclerosis, spasticity, and hyperparathyroidisim. Glaucoma sufferers alone currently number over two million Americans. Despite this finding by the DEA’s own administrative judge, marijuana continues to be totally banned for all uses, including medical applications. Indeed, penalties for possession and use of marijuana have steadily increased over the last 20 years.
Medicare, Medicaid, and Tax Policy. A growing chorus of politicians and social activists decry the “high cost” of medical care in the United States and the increasing percentage of our Gross Domestic Product that it consumes. What is seldom mentioned is that mounting health care spending and prices are largely a result of escalating demand, public policies, government health care entitlements, and tax policies.
Medicare and Medicaid, our major health care entitlements, were enacted in 1965. Closely allied with the Social Security system, Medicare provides health insurance for approximately 30 million Americans, primarily the elderly. Medicaid provides health care for tens of millions more of the disabled and indigent, and is administered by the states. In the last 25 years Medicare and Medicaid expenditures have soared: from less than $5 billion in 1967, to $79 billion in 1984, to over $160 billion in 1990.
Prior to 1983, Medicaid used a “cost-phis” system for reimbursing medical providers. Doctors were allowed to base their billings upon the cost of the services they provided. Thus the higher a doctor’s costs, the more a doctor would make. The cost-phis system made it in a doctor’s self-interest to make his costs as high as possible, contributing to a rapid growth in health care costs.
Overall, the effect of Medicare, Medicaid, and other rapidly expanding government health care spending has been greatly to increase the demand for medical services and facilities of all types, which has led to rising health care prices.
Government tax policies are another major factor in escalating demand for and prices of medical services. When health insurance is provided as an employee benefit it is fully tax-deductible; in other words, it is paid for with pre-tax dollars. But when health care is paid for by employees directly, it is paid for with very expensive after-tax dollars, and is not fully tax-deductible. Hence there is an incentive for health care to be provided by employers in the form of insurance, rather than for employees to pay for health care directly out of their own pockets. Largely as a result of U.S. tax policies, “The share of health care spending paid by business increased from 17 percent in 1965 to 28 percent in 1987, while the share paid directly by individuals fell from almost 90 percent in 1930 to just 25 percent in 1987.”
The growing reliance of Americans upon insurers (public and private) to pay their medical bills has destroyed virtually all incentive for health care consumers to monitor and control costs. As Louise B. Russell noted in her 1977 Brookings Institution study:
This incentive structure means that at the point at which decisions are made about the use of resources, the people who make those decisions are able to act as if the resources are free. Rationally they can and do make decisions that bring little or no benefit to the patient, since the resource costs of the decisions—to the people making them—are also little or nothing . . . . [T]here are virtually no economic constraints left to prevent decisionmakers in medical care from doing everything they can think of, no matter how small the benefits nor to whom they accrue.
More here
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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22 March, 2007
NHS may be restricted to core services
The NHS is slowly moving in the direction of becoming a very costly organization that consists solely of bureaucrats and provides no services at all
The National Health Service might provide only core services, with patients forced to pay for any other treatment or meet it from private insurance, the government has revealed on Monday.
News that ministers were examining the possibility of defining the services that the NHS is obliged to provide free to everyone was disclosed in the small print of the public services policy review launched on Monday by Tony Blair, the prime minister, and Gordon Brown, the chancellor. It says the government should “look at the possibility of drawing up a package of services that all users are entitled to”. Nice, the National Institute for Health and Clinical Excellence, could be asked to do that.
The health department confirmed it was “looking at the possibility in the normal process of policy development” and agreed that deciding what everyone was entitled to would also involve deciding “what they are not entitled to”.
Academics said that amounted to defining a “basic basket” of services the NHS would fund, but warned it was fraught with technical and political difficulties. Anna Dixon, deputy director of policy at the King’s Fund think-tank, and a specialist on international health systems, said: “It sounds like establishing a core package of benefits that the NHS will fund – and that is something that has long been debated in academic circles. But politicians ... have always shied away from being more explicit about entitlements.”
Social insurance systems tended to be much more explicit about what was and was not covered, with private insurance markets developing to cover excluded treatments, she said. But she warned that when lists of exclusions were drawn up, “they often do not feel right to the public”. It was “a very difficult exercise” and one that, if undertaken, “is going to be very controversial”. It would raise issues over whether infertility treatment, or so-called lifestyle drugs for obesity or impotence, should be included.
David Hunter, professor of health policy at Durham University, said: “It is very difficult to define what is in the basket, so either it doesn’t get done or very little gets left out. You don’t save much, and you are still left with the issues of how to ration care and assess quality and cost effectiveness” – something Nice was already doing but “in a rather less prescriptive way”.
Patricia Hewitt, the health secretary, was deputy chairman of a pharmaceutical industry-financed study in 1995 that called for restrictions on free services. But she disowned the report on becoming health secretary, saying the government’s big increase in NHS spending removed the need for such measures.
Source
Australia: Anger over 8-year wait for surgery
MORE than 1500 patients from across Queensland face a wait of up to eight years for operations. The Australian Medical Association says hundreds of those waiting for ear, nose and throat surgery at the Royal Brisbane Hospital may never be treated. Patients are not being told the likely wait and many give up waiting and seek private treatment.
People with the longest waits are those classified as Category 3 patients - needing operations to fix sinus problems and recurrent tonsillitis. They are constantly pushed to the bottom of the list while surgeons treat more urgent cases. State president of the Australian Medical Association Zelle Hodge said the waiting time had blown out due to a lack of resources. She said 1500 patients were waiting for surgery. "People aren't told by the hospital how long the waiting list is and I think when they eventually find out they just don't believe it," she said. "Even I find it boggling to think of an eight-year wait, but it is true. "Although people will move up the waiting list, they keep getting pushed down again because of new urgent cases that keep coming in. "Unfortunately the Royal Brisbane looks after the majority of ear nose and throat patients in the state so that makes the situation worse. "Many people give up waiting and seek treatment from private hospitals, while others who can't afford to do that will continue to wait and never get their operation."
Queensland Health says that it has reduced waiting times for patients classified as urgent and life threatening cases. In January there were 187 patients waiting longer than the clinically recommended time of 30 days, compared with 360 in October last year. But figures also reveal an increase in semi-urgent and non-urgent patients waiting longer than the target times. A quarter of semi-urgent Category 2 patients now wait longer than the target of 90 days, and more than one third of Category 3 non-urgent patients are waiting longer than the recommended 365 days. The total number of patients waiting longer than recommended is 10,200.
The Queensland Cancer Council said even cancer patients were being forced to wait too long. Coalition health spokesman John-Paul Langbroek said that Queensland Health performed fewer operations than the public health system in other states. "ENT is failing patients anyway, but to be saying eight years to people, well they might as well be saying they can't provide the service at all," he said. Queensland Health said emergency surgery must always take priority over ot,her surgery.
The above article by HANNAH DAVIES appeared in the Brisbane "Sunday Mail" on March 18, 2007
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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21 March, 2007
HOW YOU RUN A GOVERNMENT HOSPITAL
An Army contract to privatize maintenance at Walter Reed Medical Center was delayed more than three years amid bureaucratic bickering and legal squabbles that led to staff shortages and a hospital in disarray just as the number of severely wounded soldiers from Iraq and Afghanistan was rising rapidly. Documents from the investigative and auditing arm of Congress map a trail of bid, rebid, protests and appeals between 2003, when Walter Reed was first selected for outsourcing, and 2006, when a five-year, $120 million contract was finally awarded. The disputes involved hospital management, the Pentagon, Congress and IAP Worldwide Services Inc., a company with powerful political connections and the only private bidder to handle maintenance, security, public works and management of military personnel.
While medical care was not directly affected, needed repairs went undone as the staff shrank from almost 300 to less than 50 in the last year and hospital officials were unable to find enough skilled replacements.
An investigative series by The Washington Post last month sparked a furor on Capitol Hill after it detailed subpar conditions at the 98-year-old hospital in northwest Washington and substandard services for patients. Three top-ranking military officials, including the secretary of the Army, were ousted in part for what critics said was the Pentagon's mismanaged effort to reduce costs and improve efficiency at the Army's premier military hospital while the nation was at war.
IAP is owned by a New York hedge fund whose board is chaired by former Treasury Secretary John Snow, and it is led by former executives of Kellogg, Brown and Root, the subsidiary spun off by Texas-based Halliburton Inc., the oil services firm once run by Vice President Dick Cheney. IAP finally got the job in November 2006, but further delays caused by the Army and Congress delayed work until Feb. 4, two weeks before the Post series and two years after the number of patients at the hospital hit a record 900. "The Army unfortunately did not devote sufficient resources to the upfront planning part of this, and when you do that, you suffer every step of the way," said Paul Denett, administrator for federal procurement policy at the Office of Management and Budget, the White House unit that prepares the president's budget and oversees government contracts.
The contract includes management of Building 18, which houses soldiers with minor injuries and was highlighted in the Post series as symptomatic of substandard conditions: black mold on the walls of patient rooms, rodent and cockroach infestation, and shoddy mattresses. Those 54 rooms are now vacant. Interior work cannot be started until a badly damaged roof is repaired, and that will need another contract because it's not covered in the IAP contract, Walter Reed officials said. "These rooms are exactly as they were left," Sgt. Gary Rhett, manager of Building 18, said Thursday. "No changes have been made."
The Army has confirmed the timing of the contract delays but declined several requests for comment on why the protest and appeal process took so long, even as more and more injured soldiers were arriving. The trail goes back to the end of the Clinton administration. The Army began studying the cost benefits of privatization in 2000. When President Bush took office, he mandated the competitive outsourcing of 425,000 federal jobs. At the time, the Pentagon was aggressively pushing for increased outsourcing, and in June 2003, then-Defense Secretary Donald Rumsfeld told a Senate committee he was considering outsourcing up to 320,000 nonmilitary support jobs. That's the same year that the Army asked for bids on Walter Reed and, coincidentally, the same year the United States invaded Iraq.
One company responded: Johnson Controls World Services Inc., which would be acquired by IAP in March 2005. It initially bid $132 million, but it and Walter Reed's then-management agreed that the Army was underestimating the cost. By September 2004, the Army had decided it would be cheaper to continue with current management, which said it could do the work for $124.5 million. Johnson Controls filed a protest with the Government Accountability Office.
The protest was dismissed in June 2005, but the Army agreed to reopen bidding three months later to include additional costs for services. In January 2006, after two rounds of protests by IAP and two appeals by Walter Reed employees to the U.S. Army Medical Command, IAP was named the winner, according to Steve Sanderson, a Walter Reed spokesman.
Instead, in an unusual turn of events, the contract wasn't awarded for another 11 months, the GAO said. Walter Reed officials blame several factors, including an additional protest to the GAO filed by Deputy Garrison Commander Alan D. King, a separate appeal to the U.S. Army Medical Command by Walter Reed's public works director, at least one intervention by Congress, and delays on required congressional notifications about government employee dismissals. IAP spokeswoman Arlene Mellinger said "it was up to the Army to decide when to begin that contract." The company was ready to start at any time, she added.
In August 2006, led by Sen. Barbara Mikulski, D-Md., lawmakers asked then-Army Secretary Francis J. Harvey to hold off on the contract until Congress finished work on the fiscal 2007 defense appropriations bill. Congress approved that bill Sept. 29. The Army's plan then was to eliminate 360 federal jobs at Walter Reed in November and turn the work over to IAP, according to the American Federation of Government Employees, a federal workers' trade union. But the Army failed to notify Congress 45 days in advance, as required by law, so the turnover was delayed until early this year.
Then it was IAP's turn to have problems. When work finally began at the hospital, IAP made an immediate request, which the Army approved, to hire 87 temporary skilled workers for up to four months "to ease the turbulence caused by employees being placed into positions or other installations and otherwise finding new jobs early," said Sanderson, the Walter Reed official. However, a "tight" job market in the Washington area meant that only 10 qualified temporary employees were found, he added. Meanwhile, injured soldiers continue to arrive weekly to a short-handed, deteriorated hospital, which the Army still plans to close in 2011.
Source
REAL CHOICES COMING TO BRITAIN?
For hip surgery only!
Tony Blair will say today that Labour must go on reforming public services to stay in office as he unveils the reports from his last policy review. These include plans to speed up proposals to allow people waiting for acute operations to go to the hospital of their choice.
He will also announce moves to allow GPs to link up with pharmacies by sharing electronic records.The report of the public services policy group, to be outlined by Mr Blair, Gordon Brown, the Chancellor, and Patricia Hewitt, the Health Secretary, will claim that the public services have now so changed that it is the patients and parents who are calling the shots. At present people can choose from four hospitals for operations and the Government had intended people to choose from any provider, public or private, by the end of 2008. That deadline is now to be brought forward and people will be able to go anywhere for hip surgery later this year, with changes for other operations also being made this year.
In a clear message to Mr Brown, his almost certain successor, Mr Blair says in the report foreword that the Government could turn back and eschew further reform or go forward with the mission to "personalise and empower". He says Labour must embrace the vision of a Britain "where people are more empowered than today, where they enjoy more opportunity than today, and where services of all kinds are focused ever more on the personal needs of those who use them".
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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20 March, 2007
More on government medicine in America
For Dr. Martin Hoffman, the frustration has been growing for at least a year. As the head of physical medicine and rehabilitation for a Veterans Affairs health branch that sprawls through much of the Sacramento Valley, Hoffman wants another physical therapist and another chronic pain specialist in Sacramento. "Frankly, we just don't have enough staff to do the job right," he said.
Pressure to schedule relatively timely appointments for veterans coming home from Iraq or Afghanistan is driving up the waiting time for other veterans, Hoffman said. So far, he said, it's only a matter of a few extra days' wait for the veterans of World War II, Vietnam and other eras who make up the bulk of those seen at Sacramento-area VA facilities. But as more and more service members return from the lengthy Iraq war, no one expects the demand to lessen. Doctors predict the biggest new workload will fall on physical medicine, orthopedics and mental health.
The VA Northern California Health Care System last year won funding to increase its mental health staff by nearly 50 percent, adding 37 positions to an 80-person network of psychiatrists, psychologists, social workers and nurses in clinics from Redding to Oakland. "We have a wonderful thing happening in our VA," said Dr. Maja Jackson-Triche, the local system's chief of staff for mental health. She paints a picture of therapists able to see troubled veterans the same day if needed, and an administration open to more funding requests.
Some who work with veterans locally are more skeptical, and a massive nationwide analysis of VA mental health care by McClatchy Newspapers found serious deficiencies. Today's veterans are getting about one-third fewer visits with specialists in the area of psychiatric problems than a decade ago, McClatchy reported last month. The investigation found wildly uneven care from state to state, with some regions offering psychotherapy appointments as short as 20 minutes.
For those haunted by their time in uniform, stakes for getting help can be perilously high. Sean Benedict, who aids veterans struggling with homelessness and substance abuse, has been mourning the tiny, frenetic Iraq vet who came through the Sacramento Veterans Resource Center earlier this year. Her name was Jessica Rich, and she'd grown up near Chico before becoming entangled in service-related trauma that she just couldn't beat, said Benedict, the center's clinical director. Last month, Rich died in a drunken driving crash in Colorado that Benedict and others who knew her laid directly at the feet of post-traumatic stress disorder. She was 24. Rich had been undergoing therapy in Colorado when she died, and Benedict doesn't believe her death illustrates flaws in VA care. It simply shows how bad things can get, he said, for individuals and for the system that should be there to treat them. "She's the canary in the coal mine. If we start seeing hundreds and hundreds of Jessica Riches, we're in trouble," he said.
Benedict, whose agency gets funding from the VA, sees it as a system full of well-meaning caregivers hampered by too little money and a huge bureaucracy aimed partly at aiding those most desperately in need while stalling those who can wait. "We went to war without adequately preparing for the cost of war," Benedict said. "That's the problem." Amid the added focus on the most recent wave of returning troops, Benedict worries that those who served in peacetime or in Vietnam are slipping lower on the VA's priority list.
Dr. David Siegel, acting chief of staff of the VA's Northern California Health Care System, said there's a "a national mandate" that Iraq and Afghanistan vets not wait longer than 30 days to be seen. Hoffman echoed that, although VA spokeswoman Beverley Pierce said it's a broader goal that also applies to other veterans if they haven't had a medical appointment in the past two years. In 2006, the physical medicine and rehabilitation service at Sacramento's VA Medical Center at the former Mather Air Force Base hit that target only 68 percent of the time for new patients, according to Pierce.
Hoffman, who oversees physical medicine, has been keeping an eye out for trends that could help things get better -- or worse. This week, he was worried that a new screening program has diagnosed more veterans with symptoms of traumatic brain injury, which can crop up in headaches, word-finding difficulties or memory problems after a mild concussion. "If we keep getting large numbers of those, we're going to be struggling even more," Hoffman said.
By contrast, the mental health service at the Sacramento center saw 90.5 percent of its new patients within 30 days, Pierce said, adding that anything above 90 percent meets the performance target set nationally by the VA. Beyond the numbers, those who work with veterans in Sacramento are "great people," said Yesica Castillo, who turned to them for help after serving as a military police officer in Iraq's Sunni Triangle. Castillo, 23, had been safely home in Placerville for two years, thinking she was doing all right, until her husband shipped out for Iraq yet again, leaving her with their little daughter. That's when the sleeping problems, the nightmares and the irritability kicked in. Castillo, who attends group classes on post-traumatic stress every other week at the Sacramento VA center, said sometimes she thinks the program is helping, and other times she's less certain. Yet she's sure that the support and advice she's gotten from fellow veterans has been worth the long, gas-guzzling trip from Placerville to Sacramento
Source
Filth and shame in an NHS hospital
Twenty-four hours to save the NHS! I wonder how often that promise comes back to haunt Tony Blair 10 years later. Week after week reliable reports and the government's own figures tell a disgraceful story of incompetence, debt, misery and filth in the National Health Service. That story is supported, week after week, by heart-rending personal accounts of horrors on the wards.
The broken new Labour promise that caught most public attention last week was the failure to abolish mixed-sex wards. Janet Street-Porter, the ferocious media personality, wrote about the misery of her sister when dying of cancer in a mixed-sex NHS ward. Plenty of other people have tried to draw attention to this disgrace and Baroness Knight, the Conservative peer, has been campaigning about it for years but - such is the spirit of the times - it takes a loud-mouth celebrity to get public attention.
The same thing happened when Lord Winston made a fuss about the dreadful treatment that his elderly mother received in hospital. Only then did the government stop denying that there was anything wrong.
Street-Porter published extracts last week of the diary of Patricia Balsom, her dying sister. They were horrifying. Among the miseries she endured was lying neglected in a mixed ward, where she was woken more than once to see a naked male patient masturbating opposite her bed. Her shocking stories prompted a flood of others.
The late Eileen Fahey, for instance, dying of cancer, was put onto a mixed geriatric ward where confused people wandered about without supervision. One man with dementia regularly masturbated at the nurses' station and tried to get into women patients' beds; he was a threat to them all but staff took no notice, according to her daughter Maureen. Other patients have to give answers to intimate questions in the hearing of other patients. One deaf old man was repeatedly asked when he last had an erection, until tears ran down his cheeks.
A former midwife described eloquently on Radio 4 the indignities of being in a 24-bed mixed-sex ward, stripped of all dignity and intimidated. Bedlam was the word she used, and it applies even more accurately to the secure psychiatric mixed ward in London endured by Susan Craig last year, after a breakdown. She suffered regular sexual harassment, with mentally ill men groping her and exposing themselves. The nurses disbelieved her and told her husband she was "flaunting herself". If so (I don't believe them), their job was to protect a patient from her own folly. Instead they chose, in modern cant, to blame the victim.
Sexual harassment is only a small part of the problem. Many people, both men and women, feel their modesty is violated by such closeness to random members of the opposite sex, even when they are not threatened. Patients lie naked, half washed and forgotten, their sick and ageing flesh exposed to everyone, while nurses rush elsewhere. It is commonplace to have to walk to filthy mixed lavatories with gowns wide open at the back. At a time of sickness and anxiety many people are profoundly embarrassed to be surrounded by a clutter of bed pans, colostomy bags, nakedness, cries of pain and sweat, blood and tears - their own and other people's. All this is much worse, for many, when they are surrounded by members of the opposite sex; shame and anxiety are not the best bedfellows of hope and healing.
Much has been written about the rape of modesty and the death of shame. However, it is still true in this weary country that most men and women prefer to perform private bodily functions alone if possible, and among their own sex only, if not. That's why we have separate public lavatories and separate changing rooms in shops and clubs and pubs. That's why people put up towels on the beach. That's why women give birth in female wards, not in mixed wards or not - I hope - so far.
Admittedly there are some who believe that mixed wards are not a problem, but our prime minister is not one. "Is it really beyond the collective wits of the government and health administrators to deal with the problem?" he demanded in 1996, flying high on vectors of dizzying youthful indignation as leader of the opposition. "It's not just a question of money," he went on. "It's a question of political will." Well, he said it and he promised to end mixed-sex wards by 2002.
What we have come to expect of new Labour promises, following failure, changing the goalposts, more failure and exposure, is denial. Sure enough Patricia Hewitt, the health secretary, was sent onto the Today programme in denial mode last week. Although the Healthcare Commission watchdog found that on average 22% of patients have to stay in mixed-sex wards, rising to 60% in some hospitals, Hewitt's officials at the Department of Health say the government has achieved its target of abolishing mixed-sex wards, with 99% of trusts providing single-sex accommodation. It is not difficult to spot the problem with that claim. It is not the same as saying 99% of patients get single-sex accommodation; it may be "provided" for very few. There has been the usual goalpost shifting: hospitals can claim they are providing single-sex accommodation by putting screens between beds in mixed-sex wards. Brilliant.
Hewitt admits there was a problem of perception; she even admitted that there was a "clear gap" between patients' experiences and figures provided by hospital trusts to the Department of Health. One does tend to have a problem of perception, I find, if one is being misled.
My feeling is that mixed-sex wards are not the worst of NHS hospitals' problems, although they demonstrate them. They demonstrate the incompetence and deviousness of hospital management in general, and they also show something worse. In all the stories I've come across what stands out is the ignorance, incompetence, laziness and heartlessness of all too many nurses, who are allowed to neglect and insult their patients without supervision and without sanction - in single-sex wards just as much as mixed. Blair did not just promise to abolish mixed-sex wards, he also promised to save the entire NHS. He believes in divine judgment; I wonder how he will answer.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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19 March, 2007
The British Labour party gets desperate
Tony Blair is to invite retail chains including Tesco, Virgin and Boots to bid to run GP surgeries on behalf of the NHS with contracts worth 225 million pounds over five years. GPs will be encouraged to run clinics at breakfast time and in the early evening in poor areas where conventional family doctors have been reluctant to practise. Blair’s announcement, to be made tomorrow, is intended to ensure Gordon Brown carries on his reforms of the NHS after Blair leaves Downing Street. The prime minister will respond to Tory claims that he has left the NHS in “crisis” by publishing his ideas for “progressive” reform of public services. He will allow GPs to link up with pharmacies and supermarket drug counters by sharing electronic patient records.
In an indication that he is signed up to the scheme, the chancellor will announce measures to expand the use of “community pharmacies” for routine treatments and tests. Tomorrow Blair will publish the first of six policy review papers, on public services, in an effort to shift the emphasis away from producers to consumers. Patricia Hewitt, the health secretary, will name the first towns to take part in the new programme. Extra family practices, walk-in centres and minor injuries units will be opened in Hartlepool, Durham, Mansfield and Great Yarmouth. Other areas will join the programme in the coming months. Contracts for the new services will run for an initial five years, with the possibility of extension.
Although there is no national shortage of GPs, there are many “underdoctored” areas in England and Wales. The four areas involved in the first wave have significantly fewer GPs per person than the national average of 57.9 GPs per 100,000 people. The programme aims to attract a broad range of providers, from existing entrepreneurial GPs to social enterprises and FTSE-100 companies. Some extra GPs and nurses will be recruited for up to 30 health blackspots to tackle local shortages of doctors.
David Cameron will also focus on the NHS in a speech to the Conservative party’s spring forum in Nottingham today. He is expected to say: “It used to be said that Labour were the party of the NHS. Not any more. Labour are the party that is undermining the health service. “There’s a simple reason why. It’s not because they don’t care. But it is because of their values and philosophy: Labour’s mania for controlling and directing things from the centre; Labour’s pessimism about human nature; Labour’s belief that if people aren’t told what to do, they’ll do the wrong thing. Labour just don’t trust people.”
Thousands of doctors staged marches in London and Glasgow yesterday to protest at reforms to the system of medical training. They accuse the government of trying to “disempower and degrade” the profession.
Source
Junior doctor selection chaos will ‘block medical progress in Britain’
The chaotic selection system for junior doctors is threatening British medical science as well as leaving thousands of trained doctors without jobs, leading clinical researchers said yesterday. The online application process for specialist training posts will lead to a shortage of medically qualified scientists, because it does not give credit to the academic and research achievements of junior doctors, senior scientists said. The Medical Training Application Service (MTAS), which puts candidates on shortlists for specialist jobs by computer, using a rigid scoring system, has been denounced as unfair by the British Medical Association. Junior doctors and consultants have called for it to be suspended.
The system has left more than 30,000 qualified junior doctors competing for 22,000 jobs, and consultants have refused to interview candidates because they regard the shortlisting process as unfair. Lord Hunt of Kings Heath, the Health Minister, was forced to order a review of the system last week, and thousands of doctors are expected to join protest marches in London and Glasgow tomorrow. Further criticism of MTAS has come from medical research groups, who said that the “dumbed-down” method of selecting the best candidates for specialist training paid “scant regard” to the needs of clinical research. The shortlisting system did not take account of junior doctors’ academic achievements or published research, it was claimed. This made it impossible to ensure that the brightest doctors were given appropriate posts.
Professor John Bell, president of the Academy of Medical Sciences, and Professor Sir John Tooke, chairman of the Council of Heads of Medical Schools, yesterday wrote an open letter to the British Medical Journal condemning the reforms. “Academic trainees — those doctors wishing to pursue careers which encompass research as well as patient care — have been particularly badly affected by the decision to anonymise applications and deprive the assessors of details of previous clinical and research experience,” they said. “Without a scientifically informed and research-orientated medical workforce throughout the country, the Government’s vision of the UK as a world-class centre for bio-medical research and health-care cannot be realised.”
A poll of more than 1,700 people, including more than 400 consultants, found that most wanted the scheme to be suspended or scrapped. Morris Brown, Professor of Clinical Pharmacology at the University of Cambridge, who organised the survey, said that the results showed that the Government’s review did not go far enough. “Many doctors that preferred to be a physician, for instance, were allocated instead to interviews in surgery or general practice, and would not receive a second chance. Those rejected altogether may not find any of their preferred options available in the second round,” he said. “All but 205 and 241 respondents, respectively, want the first and second rounds of interviews aborted now.” He said that all but 119 respondents believed that the architects of the NHS Modernising Medical Careers programme should resign
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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18 March, 2007
The Walter Reed Fiasco
Government medicine at work in the good ol' US of A
Since its publication on Feb. 18 in the Washington Post, the story of the bureaucratic nightmares experienced at Walter Reed Army Medical Center by soldiers from the Iraq and Afghan wars has been Washington's biggest bonfire in a long time. Nearly four weeks on it still consumes official Washington--with firings, hearings, denunciations and the waving forward of commissions.The problem with bonfires made in Washington is that the high and wild flames of politics sometimes blind the public to the fire's true cause. So it is with the Walter Reed scandal. The true cause of this bonfire is Washington itself, the local tribe. As we know from dreadful experience.
The pain caused by Hurricane Katrina in 2005 was made worse by Washington's inadequacies. In 2000, the Bremer Commission on terrorism said the national-security bureaucracy was poorly organized to protect us from a terrorist attack. The 9/11 Commission retrospectively confirmed the Bremer Commission's findings. Walter Reed is a scandal, but a familiar scandal.
It has also produced a particularly bitter irony. One of its first casualties was the career of Maj. Gen. George Weightman. Gen. Weightman, the commander of Walter Reed, is in fact precisely the kind of person the nation should wish to have in public life. But in an act of supreme self-destruction, our politics is driving him out of public life. We'll return to Gen. Weightman shortly.
Last week, a spokesman for House Speaker Nancy Pelosi came forward to announce the speaker's perspective on the manifest problems at Walter Reed: "The American people spoke clearly in the November elections that they wanted accountability and oversight. Under the Republican Congress it has been almost nonexistent, and you can certainly see that with what occurred at Walter Reed." No, you cannot see that. Rep. John Tierney, a Massachusetts Democrat, added that "we should have known all this before."
But all this was known before, though not by Reps. Pelosi and Tierney.
On Feb. 17, 2005--two years ago--GOP Rep. Tom Davis and the government reform committee held a public hearing on the maltreatment of wounded soldiers. The hearing was the culmination of an investigation, begun in 2003, by the committee and the Government Accountability Office. Virtually everything of substance in that Washington Post story was described, in numbing detail, at that hearing two years ago. Two soldiers, Army Sgts. John Allen and Joseph Perez, appeared before the Davis hearing and described their tours through the same hell painted by the Post last month.
Gen. Peter Schoomaker, the Army chief of staff, described the problems at Walter Reed in words that should be inscribed on portals across every bridge leading into Washington: "Life every day in this system is like running in hip boots in a swamp." He called it a "bureaucratic morass."
The core of the problem has been the peacetime administrative system's difficulty in handling wounded or disabled soldiers from the reserves and National Guard. In the words of the system itself, they have "fallen off orders." Here's how that happens:
To enter treatment, a wounded reservist would ask to have his "active duty orders"--i.e., the order that called him up for Iraq or Afghanistan--extended for 90 days, what is called an active duty medical extension, or ADME. But some soldiers would fall off their active orders before the ADME came through. Others, often with complex injuries, would use up their three-month ADME and again fall off orders before receiving a renewal.
Sgt. First Class Allen told the Davis committee in laymen's terms what this means: "When my orders expire, it creates a multitude of problems for me and my family: no pay, no access to the base [such as Walter Reed], no medical coverage for my family and the cancellation of all my scheduled medical appointments."
Someone should make a movie called "National Lampoon's Federal Government." The dialogue would include this line from the GAO's Gregory Kutz describing the soldiers' problem: "overall, we found the current stove-piped, non-integrated order-writing, personnel, pay, and medical eligibility systems require extensive error-prone manual data entry and re-entry." That's right--"and re-entry."
Despite the public record, the committee's new Democratic chairman, Henry Waxman, has rebooted the focus of the "mice-and-mold" scandal, from the obviously dysfunctional government to "privatization" at Walter Reed. Maintenance at Walter Reed collapsed in 2005, when the BRAC base-closing commission, whatever the merits and with President Bush's approval, ill-advisedly listed Walter Reed, amid a major war. So of course the civilian workforce went looking for permanent work elsewhere.
Into this collapsing "morass" the Army six months ago dropped Maj. Gen. George Weightman, M.D. No ordinary desk-bound doc, George Weightman spent five years in the infantry after graduating in 1973 from West Point. Then he went to medical school. It's a decision that has required him to design medical assistance techniques, in theater, with the troops that entered Saudi Arabia for the first Gulf War, in Honduras with Delta Force (there contracting malaria), in Kosovo as head of the 30th Medical Brigade for all troops in Europe, and in Kuwait training the surgeons and medics who would treat our wounded in Iraq the past four years, a model system. A former Army surgeon who served there with him told me he saw "numerous instances of George cutting through the bureaucracy on the run-up to Baghdad." And this is just the official side of the ledger. One son, also West Point, is on his second Army tour in Iraq, and the other is in the Army's medical school.
So when Defense Secretary Robert Gates ordered Army Secretary Francis Harvey to run across the Potomac River to Walter Reed and fire someone, this is who he hit. He fired the wrong person. The next day, Mr. Gates fired Mr. Harvey.
Washington of late has been giving talented civilians reason not to come there to serve, for fear of being destroyed in feckless political wars. So naturally it follows we should also drive out the best people willing to forego civilian wealth to defend us in real wars.
The powers-that-be in this sorry Walter Reed saga--Congress, Secretary Gates, the Dole-Shalala commission--could prove wisdom hasn't fled Washington by reinstating Gen. Weightman. A government establishment so profligate that it thinks nothing of throwing its best people onto bonfires of its own making will likely, over time, burn down to nothing
Source
NHS DREAMING
[TV show] "Tomorrow's World" is like our Government in its attitude to the NHS. Ministers stand, Raymond Baxter-like, with a futuristic blueprint of how life will be; and they know that if they make it sound sensational enough, and have a perpetual showcase of ideas, we will barely notice that, in essence, the gadgets from the last episode are kaput, nothing has changed and all we receive are updates of stuff that did not work particularly well in the first place.
Coming soon from Tomorrow's NHS: an air-conditioning unit for those with chronic obstructive pulmonary disease. Marvel as the Health Secretary, Patricia Hewitt, explains how it will work at a press conference today. Gasp as she neatly sidesteps the fact that if everybody with this incurable illness took up the offer of air-con installation, the cost would be in the region of o250 million. Gasp anyway when the next heatwave hits and you realise there is about as much chance of your GP springing for this as there is of your local Ford dealer contacting you about the flying four-door saloon you've had on order since 1973.
Do not be alarmed, though. There will be another glimpse of our brave new NHS world next month if Gordon pulls off his favourite trick by reinventing some old money as new in his budget. Maybe the paper-clip counters will lift their restrictions on drugs that stave off aggressive cancers or slow Alzheimer's disease. Doubt it. Most likely, there will just be the usual round of meetings, followed by a stalemate and the rearranging of figures to make it look as something has been done.
"Tomorrow's World" fizzled out because even in the computer age there are not that many new inventions. There are tweaks and refinements but it is not every week that a bloke marches into the television studio, consigns your 45s to the bin and hands you something called a compact disc. So it is with the NHS. We are led to believe that big, new ideas are happening all the time. Yet those who base their opinions on first-hand experience understand that little is different under Labour. We have various pronouncements and initiatives but, as ever, nobody gets out of casualty within four hours and waiting lists for big operations are still ticked off in years and months, not weeks.
When my father-in-law was dying of a brain tumour (called glioblastoma multiforme, the axe-wielding psychopath of the cancer family) and required round-the-clock care, three suits from the local health authority attempted to have the budgetary meeting about which department picked up his tab while drinking tea in his sitting-room, in front of his family. That was a decade ago. Now, his widow, my mother-in-law, waits for a hip replacement that was agreed to be essential the Christmas before last. The Health Secretary will tell you that care has changed and nobody waits more than six months for hip operations these days. If they do, the local trust has to pay to send the patient private. But that's another flying car. The actuality is that the six-month countdown only kicks in when a patient is on the waiting list, so if there is no availability the trick is to keep her off the register for as long as possible.
Say an elderly woman whose blood pressure is up, which it might be if she was on the highest daily dose of morphine for pain, and who is throwing up every morning as a side-effect, had hung about in a corridor for two hours and was then being seen in the NHS equivalent of a MASH unit with twin consultations taking place side-by-side in the same grubby room. Well, you cannot have the operation with raised blood pressure, so we have to get that under control before we can put you on the list. The same, next time, with that slightly high thyroid reading. We'll need to adjust your medication first, I'm afraid.
No doubt it is important. But a thyroid takes weeks to get under control, the waiting list is measured in months, but the two cannot run together because this is not about good health, but good housekeeping, the management of cost and resources, better to manipulate figures. All the patient can do is keep going back in the hope that, next time, the health service can find no reason to stall. Meanwhile, drink your morphine.
So when the Health Secretary stands up with the promise of a chilled climate for a million incurable wheezers this summer, please excuse my scepticism. She may see a vision of a healthy future, but from here it is just another holiday on Mars. Air-conditioning to be provided by people that can't find you a bed? Don't hold your breath.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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17 March, 2007
600,000 pounds compensation for a man whose wife died in a NHS hospital
The husband of a woman who died from blood poisoning six days after giving birth to their second child received 600,000 pounds in compensation yesterday after two NHS trusts apologised for a series of blunders that led to her death. Ben Palmer's wife, Jessica, was 34 when she suffered a cardiac arrest in the operating theatre, leaving him to bring up their two children, Harry and Emily, now five and two.
Mrs Palmer, a personal assistant to the Conservative MP Peter Lilley, was discharged from Kingston Hospital in Surrey the day after she gave birth, even though she had low blood pressure, a fast pulse and a high temperature - all signs of infection. As her condition deteriorated and she developed a red patch across her stomach, the couple contacted Mrs Palmer's GP, who prescribed painkillers for back pain, and her midwife, but she was not readmitted to hospital until five days later. She died the next day from multiple organ failure caused by streptococcal septicaemia.
At the inquest into her death, a community midwife from St George's Hospital in Tooting, south-west London, admitted that she had made a "gross mistake" in not referring Mrs Palmer to a doctor earlier. The deputy coroner for West London concluded that Mrs Palmer's death could have been avoided had she been sent back to hospital earlier, but she stopped short of formally finding neglect. She recorded a verdict of natural causes.
The final settlement figure of 600,000 against Kingston Hospital NHS Trust and St George's Healthcare NHS Trust, which both accepted liability, includes the provision of 23,667 pounds each to Harry and Emily. Robert Wilson, solicitor for the trusts, said at the High Court yesterday that both trusts expressed their "sincere apologies" to Mr Palmer and the family for "the shortcomings in care" which led to the death of Mrs Palmer.
"Inevitably, this has led to a great deal of soul-searching and I would particularly like to convey the profound regret of all the clinicians and staff involved in her care," he said. "Of course, they recognise that the family has to live with the consequences for the rest of their lives and an apology is of scant help in these circumstances, but it is sincerely offered."
After the hearing, Mr Palmer, 36, called on the Government to improve maternity services to prevent such a tragedy happening again. "This should never have happened," he said. "My son cries in my arms at night because he misses his mother, my daughter cries in sympathy and because she never knew her mother. I cry for them both, for the loss of their mother, my wife and best friend, and for the joys of motherhood that Jessica has been denied. "With mothering Sunday coming up this weekend, I would like the health secretary to try explaining to my children why Jessica isn't going to tuck them up in bed tonight."
Claire Fazan, his solicitor, from Irwin Mitchell, said: "Each stage of Jessica's care was provided by someone different. Her ante-natal care was at one hospital, her delivery was at another, the community midwife was from another trust and the health visitor she never lived to see was from yet another trust. Jessica's case highlights the need for extra resources and continuity of care for mothers." Mr Lilley said yesterday: "Jessica was simply one of the most delightful people you could know."
Source
Australia: Your bureaucrats will protect you -- NOT
Doctors have warned a proposed Tasmanian law to relax the registration of overseas-trained specialists could lead to unsafe treatment and even death. The Medical Council of Tasmania said the amendment to the Medical Practitioners Registration Act, which passed the Upper House last year, would lower standards nationally. President Mike Hodgson said the amendment would allow up to 10 overseas-trained specialists working in the state to apply for unconditional registration without assessment of their skills or qualifications. [Extraordinary!]
"We don't know that these individuals are safe," he said. "This amendment is not in the interests of public safety. "It will not allow the Medical Council to apply conditions on the registration of such practitioners even if they are performing poorly or have health problems. "It would even allow an overseas-trained specialist who was suspended, for whatever reason, to apply for unconditional registration." Asked what the impact of the Bill could be, he said: "What happened with Dr (Jayant) Patel." Dr Patel, an Indian-trained doctor dubbed Dr Death, is alleged to have caused a number of deaths at Bundaberg hospital where he was director of surgery.
Dr Hodgson said the amendment, which still needs to pass the Lower House again to become law, would allow specialists to apply for registration without assessment. He said the amendment would also remove the Medical Council's ability to control which specialties the doctors worked. It would also allow the doctors to use their unconditional registration to practice anywhere in Australia. "Under the mutual recognition, they can practice in any other state or territory in Australia, so we are imposing our lesser standards," he said. "It is not consistent with the rest of the country."
The Medical Council can now impose conditions on doctors' registrations to ban them from certain tasks, specialities or working without supervision. It also co-ordinates the assessment of doctors' skills and qualifications, which Dr Hodgson said varied greatly between countries.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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16 March, 2007
Bungling British bureaucracy kills mother who fell ill after hours
Penny Campbell became ill and died over the course of a bank holiday weekend despite the attention of eight doctors. Her grieving partner believes that she would still be alive if the NHS out-of-hours system worked properly. Angus MacKinnon said that Ms Campbell, 41, had been a victim of the Government's approach to healthcare reform. She died from blood poisoning at the Royal London Hospital, East London, after she became infected during an operation for haemorrhoids. Her condition would have been easy to treat if caught in time, but she fell ill over the Easter weekend in 2005, while her GP was on holiday.
Eight doctors from Camidoc, a private company contracted to provide out-of-hours cover, misdiagnosed her condition because they did not have access to notes made by her GP or by each other. An inquest ruled in October that they had contributed to her death.
Mr MacKinnon, who intends to sue Camidoc, said: "I'm fairly confident that if Penny had been seen by a doctor from her own surgery, then you would not have had a situation where you can be seen by eight doctors, none of whom could diagnose correctly."
He has been told by a government source that the policy for providing out-of-hours cover was not discussed in Cabinet. "The reform was introduced without any kind of pilot scheme, which is absurd." He said that the coroner wrote to Patricia Hewitt, the Health Secretary, after the inquest to warn her that the case raised national issues. "Five months later I am still waiting for a letter from her. I think that is shocking."
Source
Reform of GP out-of-hours service an expensive shambles, says report
Government preparations for a new out-of-hours GP service were "shambolic", a report from the Public Accounts Committee has found. Doctors were allowed to opt out of providing a 24-hour service in return for a salary sacrifice of only 6,000 pounds each - half what the service costs to provide. The Department of Health was not directly involved in the negotiations and never clearly defined what it wanted.
Poor monitoring means that some primary care trusts do not know whether the services they provide are any good. In cases where quality has been measured, performance is poor.
The department overlooked the fact that ending Saturday surgeries would be inconvenient for many patients, the committee said. It also allocated 70 million pounds less to trusts than the new service cost to provide, forcing them to incur deficits or to cut budgets for other services.
Edward Leigh, Conservative MP for Gainsborough and chairman of the committee, said: "The Department of Health thoroughly mishandled the introduction of the new system of out-of-hours care. The department chose to act as an observer, and no more, in the negotiations with GPs' representatives. This hands-off approach was good news for the doctors but no one else. They were given a strong incentive to opt out - a lot less work for a small loss of income - and a disproportionate amount of taxpayers' money is now having to be spent to provide the replacement service." About nine million patients require out-of-hours care in England each year. This is provided by in-house primary care trust teams, GP cooperatives and private companies.
Mr Leigh added: "The new service is getting better, but the needs of patients are not best served by the ending of Saturday morning surgeries. They are not best served where access to advice and treatment is often extremely difficult and slow; and they are not best served where no one knows whether the service is meant for urgent cases only or for any requests for help at all. "To cap it all, the cost of the new service is around 70 million a year more than was expected. That's the last thing the primary care trusts need at this time of increasing financial pressure." The total allocated by the Department of Health to trusts for out-of-hours services in 2005-06 was 322 million, according to the report from the Public Accounts Committee. However, figures from the National Audit Office showed that actual spending in 2005-06 was likely to be 392 million.
Those who provide out-of-hours care have been set targets relating to how long it takes to answer a call and to assess whether a patient is an emergency case. But the percentage of trusts meeting the targets was extremely low, the report said.
Stephen O'Brien, the Conservative health spokesman, said: "The Government has failed on out-of-hours provision. Everyone up and down the country is suffering because of it. Patricia Hewitt's pitiful attempt to claw back money from GPs is to try and shut the gate after the horse has bolted. "Not only has the extra cost added to the billion-pound cash crisis in our NHS, but it has pushed more people into busy A&E units, putting greater pressure on our hospitals."
Norman Lamb, of the Liberal Democrats, said: "Yet again, the Government has grossly mishandled an NHS contract, putting further pressure on cash-strapped trusts and leaving patients confused about where care is being provided. The effect of this mess is that A&E services will be swamped by patients who don't know where else to turn."
The Department of Health claimed that "most patients" were benefiting from improvements in out-of-hours services thanks to the new arrangements, and denied that the ending of Saturday surgeries had anything to do with the new contract. A spokesman said: "Patients right across the country should now be assured timely and responsive care, including the guarantee of a face-to-face consultation with a GP if needed. "It was clear from the rising number of complaints that the previous system was not meeting patients' needs and was affecting the ability to recruit and retain GPs."
Hamish Meldrum, chairman of the British Medical Assocation's GPs Committee, said: "We would confirm the committee's findings that the quality of many out-of-hours services leaves a lot to be desired. We have commented about this both nationally and locally. "However, we would reject the implication that GPs were the only ones to do well out of this deal and that the Government was not really involved. The Department of Health was fully aware at all stages of the negotiations about the opt-out price."
-Before 2004 GPs were responsible for their patients 24 hours a day. For out-of-hours care (6.30pm to 8am weekdays and all weekend) they either did it themselves, shared the load with other doctors or employed locums
-The new contract allowed them to opt out of 24-hour care by sacrificing 6,000 a year. Ninety per cent of GPs accepted
-Primary care trusts had to organise out-of-hours care by employing GPs, private companies or even GPs who had opted out of providing it themselves
-As a whole, the new contract gave GPs a big rise in pay, raising the average to nearly œ100,000. A points system that rewards GPs for a quality service easily exceeds what they lost in giving up out-of-hours care
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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15 March, 2007
Swiss vote rejects single health insurer plan
Swiss voters have overwhelmingly rejected a proposal for a single health insurer. In the March 11 ballot, 71% of voters were against the proposal to establish one state-run insurer to replace the 87 that now write the coverage. Voting against the proposal was heaviest in the German-speaking part of the country with opposition lighter in the French and Italian-speaking regions.
The initiative made it onto the ballot after the left-leaning Mouvement Populaire des Familles collected 110,000 signatures to force the vote. The group claimed the current system is too costly and wanted it replaced by a single insurer that would base premiums on wealth and income. Health insurance is mandatory for Swiss residents.
Source
Australia: Another State health system in trouble
The boss of Tasmania's massive Health and Human Services department has quit, halfway through a series of major and "difficult" reforms. DHHS secretary Martyn Forrest yesterday announced his resignation, saying he had accepted an education position in the Middle East.
In the past few years there has been an exodus of senior bureaucrats and medical specialists from the department, which Health Minister Lara Giddings admits is stretched to the limit. Dr Forrest's departure comes as the DHHS is going through budget cuts and unprecedented change and all services -- including public hospitals -- are under review. A new Royal Hobart Hospital is being planned, the swamped child protection system is in the midst of an overhaul and there are fears of hospital closures in the North-West.
Dr Forrest said there was never a good time to leave. He admitted the job had been challenging and stressful and the department had been "in a bit of a moribund state, a bit depressed" when he took charge in late 2005. "Now I think that it has got a bit of confidence about what it is doing," he said.
Ms Giddings admitted Dr Forrest's departure could lead to "very short delays" in the clinical services and primary health services plan. But the State Government was committed to reform to prepare for increased future demands. And she defended the departure of Dr Forrest and other key DHHS people as "nothing out of the ordinary for a workplace of more than 11,000 people". The RHH churned through four CEOs in little more than a year and security marched emergency department head Alastair Meyer out of his office last April. Other resignations include:
-- Children's Commissioner David Fanning, who quit in September saying the system was not coping, and still has not been replaced.
-- DHHS deputy secretary Anne Brand quit last March, telling Dr Forrest it was "time to move on".
-- Alcohol and Drug Service clinical director David Jackson quit last February, saying he could no longer watch young people die of drug addiction.
-- RHH head of obstetrics and gynaecology Melwyn D'Mello resigned just before the election was called last February.
-- And hospital CEO Ted Rayment was deposed under a shroud of mystery in August 2005.
Australian Medical Association southern division chairman Haydn Walters said Dr Forrest had overseen a period when politics, not clinical need, had driven spending. Prof Walters said Ms Giddings now had a good opportunity to appoint someone with experience in health -- which he said Dr Forrest lacked -- to spend money sensibly. "Find somebody who wants to work with the doctors and nurses rather than treat them like the enemy because they spend money," he said.
Australian Nursing Federation state secretary Neroli Ellis said Dr Forrest had replaced senior nurses with bureaucrats from the Education Department. Dr Forrest was head of the Education Department from 1997 until October 2005, when he moved to the DHHS to replace John Ramsay. "ANF has serious concerns with the legacy he has left behind," Ms Ellis said, adding many of the bureaucrats were on five-year contracts.
State Opposition health spokesman Brett Whiteley said Dr Forrest had been an impeccable public servant and his departure was a "major blow". Mr Whiteley said the health system had been in "meltdown" under Labor and delays in vital reforms were expected. Dr Forrest said the Fit program to cut red tape in the bureaucracy had been his major achievement during his 17-month term. Ms Giddings thanked Dr Forrest for his leadership and initiating reforms and said his departure should not hurt the department.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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14 March, 2007
NHS negligence kills baby
Even spinning like a top could not quite cover this one up
A newborn baby became the youngest victim of MRSA in Britain when he died in hospital after contracting the virulent superbug, a coroner ruled yesterday. Luke Day was only 36 hours old when he died, though he may have been saved if medical staff had followed procedures and given him special care, an inquest into his death was told. An attempt by doctors to resuscitate him failed after he was found lifeless in a cot beside his mother on the maternity ward at Ipswich Hospital in February 2005. An internal inquiry revealed that staff had failed to recognise signs that Luke could have been ill up to 16 hours before his death.
Specialists said they could not be sure MRSA was the cause of death, but Peter Dean, the Suffolk coroner, said that on the balance of probabilities Luke had died as a result of contracting it. Staff at the hospital were unable to find the source of the bug, despite carrying out extensive inquiries.
Luke’s mother, Glynis Day, now 19, a kitchen assistant from Woodbridge, Suffolk, attended the hearing with Luke’s father, Kevin Fenton, 26. They criticised the hospital’s failure to detect warning signs. “I think it is disgusting,” Ms Day said. Mr Fenton said that hearing the details of how Luke died “makes me sick”.
Marion Malone, who conducted a postmortem examination at Great Ormond Street Hospital in London, which found MRSA in Luke’s lungs, heart and spleen, told the hearing that she believed his death had been caused by septicaemia due to bacterial infection.
The inquest heard how Luke should have been tested for possible infections after staff noticed that his temperature was low, that he had low blood-sugar levels and he appeared “lethargic and slightly floppy”. Tests later revealed that his blood contained MRSA — methicillin-re-sistant staphylococcus aureus — as well as a less dangerous form ofstaphylococcus.
Peter Wilson, a consultant microbiologist at University College Hospital, London, who analysed Luke’s blood samples, said the balance of probability was that Luke’s death was caused by the bacteria. But he added that he could not say for sure if the MRSA strain was responsible or whether death was caused by septicaemia or toxins in the blood caused by the bacteria.
The coroner asked him: “Are you saying that there were signs that should have triggered referral and it would appear these signs were not picked up so Luke therefore did not have the benefit of an infection screen? “Is it fair to say that his chances would have been better had protocol been followed? [That] we don’t know if the outcome would have been different, but [that] Luke would have had a better chance?” Dr Wilson replied: “Yes, that is correct. It all depends on whether the signs that were present should have been spotted.” He added that Luke could have been treated with antibiotics if infection was suspected, which could have saved him by preventing the septicaemia from spreading.
The inquest heard how Luke weighed a healthy 7lb 7oz when born naturally at 6.53am on February 2, 2005. Staff had no concerns about his condition, but then found he was “grunting”, had low glucose levels in his blood and a lower than normal temperature at 2.10am the next day. Jane Gosling, the senior midwife, was later attending to Ms Day when she noticed that Luke was cold. He was immediately transferred for resuscitation but was declared dead 30 minutes later. The internal hospital inquiry report said there were deviations from clinical guidelines and that a paediatrician should have been called to examine Luke because of his low temperature and blood-sugar levels. It added that some of the clinical guidelines were ambiguous, but that there was “no overarching coordination of Luke’s care”.
Source
What a marvellous miracle! -- this baby survived
Healthy Baby Born After Prenatal Screening Falsely Showed he "Died". Baby boy miraculously survived womb-scraping procedure to remove its body
A prenatal screening test given to a UK woman in early pregnancy showed her baby had died, and the next day she underwent a procedure to remove the child's body from the womb. Three weeks later, however, she discovered her baby was alive and healthy, in a miraculous escape from failed technology. Jake Brown was born Feb. 24 at St. John's Hospital in Livingston, healthy and untouched by the trauma of his early development, The Telegraph reported March 7. His mother, Julie Brown, 29, said "The thought of them trying to get rid of a perfectly healthy baby makes me sick to the pit of my stomach, but I've got to move forward now."
The hospital had conducted a scan on Mrs. Brown at five and a half weeks gestation and could not find a heart beat or signs of growth. She was told the child had died and scheduled for a dilation and curettage procedure the next day. Somehow, her baby survived. ""The hospital has explained to me exactly what went wrong (with the diagnosis)," Mrs. Brown said. "The baby's sac hadn't changed size, but the baby had. The woman carrying out the scan didn't notice this and she thought I'd miscarried."
Errors in prenatal testing are far more common than many people realize. While more and more parents are depending on technology to identify potential health problems in their unborn children, many are not aware of the significant inaccuracy rates in prenatal screening. Abortion of the child is most often the result, even though in many cases scans are inconclusive or show only an increased possibility of health problems.
Down's syndrome is one of the most common pre-natal diagnoses to lead to abortion--but studies show screening tests for Down's are inaccurate up to 40 percent of the time. A recent Canadian study found more natural differences between the genetic code of individuals than previous researchers had thought existed, leading to greater difficulty in establishing a "normal" genetic code as a basis for evaluating pre-natal scans. Published in the journal Nature, the report suggested that prenatal screening may incorrectly diagnose genetic differences as "defects".
While the Browns don't intend to pursue legal action against the hospital, the couple said the mistake caused pain and trauma to the whole family. "They booked me in for an operation to remove the baby and we were all devastated,' Mrs. Brown said. "We then had to explain to my children Sarah and Leon that the baby had gone to heaven. My husband and the children were in floods of tears."
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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13 March, 2007
Wal-Mart's capitulation endangers American health care
Wal-Mart Chief Executive H. Lee Scott is leading his company down a most dangerous path by allying with its union critics to endorse government-run universal health care. Last week, Scott teamed up with Andrew Stern of the Service Employees International Union (SEIU), one of Wal-Mart's harshest critics, to launch the "Better Health Care Together" campaign. This campaign seeks to co-opt business leaders to join unions and liberal advocacy groups to press for universal health care by 2012. Other members of the Better Health Care Together campaign include the Communications Workers of America (CWA), the George Soros-funded Center for American Progress, AT&T and other corporations.
Scott and Stern listed four "common-sense principles" that would guide the coalition in "achieving a new American health care system." One of these principles stated: "We believe every person in America must have quality, affordable health insurance coverage." No one advanced any specific plan or policy prescription to achieve that goal. However, the statements by the union bosses make quite clear that they understand universal health care to be a government-run, taxpayer-financed system in which Americans' most basic health care choices will be dictated by bureaucrats.
Stern said, "I think (the) employer-based health care system is dead." CWA President Larry Cohen added, "It's long past time to move health care -- a public good -- from the corporate balance sheet to the public balance sheet." Far from taking issue with these sweeping endorsements of socialized medicine, Scott vowed that Wal-Mart will "put aside disagreements" with its union critics so business, labor and government can "work together" to solve the health care crisis. This capitulation to the unions is just the latest example of Wal-Mart caving into its liberal critics in a desperate and futile bid to buy political peace.
For a couple of years now, Wal-Mart has been kowtowing to the environmental movement. The company is spending $500 million a year to cut its greenhouse gas emissions to combat the unproven global warming threat. Not content with that, Wal-Mart is pressuring its 60,000 suppliers to cut their emissions and adhere to other onerous environmental mandates or risk losing their lucrative contracts with the retailer.
What does Wal-Mart have to show for toeing the green agenda? Absolutely nothing. The environmental movement, to a large extent, still rejects Wal-Mart. Greenpeace, the Sierra Club and Friends of the Earth continue to denounce the company's environmental strategy as insufficient or a sham. Yet, Lee Scott somehow believes that by appeasing unions -- Wal-Mart's most implacable enemy on the left -- the company can silence its labor critics. Scott is simply deluded.
Stern may be willing to share a podium with Scott to push his cherished goal of taxpayer-financed health care, but he is not going to stop his anti-Wal-Mart campaign until every Wal-Mart employee is a dues-paying union member.
And it certainly doesn't bode well for the success of Scott's union outreach effort when his endorsement of universal health care was immediately met with scorn by the labor movement. Paul Blank of WakeUpWalMart.com, which is funded by the United Food and Commercial Workers Union, said Wal-Mart's commitment to health care cannot be taken seriously until it gives universal coverage to its own workers and stops giving political contributions to pro-free market, Republican politicians.
Scott's endorsement of universal health care is bad for Wal-Mart, bad for its customers and bad for its shareholders. Ultimately, the cost of any government-run universal health care system will be borne by the taxpayers. And those taxes will come right out of the wallets of the moderate-income workers that are Wal-Mart's customer base.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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12 March, 2007
NHS DENTISTRY BUNGLE
NHS dentistry faces a 120 million pound shortfall because the Health Department wrongly estimated how many patients would contribute to the cost of their treatment, the Tories claimed yesterday. Many people appear to have abandoned the NHS to go private, reducing the amount of money that NHS dentists are able to collect through patient charges.
Andrew Lansley, the Shadow Health Secretary, used the Freedom of Information Act to seek data for 51 of England's 152 primary care trusts, which pay dentists. He said that nearly all were collecting less patient revenue than they had expected. The deficit for the 51 trusts was more than 41 million pounds, which suggested, Mr Lansley said, that the deficit for all 152 trusts would 120 million.
The figures also suggested that since 2005-06 there had been a 6 per cent drop in the level of dental care on the NHS, equivalent to 1.4 million fewer people registered with an NHS dentist, he said. "This is the latest revelation in a long series of NHS mismanagements under Labour. Eight years ago, Tony Blair promised everyone would have access to an NHS dentist but in the last year alone, 1.4 million fewer people have access. Labour wanted to milk dental patients through higher charges but the decline in NHS dentistry has even thwarted that plan."
The Health Department contested Mr Lansley's claims. "This survey paints a picture of NHS dentistry that we do not recognise. We do not accept the claim that 1.4 million fewer people now have access to NHS dentistry," it said. "Equally it is nonsense to talk of a massive shortfall in investment.
Source
The health bungles never stop in Australia's oldest socialized medicine system
[Queensland] Health bosses are building a $30 million operating theatre at a Brisbane hospital, while existing theatres sit empty because of a lack of staff. Only last month, the Beattie Government talked of slashing elective surgery spending after a budget blowout. Theatres at Ipswich, Logan and Redland hospitals have been out of action for months because there are not enough staff.
But plans for a new theatre at the Queen Elizabeth II Hospital, which is next to Health Minister Stephen Robertson's electorate, are forging ahead. The project is part of a $95 million refurbishment promised for QEII during the election campaign. It will incorporate 30 beds and will open early next year, aiming to cut the number of patients waiting too long for operations.
The Australian Medical Association has criticised building new theatres when others sit idle. State president Zelle Hodge said: "It's like a scene from 'Yes Minister'. "You have to question why they are building a new theatre when we already have theatres in the same area not being used because of a lack of staff or beds."
Figures show more than 10,000 patients are waiting longer than is clinically desirable for elective surgery in public hospitals - almost 200 of those are classified as urgent. Meanwhile, an operating theatre at the Princess Alexandra Hospital has sat idle for the past four years - used only as a storeroom. It finally opened last month after a Sunday Mail report prompted Queensland Health to take action.
Doctors are disappointed about the new QEII theatre and say other services have been sacrificed to support "another Robertson ribbon-cutting photo opportunity". One member of staff, who refused to be named because of a Queensland Health ban on speaking to the media, said creating more theatres was "a ridiculous plan'. A doctor said: They might as well just pour the money down the drain."
In recent months, two new operating theatres have opened at Redcliffe and Caboolture hospitals at a cost of $68.6 million. The emergency department at Caboolture Hospital is still being managed by a private firm at a cost more than double the standard public running costs - a year after it had to close because of staff shortages.
Opposition health spokesman John-Paul Langbroek said the funding should be spent on extra beds. Queensland Health refused to comment when asked why a new theatre was being built while others stood empty. It also refused to say whether there would be staff available to run it.
The above report by HANNAH DAVIES appeared in the Brisbane "Sunday Mail" on March 11, 2007
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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11 March, 2007
Improving on the Bush health plan
President Bush has finally come up with a truly good idea: a plan to restore the market for healthcare in this country, a plan that reduces moral hazards and the subsidies for wage slavery. Alas, he waited until his own party lost its majority in both the House and Senate before putting forth the plan. So, is the plan dead on arrival? Will the Democrats hold out for a socialized healthcare system, giving us all the efficiency and performance of the public school system?
Message to Democrats: please don't hold out. But do feel free to put your own imprint on the plan. You can make it more progressive, while making it simpler and more effective.
How? Replace Bush's $7500 tax deduction with a tax credit - say $2500. This is obviously simpler than a tax deduction. It is also more progressive, since the poor get just as much benefit as the rich.
I could hear some right-wingers whining as I wrote that last sentence, "Not another wealth transfer to the poor! We can't afford to give every insured person a $2500 tax credit." Indeed, such a tax credit would cost the IRS more money. But it might not cost the government much more. It might even save money. What is lost as tax credit would be at least partially made up for in less welfare payments. If an uninsured well off person gets sick, there are many assets to tap before that person resorts to government aid. The government gains little by making sure such people have health insurance. On the other hand, if a low income person gets very sick, it isn't long before that person is resorting to government aid or abusing the emergency room.
Why do we grant a tax break for the well off to buy health insurance, anyway? The well off have far more to lose if they get seriously ill without healthcare coverage. If you have nothing, you can simply declare bankruptcy and go on the dole. If you have home equity or money in your accounts, this is a major financial loss. Thus, we can expect the well off to buy at least catastrophic coverage even if there was no tax benefit.
But suppose the well off decided to self-insure. That would be better! We would have people shopping for major treatments using their own money. The market for serious care would improve greatly. If anything, it would be in society's interest to penalize wealthy people for buying health insurance.
It's the uninsured lower classes that gum up the system. They are the ones who cannot pay their bills when the bills get high, which drives up overall expenses for doctors and hospitals - and ultimately for paying customers. If we are going to use the tax code to encourage the buying of health insurance, we should target the lower classes as much as possible. A tax credit is a big step in this direction, and is simple to boot.
Source
Second lung cancer drug not made available to NHS patients
Another new cancer drug has been rejected by the Government's value-for-money watchdog. Roche, the healthcare company that makes Tarceva, used to treat lung cancer, said that it would appeal against the decision by the National Institute for Health and Clinical Excellence (NICE), which it said was perverse and disappointing. It claimed that the evidence Roche presented had been assessed "neither fairly nor appropriately" by NICE. Tarceva has been approved for use in Scotland since June 2006.
The NICE guidance said it did not believe that Tarceva (erlotinib) was the best use of resources in the care of sufferers of non-small cell lung cancer. It said that the drug would be reviewed again next year. Andrew Dillon, chief executive, said: "After considering all the evidence available, as well as the comments received during consultation on the earlier draft, the independent appraisal committee concluded that erlotinib is not an effective use of NHS resources when compared with either docetaxel or best supportive care. The committee was also concerned that erlotinib would not be as effective as the existing standard treatment, docetaxel.
"However, given the rapidly changing evidence base for erlotinib, the committee advised that the guidance should be considered for early review. Therefore this guidance will be reviewed in February 2008. "The committee also recommends that further research be undertaken into subgroups for whom erlotinib may provide greater benefit." Subject to an appeal being received, final guidance to the NHS is expected in April.
Mike Unger, chief executive of the Roy Castle Lung Cancer Foundation, said: "We are obviously severely disappointed and disillusioned with NICE's decision not to approve Tarceva purely on economic grounds. It's the second blow that NICE has dealt to lung cancer patients in a month, following the announcement to decline Alimta - so there are now very few options left for lung cancer patients."
Mr Unger added: "This leaves massive inconsistencies in treatment options for lung cancer patients in the UK. It's absurd that Tarceva is available to certain patients in Scotland, but not the rest of the UK. Tarceva is used as a standard treatment in many other European countries and this should be the case here." Tarceva has been hailed by the medical profession as a big advance in a neglected area of cancer.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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10 March, 2007
NHS sees light and saves couple from choosing who goes blind
An elderly couple who faced having to choose which of them should go blind because they could not both afford sight-saving drugs have finally been saved by the NHS. Olive Roberts, 79, and her husband, Ron, 81, both suffer from wet age-related macular degeneration (AMD), the most common form of blindness in Britain. They were told that the only way to treat their condition quickly enough was to go private. However, the treatment would have cost them more than 14,000 pounds each. They could afford only one course and decided that Mrs Roberts should have it as her sight was deteriorating faster.
Yesterday Wiltshire Primary Care Trust announced that it would fund Mrs Roberts's treatment. The trust denied accusations of a U-turn, but was criticised by campaigners for allowing the couple's condition to deteriorate by taking more than two months to decide. The couple are among tens of thousands of people with AMD who urgently need sight-saving treatment but who say that they have been let down by local health authorities refusing to fund new and effective drugs to treat the condition. The Royal National Institute for the Blind, which supported the couple's case, said that four out of five NHS trusts were denying patients prompt treatment with sight-saving drugs.
Mr and Mrs Roberts had AMD diagnosed after sudden onsets of blindness last year. Mr Roberts, a retired civil servant who served with the RAF and the Royal Navy during the Second World War, was disappointed that the trust had not contacted them directly with the news. "While we are delighted that Olive can receive the treatment she needs, we have been through hell in the past three months, and this highlights the fact that many other people are not getting the help they need."
AMD damages the part of the retina responsible for precise vision. Treatments are approved for use on the NHS in only a quarter of cases and can merely slow the disease's onset. The Roberts were advised that only prompt treatment with the drug Lucentis could prevent blindness. However, it is not approved for widespread use on the NHS. Mr and Mrs Roberts, of Malmesbury, asked Wiltshire Primary Care Trust to fund the treatment, but were told that they would have to wait up to three months for a decision.
Advised to undergo treatment within that time, the couple decided to buy Mrs Roberts a course of the bowel cancer drug Avastin, a cheaper alternative. However, clinical trials have not proved its safety and efficacy in AMD. Paul Jakeman, medical director for Wiltshire trust, said that the NHS would fund Mrs Roberts's treatment with Lucentis. Mr Roberts said that he could now afford to pay for Avastin for himself. "It seems that only those who shout loudest will get this treatment," he said.
Source
NHS to face elderly care probe
About 25 NHS trusts are to be inspected after concerns were raised about the way they care for older people, the Healthcare Commission has said. The inspections will form part of a wider review for a report published later in the year. The announcement comes after concerns were raised, including some by charities, about the way the trusts treat elderly patients.
The Healthcare Commission already inspects all NHS trusts but they are allowed to self-report on whether they meet core Government standards. These include on privacy, treating patients with respect, and ensuring their nutritional needs are met.
The 25 or so trusts have said they meet the core standards but this will now be verified by the Healthcare Commission. The Commission has given the trusts two weeks' notice that they will be inspected, but not which wards. Inspectors will go through files, observe wards and speak to staff, who will be interviewed anonymously. Trusts that are performing well will also be examined to help inform best practice.
Anna Walker, the Commission's Chief Executive, said: "Let's be clear that the vast majority of NHS staff go to work to look after patients well and make an excellent job of doing so. "But sadly, it is also true that some patients are not treated with the dignity and respect they deserve. That is simply unacceptable in the modern NHS."
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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9 March, 2007
Is the Governator's plan illegal?
Post lifted from Democracy Project
Chris Reed, an editorialist of the San Diego Union-Tribune, (here's his bio) has been doing a fantastic and knowledgeable job of exposing the new clothes of the grandiose health care proposal by California Gubernator Schwarzenegger as lacking fiber.
In his online blog at the newspaper, today, Reed cites the court decision striking down the Maryland so-called "Wal-Mart tax" requiring a certain level of health benefits by employers or else pay a tax to a state fund for the benefit of the uninsured:
Because the Fair Share Act effectively mandates that employers structure their employee healthcare plans to provide a certain level of benefits, the Act has an obvious "connection with" employee benefit plans and so is preempted by ERISA.Reed then phones one of the nations leading ERISA experts, who was general counsel for Wal-Mart, to check up on California governor Schwarzenegger's proposed health care plan that also imposes a "play-or-pay" on employers:
"Frankly, I'm not impressed here. ... They are trying to skirt around these prickly issues and sell the overall idea (of extending health insurance coverage)," he said. "Respectfully speaking, I don't know where they're getting all this."As Reed sums up:
[T]he governor's staff: Declines to name a single lawyer not in the administration's pay who thinks its health insurance plan is legal..Maybe the Gubernator is hoping on a special dispensation from Congress, or in-law Teddy to drive to the rescue (without himself going off a bridge but sending the rest of us there).
This would be comic if the stakes weren't so high. We're about to have a bitter fight for months over something that's plainly illegal, a fact that's obvious to every ERISA expert out there, but not to our governor or his high-paid staff. Just great.
Read Reed's comprehensive editorial, "Governor's plan falls apart under scrutiny," from yesterday's San Diego Union-Tribune to get the whole sorry picture of the naked foolishness by Schwarzenegger.
Reed is dogged in revealing the empty rhetoric driving most other newspapers, as they lament the "uninsured." The poor already receive health care, through Medicaid and similar programs for working poor, and even illegals are guaranteed emergency care. Most of the uninsured are, actually, the young and foolish, and most others can afford at least catastrophic insurance if they didn't prioritize lattes and other luxuries over self-responsibility. Here and here, Reed names the newspapers glibly citing that there are 47-million uninsured, when up to 12-million are actually illegal aliens.
The mantra that we must upend the health care arrangements and economics of the 85% of us with insurance, polls usually showing 80% satisfaction, in order to subsidize the inflated, undeserving and irresponsible bulk of the uninsured 15% is public policy insanity, driven by the Left's obsession with enlarging government and bureaucrats' power over us via a government-run, nationalized health care system.
Red tape killing NHS
The National Health Service is groaning under the weight of inspection and regulation, with at least 56 bodies with a right to visit NHS hospitals and trusts, many without an invitation. There are so many bodies that the authors of a new report from the NHS Confederation say that they are not sure they have managed to count them all. Calling for a halt to overbearing bureaucrats, the confederation - which represents NHS managers in 90 per cent of trusts - says something must be done to reduce the burden.
The burden of providing data is even worse than that of playing host to Government inspectors, the report says. Often different bodies call for the same data, but in subtly different forms, so that it must be collated twice at huge cost. "The sheer number of inspections, standards, and volume of information required to demonstrate compliance is making it difficult for NHS organisations to extract value from these various process and use them to drive improvement in services for patients" the report says.
Despite claims by the Healthcare Commission, the principal inspector, that it would adopt a "light touch" and promises by Government to ease the burden of regulation, things are getting worse, not better. The impact of the commission's annual health check is "overwhelming", the report says, and loses its meaning because of its wide-ranging nature. The process requires 500 separate information topics to be addressed, so voluminous that managers told the confederation they doubted they could ever complete them well enough.
There is also huge overlap with data required by the Clinical Negligence Scheme for Trusts and the Healthcare Commission.
There is also criticism of the commission's move to ask trusts to "self declare" compliance with its standards. While the aim was to reduce inspections, the result has been confusion as trusts do not know what documents they need. "This has led to an increased feeling of a burdensome system where the board has to second guess what the Healthcare Commission is looking for," the report says.
Sometimes the demands are absurd. One hospital installed a toilet block and single-sex wards, but the commission refused to accept this as there was no paperwork. Extra work was needed to generate paper that has no function except to satisfy the regulator.
Gill Morgan, chief executive of the confederation, said: "NHS leaders welcome meaningful regulation and inspection, but unsurprisingly they don't like excessive bureaucracy. "Regulation is not an end in itself. It will only fulfil its purpose if it helps NHS organisations assess themselves as a way of driving forward improvement and providing public assurance about quality and safety of the service."
The commission has introduced a concordat between inspection bodies aimed at reducing the burden. But, the conferedation says, it is not working. It recommends the sharing of information between regulators, cuts to inspections and data collections, inspections managed to avoid unnecessary evidence gathering and that the concordat be extended to all organisations
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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8 March, 2007
Replace VA hospitals with VA health cards
A way around the woeful standards of America's war veterans' hospitals. For background on how bad the problem is, see here
Anne Hull and Dana Priest of the Washington Post follow up their scoop on Walter Reed's problems - a scandal that cost the Army secretary his job - with a look at the 157 VA hospitals. Walter Reed is an Army hospital. Senators and presidents use it. The VA hospitals are for veterans and have been a problem for a long time. The opening paragraph ended, "His own VA hospital in Livermore was a mess. The gown he wore was torn. The wheelchairs were old and broken."
May I make a suggestion? Replace the VA hospitals with a VA health card. Let us ex-soldiers use regular hospitals for our health problems. Most of the 24.3 million veterans have some sort of health care. Those who need the VA's help need something better than, as the Washington Post pointed out, "substandard, underfunded care in the 154 VA hospitals and hundreds of community health centers around the country."
VA funding has skyrocketed under Bush. He wants $86 billion next year. That is nearly double the $47 billion it was in the last year of the Clinton presidency.
Money is not the problem; the concept is. We did not build a string of VA colleges to get veterans their education. We do not have a string of Medicaid hospitals or Medicare hospitals. Mainstream the veterans. That should improve their care. This is not to disparage the people who work at VA facilities. I am sure they are good, hard-working, patriotic people. The concept is just so flawed it won't work. You cannot provide access to 24.3 million people with 154 hospitals.
I realize that some of the health problems for veterans are unique to their military experiences. But I am sure civilian psychiatrists and others can adapt to the situation. Maybe if people saw more veterans the nation would understand the military better. And a heart attack is pretty much a heart attack. Instead of plowing in all this money into a string of hospitals that are woefully insufficient to handle all the needs, give the vets who need them a health card and let them go to the local hospital instead of the nearest VA hospital - which may be hundreds of miles away.
Source
NHS Doctors' training system 'a shambles'
Thousands of young doctors have been left without jobs because a new NHS training system has gone "disastrously wrong", it was disclosed yesterday. As much as £2 billion has been spent on the training of up to 8,000 doctors who find themselves without a new job under a Government initiative.Such is the fury at the scheme, called Modernising Medical Careers (MMC), that doctors have renamed it "Massive Medical Cull". It costs £250,000 to train a doctor and the "shambles" is said to be blighting the careers of dedicated young men and women who may now leave the NHS. Many are also saddled with debts of more than £40,000 after funding their training
The Daily Telegraph has been inundated with letters and emails from despairing doctors and their parents who "feel like crying". This comes a day after this newspaper reported that three out of four trusts were restricting patients' treatment because of the NHS financial crisis. Patricia Hewitt, the Health Secretary, is preparing for further NHS closures by sending managers guidance on how to deal with patients' protests.
The latest crisis has come about because there were only 22,000 jobs for 30,000 junior doctors. The glut in applicants was caused by the introduction of a system where those who started training two years ago are competing for the same jobs as those who began three or four years ago. The doctors' anger has been exacerbated by the introduction of an online system for applying for jobs which is criticised for failing to take full account of their experience and qualifications.
Many of the doctors who have written to The Daily Telegraph complained of a "Kafkaesque" application procedure which asks them "vague and waffling" questions about their personal experience but take insufficient account of their qualifications, references and independent appraisals. As a result, some highly qualified junior doctors have not been offered a single interview. And, because of technical problems, others have been offered interviews for which they did not apply. Doctors said it was easy to lie on the forms. It is alleged that some applicants used companies selling information on how to fill in forms.
Most of the doctors left medical school two to four years ago and are at the point in their careers where they have decided which speciality they want to follow. They would expect to train as specialist registrars for about five years and pass more exams before they could apply to become consultants.
Under MMC, doctors have been required to reapply for their jobs, which end in August. Last night, the Conservatives and the British Medical Association condemned the system. Dr Faith Harries, a junior doctor, who has been offered no interview said: "I came out of medical school with £42,000 debt. "I thought I was guaranteed a job in training in the UK — because I thought I would be able to pay it back. Now I am thinking of going abroad." Another junior doctor said: "Many a tear will be shed this week by brilliant young doctors whose hopes and dreams have been crushed in a quite barbaric fashion". A senior consultant said: "I despair for dedicated hard-working trainees who are being treated so shabbily."
Dr Tom Dolphin, the deputy chairman of the BMA junior doctors' committee, said: "The system is going disastrously wrong. Highly qualified doctors with huge amounts of experience haven't been offered any interviews. "Others have been offered interviews in the wrong speciality or at the wrong level. There are reports that the confidential marking system has been leaked and that unqualified people are being asked to short-listing. People's entire livelihoods are at stake." He said the BMA had been calling for the process to be delayed since last summer. "Now we are seeing the consequences of their failure to listen. They must halt the interview process."
Andrew Lansley, the shadow health secretary said: "This is about motivated young people, who we have trained, being sent away with absolutely no confidence they will get the post they want, or indeed, any post at all. "The new system is a shambles and we have asked Patricia Hewitt for an urgent review." He said he had seen a letter to another MP from a consultant who told of a junior doctor who had threatened suicide.
A spokesman for the Department of Health said: "This is a competitive process so there will be applicants who do not secure an interview in this first round. "Applicants who have not been short-listed will have the opportunity to apply for programmes in the second round where there will be more posts available. "Allegations of plagiarism will be investigated and if applicants are found to have plagiarised or deliberately falsified their application in any way, they may be referred to the GMC."
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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7 March, 2007
Other answers to "health insurance"
Let's take another look at the "health insurance" model, using a combination of personal experience and written discoveries. I was having dinner with some friends the other night, and (not surprisingly, given my own current endeavors) one conversation got around to this very issue, about health insurance. My tablemate avowed that she had recently taken several steps to take charge of her own wellness "coverage," spurred on by her experiences with her (now-former) employer - whose economic stability was in some doubt, at least to her eyes.
Rather than remain on a company-healthcare program with a company that might not be around forever, my friend decided to take on her own policy. So she went out and investigated her options, and ended up purchasing a low-premium, high-deductible personal coverage policy through Blue Cross, one designed for minimal use yet capable of covering a major ailment, were one to be detected. As she noted in the conversation, she's generally not a high risk-taker (no skydiving or bungee-jumping, thanks), so it made little sense for her to take on bigger bills. However, now she had her own coverage, in her own control, and not dependent on the fiscal future of her employer. In addition, she took another portion of her income and deposited it in a Medical Savings Account, as a buffer against the deductible costs.
Then, she said, she changed jobs, and is now with a more stable firm. But she kept the insurance policy; what's more, she was able to negotiate with the new employer, which now not only pays her monthly premiums (on the policy she controls), but makes regular contributions to that MSA she still holds. The only fly in the ointment is the limit placed on MSA contributions at present; instead of being able to deposit the full $5,000 of her deductible amount, she is only permitted to put away about $2,800 a year. So far, this has been inadequate to cover her annual deductibles, though she hopes the employer contributions will mitigate that somewhat, or that she will have lower out of pocket costs in 2007.
So there's a real world, right-here-and-now example of how at least one person is coping with the healthcare system. If the new plans advanced by President Bush go forward into law, one would hope they would also remove the restrictions on MSA levels, so that the much-vaunted healthcare deduction could be put to better use than just buying another overpriced "insulation" policy.
But then there are other folks who find the whole thing a complete waste of time. For example, in this editor's "other life" as a Healthcare Columnist over at Free Market News, he just encountered some feedback to the latest installment of the "healthcare reform" series. The poster, one Joe Furcinite, affirms, "I don't want so-called health care insurance," and offers a link to an essay where he explains his position more thoroughly.
Upon further investigation, we find that this self-affirmed "almost 62-year-old" has rarely if ever possessed conventional health insurance, preferring instead to see to his own well-being, using a variety of methods, alternative and natural. In fact, as he puts it, "the more I learn about our so-called health care system the less I want anything to do with it. There are alternatives that are usually more natural, safer and much less expensive but are not FDA and AMA approved and are not covered by insurance."
He then goes on to lay out just how the whole medical and health insurance games are set up, with all the extraneous costs and superfluous services, mainly thanks to the same third-party payment structures and misdirected intentions this editor has been complaining about for years now. He reminisces about how it was in his childhood, or even in more recent times, before chiropractic healing became part of the conventional medicine umbrella. He also challenges the conventional wisdom (growing less voluble with each passing scandal?) of how the Food and Drug Administration's fiats are so allegedly wonderful for the wellness of us all.
In short he says about the same things we've been saying, in this space and elsewhere, and echoes the rising tide of people who are looking for better answers to all of this. Always nice to find another sane voice in the wilderness.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
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6 March, 2007
AN UNINSURED U.S. DOCTOR COMMENTS
Before I get into more details, remember that health "insurance" is not the same as actually getting medical needs met. Having health insurance is often very different from actually getting medical problems evaluated and treated quickly and appropriately.
Centralized or socialized health services always seem to end up delaying medical care for serious conditions or expensive treatment, such as cancer and joint replacements. The Soviet Union, England, Canada, and many other countries cause much suffering because the supposedly guaranteed rights to medical services were often not fulfilled in time.
Some of our uninsured brethren don't pay their bills for hospital emergency room services, forcing hospitals and doctors to make up the difference by overcharging those who can pay, such as people with insurance or uninsured people with money.
John R. Graham of the Pacific Research Institute based in San Francisco recently published "The Uninsured Versus The Insured: Who Subsidizes Whom?" (Go here.) He writes, "To back up this notion, Families USA, a self-styled consumer advocacy group, estimates that the uninsured used about $29 billion worth of health services in 2005 that the privately insured paid for through higher premiums." But there's more to the story.
Graham calculates that "the uninsured likely pay at least $150 billion extra in federal income taxes alone, by forgoing the tax savings associated with private health insurance." These dollars - five times the purported hidden tax - "dwarf the hidden tax of uninsurance." In terms of taxes paid, we uninsured are actually subsidizing the insured rather than the other way around. The insured are the ones getting the income tax break, not us uninsureds.
Graham claims there is indeed a real hidden tax, "but it is levied by the insured on their fellow insured. Because of bad incentives, insured Americans use health services twice as much, per person, as the uninsured."
Some politicians want to force us uninsured to get some kind of insurance so that they can claim that they have solved our "problem" of not having (or not wanting) health insurance. Graham notes, "political success in health policy now consists, basically, of ordering the uninsured to become insured."
We doubt that any such mandate will be any more effective than the laws in 47 states that require drivers to buy liability auto insurance. As Greg Scandlen, president of Consumers for Health Care Choices based in Hagerstown, Md., reports in the Baltimore Sun, "the notion that a legislature can wave a magic wand and change everyone's behavior is naive at best."
Although my own Washington state requires automobile owners and drivers to have auto liability insurance, about 18 percent of motorists do not. Even though health insurance isn't mandated, 16 percent of the Washington population has coverage, according to Scandlen. And speaking of mandates, most states have laws to force insurance companies to include pet coverages in health insurance policies. Although politicians often try to claim these mandates "protect the public" or are "good for you" mandates invariably reflect the medical and financial interests of pressure groups. If mandates did protect the public at the expense of special interest groups, those groups would campaign against them. Special interest groups, such as general medical or limited practitioners, back proposed mandates, not the other way around, to enhance their own power, income or both.
I am uninsured because health insurance is unhealthy for me. After diligently studying and promoting medical savings account (MSA) plans 10 years ago, I bought a policy from Anthem Health of New Jersey to cover my college-age son and me. To make the long story short, the insurance proposal of dozens of pages had a $2,000 individual deductible; but the 100-page insurance policy actually issued had a $4,000 deductible, causing a great deal of correspondence and dismay when medical services were actually used. I canceled that policy early in 1998.
I've been living uninsured and more happily ever since, until the Social Security bureaucrats foisted Medicare Part A on me. I could swear off Medicare Part A but the ever-so-wise Social Security Administration would then stop sending Social Security checks. I am currently "covered" for hospital services by Medicare Part A. I have sworn off Medicare Part B and D. (Don't ask me what Part C is.)
Health insurance can be a valuable financial planning tool. But insurance itself is not the goal; the goal is appropriate, timely and efficient care of medical needs, as judged by real patients and their families, not politicians or medical insurance bureaucrats.
Source
Update:
A reader writes:
"In reference to the statement: "Although my own Washington state requires automobile owners and drivers to have auto liability insurance, about 18 percent of motorists do not. Even though health insurance isn't mandated, 16 percent of the Washington population has coverage, according to Scandlen."
I think he meant to write that 16 percent of Washington residents DO NOT have health coverage. According to Scandlen (source: Consumer Power Report # 70 -- February 22, 2007): "In Washington state 18% of drivers are uninsured, while only 16% of the entire population under age 65 are without health insurance coverage.""
Another suspicious hospital death
The Queensland meltdown continues
Queensland Health is about to become embroiled in another medical controversy. The details surrounding the death of Deborah Burgen, 49, will be heard in a coronial inquest today. The Mount Isa hearing is the first significant coronial inquest since Queensland Health was embarrassed by the Davies commission of inquiry in 2005. Paramedics took Ms Burgen to hospital, but she died from surgical complications on February 28, 2005. She was operated on for a twisted bowel.
Ms Burgen's family told The Courier-Mail that: "She was a person who lived for her family. "We feel absolutely robbed, robbed of everything." Unlike the furore embroiling Dr Jayant Patel - who is wanted on several counts of manslaughter, grievous bodily harm and fraud - more than one doctor was assigned to treat Ms Burgen. At least five doctors looked after Ms Burgen over two weeks. One of the doctors who treated Ms Burgen was overseas trained and will give his evidence via video link in India.
Dell Burgen said her sister loved her family and "spoiled them rotten". "She had so much to live for," she said. "She loved to laugh. She would throw her head back and let out a big roar."
State Coroner Michael Barnes, who will hear the case, said the purpose of an inquest was to put on the public record the facts and circumstances surrounding deaths. "It has to consider any changes to policy or practices that could reduce other deaths happening in the future," Mr Barnes said. "The material produced from the inquest can be referred to prosecution authorities of disciplinary bodies for failing to take action."
In yet more embarrassing news for the department, southeast Queensland public hospitals yesterday ran out of psychiatric beds, forcing mentally ill patients, some suicidal, to wait for hours in crowded emergency departments. Australian Medical Association Queensland president Zelle Hodge said hospital psychiatric staff were "almost at the end of their tether" with the huge demand. "The psychiatrists are telling us that they have to work out which are the least sick patients in hospital that they can move out," Dr Hodge said. "People are being discharged not on the grounds that this is an appropriate time for them to go but because they're the person who probably needs the bed least."
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
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5 March, 2007
UPDATE ON A HEALTH SYSTEM MELTDOWN
Bureaucracy is a sort of slow-growing cancer. Things look OK at first but the slow decline ends up with the function concerned in a very bad way eventually. The Queensland "free" health service is a very old one (dating from 1944) -- and it is now in such big trouble that patients are dying rather than being helped. The "Dr. Patel" scandal led to apparent reform attempts but the downhill slide continues nonetheless. That there are now three bureaucrats for every health worker is a large part of the cancer. Several articles below. The first is a letter to the editor of the Brisbane "Courier Mail" and refers to the story about elderly public hospital patients being slowly starved that was mentioned here on Feb. 27th. The letter appeared on Saturday, March 3rd.
Hospital shocks
I refer to reports of patients in hospital becoming malnourished. I was a patient in a major public hospital recently. On either side of me were two elderly patients.
Their meal trays would be put on their bed trolleys and half hour or so later the tray person would collect and remove the untouched tray.
I told nursing staff that these people could not reach the trays or feed themselves or get the items open. I was told in a roundabout way to mind my own business. I would struggle out of bed, place the trays close enough to them, open the little fiddly butter/ juice lids and encourage them to eat.
This caused me great distress as for the entire time I was there (three weeks) these two people had very little oral intake. Again when I took it higher to the ward supervisor, I was told politely she would look into it.
I have witnessed enforced a malnutrition on many occasions. It seems the lack of staffing is the crux of the problem. Staff have so many urgent duties to attend to that spending 30 minutes feeding up to 20 patients does not take priority.
On another topic, who made the brilliant decision to mix patient gender in wards at a certain public hospital? It is not good to wake up following surgery to see three elderly male patients sharing the bay with you, and have to spend your time with curtains around your bed to screen out the views of various parts of the male anatomy being left uncovered, as well as procedures being done without any form of privacy being considered. Maybe this is shock therapy to make sure you do not return to this hospital in future.
P. Townsend, Albion
Hypocritical health boss in damage control
Health bosses have sent an urgent memo to staff telling them Health Minister Stephen Robertson has "complete confidence in the public health system". The "Special Broadcast" came after an opinion column in The Sunday Mail criticising Mr Robertson's decision to have heart surgery at a private hospital.
In an email sent on Monday, Queensland Health director-general Uschi Schreiber said: "I am particularly concerned that these media articles include disparaging statements about Queensland hospitals and, by implication, of the people who work in them. "I want to stress that I know from working closely with the minister over the last 20 months that he has complete confidence in Queensaand's public health system and the highest admiration for the people working, in it. "He is a strong advocate for the public health system."
But staff are not convinced, describing the email as "hilarious". One doctor, who declined to be named because of a Queensland Health ban on staff speaking to the media, said if Mr Robertson had faith in the public system he would have used it. "He did exactly what we expected him to do, even though it was a bad political move," he said. "It was a life-or-death situation for him and he's not going to be a patient in a public hospital in a system that he knows is in trouble."
Mr Robertson, 45, chose St Andrew's Hospital at Spring Hill in Brisbane for an angioplasty operation to open his arteries. In the email to staff, Ms Schreiber said: "It is probably worth pointing out that the minister would have been equally criticised had he chosen to occupy a public hospital bed despite having private health insurance."
But one member of staff said Mr Robertson should have gone into a public hospital as a privately subsidised patient. "It would have been a big pat on the shoulders for staff if he had done that," he said. "Morale is low enough without having the Health Minister snubbing us. "They put the email out to stop people making comment, and everyone found it hilarious because we all know the real state of play."
Grandmother Lee Brown, 66, of Redland Bay, has no choice but to wait for her angioplasty at Redland Hospital because she cannot afford to be treated privately. "I read about Mr Robertson in The Sunday Mail while I was in hospital and I thought, `holy mackerel, that's just double standards'," she said. "I don't think these ministers have the faintest idea how to run the health system. They don't live in the real world, where people have to wait for nine hours in casualty."
The above article by HANNAH DAVIES appeared in the Brisbane "Sunday Mail" on March 4th., 2007
Ambulance response time slips
Response times for ambulances sent to code-one emergencies are getting worse despite record funding for paramedics. More than one-third of patients with life-threatening injuries or illness wait longer for help than the government benchmark time. Queensland Ambulance Service figures show response times have slowed for 2006-07. This comes despite a budget of $355.7 million, up $42.4 million on the previous year. If the trend continues to July, about 5000 additional patients will be affected.
A spokeswoman for Ambulance Commissioner Jim Higgins confirmed that the number of first-on-scene responses in under 10 minutes had dropped. But she said paramedics had attended more code one emergency cases than ever before. To March 1, the QAS had responded to 5506 more incidents within 10 minutes com- pared to the corresponding period last year. "Each year the demand for ambulance services continues to grow as a result of Queensland s growing and ageing population,' she said. The QAS continues to boost frontline paramedic numbers, with 280 new paramedic position since 2003."
Emergency Services Minister Pat Purcell last year said ambulances arrived at code one callouts within 10 minutes in 69.38 per cent of cases. The Government had set a benchmark of 68 per cent which had been lowered from the original 70 per cent. But sources told The Sunday Mail the latest figure had dropped to 66 per cent statewide this year. In some regions of Brisbane, the Gold and Sunshine Coasts, response times had fallen to under 60 per cent.
Opposition emergency services spokesman Ted Malone said the slower response was costing lives. "Taking longer than 10 minutes to respond to an emergency (code one) is a matter of life and death," Mr Malone said. "There can be no arguments that patients have died because ambulances have not got to them on time." He also slammed the Government over the $100 annual ambulance levy paid by all Queenslanders - "with little to show for their money"
"Peter Beattie's promise of the world's best anibulance service has proved to be as hollow as most of his promises", Mr Malone said.
The above article by DARRELL GILES appeared in the Brisbane "Sunday Mail" on March 4th., 2007
Injured woman waits in pain
A grandmother who broke her leg had to wait in the sun for more than an hour for an ambulance. Lynne Jones, 59, slipped and injured herself at Redland Bay last month. "I was in a lot of pain. I was lying on the grass in the heat, with ants crawling all over me," said Mrs Jones, of Thornlands in Redland Shire. "It was a Sunday morning. You would expect 15-20 minutes for an ambulance to turn up, not 65 minutes. It was totally unsatisfactory."
Mrs Jones' grandson had called Triple-0 and the operator advised not to move her until the ambulance arrived. When her daughter called about 30 minutes later she was told there was no ambulance at Redland Bay and one had to be sent from Wynnum, 25km away. Mrs Jones said Lions Club volunteers who were running a sausage sizzle nearby kept her comfortable, shading her with an umbrella and using a wet towel to keep her cool in the 30C heat.
One of the volunteers drove to the Redland Bay ambulance station, only to find it locked up. "They were starting to get a bit worried for me," Mrs Jones said.
The paramedic who eventually turned up needed help from the volunteers to get her into the ambulance. He expressed his dismay to her about the delay, she said. "It does make you wonder what we pay our ambulance levy for." Mrs Jones said she had waited 45 minutes for an ambulance after a previous fall at a shopping centre. "The service has got worse, not better," she said.
A Queensland Ambulance Service spokeswoman said higher-priority incidents came ahead of Mrs Jones' non life-threatening case. "At the time, the QAS was experiencing an unusually busy period with nearly twice the average workload for that area," she said.
The above article by DARRELL GILES appeared in the Brisbane "Sunday Mail" on March 4th., 2007
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
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4 March, 2007
Senators Kennedy, Domenici and Enzi to Make Health Insurance More Expensive with So-Called Mental Health Parity Act
Legislation advancing through in the U.S. Senate to regulate so-called mental health parity will instead simply make health insurance more expensive or mental health benefits less available, says the National Center for Public Policy Research. "This is a surefire way to wreak more havoc on health insurance markets," says David Hogberg, a senior policy analyst with The National Center for Public Policy Research. Hogberg notes that 33 states have already imposed mental health parity mandates on their insurance markets. According to the Council for Affordable Health Insurance, these mandates have increased insurance costs by an estimated five to ten percent.
"The Mental Health Party Act of 2007," sponsored by Senators Ted Kennedy (D-MA), Pete Domenici (R-NM) and Mike Enzi (R-WY), forces the health insurance programs of large businesses that cover mental illnesses to treat mental illness the same way it treats other illnesses. In practice, this means that insurance programs cannot have different co-pays and deductibles for mental health services and procedures than they have for other health services and procedures.
"If you force insurance programs to cover mental health the same way as other illnesses, the result is more expensive health insurance. That means more businesses will increase their insurance premiums or drop their insurance altogether, resulting in an increase in the uninsured," says Hogberg. "The more likely result is that businesses will simply drop their mental illness coverage from their insurance policies, meaning that employees will have less access to mental health benefits."
"For all the hype and worry in Congress about making health insurance more affordable and preventing the unraveling of the employer-based health insurance system, you'd think the senators would have more sense than this," noted Hogberg.
Thus far, the Mental Health Parity Act of 2007 has been approved in the Senate by Senator Kennedy's Health, Welfare, Labor and Pensions Committee. A similar measure is being pushed in the House of Representatives by Senator Kennedy's son, Patrick Kennedy (D-RI), along with Reps. Jim Ramstad (R-MN) and Anna Eshoo (D-CA).
"Congress needs to come to its senses about the Mental Health Parity Act," said Hogberg. "This is exactly the sort of measure that has made health insurance costs rise so precipitously in recent years."
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
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3 March, 2007
A DENTAL DISASTER IN U.S. SOCIALIZED MEDICINE
The kid in the story below WAS covered by a socialized medicine system -- Medicaid -- but a disorganized mother failed him. There are also many stories of dental mayhem from Britain's NHS. See e.g. here
The Washington Post reported today that a twelve year old Prince George's County, Maryland boy died Sunday after the infection from an abscessed tooth spread to his brain. The boy had not been receiving routine dental care. According to the Washington Post, twelve year old Diamonte Driver first complained of a headache six weeks ago. He was treated at a hospital for a tooth abscess, sinusitis and the headache. Shortly after beginning treatment, he was hospitalized at Children's Hospital in the District of Columbia and underwent two brain surgeries, the Post said.
Diamonte's mother did not have dental insurance or Medicaid coverage; a timely $80 tooth extraction could have saved his life, according to the Washington, Post.The Post reported that when Diamonte first began experiencing a toothache, his mother was having trouble finding a dental provider who would accept Medicaid to extract six abscessed teeth from Diamonte's younger brother DeShawn.. After finally finding an oral surgeon who would accept Medicaid and making an appointment for DeShawn, she learned that her Medicaid coverage had lapsed and cancled the appointment. The coverage lapse apparently occurred when her family moved had moved from the homeless shelter address listed on the Medicaid application.
A 1996 study by the American Dental Association supports the conclusion that health insurance coverage relates positively to children's receipt of dental care. The study showed the 56% percent of children with private dental insurance made at least one dental visit during the year 1996 while only 28% of those eligible but without such coverage made at least one dental visit. For those with Medicaid insurance, 28 % made at least one dental visit during the year 1996 as compared with 19% of noncovered children in the Medicaid program (coverage varies from state to state). The study concluded that private insurance increased the likelihood of a child receiving dental coverage more than having Medicaid insurance did.....
States are required to provide Early and Periodic Screening, Diagnostic and Treatment (EPSDT) to children enrolled in Medicaid. It is up to each state to determine in conjunction with dental experts what coverage intervals meet reasonable standards of dental practice. At a minimum, Medicaid must cover pain relief, treatment of infections, tooth restorations and maintenance. Had Diamonte's Medicaid coverage not lapsed, treatment for an abscess would have been covered assuming his mother could have found a dentist willing to treat him. [Which she did]
Source
Update:
A reader writes:
"I took a look at your comments because the headline looked like you might be a little critical of the mother in Maryland. I wondered why none of the mainstream news articles had mentioned how earlier treatment could have prevented this or possibly how long since this child had seen a dentist, ever?
Thought I might tell you that in another case in the U.S., a mother was jailed for allowing her five year old to suffer with numerous rotted/abscessed teeth. By the time this woman too her child to the dentist, he could hardly eat. Her excuse was, "I knew they were baby teeth, I thought they'd just fall out." That child was treated and placed in foster care, hopefully to a more empathetic set of parents.
When I read that the boy in Maryland had a brother, even younger, with 5 or 6 abcessed teeth, I wondered what had that mom been doing the last two or three years in caring for these children. I have all the sympathy in the world for her losing a child, but dadgum it, sometimes as a parent you need to be taking care of things. Being poor doesn't limit a persons ability to brush. Having her kids brush and floss their teeth, not drink pop/kool aid, and making sure she got them to one of the 600 dentists in Maryland that did take Medicaid cards, preferably before their teeth were abscessed, for check-ups.
I know a lot of mothers that are the working poor, no dental insurance and no Medicaid, that would not let an expired card keep them from getting their kids some kind of treatment. I live in the Midwest U.S. Two years ago, through some kind of dental school experience/government grant program, they offered free dental care for the uninsured for maybe two days at a local university. No crowns or fancy stuff, just cleaning, filling cavities, and extractions. In my little state, they had over 4000 people sign up. Parents with no insurance took their children out of school for the day, waited in line for a long time, but really took advantage of the opportunity.
I guess I wonder how people turn all their responsibility over to the schools and to the government. Blaming Medicaid because she didn't give them a current address is ridiculous. If she had a card earlier, she should have gotten them in to a dentist two or three years ago. I'm sorry for any kids that suffer and there sure seem to be a lot of them. Too many children are still waiting for their parents to actually do what parents should do, be parents. I guess I'm wondering how in the world she could know her children were suffering and not figure out something. I'd have begged, pleaded, kept the appointment and explained that it was emergency, immediately contacted the Medicaid office and explained...something. What a needless death.
Sad thing is, communities in the U.S. offer parenting classes for free. Guess who shows up? Usually just the parents that are already doing a good job. I've been to seminars that explain the difference in thinking between those that live in poverty and those that don't. I know there's a difference, but somewhere along the way, we've lost something. People don't know how to have any initiative, any survival type skills as to what needs to be done. I have a theory that the more educated we become, the fewer things we actually know how to do."
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
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2 March, 2007
Britain: Island of fear
Excerpt from Prof. Brignell
The climate among ordinary people in Britain seems to be evolving from resentment to fear. You sense it in conversations in the streets, pubs and clubs. The state is out of control, but firmly in control. Stress and anxiety abound.
Suddenly, falling ill has been transformed from a misfortune to a disaster, especially if it happens out of office hours. Your bending author's family recently had an experience like this [ambulance very slow to arrive], without the blood but with a genuine threat to life.
The unremitting reorganisation of the NHS over the last decade, with drastic and often circular changes, has brought it almost to a standstill: note, by the way, how accurately the law of targets has been followed. Bureaucrats like big; so small effective local hospitals are forced to close. If you double the distance to the nearest hospital (as is now a common experience) you quadruple the time for the round trip by the ambulance, even it there is one available.
It appears that everyone who dials the emergency number is now routinely told "We are very busy at the moment." It seems to take about eight hours from someone falling seriously ill to their being received in an emergency ward: more if they are inconsiderate enough to do it out of office hours.
When they arrive at the hospital, they are placed in a filthy mixed ward, where dedicated but demoralised staff struggle to heal them, first of their primary illness and then (for the unlucky ones) of the hospital-borne infection.
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
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1 March, 2007
Children 'are being let down badly by many NHS hospitals'
Children are being let down by the care they receive in hospitals across England, a critical report by the health watchdog says today. Nearly one in five hospitals is failing to provide sufficient emergency life-support care for children at night, while in many others child protection and training staff to treat children are still largely overlooked. In the review, carried out by the Healthcare Commission, three quarters of the hospitals examined scored only "fair" or "weak" for the overall service provided for children.
Surgeons in 8 per cent of hospital trusts did not operate on enough children to keep their skill levels up, while 16 per cent of paediatric inpatient units did not carry out enough work to reach the minimum recommended professional level.
The findings, described by child health experts as horrifying, suggest that many hospitals have failed to comply with national guidelines published by the Government four years ago. The commission said its report showed cause for serious concern and constituted a "wake-up call" for those hospital trusts that did not put the health of children first. It pledged to put pressure on the worst hospitals to improve. The report found that 1.8 million children attended mixed adult-child A&E departments last year and that 2.5 million children went to mixed adult-child out-patients, while 62,000 children were classed as day cases.
The commission praised the work of the majority of dedicated paediatric inpatient departments, with 70 per cent ranked either good or excellent, but it said that the overall service was less impressive. It also looked at out-patient wards, accident and emergency departments and day-surgery cases in 157 hospital trusts.
Among the best hospitals included Great Ormond Street Hospital for Children NHS Trust, the Royal Liverpool Children's NHS Trust and Sheffield Children's NHS Trust. The list of the weakest included hospitals in Brighton, Co Durham and Scarborough. Of those found to have insufficient life-support care last year, eight had failed to assure the commission that the situation had since been remedied.
Anna Walker, chief executive of the Healthcare Commission, said that the review had been carried out after recommendations from reports such as the Victoria Climbie inquiry, which listed a catalogue of failures in care. The eight-year-old died from abuse and neglect seven years ago, despite having been seen by dozens of healthcare and social workers who could have raised the alarm. As part of its response to the case the Government set up the National Service Framework for Children and Young People in 2003, but Ms Walker said that some hospitals were still neglecting the guidelines. "This is a wake-up call to the trust's boards," she said. "Do not let another Victoria Climbie take place.
"We have found areas that are positive - the results from the paediatric inpatient wards are good. But we are very concerned about the overall results - the 75 per cent fair and weak results. Children's healthcare is not one of the main services like cancer, hips, stroke or heart disease. It is a specialist area and can tend to get overlooked."
Maggie Kemmner, the report's author, suggested that rota problems and a lack of suitable trained staff had caused 12 per cent of hospitals to report a lack of life support for children during the day, a figure that rose to 18 per cent at night Patricia Hamilton, president of the Royal College of Paediatrics and Child Health, said that she was horrified and dismayed by the report. "Seventy-five per cent of hospitals were rated as fair or weak. This is unacceptable, but not surprising, as children's services have long been underresourced and have not been given the priority they deserve," she said. It confirmed the view of the royal college that the current level of paediatric units could not be sustained. Ivan Lewis, Minister for Care Services, said last night that he would consider any action to make a positive difference.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
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