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31 October, 2009

Patient dies after British doctors failed to diagnose broken pelvis in 'chaotic' hospital

A woman who had been run over by a minibus that left a tyre mark across her trousers died after staff at a "chaotic" hospital failed to diagnose her broken pelvis. Susan Haigh, 50, told paramedics she could feel no pain and was able to walk after the accident, but she had actually suffered two fractures and a torn bladder. The injuries were not picked up by medics at Barnsley District Hospital A&E department, South Yorkshire, which was short staffed and in a state of "chaos" when Mrs Haigh was admitted, an inquest heard.

A breakdown in communication meant doctors were not informed that she could have been suffering from serious crush injuries and the tyre marks and blood on her white jeans had not been pointed out.

Mrs Haigh was assessed and then discharged by Dr Jane Brenchley, a consultant, on Saturday May 3 2008, despite protests from her daughters who insisted she was in pain. She was readmitted the next day and rushed to intensive care, but died three days later after medics discovered two pelvic fractures.

The inquest in Sheffield heard that paramedic Andrew Flavell, who was called to the scene of the accident, saw the tyre mark on her jeans and told Nurse Pam Whittaker that he suspected crush injuries when they arrived at hospital. Mrs Haigh was put on a trolley in a corridor and Nurse Whittaker passed on the information to A&E coordinator Tom Holmes, but was only 98 per cent sure she mentioned the tyre mark.

However, details about the patient were not written down because it was not hospital policy at the time. She had also not been properly assessed by a nurse before being seen by a consultant.

Mr Holmes told the inquest that the hospital, which has five nurses and three doctors, was understaffed and on the night in question it was "quite chaotic." "We were busy from the onset of the shift and it just deteriorated," he added. He said that Nurse Whittaker had not expressed any urgent concern for Mrs Haigh and said he could not remember being told about the tyre mark. "The consultant has seen the patient and made the decision. My own personal feeling was that "it's a consultant, things must be OK."

Mr Holmes added that Dr Brenchley, who was on call, seemed "annoyed" at being asked to come into hospital.

The inquest heard that Mrs Haigh, from Goldthorpe, Barnsley, had been involved in a row with a group of women when she fell under the wheels of a minibus during a night out. The back wheel of the bus ran over her legs.

SOURCE




Battles over cost, Medicare loom for House health plan

The House Democrats' health care overhaul bill released Thursday creates a government-run insurance program, provides insurance coverage to 96 percent of all Americans and sets the stage for major battles over politically risky cuts to Medicare, new taxes, high spending and the hot-button issues of abortion and immigration.

The landmark legislation also ensures a fight with the powerful lobby for the pharmaceutical industry by overriding a deal among Pharmaceutical Research and Manufacturers of America (PhRMA), the drug industry trade group; the White House; and a Senate committee to help pay for the $1.06 trillion bill.

"There's a lot of political posturing going on right now," PhRMA spokesman Ken Johnson said. "But unfortunately, many people are unrealistic in their expectations of what our industry can contribute to health care reform" without job losses or a decrease in research and development.

Under the House blueprint, nearly all Americans for the first time would be required to purchase health insurance and most large employers would have to provide it, with tax credits available to low- and middle-income people. The proposal would be paid for through new taxes on individuals making more than $500,000, or couples more than $1 million, hoped-for reductions in Medicare waste and a 2.5 percent tax on medical devices not sold in retail stores. The Congressional Budget Office (CBO) said the bill, estimated to have a gross cost of $1.06 trillion, would reduce the deficit by $104 billion through 2019.

House Democrats put the net cost of their bill at $894 billion Thursday, based on CBO projections that penalties paid by companies that don't offer insurance and individuals who do not purchase coverage will lower the final tab. President Obama had set a $900 billion target for the 10-year cost.

Top Democrats said Thursday that they have the votes to pass the bill, possibly by Veterans Day, and praised the progress made in the House and Senate on Mr. Obama's goal to reshape the health care system.

"Leaders of all political parties, starting over a century ago with President Theodore Roosevelt, have called and fought for health care and health insurance reform," House Speaker Nancy Pelosi said while introducing the bill on the West Front of the Capitol, surrounded by her Democratic colleagues.

"Today, we are about to deliver on the promise of making affordable, quality health care available for all Americans, laying the foundation for a brighter future for generations to come," the California Democrat said.

But there are plenty of obstacles ahead as floor debate is expected to start in a week. Even the size of the bill -- 1,990 pages -- has sparked controversy as Republicans say it symbolizes the scope of Democrats' plans. House leaders said Wednesday that they introduced the bill with the understanding that changes would be made as the process moved forward.

The final House draft -- a merging of three committees' work over the past months -- does not have the so-called robust public option, which was favored by liberal Democrats and would have reimbursed doctors based on Medicare rates plus a 5 percent premium. The more moderate version would allow the Department of Health and Human Services to negotiate rates with providers, as private insurers do.

More here




Health bill: 42 studies, 214 mentions of taxes

House Democrats' health care bill runs to 1,990 pages, costs $1.06 trillion, covers 96 percent of eligible Americans and demands the production of 42 studies on everything from whether post-partum screening should be required to using student loan programs to help recruit doctors.

The studies could be a blueprint for action by future congresses. They include looking at geographic disparities in Medicare, whether more services need to be provided for those who don't speak English and the undercapitalization of nursing homes. But studies are just part of the extensive reach of the measure, which Democrats introduced Thursday.

The word "report" appears 364 times and "tax" is used 214 times -- and while some of those refer to bookkeeping such as tax years, the bill does raise several key levies, such as a "surcharge" of 5.4 percent on individual taxpayers who earn $500,000 or couples with incomes of $1 million.

Rep. Mike Pence, Indiana Republican, said the bill uses the word "shall" 3,425 times, which he said was an indication that a lot of new mandates are being imposed. Among them is a requirement that chain restaurants print directly on their menus how many calories each item contains.

The bill also takes care of some long-languishing measures, such as reauthorizing the Indian Health Service, which has been kicking around for the past decade and was most recently held up by a fight over abortion.

The Congressional Budget Office says the bill will have a gross cost of $1.06 trillion but, with $167 billion in new penalty taxes imposed on businesses and individuals, the net cost is $894 billion. It would mean 36 million more people would be covered than the status quo by 2019, and leave about 18 million without insurance. One-third of those left uncovered would be illegal immigrants.

SOURCE




The Public Option Is Not an Option

Can you imagine the brazenness of President Barack Obama and his cohorts in going so far as to ridicule opponents of Obamacare for rightly pointing out that its ultimate goal is single-payer socialized medicine?

These people are propaganda virtuosos of the highest order. You might expect grand artists of deception just to silently dismiss such claims from critics or, at most, to summarily deny them. But they go further and mock the critics, trying to reduce them to acutely paranoid, tinfoil-hat-wearing, black-helicopter-hallucinating Cuckoo's Nest inpatients.

What better way to distract attention from what is right in front of our faces? It's brilliant reverse jujitsu: using the outrageousness of your own plan to discredit as preposterous the allegations of your opponents about your truly outrageous plan. Shameless!

Obama and his minions are indeed conspiring to foist socialized medicine on this nation through whatever means necessary -- including outright deception over the nature and purpose of the so-called public option. But before presenting proof of that, let me pose a few questions bearing on the likelihood Obama would be involved in such a deception in pursuit of this goal.

Didn't Obama repeatedly threaten to "spread the wealth"? Isn't he deliberately indebting us through government expenditures of borrowed funds not remotely designed to appreciably increase employment? This "stimulus" monstrosity is a massive redistributive scheme not only in its direct transfer payments but also in the confiscatory tax increases it will necessitate to retire the debt it is generating.

Obama is hellbent on passing economically crippling cap-and-tax legislation on the dubious pretense that man-made global warming is leading to an apocalypse. The Heritage Foundation's Center for Data Analysis estimates that this legislation would make the United States some $9.4 trillion poorer by 2035 while moderating temperatures by only hundredths of a degree in 40 years. Obama's former colleague Sen. John Kerry, adding insult to injury, has the audacity to sell this plan as one that would enhance our national security -- security that depends on our economic viability.

Based on those two examples alone, the inescapable conclusion is Obama believes that America's resources have been unfairly allocated under its free enterprise system and that he must preside over an unprecedented correction of this "injustice" through institutional changes disguised as benign measures necessary to stop phantom demons.

But if you're not sufficiently convinced of Obama's Marxist bent to understand he is determined to implement socialized medicine as a means to establishing government control over all aspects of our lives, how about considering direct evidence of the administration's deception concerning the true purpose of the public option?

First, we have Obama's pre-presidential words (in a 2003 speech) on a single-payer system. "I happen to be a proponent of a single-payer universal health care program. ... We may not get there immediately."

Bloggers at Verum Serum have further exposed this "transparent deception" with a video montage of Obama and other leftists -- including politicians, professors and journalists -- speaking candidly about the relationship between a "public option" and a single-payer system.

The videos show Rep. Jan Schakowsky, D-Ill., telling her audience that an insurance company spokesman claimed that a public option would put the private insurance industry out of business and lead to a single-payer system. "My single-payer friends," said Schakowsky, "he was right. ... This is not a principled fight. This is a fight about strategy for getting there, and I believe we will." Professor Jacob Hacker smugly boasts: "Someone once said to me this is a Trojan horse for single-payer. Well, it's not a Trojan horse, right? It's just right there." Health and Human Services Secretary Kathleen Sebelius confesses: "I'm all for a single-payer system, eventually. ... What we have to do, though, is work with what we've got to close the gap." Rep. Barney Frank says a public option "is the best way to reach single-payer." New York Times columnist Paul Krugman believes that a public option would, "in the end, kill the private plan." Presidential adviser Rahm Emanuel, in explaining Obama's apparent flip-flop on the public option, said, "The objective is what's important; it's not the means."

If you need more proof, you can read a short history of the public option on "Tapped," The American Prospect's leftist blog, which traces the genesis of the public option idea as a means to get to single-payer. Because single-payer wasn't politically feasible if directly proposed, the public option was crafted as a compromise that would eventually lead to single-payer. "Ideally, it would someday magically turn into single-payer."

Apart from Obama's statist ideology and the evidence of his true aims, our common sense tells us that a "public option" backed by a government-stacked deck against private insurance companies -- which Obama hasn't demonized for nothing -- will eventually bury private health insurance companies. Let's wake up!

SOURCE




Obamacare: Startling New Revelations Scare Public

First, we learned that a $500 billion cut in Medicare will dramatically affect the quality and quantity of healthcare available to America's senior citizens. Grandma's access is being slashed to add illegal immigrants and twenty-somethings into the insurance system. However, this revelation pales in relation to what we heard this week.

Here's the latest shock: Average current health insurance premiums with likely triple under Obamacare. The new data comes from a well regarded, state-by-state study conducted for WellPoint, Inc. The most dramatic premium boosts will hit young people. These are the actual individuals that often opt out of insurance plans now.

Reaction from the Obama White House was swift and harsh. Linda Douglass, Obama's healthcare spokesperson, had the audacity to compare the health insurance firm with tobacco companies. Since the White House refuses to argue the facts, they instead turned to using one of their favorite tactics, which is demonizing any voices of dissent.

The reason for the dramatic insurance premium increases is the result of Obamacare regulations. First cause is the mandate that insurance companies take any customer. Insurance traditionally is an actuarial business that rates different customers based on risk factors. This is the reason a driver aged 19 with two speeding tickets pays more for auto insurance than a customer aged 35 with no speeding tickets. Nineteen-year-olds have more accidents. Therefore they pose more risk.

Traditionally, health insurance companies charged customers with risk factors and chronic illness more than young, healthy 19-year-olds. Obamacare stands the concept of insurance on its head. Since an insurance company will be forced to sell to any sick patient, the incentive to buy insurance when you are healthy decreases. Why not wait until you are sick; get cancer, diabetes or some other severe illness before you buy? To circumvent this problem, Obama is riddling the program with police-state mandates on healthy, younger citizens. Perverted, negative incentives such as threats of large fines and even prison time will hang over young people's heads to force them to join and stay enrolled in Obama's healthcare scheme. Does this sound like America to you?

Democratic leaders in Congress are seeing support slip through their fingers because Americans are learning that they will end up paying more for less-adequate care. The beneficiaries of this plan are still lobbying hard. Big business will likely dump most of their current employee-based plans and pay the less expensive tax. Big unions are facing the reality that they are going to be bankrupted by their generous membership health plans. Many want to dump their responsibilities on the new government option recently revived by Senate Majority Leader Harry Reid, D-Nev. AARP is salivating at the money they will make selling new, bigger Medicare-gap plans after the current program is gutted.

These powerful lobbies are the driving force for change. Individual family finances will pay the higher costs and see no benefit.

There is still time to kill this wrongheaded plan and replace it with reforms that will truly work. Selling insurance across state lines will increase competition and lower prices. Tort reform that eliminates outrageous judgments in malpractice cases will get lawyers out of medicine; this will result in eliminating billions currently being spent in the name of defensive medicine.

Insurance can work, but the costly mandates and regulations already choking the healthcare system are a big barrier to cutting costs. Free markets deliver to Americans consumer goods, groceries, veterinary services, and even plastic surgery at affordable prices with little government meddling. Let the free market price and correct the distortions currently in the health care system.

Government has bankrupted Fannie Mae, Freddie Mac, Social Security, Medicare and the U.S. Postal Service. Let's not let the politicians destroy the greatest healthcare delivery system in the world.

SOURCE





30 October, 2009

House Dems reach deal on key health care elements

House Democrats reached agreement Wednesday on key elements of a health care bill that would vastly alter America's medical landscape, requiring virtually universal sign-ups and establishing a new government-run insurance option for millions. House Speaker Nancy Pelosi planned a formal announcement Thursday morning in front of the Capitol. Lawmakers said the legislation could be up for a vote on the House floor next week.

The rollout will cap months of arduous negotiations to bridge differences between liberal and moderate Democrats and blend health care overhaul bills passed by three separate committees over the summer. The developments in the House came as Senate Majority Leader Harry Reid, D-Nev., tried to round up support among moderate Democrats for his bill, which includes a modified government insurance option that states could opt out of. Reid met Wednesday with Arkansas Sen. Blanche Lincoln, who faces a potentially tough re-election next year.

The final product in the House, reflecting many of President Barack Obama's priorities, includes new requirements for employers to offer insurance to their workers or face penalties, fines on Americans who don't purchase coverage and subsidies to help lower-income people do so. Insurance companies would face new prohibitions against charging much more to older people or denying coverage to people with health conditions.

Pelosi has also said the bill would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price fixing and bid rigging.

The price tag, topping $1 trillion over 10 years, would be paid for by taxing high-income people and cutting some $500 billion in payments to Medicare providers. The legislation would extend health coverage to around 95 percent of Americans.

Republicans criticized the bill even before it was unveiled. "Americans' health care is too important to risk on one gigantic bill that was negotiated behind closed doors," said Rep. Dave Camp, R-Mich. "The Medicare cuts will hurt seniors, the tax increases will kill jobs and the government takeover of health care will increase premium costs."

One change expected to be revealed Thursday is that some of the provisions of the bill, which were set to take effect mostly in 2013, have been moved up so Americans would see the benefits of the legislation more quickly, according to Pelosi spokesman Nadeam Elshami.

"I'm pretty confident that we've got the right pieces in place," said Rep. George Miller, D-Calif., chairman of the Education and Labor Committee, one of the three panels involved in writing the bill. "We can quibble over parts of it, but the fact is when you're taking a 60-year-old system that grew up in a rather haphazard fashion and you're trying to bring some coherence to it, these are sort of the things you have to do at the beginning of that process."

Plenty of work remains to be done before a bill could land on Obama's desk - and there's still no guarantee that Congress can complete the legislation before year's end, as the president wants. If Obama does sign a health overhaul bill, he will have bucked decades of failed attempts by past administrations, most recently by former President Bill Clinton in the 1990s. House leaders hope to finish the bill before Veteran's Day, Nov. 11. The Senate is aiming to start debate sometime in the next several weeks.

Bills passed by the House and Senate would have to be merged before a final product could be sent to Obama, and there are a number of differences between the two chambers that would have to be reconciled. Among them are the different approaches to the public plan. The House does not include the opt-out provision for states, and it has more stringent requirements for employers. The Senate would use a tax on high-value insurance plans to pay for the bill, an approach that the House version doesn't have.

In the end, Pelosi, D-Calif., and other House leaders were unable to round up the necessary votes for their preferred version of the government insurance plan - one that would base payment rates to providers on rates paid by Medicare. Instead, the Health and Human Services secretary would negotiate rates with providers, the approach preferred by moderates and the one that will be featured in the Senate's version. That marked a defeat for liberal lawmakers, who argued for months that a public insurance plan tied to Medicare would save more money for the government, and offer cheaper rates to consumers. Moderates feared that doctors, hospitals and other providers, particularly those in rural states, would be hurt, and in the end they looked poised to prevail, despite constituting a distinct minority in the 256-member House Democratic caucus.

Some liberals were prepared to accept the negotiated rate structure. Others were still withholding support, even while pointing to Reid's inclusion of a government insurance plan in the Senate bill as a victory in itself. "We were laughed at in August. Who would have thought that the Senate bill would have a public option?" said Rep. Lynn Woolsey, D-Calif., a co-chair of the Congressional Progressive Caucus. Woolsey was noncommittal about whether progressives would accept the negotiated rates. "This is not walkaway time and it is not acceptance time," Woolsey said.

Members of the progressive caucus, along with lawmakers from the black, Hispanic and Asian-Pacific American caucuses, were scheduled to meet with Obama at the White House on Thursday, she said.

The legislation would set up a new purchasing exchange where small businesses and individuals without affordable health care options could shop for and compare insurance plans. The new public plan would be one offered in the exchange, and it would be optional; an analysis by the Congressional Budget Office of early versions of the bill said that the public plan would be expected to cover 9 million to 10 million people by 2019. The House plan also envisions a significant expansion of Medicaid, the federal-state health care program for low income people.

Democratic leaders still faced disputes over prohibiting taxpayer money for abortions and health care for illegal immigrants, issues they hoped to resolve after the bill's unveiling.

SOURCE




The real costs and benefits of Obamacare

As individual citizens and taxpayers read the various healthcare bills that their legislators have not read, it becomes very clear that there are many losers in the Administration's healthcare reform plan. And it is experience with previous government healthcare programs shows that proponents of new government programs will misrepresent the cost to the public to get programs approved.

For example, when Medicare was proposed in 1965, the projected cost in 1990 was determined by the Johnson Administration to be 12 billion dollars. The real cost in 1990 was 107 billion dollars. The cost was underestimated by a factor of 9 to obtain passage of the legislation. Imagine what the real cost of healthcare reform would be in 10 years if the CBO estimate of 1.2 trillion dollars is equally under estimated. Clearly the American taxpayers are losers in this legislation.

The Medicare experience shows that when inexpensive medical coverage is offered, utilization increases. The only way to prevent greater utilization is to impose rationing. If Obamacare is to have any hope of containing costs it will have to limit care to those that use healthcare most extensively. Since more is spent on healthcare in the first and last years of one’s life than all the years in between, seniors will have rationed care.

To help pay for inclusion of the uninsured into healthcare, taxes will be levied on businesses that provide healthcare coverage to their employees and responsible individuals that purchase their own coverage. So clearly, small businesses and responsible individuals do not benefit from this reform.

However, there are groups that do benefit from this legislation. Those groups have “contributed” significantly to the Obama administration and the legislators drafting Obamacare.

In some ways, hospitals will benefit from not absorbing the cost of providing medical services to the uninsured. And this can be a significant cost especially if there is a large illegal alien population. But at the same time, Obama has promised to reduce Medicare/Medicaid spending on hospitals.

Pharmaceutical companies will have a new taxpayer-funded market for their products. In early March they met with the Obama team to negotiate support for the bill in exchange for more generous prescription drug reimbursement, which will undoubtedly cause costs to rise even faster.

Not to mention, insurance companies support this legislation because it will force 30 million young and healthy people to by insurance. This is almost half of the current uninsured and represents a profitable untapped market for insurers, making a massive government-granted cartel.

However, perhaps the largest beneficiary of this legislation is not quite so obvious. The Service Employees Union International (SEUI) contributed 60 million dollars and thousand of hours to the Obama campaign. Their purple shirted members have attended August town hall meetings to support Obamacare through intimidation and violence.

The real prize in this legislation is the ability to organize 7.5 million new government employees that Obamacare will create. The National Health Service (NHS) in England employs approximately 1.4 million workers in a country with a population of 60 million. The voting power of those workers effectively thwarts any NHS reform efforts in that country.

The SEUI has used threats and intimidation to pirate nurses and other service workers from other unions in California. It has used taxpayer funds fraudulently provided by ACORN programs to enrich its bosses and diverted member dues to subsidize ACORN’s supposedly non-partisan voter registration programs. In testimony before the Pennsylvania Legislature it recently admitted to knowingly organizing and collecting dues from illegal aliens. It has also been one of the most vocal advocates of Card Check legislation that would replace secret voting on union representation with public intimidation.

In the healthcare debate, if those wearing purple win, the American taxpayer, small business owners and senior citizens will lose.

SOURCE




“Public option” is a gimmick that won’t improve healthcare

In the Washington Post, Robert J. Samuelson explains in the “Public Plan Mirage” how the so-called “public option” contained in congressional health-care reform bills is just a gimmick: “It pretends to control costs and improve access to quality care when it doesn’t.” Steve Chapman wrote earlier about the “‘Public Option’ Health Care Scam.”

In other news, a study by PriceWaterhouseCoopers found that the provisions in the Senate health care “reform” bill sponsored by Sen. Max Baucus (D-Mont.) would add $1,700 a year to the cost of family coverage in 2013 and $600 for a single person. By 2019, family premiums could be $4,000 higher and individual premiums could be $1,500 higher.

CEI’s Greg Conko calls the Baucus bill “worse than the disease.” In a recently-released paper, “A Cure Worse than the Disease: Obama Care Won’t Cut Costs, But May Cut Quality,” Conko notes that most of the alleged cost-cutting measures in the Baucus bill merely shift costs from the federal government onto the states or private payers, without reducing long-term health care inflation. The only measures that could conceivably reduce the annual rate of growth in health care costs would erect government barriers between patients and their doctors, while jeopardizing long-term medical innovation.

A new study by the Oliver Wyman consultancy found that provisions contained in the health-care reform bills, like guaranteed issue and community rating mandates, would drive up premiums by 50 percent for individual policies and 19 percent for small group plans.

A study from the Independence Institute says that ObamaCare would drive up inflation and medical-care costs, while shrinking the economy.

As CEI’s Conko notes, many states have highly concentrated markets. In Hawaii, Rhode Island, and Alaska, for example, 95 percent or more of the health insurance market is served by just two insurers. But Obama and congressional Democrats oppose letting insurers compete across state lines, blocking competition that could make health insurance cheaper. Other countries with cheaper health insurance permit insurers to compete nationally.

ObamaCare would raise taxes. It would also explode state and federal budget deficits, and would actually cost $2 trillion — far more than its promised $800 billion price tag. It also ignores needed reforms that would actually reduce the costs of health care, like steps to reduce the cost of defensive medicine, which wastes $200 billion annually. And it contains special-interest pork, like racial preferences.

SOURCE




The malpractice problem

We can't have health care reform without tort reform

The extra imaging study, the extra day in hospital at the end of an admission, the repetitive laboratory testing, the admission to the hospital to be "sure" about the diagnosis are all inherent in the culture of American medical care. The avoidance of litigation has become ingrained into all aspects of medical care. Since physicians are not liable for the increased costs of care but are liable for any error or missed diagnosis, it would be foolish for them to act in any other fashion. The costs of this mindset cannot be easily assessed by surveys.

No one can identify how the current health care bills being debated and apparently continuously modified in Congress will reduce the cost of health care. They may produce a reduction in insurance premiums for some, but just paying less for health care does not magically produce a diminution in the actual cost of health care. The latter would only occur if there were large profits in the overall health care enterprise that could be trimmed without changing the basic character of the system. But no one has identified such profits. The president points to for-profit insurance companies, but for-profit insurance companies only make up 25 percent of the system and they are not that profitable, ranking 85th among all U.S. industries. "Reform" will redistribute the money, not reduce the overall cost. This is pretty much what the American Health Insurance Plans study, so denigrated by the president, concluded. Unless the costs of health care fall, lowering insurance payments in one segment of the populace will inevitably cause an increase for some other group.

There is much that can be done to make our system more efficient. Tort reform is a great place to start. Medical errors are common and fairness demands that compensation be paid when someone is injured. However, the price for the current system is enormous. The view from the left is that the direct costs of the current malpractice system -- the actual payout of dollars in lawsuits -- are pretty minimal compared to overall health care spending. The indirect costs, the use of tests and procedures to avoid lawsuits, are also said to be overstated in studies, as those who answer surveys about this issue are assumed to be biased. The view from the right is precisely the opposite and ascribes an important component of health care spending to malpractice costs. This view also blames the lawyers.

The experience in Texas, where there is a law capping payments for pain and suffering to $250,000, suggests some benefit. For example, as reported in the Wall Street Journal, malpractice suits have been dramatically reduced. The year before the caps on pain and suffering payments took effect, there were over 1,100 medical liability suits filed in Dallas. Only 142 cases were filed in 2004. In addition, there was a surge of physicians entering Texas to set up practice as malpractice premiums fell by about 50 percent. Texas also is actually a state with low health care spending. According to the National Center for Policy Analysis, although Texas is fifth highest in Medicare spending per capita, it is 43rd in per capita spending for the state's entire population. Whether the malpractice caps in Texas account in any way for these data is uncertain but the pattern is encouraging.

More here




The big “single-payer” lie

Scan the history of government programs. The scope and costs usually grow much larger than originally projected. Moreover, ham-fisted government intervention distorts markets, causing shortages or excesses of supply, leading to high prices for goods that should be cheap, and so on.

When the problems pile up one can either repeal the controls or heap on more controls. Guess which “solution” politicians tend to prefer.

Regarding medical care, the politicians’ answer to decades of government bungling is more bungling: regulation, subsidies, rationing, mandates and a new “public option” in health insurance to squeeze out private plans.

President Obama and other public option advocates promise, on stacks of Bibles, that this is not “somehow a Trojan horse for a single-payer system.” But they’re lying. Go to YouTube. Watch the videos of Obama and congressmen explicitly admitting their goal of a single-payer system. Just two years ago, Obama was saying, “But I don’t think we’re gonna be able to eliminate employer coverage immediately. There’s gonna be potentially some transition process. . . .”

That’s how we lose our freedoms. Not all at once, but a slice at a time.

Oh, and about employer-provided medical insurance. That’s a clumsy institution that exists because of World War II wage controls. We do have to transition out of that system. But we should “transition” towards more freedom, not less.

SOURCE




Why government health care keeps falling in the polls

The health-care debate is part of a larger moral struggle over the free-enterprise system

Regardless of how President Barack Obama's health-care agenda plays out in Congress, it has not been a success in public opinion. Opposition to ObamaCare has risen all year. According to the Gallup polling organization, the percentage of Americans who believe the cost of health care for their families will "get worse" under the proposed reforms rose to 49% from 42% in just the past month. The percentage saying it would "get better" stayed at 22%.

Many are searching for explanations. One popular notion is that demagogues in the media are stirring up falsehoods against what they say is a long-overdue solution to the country's health-care crisis. Americans deserve more credit. They haven't been brainwashed, and they aren't upset merely over the budget-busting details. Rather, public resistance stems from the sense that the proposed reforms do violence to three core values of America's free enterprise culture: individual choice, personal accountability, and rewards for ambition.

First, Americans recoil at policies that strip choices from citizens and pass them to bureaucrats. ObamaCare systematically does so. The current proposals in Congress would effectively limit choice across the entire spectrum of health care: What kind of health insurance citizens can buy, what kind of doctors they can see, what kind of procedures their doctors will perform, what kind of drugs they can take, and what treatment options they may have. Meanwhile, ObamaCare would limit the ability of people to choose affordable insurance coverage through less-comprehensive, consumer-driven insurance plans. And it wouldn't allow Americans to shop for better health-care plans from out-of-state carriers.

Second, Americans believe we should be responsible for the consequences of our actions. Many citizens bitterly view the auto and Wall Street bailouts as gifts to people who took imprudent risks, imperiled the entire economic system, and now appear to be walking away from the mess.

Similarly, Americans are cold to a health-care system that effectively rewards individuals for waiting to get insurance until they get sick—subsidizing their coverage by taxing those who responsibly carry insurance in good times and bad.

On its face, the reformers' promise to provide health insurance to nearly all, regardless of pre-existing conditions, is appealing. But as most instinctively realize, if people don't have to worry about carrying insurance until they need it, many won't buy it. Already, the Census Bureau tells us that 21% of the uninsured are in households earning at least $75,000. Although there are certainly plausible reasons for this in some cases, this phenomenon will worsen under ObamaCare.

Third, ObamaCare discourages personal ambition. The proposed reforms will institute a set of government mandates, price controls and other strictures that will make highly trained specialists, drug researchers and medical device makers less valued now and in the future. Americans understand that when you take away the incentive to make money while saving lots of lives, the cures, therapies and medical innovations of tomorrow may never be discovered.

Yet we are told this is all for the best. In his commencement speech at Arizona State University earlier this year, Mr. Obama told the graduates not to "fall back on the formulas of success that have been peddled so frequently in recent years": "You're taught to chase after all the usual brass rings . . . let me suggest that such an approach won't get you where you want to go."

Crass materialism is indeed a tyranny that can lead to personal misery. But most Americans believe it's up to individuals, not a nannying government, to decide what constitutes too much income and too much ambition.

An April 2009 survey conducted by the polling firm Ayers, McHenry & Associates for the conservative nonprofit group Resurgent Republic asked respondents which of the following statements about the role of government came closer to their view: (a) "Government policies should promote fairness by narrowing the gap between rich and poor, spreading the wealth, and making sure that economic outcomes are more equal"; or (b) "Government policies should promote opportunity by fostering job growth, encouraging entrepreneurs, and allowing people to keep more of what they earn." Sixty-three percent chose the second option; just 31% chose the first. This is consistent with nonpartisan surveys showing that most Americans think our increasingly redistributionist government is overstepping its bounds. For example, a September 2009 Gallup Poll found that 57% believe the government is "doing too much"—the highest percentage in more than a decade. Just 38% said it "should do more."

We will continue to hear both sides of the health-care debate argue about particulars of insurance markets, the deficit impacts of reform, and the minutiae of budgetary assumptions. These arguments, while important, do not address the deeper issues involved.

The health-care debate is part of a moral struggle currently being played out over the free enterprise system. It will be replayed in every major policy debate in the coming months, from financial regulatory reform to a cap-and-trade system for limiting carbon emissions. The choices will ultimately always come down to competing visions of America's future. Will we strengthen freedom, individual opportunity and enterprise? Or will we expand the role of the state and its power?

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29 October, 2009

British doctors engaged in ‘slow euthanasia’ for patients with terminal illnesses

Patients with terminal illness are being heavily sedated by doctors before their deaths in a form of “slow euthanasia”, research suggests. A poll of nearly 3,000 doctors found that almost one in five had administered infusions of drugs to keep patients unconscious for hours or days at a time.

In appropriate doses, sedatives and strong painkillers are considered a valuable way of easing the pain and anxiety of patients who are dying with conditions such as cancer. But 18.7 per cent of British doctors polled said they used drugs to invoke “continuous deep sedation” in a dying patient, a practice which in other countries is seen as an alternative to legalised euthanasia.

GPs and hospital doctors who are not palliative care specialists were more likely to report using high doses of sedatives or painkillers to keep patients asleep, leading to calls for all doctors to have mandatory training in the care of dying patients. Guidelines for care at the end of life emphasise that doctors should always act in a patient’s best interests and act within the law, which prohibits euthanasia or actively helping someone to die.

The study, published in the Journal of Pain and Symptom Management, also found that of the sample of 2,786 doctors, those who strongly supported the legalisation of assisted suicide were nearly 40 per cent more likely to employ continued deep sedation than the average. By contrast, doctors who reported strong religious beliefs or who actively opposed changing the law were less likely to report sedating patients before death.

In most cases sedation was used for between one and seven days or less than 24 hours. But in a significant minority of patients — 8 per cent — doctors reported sedating patients for more than a week before they died.

Clive Seale, a professor of medical sociology who led the study at Queen Mary, University of London, said that deliberately keeping patients unconscious until death was controversial, with some physicians viewing it as a form of “slow euthanasia”. “Sedation in itself not directly kill a patient, but it does put them to sleep and is associated with other things such as the withdrawal of fluids and ventilation,” he added. “In this country it can be seen as a form of treatment to relieve intractable suffering but in the Netherlands and Belgium, doctors also see it as an easier alternative to legalised euthanasia.”

Most doctors who sedated patients reported using midazolam, a drug which in high, continuous doses can cause loss of consciousness and memory loss. But nearly a quarter of those surveyed also reported using only opiate painkillers such as morphine or medical forms of heroin to sedate patients, which experts said suggested they misunderstood the effects of the drugs.

Rob George, of the Association for Palliative Medicine, said that rather than deliberately acting to bring on a patient’s death, some doctors may be misreporting the effect of the drugs. “Some doctors who are not specialists may be confused and incompetent in using these drugs but the study suggests they are misunderstanding what they are doing as well. "Dying patients are more likely to be drowsy or asleep in their final days and doctors might assume wrongly that this is a result of medication. “It does not mean that they are hastening a patient’s death. But we do have ample evidence that many doctors do not know what they are doing when it comes to palliative care, and whether or not [dying patients] get good control of their pain and symptoms is a lottery.”

The National Council for Palliative Care, which funded the study with medical charities, estimates that 300,000 people die each year without getting the specialist care and pain management they need. Simon Chapman, director of policy at the council, said that sedation was recognised as an appropriate part of end of life care for some patients.

An official for the Patients Association said: “There is no doubt that the vast majority of patients’ families who contact us after a death do so because they are haunted forever by watching their loved one not have the necessary care, including sedation. “It is imperative that everyone considers making a living will to make your views about end of life care clear and understood. “At the moment you have more training in pain relief as a vet than a doctor.”

SOURCE




Half of British doctors 'too busy using computers to look patients in the eye'

America's got some great things to look forward to under Obamacare!

Nearly half of GPs claim they are too busy to look patients in the eye during consultations, according to a shocking poll out today. A survey of family doctors found that 38 per cent are unable to give patients enough eye contact because they are spending so much time tapping information into their computers to meet Government targets. They say a third of their time with patients is spent on paperwork or data inputs - meaning there is less time to listen to patients.

Although the average length of consultations has increased in recent years, GPs are now working an average of seven hours a week less since a lucrative new contract negotiated in 2003.

The study also showed that half of GPs say their primary care trust did not actively support their practice in offering high-quality patient care, and 27 per cent said they were ‘actively obstructive’.

Last night critics said doctors would be able to spend more time with patients if they worked a bit longer.

The survey of 600 GPs in Pulse magazine found the computer-based work - such as the recording of data to meet Government targets - has left doctors struggling to deliver patients' personal care. Much of the information they are forced to input leads to bonus payments under the performance-related part of their contract.

The poll found that 38 per cent of GPs said they were unable to give patients enough eye contract during consultations. They said that just over half of each consultation - 55 per cent - is now spent speaking to patients and addressing their needs, while a third is spent on paperwork and data input.

Almost all - 97 per cent - said consultations had become more complex and intense over the past five years, with three quarters saying complexity had 'greatly increased'. Although the length of consultants has been increased to an average of 11 minutes, the GPs surveyed said they really needed 14 minutes to give the best service to their patients.

Dr Robert Baker, a GP in Swanage, Dorset, told Pulse that the bureaucratic burden was affecting the doctor-patient relationship. 'I could do with being split in two to manage prevention and curative aspects; both of which I am expected to address, for multiple systems, in 10 minutes,' he said. 'The demands of the patient's agenda, the Government's agenda and the requirement that everything I hear, say and do must be meticulously recorded make for an extremely crowded consultation.’

But Vanessa Bourne, of the Patients Association, said: 'GPs are the gatekeepers to all other healthcare. Patients must be able to trust that an accurate diagnosis is being made. At the very least that means having a proper look at the patient. 'If PCTs are to blame for the wrong priorities in a consultation, then patients risk being shortchanged twice over - once by their GP and again by the PCT. ‘For over a quarter of GPs to feel that their PCT is being “actively obstructive" tells patients that urgent action is needed.’

Richard Hoey, editor of Pulse, said: 'GPs' consultations with patients may have got a little longer, but they've failed to keep pace with the steep rise in computer work and the growing complexity of cases, as patients are managed in the community rather than in hospital. 'With 101 things to squeeze into a consultation, it's the personal elements that are being squeezed out - and that includes the real basics such as making eye contact with the patient.'

SOURCE




Reid's public option plan splits Democrats

Senate Democrats remain divided over Majority Leader Harry Reid's plan to establish a national health insurance program run by the government, signaling that Capitol Hill leaders could have a difficult time scraping together enough votes for passage. Sen. Joe Lieberman of Connecticut, an independent who typically votes with Democrats, became the first to declare that he would join a Republican filibuster to block passage of a bill that enacts a national public option. But he left room for negotiation, saying he doesn't oppose state-based programs or cooperatives.

Other moderate Democrats in both the House and Senate remain skeptical of plans to establish a government insurance program over concern that it would add to the federal deficit and increase private insurance rates, but didn't go so far as promise to block it. Many are waiting to see the details in the text of the bill, which hasn't been released yet.

Mr. Reid's announcement Monday that he would pursue a public option in his health care reform bill re-energized liberal Democrats, who say the plan is the only way to drive down costs and truly reform the nation's health care system. But all 40 Senate Republicans are expected to vote against the bill and any procedural votes required, meaning Democrats would need to keep all 60 of their members within the fold to overcome a filibuster.

Mr. Reid, Nevada Democrat, told reporters he thinks Mr. Lieberman and other Democrats will come around. "There are a lot of senators, Democrat and Republicans, who don't like part of what's in this bill," Mr. Reid said. "We're going to see what the final product is. We're not there yet."

In the House, conservative "Blue Dog" Democrats have been skeptical of the plan's cost and another group of 40 pro-life Democrats say they will block the bill from getting to the floor unless they are promised a chance to debate their proposal to ban government funding of abortions.

House leaders are trying to determine whether they have support for a "robust" public option, which is favored by liberals and reimburses doctors based on Medicare rates, plus 5 percent. There is wider support for a public option that negotiates its own rates with health providers, but it saves less money.

House Speaker Nancy Pelosi of California encouraged Democrats to come together to support the bill in a caucus meeting Tuesday and told members she expects the bill to be released this week, with floor debate beginning next week.

In the Senate, Democrats are already crafting alternatives in case their proposal to allow states to "opt out" of the public plan doesn't do enough to generate moderate support. Sen. Thomas R. Carper of Delaware is floating an "opt-in and opt-out" alternative that would only establish the public plan in states with expensive insurance rates or little competition and later allow other states to join or leave the program. "There's some senators, Democrats, who aren't going to vote for a public option in all 50 states," he said, calling the opt-in and out-out plan, "more acceptable to some of our centrists."

Republicans have pledged to vote against the reform plans if they include a public option, arguing that the proposals would drive up costs for people who already have health insurance and lead to a government takeover of the health care system. "We know that it will include a half a trillion dollars in Medicare cuts," Senate Minority Leader Mitch McConnell of Kentucky said of the pending legislation. "We know it will include $400 billion in new taxes. And we know that independent - independent groups taking a look at the effect on the insurance market have indicated that insurance for the 85 percent of Americans who have insurance - health insurance is going to go up."

SOURCE




Constitutionality of health overhaul questioned

On top of all the other obstacles facing President Obama in his quest to pass health reform is this one: Does the U.S. Constitution allow the government to require uninsured Americans to buy medical insurance or impose a tax penalty if they refuse? Congress has never before required citizens to purchase any good or service, but that is what both House and Senate health bills would mandate.

While this debate has been overshadowed by other issues involving the plan's nearly $1 trillion cost and its government-run option, the constitutional argument strikes at a pivotal part of the health care plan's finances. To make a government-run health care plan work, the nation's largely uninsured young adults would need to be covered to help subsidize medical care for older and typically less-healthy Americans, legislators say.

House Speaker Nancy Pelosi dismissed the complaint Thursday when she was asked by a reporter if the Democrats' health reform proposal was constitutional. "Are you serious? Are you serious?" Mrs. Pelosi replied.

But House Minority Leader John A. Boehner said the argument could not be ignored. "I'm not a lawyer, and I'm certainly not a constitutional lawyer, but I think it's wrong to mandate that the American people have to do anything," he told reporters at his own press briefing last week.

The question of the mandate's constitutionality "hasn't been part of the public debate, but the legal community has been debating it. It's been on all the legal blogs," said Michael Cannon, director of health-policy studies at the libertarian Cato Institute. He said "the Constitution does not grant Congress the power to force Americans to purchase health insurance."

In 1994, the nonpartisan Congressional Budget Office noted that a "mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action." "The government has never required people to buy any good or service as a condition of lawful residence in the United States," the CBO said. The statement was part of an analysis of then-President Clinton's ill-fated health care reform plan, which also required that all Americans purchase health insurance plans.

More here




Fraud plagues government health care

Two recent headlines convey a disturbing contradiction: "Medicare fraud: A $60 billion crime" ("60 Minutes"), and "Reid to announce push for public option" (Politico). The former is the latest in a long parade of similar articles about Medicare, the government's biggest health care program. The latter updates liberal Democrats' continued effort to expand government health care despite its long and dreary record of waste and fraud.

Indeed, Medicare corruption has been so extensive for so long that the terms "federal health care spending" and "waste, fraud and abuse" are virtually synonyms. In May 1986, for example, Department of Health and Human Services Inspector General Richard Kusserow reported that in the prior six months 65 people were convicted of attempting to defraud Medicare, Medicaid or Social Security, with savings of more than $50 million as a result. During his long tenure as the department IG from 1982 to 1991, Kusserow unearthed hundreds of millions of dollars in fraud and helped gain convictions of thousands of people.

Nothing much has changed in the 23 years since Kusserow's 1986 report. Last Sunday, "60 Minutes" broadcast a devastating segment featuring a depressing progression of government and private lawyers, law enforcement officers, auditors, investigators, and people convicted of Medicare fraud explaining why and how ripping off Medicare has become one of the easiest and most profitable crimes in America.

One of the criminals explained that Medicare management was so lax that he got $150,000 by claiming reimbursement 10 times for a "gas-powered prosthetic arm." The same criminal said there are "thousands" of companies in the Miami area being paid for such fraudulent claims every day. A lawyer with extensive experience defending those accused of Medicare scams told "60 Minutes" that Medicare fraud is bigger than the drug trade in South Florida.

Predictably, Attorney General Eric Holder told "60 Minutes" the government needs a bigger budget and more employees before it can stop the fraud. But HHS has worked for more than two decades to clean up Medicare fraud and currently has more than 63,000 employees. If, after working all those years -- with the Justice Department, FBI and state authorities -- HHS still can't stop Medicare fraud, why is hiring more people and fattening up the department's budget going to do the trick?

Kusserow told the San Francisco Chronicle in 2003 that every time the government nailed one abuse, three new ones soon took its place. We hear a lot these days about companies that are "too big to fail." We should worry even more about government that has grown too big to do anything but fail.

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28 October, 2009

Many fake doctors in Pakistan

Most English-speaking countries have recruited substantial numbers of doctors from Pakistan and many of those in Britain's NHS have been found to be poor performers. Could the report below be relevant to that? Australian bureaucrats have certainly often been very lax in checking the credentials of overseas doctors

SOME 70,000 quacks with bogus medical degrees are said to be endangering lives across the country. But the recent news of a fake doctors’ recruitment scam at the District Headquarters Hospital in Rawalpindi raises new concerns about the infiltration of such charlatans into our public healthcare institutions. Several senior health officials have already been arrested for the hiring of at least four people — three of them brothers — whose medical certificates were found to be bogus. One was taken on by the hospital as a neurosurgeon no less. While all those found guilty ought to be prosecuted and punished, more comprehensive preventative measures are also in order.

For starters, the Pakistan Medical and Dental Council could ask all public and private hospitals in the Rawalpindi-Islamabad area to send a list of their doctors for verification. The PMDC needs to introduce a multi-tiered checking and monitoring system which should include routine degree verification in all hospitals. Fake doctors are either not registered with the PMDC or hold phoney registration certificates, and as such unqualified doctors can be weeded out without harassing genuine practitioners. Hospitals which fail to verify credentials with the PMDC before hiring new doctors should be appropriately penalised. Detecting fake doctors requires diligent regulation as well as public awareness and prompt reporting by medical professionals who are suspicious of a colleague’s credentials. Not many people perhaps know that the PMDC’s website allows the general public to check if their doctors are registered with the council and are thus licensed to practise medicine. The PMDC and the health authorities should encourage the general public, through advertisements and posters, to be involved in exposing fake doctors in this manner. After all it is the public that will benefit most, in terms of safer healthcare, by the eradication of bogus physicians.

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A cure worse than the disease

With Democratic support coalescing around Sen. Max Baucus’s (D-Mont.) health care reform proposal, passage of a comprehensive overhaul now appears more likely than ever. One reason is the Congressional Budget Office’s (CBO) preliminary cost estimate for the bill suggesting that it would cost $829 billion over the 10-year budget window, but actually reduce the federal deficit by $81 billion.

On paper, the plan looks affordable, because it contains several features intended to reduce long-term health care costs. However, there is good reason to believe these proposals will not cut costs substantially, and could reduce the quality of care for patients. Most of the alleged cost-cutting measures merely shift costs from the federal government onto the states or private payers, without affecting long-term health care inflation. The only measures that could reduce the annual rate of growth in health care costs would erect government barriers between patients and their doctors, while jeopardizing long-term medical innovation.

Bringing millions of currently uninsured Americans into public or private health plans will not be cheap. That is why White House Chief of Staff Rahm Emanuel has said that the administration’s first priority is “getting health care costs under control.” And, in an August New York Times op-ed, President Obama wrote that the Democratic proposals “will finally bring skyrocketing health-care costs under control” by cutting “hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid.”

In order to keep the bill’s reported net costs down, Sen. Baucus’s plan relies on $397 billion of new taxes and other expected revenue and on accounting and cost-shifting gimmicks. For example, to help increase health care coverage, the bill would expand Medicaid eligibility, a move that shifts an estimated $33 billion of spending to the states. The CBO’s analysis notes this, but because it is not a federal expenditure, does not account for it in the bill’s budget score.

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American healthcare fascialism

Some time ago I invented the phrase "fascialism" to describe the American system of political economy. Fascialism means an economy is part fascist, part socialist. Economic fascism has nothing to do with dictatorship, militarism, or bizarre racial theories. Fascism is a brand of socialism that was the economic system of Germany and Italy in the early 20th century. It was characterized by private enterprise, but private enterprise that was comprehensively regulated and regimented by the state, ostensibly "in the public interest" (as arbitrarily defined by the state).

Socialism started out meaning government ownership of the means of production, but it came to mean egalitarianism promoted by "progressive" taxation and the institutions of the welfare state, as F.A. Hayek stated in the preface to the 1976 edition of The Road to Serfdom. The problems of the American healthcare system are caused entirely by the fact that the government subjects the system to massive interventions, some of which are fascist in nature, while others are socialist.

In 1992, the Hoover Institution published an essay by Milton Friedman titled "Input and Output in Medical Care," in which Friedman documented how, at the beginning of the 20th century, about 90% of all American hospitals were private, for-profit enterprises. State and local governments then began taking over the hospital industry. So, by the early 1990s only about 10% of all American hospitals were private, for-profit enterprises. Socialism characterizes at least 90% of all hospitals. Many other hospitals have received government subsidies, and with the subsidies come reams of regulation, making them fascist by definition.

The effect of this vast government takeover of the hospital industry, Friedman documented, is what any student of the economics of bureaucracy should expect: the more that is spent on hospital care, the worse the quality and quantity of care become, thanks to the effects of governmental bureaucratization. According to Friedman, as governments took over an ever-larger share of the hospital industry (being exempt from antitrust laws), hospital personnel per occupied hospital bed quintupled, as cost per bed rose tenfold.

Friedman concluded that "Gammon's Law," named after British physician Max Gammon, "has been in full operation for U.S. hospitals since the end of World War II." Gammon's Law states that "In a bureaucratic system, increases in expenditure will be matched by a fall in production.… Such systems will act rather like 'black holes' in the economic universe, simultaneously sucking in resources, and shrinking in terms of … production." Dr. Gammon surely knew what he was talking about, having spent his career in the British National Health Service.

"The U.S. medical system, in large part, has become a socialist enterprise," Friedman ended. Friedman also once suggested a syllogism to explain the bizarre spectacle on display today of responding to problems caused by healthcare socialism with even more healthcare socialism. The syllogism goes as follows:

1. Socialism has been a failure everywhere it has been tried;

2. Everyone knows this; and

3. Therefore, we need more socialism.

Layers of regulation plague every aspect of medical care and health insurance in America. In the health-insurance industry, for instance, each state imposes dozens of regulatory mandates on health insurers, requiring them to include coverage of everything from massage therapy to hair implants. The reason for mandates is that the message-therapy and hair-implant industries (and many others) hire lobbyists to bribe state legislators to require insurers to cover their particular practice if they want to sell insurance within a state. Among the states with the largest number of mandates as of 2009 are Rhode Island (70), Minnesota (68), Maryland (66), New Mexico (57), and Maine (55). Idaho has the fewest mandates (13), followed by Alabama (21), Utah (23), and Hawaii (24).

Each mandate increases the cost of health insurance and probably increases the typical health-insurance policy by hundreds, or thousands, of dollars yearly. This is a good example of healthcare fascism.

Government policy in the health-insurance industry applies both the brakes and the gas at the same time. While imposing onerous and cost-increasing regulations, government also limits legal liability in some cases where an insurer refuses to pay for a particular procedure or treatment that costs a patient his life. The state also creates state-wide cartels with laws prohibiting the portability of some aspects of health insurance. (For example, my employer-provided health insurance covers pharmaceuticals in Maryland, where I reside, but not in other states.)

Getting back to pure socialism, Medicare, Medicaid, and the Veterans Administration hospitals socialize a very large portion of healthcare in America, with the same predictable results as the socialization of hospitals: runaway costs for decade after decade, coupled with massive fraud, as is often the case when politicians are enabled to spend other people's money. Even the federal government admits that there is currently about $60 billion in Medicare fraud. Since government always understates the cost of everything it does, it is likely that the real number is at least two or three times that amount.

Having taken over most of the hospital industry, government-run or government-subsidized hospitals have created regional monopoly power for themselves with so-called "certificate-of-need" (CON) regulation. How this regulatory scam works is that an existing hospital in an area will give itself the legal "right" to decide whether there is a legitimate "need" for more hospitals. They have given themselves, in other words, the right to veto new competition in the hospital industry. It is as if the Microsoft Corporation had a legal right to veto new competition in the computer industry.

Not surprisingly, research has shown that CON regulation has increased hospital costs. CON regulation is also used to block competition in various healthcare professions as well, from nursing to home healthcare. (I was once asked to assist several nurses in obtaining a CON license from the Fairfax County, Virginia government so that they could start up their own home healthcare business. The county government was already in the business itself, and vetoed their application, naturally.)

Physicians have long enjoyed a degree of monopoly power derived from state legislatures that delegate to the American Medical Association (the doctors' union) the "right" to limit entry into medical schools through accreditation. Only graduates of accredited (by the AMA) medical schools are licensed to practice medicine. The AMA has used these state-granted privileges to limit both the number of medical schools and the number of medical-school graduates. The reduced supply of doctors drives up the price of medical care and the income of AMA members. Hundreds of other health professions limit entry with the help of occupational licensing regulation, the primary effect of which is to create monopoly profits, not to ensure quality of care.

Government regulation of pharmaceuticals and medical devices, primarily by the Food and Drug Administration (FDA), increases healthcare costs, denies the benefits of myriad helpful drugs and devices, and creates monopoly power. It has literally been responsible for the premature death of thousands of Americans who have been deprived of drugs that were long available to people in other countries.

FDA bureaucrats are extremely risk averse: On the one hand, it costs them nothing personally to delay a life-saving drug for years, if not decades, by demanding test after test. On the other hand, if they permit a drug to enter the marketplace that turns out to be dangerous, it is a public-relations disaster for the agency, which it does not want to be associated with. Consequently, the entrance of new drugs and medical devices onto the market is often delayed by years, costing many lives and inflicting much needless pain on those already suffering, while driving up prices.

The FDA also makes the market for pharmaceuticals less competitive by restricting what advertising may say for myriad drugs — even aspirin. New drugs do consumers no good if they do not know about them. Advertising restrictions imposed by the FDA, therefore, prop up the profits of incumbent drug marketers at the expense of newcomers in the industry and of consumers.

The government's legal system is also responsible for what used to be called "the liability crisis." The genesis of this crisis began in the 1960s. The government courts began accepting the Chicago School Law and Economics argument that assigning all liability in product-liability cases to manufacturers would be a good way to minimize the "social costs" of accidents. Manufacturers know more about products such as medical devices than anyone else, the argument went, so contract law and shared responsibility for accidents with the users of the products were thrown out the window.

So, when accidents occur, slick trial lawyers have had an easy time convincing dumbed-down juries to award millions, or hundreds of millions, of dollars in liability lawsuits. These lawsuits have bankrupted the manufacturers of many medical devices, while convincing others that the devices are too risky to make. The effect on the healthcare consumer is poorer healthcare and higher prices.

There are thousands of other government regulations and controls on all aspects of healthcare, even (or especially) the nursing-home industry. Like most regulation, it has little or no beneficial effect for the public. More often than not, it is part of a cartel arrangement by some group of medical practitioners who are in cahoots with federal, state, or local politicians who are always more than willing to sell their "constituents" down the river for a generous campaign "contribution."

The only sensible approach to healthcare "reform" would be massive privatization of America's socialized hospitals, combined with deregulation of the medical professions to introduce more competition, and deregulation of the health-insurance industry. Free-market competition would produce medical "miracles" the likes of which have never been seen, while dramatically lowering the cost of healthcare, just as it has done in every other industry where it is allowed to exist to any large degree.

This is not likely to happen in the United States, which at the moment seems hell-bent on descending into the abyss of socialism. Once some states begin seceding from the new American fascialistic state, however, there will be opportunities to restore healthcare freedom within them.

SOURCE




Congress' health care bills leave millions uninsured

The high cost of health insurance premiums would continue to put coverage out of reach for millions even if Congress approves legislation President Obama says is intended to ensure "that every American has affordable health care."

The number of people who remain uninsured will depend on how House and Senate leaders reconcile separate versions of health care legislation to arrive at a final bill. The factors include the size of government subsidies to help low-income families pay for insurance and the scope of penalties that would be charged for those who don't buy a plan.

"A lot of this really depends on affordability," said Diane Rowland, executive vice president of the Kaiser Family Foundation. "As they put these bills together, one question is, 'Are the subsidies ... going to be sufficient to make coverage affordable?' "

The non-partisan Congressional Budget Office estimates 17 million Americans would remain uninsured under the Senate Finance Committee's 10-year, $829 billion health care bill. Health experts such as Rowland say that number would include families who earn too much to qualify for Medicaid but not enough to pay for insurance.

Others who could remain uninsured under the Finance Committee bill include people who choose to pay a proposed $750-a-year fine rather than buy coverage and those who are eligible for Medicaid but don't enroll.

Senate Majority Leader Harry Reid, D-Nev., is working behind the scenes to merge the Finance Committee bill with one passed in July by the Senate health committee.

The Finance Committee's bill would expand coverage to 29 million Americans who wouldn't otherwise have it, ensuring that 94% of U.S. residents are covered, according to the Congressional Budget Office. An early analysis found that a proposal being developed in the House would cover an additional 6 million to 7 million people, said Brendan Daly, a spokesman for House Speaker Nancy Pelosi, D-Calif. The speaker is leading negotiations in her chamber to combine three House bills into one.

Details of the House and Senate proposals are evolving. Lawmakers, including Senate Finance Committee Chairman Max Baucus, D-Mont., have said that no matter how the legislation is crafted, not everyone will have coverage. Those who could remain uninsured include:

•Those who can't afford it. All of the health care bills would mandate that individuals have health insurance and would provide subsidies to help low-income families pay for premiums. The Finance Committee bill would allow people to opt out of buying coverage if the lowest-cost plan available equals 8% or more of their income after subsidies.

A Center on Budget and Policy Priorities study estimates a family of three earning $27,465 a year would pay 4.5% of its income for insurance under the Finance panel's bill, more than four times the amount the same family would pay under the health committee's bill. "A family ... at that level is stretching it every day to make ends meet," said Judith Solomon, a senior fellow at the center.

•Individuals and families who choose to pay a penalty instead of buying insurance. The Congressional Budget Office has not said how many people it believes would make the decision, but it estimates the government would collect $900 million in penalties in 2016.

About 48% of those penalties would come from people earning between 100% and 300% of poverty, or between $18,310 and $54,930 for a family of three, according to the budget agency. About 29% of the money would come from people earning more than five times the poverty line.

•People who are eligible for Medicaid and other programs but do not enroll. Marc Cohan, director of litigation for the National Center for Law and Economic Justice, said one reason eligible people do not apply is because of the bureaucracy involved. "A lot of people ultimately throw up their hands in despair and walk away," he said.

Sen. Jim Bunning, R-Ky., criticized the Finance Committee's bill this month for adding "hundreds of billions of dollars more in new taxes ... and yet 25 million people will still remain uninsured." The number includes 8 million illegal immigrants who would not be covered under any of the bills in Congress.

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Health reform written behind closed doors

By day, Democrats tout how open they have been while crafting a bill to reform the nation's health care system. By early evening, they're behind closed doors. Three times last week, White House officials went to Capitol Hill to meet in closed sessions with top Senate Democrats to put together a health bill. They left with not much more than a thumbs up or a "we're making progress"-type comment to the reporters waiting outside. It's not exactly the level of transparency that President Obama promised during the campaign, when he said health care talks would be aired live on C-SPAN.

"I'm going to have all the negotiations around a big table," he told a town hall audience in Chester, Va., in August 2008. "We'll have the negotiations televised on C-SPAN, so that people can see who is making arguments on behalf of their constituents and who are making arguments on behalf of the drug companies or the insurance companies. And so, that approach, I think, is what is going to allow people to stay involved in this process."

The small group of White House officials and three senators met in Senate Majority Leader Harry Reid's office three evenings last week to discuss what kind of bill to send to the Senate floor. The negotiation team includes Mr. Reid, Finance Committee Chairman Max Baucus of Montana, and Christopher J. Dodd of Connecticut, who led the work on the Health, Education, Labor and Pensions (HELP) Committee bill.

White House officials seen leaving the meetings include Chief of Staff Rahm Emanuel, Health and Human Services Secretary Kathleen Sebelius, health care "czar" Nancy-Ann DeParle, and Peter Orszag, director of the Office of Management and Budget.

It's hardly unexpected that major legislation on Capitol Hill, particularly on an issue as complex as health care reform, would be done in a small group and behind closed doors. The reform debate is now at a particularly sensitive stage, as House and Senate leaders have to make major political and policy decisions on what kind of legislation to send to their chambers' floors.

But Mr. Obama's campaign promises have provided Republicans and other opponents of the Democrats' reform plans with an easy criticism of how he's crafting the legislation. "They're writing a health care bill in secret, even though the president called for all of this to be out on an open table and have C-SPAN cameras in the room," House Minority Leader John A. Boehner of Ohio said last week. "We're about to significantly alter one-sixth of the economy, and if there was ever a need for transparency it is now," Sen. Mike Johanns of Nebraska warned in a recent Republican address.

More here





27 October, 2009

Incredible stupidity from the Australian medical bureaucracy

Yet another boneheaded and useless attempt at computerization. Britain has spent 12.5 BILLION pounds on their system and it still is not working. Let's hope the Australian authorities stop their nonsense long before that point

A FEDERAL scheme to provide thousands of GPs with communications encryption technology so they can send sensitive health information securely over the internet risks turning into an expensive white elephant because hardly any other health workers can decode the messages. A revamp of federal government incentive payments in August meant GPs must be signed up for the secure communications method known as "public key infrastructure" in order to remain eligible for grants worth up to $50,000 per practice each year.

The idea of the system is that it allows doctors to send sensitive patient data, including referrals and test results, to each other without risk of the information being seen by other people.

But Mukesh Haikerwal, one of the 10 commissioners who wrote the recent National Health and Hospitals Reform Commission report, says the scheme is turning into a "superhighway to nowhere" because hardly any hospitals, specialists or allied health workers have the technology, and they have been given little incentive to adopt it.

"If everybody was connected, it would be a very useful thing to be doing," said Dr Haikerwal, a former Australian Medical Association president who is also a vocal advocate for greater use of information technology in health care. "But it's not (currently useful) -- either you stop the rollout, or you enable everyone to be part of the system. Ninety-eight per cent of us (GPs) are able to send stuff securely, but none are able to receive it in a secure electronic form, and none are able to send us stuff back."

Once GPs have signed up to the scheme, the federal Health Department sends them chip cards that encode a GP's identity, and the readers used to verify the card information and activate the system once a password is entered. Mini chip cards that fit into a USB key that plugs into the GP's computer are also being sent out. The federal Health Department estimates 10,000 GPs are likely to apply for the technology, and says 9000 have done so already.

Medicare sends the necessary equipment free to those who apply, but a Medicare Australia spokesman said the cost of this was commercial-in-confidence. Dr Haikerwal estimated that the cost of extending the technology to specialists could be $7000 to $10,000 a practice for the hardware, software and training, although not all of this would be expected to come from taxpayers.

Dr Haikerwal's concerns were backed by Royal Australian College of General Practitioners president Chris Mitchell, who said there was no point in having a secure messaging system "that allows you just to communicate with yourself".

Stephen Johnston, head of national infrastructure services for the federal government's National E-Health Transition Authority, said the "whole health system has to be connected". "GPs are just one part of the story," Mr Johnston said. "But it won't happen overnight." A spokesman for the Health Department said take-up of the technology was "progressing" and predicted others would come on board steadily.

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No health care measure can alter the fact that medical resources are limited

If you've been following the health care debate over the last couple of years, you may have heard the grim tale of Nataline Sarkisyan. Just 17 years old, afflicted with leukemia, she needed a liver transplant, but the insurance company Cigna refused to cover the surgery. After being picketed by nurses and the family, the insurer relented, but too late: She died that same day.

When he ran for president, John Edwards used the girl's experience as proof of the need for reform. Her parents went to Cigna headquarters to charge the company with killing their daughter to make money. Lately, a liberal group called Americans United for Change has used her in a TV spot to dramatize its claim that "if insurance companies win, we lose."

Her case is an excellent illustration of what is wrong with our approach to health care -- but not how Cigna's critics mean. The insurer declined to pay for the transplant because, it said, "the treatment would be unproven and ineffective -- and therefore experimental and not covered."

Nataline's surgeons disagreed, estimating she had a 65 percent chance of surviving six months with a new liver. But Dr. Goran Klintmalm, head of the Baylor Regional Transplant Institute in Dallas, told The Los Angeles Times the surgery was "very high-risk" and "on the margins." Even on the best prognosis, she stood a one-in-three chance of dying -- after undergoing a very expensive operation and taking a liver that might otherwise have gone to someone with a better chance of survival.

Maybe Cigna was mistaken. Maybe not. The problem is that the critics seem to imagine that once we crack down on insurance companies or go to a single-payer government health insurance plan, future patients like Nataline will get anything their doctors recommend.

They won't. No matter how we "reform" health insurance, there will still be close calls, where it's not clear that a costly procedure will actually do any good. There will have to be someone, either in government or in the private sector, to decide which operations and treatments should be covered and which should not. And there will be patients who will die after being refused.

Health care "reform" won't eliminate such incidents and may produce more of them. Despite all those greedy private health insurers -- or maybe because of them -- Americans get far more liver transplants per capita than the residents of Canada, France or Britain.

But liberals are not the only people who fantasize that our health care resources are unlimited. Republicans have accused the Obama administration of plotting to set up "death panels" to ration care for seniors. Former Lt. Gov. Betsy McCaughey of New York called the House Democratic health care bill "a vicious assault on elderly people" that will "cut your life short." Republican National Committee Chairman Michael Steele has taken the same tack. After the administration proposed modest reductions in the growth of spending on Medicare, he did an impersonation of John Edwards.

"We want to make sure that we are not cutting the Medicare program," Steele said. "Anytime you get a body of individuals that go beyond me and my doctor who are going to make decisions about what kind of health care I get, that's rationing of health care." But as long as someone else has to pay for those decisions, someone other than doctors and patients is going to make decisions about what treatments are worth the cost.

As it happens, Washington is not about to get stingy with seniors. The cost constraints in the health care bills moving through Congress would trim total projected Medicare outlays by only 3 to 5 percent over the next decade. A cut of 5 percent in 2019 spending, however, would leave it 80 percent higher than this year.

Ten years from now, even with such "cuts," seniors will have more and better medical options than today. Yet Republicans act as though everyone over 65 will be herded onto an iceberg and pushed out to sea.

What left and right have in common is the delusion that when it comes to medicine, nothing succeeds like excess. But no health care measure can alter the fact that our resources are not unlimited. We may not want to hear it, but no matter what kind of insurance system you have, sometimes someone has to say "no."

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End of Life Care Should Not End Life

The subject of how best to honor and care for those facing death due to terminal illness or old age has always been controversial. As talk of "death panels" and "rationing" stirs debate over the government's proper role in health care, two new studies funded by the National Institutes of Health are lending new weight to the argument that, when it comes to providing end-of-life care for the elderly and terminally ill, sometimes less is better. The studies, featured in the New England Journal of Medicine, document how certain medical therapies implemented in the final months of a patient's life often cause emotional and physical stress and pain, effectively negating any positive benefits associated with such treatments.

However, those worried that a government takeover of health care will result in health care rationing in keeping with Dr. Ezekiel Emanuel's "complete lives" theory view these studies with alarm-and for good reason. In a culture where "quality of life" is increasingly viewed as the predominant justification for abortion, assisted suicide, and even infanticide , there is a legitimate concern that these kinds of studies will be used by the government to advance policies that endanger society's most vulnerable members.

The pivotal question is not whether difficult end-of-life decisions must sometimes be made, or whether-as the NIH studies indicate-sometimes the best decision is to forego heroic measures in favor of simply keeping a patient comfortable in his or her final days. The traditions of hospice and palliative care, for example, both work to keep dying individuals in a state of dignity and comfort without resorting to extraordinary, and ultimately futile, measures. The question is who should make these decisions.

Government-run health care has ominous implications because it supplants individual doctor-patient relationships with generalized protocols crafted by bureaucrats who have no way of accounting for the particular needs of the human beings affected by them. These protocols are often drafted with cost-cutting goals and resource management in mind-not the criteria most want at the top of the list when it comes to life and death medical care.

At many hospitals and nursing homes in the United Kingdom, for example, elderly patients deemed close to death are placed in a "care pathway" designed to ease the dying process and conserve medical resources. Once it is determined that a patient is near death, life sustaining fluids and medicines are withdrawn and the patient is placed under heavy sedation. As bioethicist Wesley J. Smith describes it, "the Pathway misuses the legitimate treatment of palliative sedation, and mutates it in some cases into a method of causing death, known as terminal sedation. This means that sedation is sometimes administered, not because the individual patient actually needs the procedure, but because he or she has been reduced to a category member, and that's how members of the category are treated." When this kind of one-size-fits-all approach is employed, casualties are inevitable. One man has already lost his life due to the misapplication of England's bureaucratic approach to end-of-life care.

At the other end of life's spectrum, last month a woman in England was forced to watch her premature infant struggle to survive without medical care for hours before finally dying on the delivery room table. The reason? Doctors told the new mother that "national regulations" prevented them from providing medical care because the baby was born two days too early to qualify for life-saving measures. In Canada, the government recently decided to end funding for a medication that adds an additional nine months to the lives of colon cancer patients. Why? "Clinical" evidence suggested that the additional months of life were not worth the cost of the medication.

In each of these situations, end-of-life decisions were made without the input of, and sometimes against the explicit wishes of, the individuals involved. These treatments are not being employed as one option among many-they are being imposed uniformly as a matter of policy.

Few would deny that some measure of reform is needed in the healthcare arena. Our country is on the threshold of a veritable Senior Tsunami; an enormous age wave is coming. As America increasingly becomes a mass geriatric society, large numbers of the elderly will soon need acute and long term care. Yet, even as the demand for medical care is increasing, Medicare funds are in short supply, and something's got to give .

But if our leaders in Washington are unable or unwilling to come up with a uniquely American solution to this problem, and if the looming healthcare crisis continues to be exploited by leaders on the Left simply as a means to a greater ideological end , there is good reason to fear that the cold comfort of England's "care pathway" approach to end-of-life care may be coming soon to a hospital near you.

SOURCE




Obama Taxes Pacemakers, Heart Valves

The more fiscal details of the health care bills emerge, the more appalling they seem. The Senate Finance Committee bill includes a broad provision taxing all manner of medical devices. This tax includes such frivolous luxuries as pacemakers, stents, artificial heart valves, defibrillators, automated wheelchairs, mechanized artificial limbs, replacement hips and knees, surgical gurneys, laparoscopic equipment and the like. President Obama is planning to reduce the cost of medical care by taxing it!

The most recent Gallup Poll reflected that 49 percent of respondents said they believed that the Obamacare plan will increase their health care costs. Only about 20 percent said it would lower them. It is taxes like these that substantiate this kind of concern.

The origins of this new medical device tax are troubling, as well. The medical device industry had its day at the White House, as did the insurance industry, the drug makers, the nurses and the doctors. In turn, each group heard the White House request that they come up with voluntary cuts in their health care costs and support Obama's proposed changes in return for assurances that Congress would not impose deeper cuts (or, in the case of the doctors, that it would actually rescind cuts already scheduled under current statutes).

But, unlike all these other groups, the medical device industry refused the deal. This posture enraged the tyrants in the White House, who vowed to punish the industry with cuts imposed by Congress. The result was a decision by the revenue-hungry Senate Finance Committee to extract billions in funds from the industry.

The legislation does not work like a sales or excise tax. Rather, it follows the model of the punitive tobacco settlement imposed on cigarette companies in the '90s. It assesses an industry-wide payment that firms must make in proportion to their market share. It bars them from passing along the cost of the assessment by charging more for certain basic products, but allows them to raise the price of others to raise the funds for the fee.

So, the result will be that virtually every piece of advanced surgical equipment will be subject to a price increase to meet the levy from Washington. No matter that these devices often make the difference between life and death and that, in effect, taxing them raises the cost of vital treatments. The vengeful White House will have its pound of flesh from the medical device industry for daring to be independent and refusing to knuckle down to administration pressure.

This tax, imposed in a spirit of haughty arrogance, falls on totally inappropriate objects. Valves, prosthetic limbs, pacemakers, hearing aids and such are essential therapies that make life longer, better and less painful. To tax them makes no sense -- except in the world of sharp elbows and interest group politics that grips this take-no-prisoners and show-no-mercy White House.

SOURCE




House health care bill exceeds $1 trillion

Health care legislation taking shape in the House carries a price tag of at least $1 trillion over a decade, significantly higher than the target President Barack Obama has set, congressional officials said Friday as they struggled to finish work on the measure for a vote early next month.

Democrats have touted an unreleased Congressional Budget Office estimate of $871 billion in recent days, a total that numerous officials acknowledge understates the bill's true cost by $150 billion or more. That figure excludes several items designed to improve benefits for Medicare and Medicaid recipients and providers, as well as public health programs and more, they added.

The officials who disclosed the details did so on condition of anonymity, saying they were not authorized to discuss them publicly.

Some moderate Democrats have expressed reluctance to support a bill as high as $1 trillion. Last month, Obama said in a nationally televised address before a joint session of Congress that he preferred a package with a price tag of around $900 billion.

Obama also said he would not sign a bill that raised deficits, and the CBO estimates the emerging House bill meets that objective. Officials said the measure would reduce deficits by at least $50 billion over 10 years and perhaps as much as $120 billion.

Democrats also said the bill would slow the rate of growth of the giant Medicare program from 6.6 percent annually to 5.3 percent.

"The bill will be paid for over 10 years. It will reduce costs but also will not add a dime to the deficit" in future years, House Speaker Nancy Pelosi, D-Calif., said at a news conference.

Still, Obama's speech provoked enough concern among House Democrats that senior presidential aides were called to a meeting in the Capitol to explain precisely what the president had in mind when he set the $900 billion target.

The figure of $871 billion "is a coverage number. I think the White House has made that very clear. It is a number about coverage," Pelosi said recently when asked about the size of the measure.

Linda Douglass, a spokeswoman for the White House, said, "The speaker is working on a plan that meets with the president's price tag of around $900 billion for health insurance reform and will not add a dime to the deficit."

House Democrats took steps to fulfill another of Obama's goals during the day, announcing their legislation would completely close a gap in Medicare prescription drug coverage within a decade, five years faster than originally contemplated.

In addition, Pelosi said, "as of Jan. 1, 2010, our legislation will give a 50 percent discount for brand-name drugs to recipients in the donut hole and it will reduce the size of the donut hole by $500."

After months of delay, Democrats in the House and Senate are aiming for votes next month on legislation to fulfill Obama's goal of expanding coverage to millions who lack it, banning insurance industry practices such as denying coverage for pre-existing conditions and slowing the growth in health care spending nationally. The House bill will also lift the insurance industry's exemption from federal anti-trust laws, a provision under consideration in Senate negotiations as well.

With time growing short, Pelosi and Senate Majority Leader Harry Reid are struggling independently with the most controversial of all issues involved with health care, proposals for a government-run insurance option to compete with private industry.

In the House, Democrats have tentatively concluded they cannot win passage of the provisions favored by most liberals, one calling for a nationwide government-run plan with payments to doctors and hospitals linked to rates paid by Medicare. It was unclear what fall-back plan was under consideration, but the internal disagreement cast doubt on plans to publicly unveil legislation early next week.

Across the Capitol, Reid, D-Nev., assessed support for a nationwide government-run insurance option that would allow states to opt out of the system. While the plan evidently enjoys a clear majority, it is uncertain whether it can command the 60 votes needed to overcome a threatened Republican filibuster.

Democrats hold 60 votes in the Senate, but one, Sen. Ben Nelson, D-Neb., has spoken out strongly against a so-called public option. A few other members of the rank and file have been non-committal.

One, Sen. Mary Landrieu, D-La., met with Reid during the day and later issued a statement saying she was encouraged that a compromise might be possible. She also added pointedly that she had told Reid about "the unique challenges Louisiana is facing in terms of Medicaid and the special concerns I have about teaching hospitals," a possible signal that easing home-state concerns could influence her vote on the larger, national question of a government-run insurance option.

Also opposed is Sen. Olympia Snowe of Maine, the only Republican this year who has voted for a Democratic-drafted health care bill in committee. As an alternative, she favors allowing the government to step in only if there is insufficient competition in the private insurance industry.

Nor was it clear whether Democrats would be able to enlist additional Republicans. Sen. George Voinovich, R-Ohio, frequently mentioned by Democrats as a potential convert, said in an interview, "We can't afford the health care system that we have right now. And if we can't afford the one we have right now, how are we going to afford another one that's going to cost more money."

For Reid, the question of a government-run option is one of a many thorny issues to be settled before he can bring health care legislation to the Senate floor. He and senior committee chairmen have been meeting with top White House aides in recent days to produce a bill, and hopes of largely wrapping up the work by the end of the week went unfulfilled.

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26 October, 2009

It's time to slay the bureaucratic monster that's ruining the NHS

Why is there a layer of bureaucracy between Primary Care Trusts and the British government?

Who actually runs the National Health Service in my Sevenoaks constituency? Is it Dawn Hall, the manager of Sevenoaks hospital, or Andy Burnham, the Secretary of State for Health? There are an awful lot of people between Dawn Hall and Andy Burnham, and most of them aren't medical at all.

First, there's the West Kent NHS Primary Care Trust. It has 21 directors, and "around" 350 "commissioning" staff; management costs are £12 million a year. Its accounts reveal a director of strategy and corporate affairs, whose pay last year rose from £90-95,000 to £95-100,000, and a director of strategy and communications, whose pay went up by 10 per cent to £85-90,000. All executive directors received a 3 per cent bonus.

Next, there's the Kent & Medway NHS and Social Care Partnership Trust, which is mainly responsible for mental health services. Fifteen directors here, including a "director of corporate services" on £75-80,000 a year. Management costs are £11 million.

Then there's the Maidstone & Tunbridge Wells NHS Trust, which runs three acute hospitals. Management costs increased 7 per cent last year, to £9 million. Reporting to 10 board directors are a corporate development director (£85-90,000), a chief operating officer (£155-160,000), as well as a chief executive (£190-195,000).

Serving the trusts is another – the South East Coast Ambulance Service NHS Trust. It has 13 directors, including a director of corporate affairs and service development (£90-95,000) and a director of human resources and organisational development (£105-110,000). Management costs are £10 million, 6.6 per cent of income, and rose 25 per cent in 2008-09.

But the queen quango of them all is our Strategic Health Authority, NHS South East Coast. It has 14 directors, including a director of communications and engagement who was paid £125-130,000 last year. In 2008-09, its budget was so large – at £313 million – that it couldn't spend £40 million. Management costs rose 30 per cent, to £16.8 million. Employing 343 staff cost £20 million a year.

So what do they do for us in Sevenoaks at their HQ in Horley, Surrey? Given that the Primary Care Trusts are much larger now, why is there a layer of bureaucracy between them and Whitehall?

The hospital building programme has passed its peak; the trusts have been reorganised; there are numerous regulators, inspectorates and commissions. So what is there strategic to do?

NHS South East Coast's report boasts a string of successes, including reducing infection, speeding up treatment times and extending GPs' opening times. But these improvements are delivered by local professionals, not regional bureaucrats. The Strategic Health Authority even claims credit for the Ambulance Trust's improvement in response times: that's because we spend £150 million on the latter, not the former. So what's a strategic health authority for?

Let's look at that under-spend again. £1.5 million was under-spent on "workforce and development"; £5.6 million (62 per cent of budget) was under-spent on "sponsored services"; £11.4 million (55 per cent) under-spent on "strategic health authority central initiatives".

If regional bureaucrats can't even spend the money they have got, why not delegate it straight through to the trusts? There is simply too much management right across the NHS, most of it duplicating, interfering or counter-productive, and all of it diverting resources from the hard-pressed units and nurses who treat real people.

Andy Burnham has inherited this nightmare, but it's too late for Labour to roll back the bureaucratic monster it created. Exactly half of the entire 1.3 million NHS workforce isn't treating patients. The real questions are for the Conservative shadow health secretary: Andrew Lansley, are you listening?

SOURCE




In Health Care, Nobody Knows Anything

Two new industry studies reignite the debate about what makes health care so expensive

“Nobody knows anything,” is the famous dictum that screenwriter William Goldman once asserted about Hollywood movie-making. Goldman was saying that movie producers have no clue about whether or not a movie will sell until it hits the theaters. There is no formula for a hit movie.

Figuring out health care in America is only slightly more complicated and mysterious than making a hit movie. Fifty million Americans are unable to buy health insurance and premiums have doubled over the past decade. Health care spending in 2009 consumes about $2.5 trillion, more than 17 percent of our gross domestic product. And as spending has skyrocketed, improvements in health outcomes have been real, but modest. What’s going on?

On Saturday, President Barack Obama denounced two new studies, sponsored by the health insurance industry, which found that current health care reform bills in Congress will increase premium prices for consumers. One study, done for the lobbying group America’s Health Insurance Plans by the consultancy PriceWaterhouseCoopers, found that the provisions in the Senate bill sponsored by Sen. Max Baucus (D-Mont.) would add $1,700 a year to the cost of family coverage in 2013 and $600 for a single person. By 2019, family premiums could be $4,000 higher and individual premiums could be $1,500 higher. A weak individual coverage mandate, coupled with a guarantee issue requirement, no preexisting condition limits, and no rating based on health status would significantly boost insurance premiums.

The Blue Cross Blue Shield Association commissioned a new study by the Oliver Wyman consultancy which also found that guaranteed issue and community rating mandates coupled with a weak individual mandate would drive up premiums by 50 percent for individual policies and 19 percent for small group plans.

“Every time we get close to passing reform, the insurance companies produce these phony studies as a prescription and say, ‘Take one of these, and call us in a decade,’" declared the president. “Well, not this time.”

The president is right that we should always be skeptical of studies that find in favor of the groups that sponsor them. And these two insurance industry-sponsored studies do have their flaws. But the finding that guaranteed issue and community rating mandates increase insurance premium prices has been corroborated by other academic researchers. For example, researchers from MIT, the Brookings Institution, and Brigham Young University reported in a 2008 study published in Forum for Health Economics & Policy that community rating regulations increased premiums for high-deductible policies for individuals by as much as 17 percent and families by as much 33 percent in the nongroup market. In addition, the researchers found that the “guarantee issue regulations that accompany community rating regulations in New Jersey are associated with premium increases of well over 100 percent for individual and family policies.” And as my colleague Peter Suderman recently pointed out, Massachusetts, the one state that combines an individual mandate, community rating, and guaranteed issue, now has the highest premiums for family insurance plans in the country.

President Obama also denounced the insurance industry malefactors for “making this last-ditch effort to stop reform even as costs continue to rise and our health care dollars continue to be poured into their profits, bonuses, and administrative costs that do nothing to make us healthy—that often actually go toward figuring out how to avoid covering people.”

Obama is right that administration costs can be quite large. Why would health insurers spend so much money on administration? According to the New England Journal of Medicine, the director of the Office of Management and Budget, Peter Orszag, cites evidence that $830 billion is being spent this year on unnecessary care. That represents about 30 percent of all health care spending. Of course, insurers have a big interest in trying to reduce unnecessary spending, so they hire flocks of administrators to negotiate lower rates and to monitor medical spending charged by doctors and hospital administrators. Government health care programs like Medicare don’t have to negotiate; government agencies just fix prices, which means they fail to combat waste and fraud effectively.

What about those insurance company profits? Back in July, President Obama asserted that health insurance companies are making “record profits.” Not really. The Annenberg Public Policy Center’s FactCheck.org reported, “In general, the health insurance industry did poorly toward the end of 2008 and in the first quarter of 2009, so record profits weren’t likely in the second quarter.” Averaging profits of 3.3 percent, health insurers are the 86th most profitable industry in the U.S., well behind chain restaurants (7.7 percent), electric utilities (6.2 percent), and brewers (18 percent), but ahead of major auto manufacturers (-3.3 percent), resorts and casinos (-8.9 percent), and major airlines (-11 percent).

We’ll pass over the president’s naked attempt to provoke voter envy about the big paychecks of health insurance executives, since taxing them away entirely would not perceptibly lower the costs of health insurance.

So why have health costs, and especially health insurance premiums, skyrocketed since 2000? Let’s look at one plausible theory: market consolidation. In the past two decades, fewer and fewer competitors are exercising more and more monopoly control over health care spending. Case Western Reserve political scientist Joseph White looks at the last time a Democratic administration pushed for health reform. In 1993, recalls White, “costs were expected to quickly hit 14 percent of GDP and rise to 18 percent by the end of the decade.” But that didn’t happen. Why? One plausible story focuses on the rise of health maintenance organizations (HMOs).

The rise of HMOs was enabled by an earlier federal government attempt to rein in health care costs, the Health Maintenance Organization Act of 1973. The idea behind HMOs was that these insurers would control costs by offering a wide array of preventive care to their subscribers. That sounds like a plausible idea until one realizes that people, on average, change insurers every four years or so. An insurer that invested in preventive care was unlikely to reap the cost-saving benefits. Thanks to the spread of HMOs, the 1990s saw the rise in health care expenditures slow down. Why? Chiefly because HMOs fiercely negotiated lower prices from physicians and hospitals. But the era of modest premium price increases didn’t last long.

Hospitals and physicians struck back by beginning to consolidate themselves. As hospital mergers produced local monopolies, they were able to increase their prices substantially. “I find that hospitals increase price by roughly 40 percent following the merger of nearby rivals,” Leemore Dafny, an economist at the Kellogg School of Management at Northwestern University concluded in a 2008 study. Insurers with relatively few patients could not bargain effectively with the new local health monopolies, and so dropped out of those markets.

According to White, the result of the 1990s orgy of insurer and provider consolidation was that “there were half as many health plans in 2004 as in 1996.” In addition, “in thirty-eight states the largest firm controlled at least one-third of the insurance market; in sixteen states it controlled at least half.” In this analysis, insurers and hospitals have evolved into local oligopolies. One plausible story, it seems, is that an ever more monopolistic health care system has been fueling the recent double digit increases in health care costs.

But then you remember, nobody knows anything when it comes to health care. In 2003, the Federal Trade Commission issued a report that concluded that there was “no valid empirical basis” for the claim that consolidations among hospitals “have accounted for increases on hospital services.” But what about consolidation among insurers? “The insurance industry is congenitally weak in bargaining with supply side of the American health sector,” explained Princeton University health economist Uwe Reinhardt on a recent NPR Money Planet segment. Reinhardt believes that insurers largely dance to the fiscal tune whistled by hospitals and physicians.

Clearly there has been a drastic failure of market competition when it comes to the health care sector. The question is how can market forces of competition be brought to bear on escalating health care costs?

An essential player is absent from the competitive field: the actual consumer of health care services. So long as insurers can extract their premiums from employers and providers can extract payments from insurers, the health care industrial complex has very little incentive to rein in costs.

Recent efforts have been made to create so-called consumer-driven health care based on high deductible insurance policies. Because consumers are on the hook for the first several thousand dollars in health care costs, the idea is that savvy consumers will shop around for health care services and thus force insurers and providers to lower their prices. This cost-reducing dynamic works in most other areas of our economy, so why not in health care?

One of the chief problems is that consumers haven’t a clue about what their insurance and medical services cost. Hospital chargemasters (essentially comprehensive lists of all charges) typically contain prices for over 20,000 items and services. Sorting through those lists for the best prices would be impossible for consumers. But why should they have to? In markets, the proper dictum is that “nobody has to know everything.” Markets are superb at gathering widely dispersed information and resources from millions of people and firms and then distilling that information into prices.

When someone buys a car, they are not confronted with a bill listing separate prices for pistons, radiators, assembly line screw tightening, seats, gas tanks, windows, and so forth. Nor when they buy a hamburger are the prices for the beef, bun, wrapping paper, and special sauce listed and charged for individually. The market has bundled those separate items together into a single price. Competition sparked by consumer demand could unleash a similar simplifying dynamic in which prices for health insurance and medical services become bundled and more transparent.

So what kind of real reforms could increase health care competition? Congress should aim to break up the system of local monopolies into which our health care sector has devolved. In his Saturday attack on health insurers, President Obama noted that the industry enjoys “a privileged exception from our anti-trust laws, a matter that Congress is rightfully reviewing.” What he is talking about is the McCarran-Ferguson Act of 1945 that allows state governments to regulate the business of insurance without federal government interference. The Act is, in part, responsible for the evolution toward state insurance markets dominated by just a few large insurers.

Consumers cannot purchase insurance policies that are not licensed by their state insurance commissions and which do not incorporate all the mandates imposed by those commissions. Congress and the states should open up competition between insurance companies by enabling “regulatory federalism” that would allow individuals and employers to purchase health insurance from other states. As a report from the free-market Cato Institute notes, regulatory federalism would force state insurance commissions to compete among themselves. The result would be that “states that impose unwanted regulatory costs on insurance purchasers would see their residents’ business—and their premium tax revenue—go elsewhere.”

Barriers to increased competition among health care providers must be removed too. For example, many states have certificate of need programs that forbid the construction of new health care facilities without prior regulatory approval. Passed by Congress in 1974 as a cost-cutting measure, the ostensible purpose of the programs is to keep health care costs low by requiring advance approval by state agencies for most hospital expansions and major equipment purchases. But regulations don’t really work that way. “Market incumbents can too easily use [certificate of need] procedures to forestall competitors from entering an incumbent’s market,” according to a 2004 Federal Trade Commission report. In fact, “programs can actually increase prices by fostering anti-competitive barriers to entry.” State enforced monopolies increase prices? Who knew?

There is one thing that everybody should know when it comes to health care: Competition in markets tends to lower prices and improve quality over time. It can do so in health care markets as well.

Source




The desperate defense of Obamacare

The political arena has abandoned all civility, it seems. It was coming our way once folks like Ralph Nader and Michael Moore got to be bigwigs, speaking up in support of populism and a massive federal government. The American citizenry tends to be middle of the road, championing a mixed economy but resisting either extensive statism or full freedom from coercive government. Most people seem to want the chance to get government to do their special bidding, so they will not sign up to restrain its powers completely. Neither, however, will they grant the government all the powers its most avid advocates would like. I have in mind the likes of Chuck Shumer and Henry Waxman among the Democrat politicians and some of the Republicans who border on authoritarianism.

But these days if you opposed government health care, you are a right-wing lunatic, a wild person or barbarian so there is no use trying to argue with those who are committed to socialize the American medical system. They have dismissed all serious skeptics. The train must not be stopped as it is hurling toward full government involvement in all areas of society, at every level. This may not be objected to without getting those who love it to call you names and flatly ignore your concerns. Only compromisers will get some attention since they don't question the policies at their foundations.

I am a regular reader of the center left magazine The New Republic and even it is having a hard time remaining somewhat civil about opponents of President Obama's mission. In a recent issue the editors jump on board with those who have declare Americans who fervently oppose Obama's health care and insurance plans as racists of some kind. The writers said they don't much worry about this racism but insisted that it was that, not bona fide political disagreement about the direction the federal government is taking under this president. And The New York Review of Books, which I also read regularly, has rolled out Elizabeth Drew who tries to tarnish everyone who doesn't genuflect at the altar of medical statism.

Some in this administration are really quite un-American, seriously! I have in mind, among others, Obama's regulatory czar, Professor Cass Sunstein, who believes that (a) government is the source of our rights and (b) government should grant animals rights of the sort human beings have. This is no small matter. After all, what is distinctive about the American political tradition is what it says in the Declaration of Independence, namely, that the rights everyone has, every human being, are ours by virtue of the fact that we are human beings. All of us, except the hopelessly incapacitated, have these rights, yet Professor Sunstein and his boss, we may assume, think that governments, in the fashion of monarchs of days gone by, hand out rights, meaning, grant privileges or permissions. (I always cringe when people say "Government allows us to...." because government as the American Founders and their teachers knew haven't any magical powers to allow anyone anything.)

Government doesn't stand to us, the citizenry, as parents and nannies stand to children. Government is a group of hired administrators, not czars, kings or Caesars. So when this president eagerly endorses the views of people such as Sunstein as he is charging ahead with transforming the country into something it had vehemently gotten away from when it was founded, opposition should be expected. And some of it will be loud, even a bit unruly. Instead, however, of laying out a set of reasons for why this change ought to be undertaken and communicating them to us all, the critics are being denigrated, dismissed, and besmirched...

But perhaps the hysterical attitude toward all who question Mr. Obama's rush to massive statism carries an implicitly hopeful message. The ideas behind this march are bankrupt so its champions will not talk them up. Instead they have to demonize those who are skeptical.

SOURCE




Where Does Congress Get The Authority To Mandate Purchase Of Health Insurance?

When asked where Congress was given the authority to force Americans to buy health insurance, Senate Judiciary Chairman Patrick Leahy (D-Vt.) didn't really have an answer -- he just deflected the question by accusing the reporter of asking an inappropriate question: " Why would you say there is no authority? I mean, there’s no question there’s authority. Nobody questions that!"

House Majority Leader Steny Hoyer (D-Md.) at least dusted off the old Constitution. He referred to Article I, Section 8, where the the Constitution gives Congress the power to raising taxes to “provide for the … general welfare of the United States.”

"Well, in promoting the general welfare the Constitution obviously gives broad authority to Congress to effect that end,” Hoyer said. “The end that we’re trying to effect is to make health care affordable, so I think clearly this is within our constitutional responsibility."

Nice try, Congressman -- except, as CNS News points out, the authority to impose a tax isn't the same as the authority to mandate purchase of a good or service.

SOURCE




Cognitive dissonance on health care reform

Cognitive dissonance is defined as holding two completely contradictory ideas at the same time. That seems to be the case with the American public, with a new poll showing rising support for a so-called public option in health care, even as the public continues to oppose greater government control over the health care system.

Most likely that is because supporters of a public option have successfully framed it as just that: an option. That seems entirely reasonable. The American people believe in "choice" and "competition." So why not allow another choice? Most Americans would keep the insurance they have today (and are happy with), but those who wanted to join the government plan could do so. But that's not the way it would actually work.

A government-run plan would have an inherent advantage in the marketplace, because it ultimately would be subsidized by taxpayers. The government plan could keep its premiums artificially low or offer extra benefits, because it could turn to taxpayers to cover any shortfalls. At the very least, the program carries with it an implicit guarantee against future losses. Would a Congress that has bailed out banks and automobile companies because they are "too big to fail" resist subsidizing the government's insurance plan if it began to lose money?

Even without direct subsidies, the government could prevent the true cost of the program from showing up in premium prices in myriad ways. For example, the government-run plan will not have to pay state or federal taxes, and unlike private insurance plans, who can be sued in state courts, the government-run plan could only be sued in federal court.

Government plans such as Medicare and Medicaid traditionally reimburse providers at rates considerably lower than those of private insurance. Providers recoup the lost income by shifting costs onto those with private insurance. Indeed, it is estimated that privately insured patients pay $89 billion annually in additional insurance costs because of cost-shifting from government programs. If one assumes that the new public option has similar reimbursement policies, it would both allow the public plan to keep its own premiums artificially low while simultaneously increasing costs and, therefore, premium prices for private insurance.

All of this means that the government-run plan would be significantly cheaper than private insurance, not because it would out-compete private insurance or because it was more efficient, but because it had unfair advantages. Businesses, in particular, would have every incentive to dump their workers into the government plan.

Estimates of how many people would ultimately be forced out of their current insurance and into the government plan vary widely. At the low end, the Congressional Budget Office suggests that about three million people would be involuntarily shifted to the government plan under the House bill. It bases this estimate on a premise that that the plan would only be open to the currently uninsured and employers with fewer than 50 employees. On the other hand, the actuarial firm Lewin Associates assumes that the government plan would be open to everyone. Under that scenario, they suggest, 89.5 million workers would be forced into the government plan.

In the end, the private insurance market would be eviscerated, leaving millions of Americans with no choice but the government-run program. No choice. No competition. We would effectively be on the road to a single-payer health care system, with the government in complete control of one-sixth of the U.S. health care system and some of the most important, personal, and private decisions in our lives. Down that road lie massive new taxes, huge budget deficits, and ultimately government rationing of care. That is not what the American people are telling pollsters they support.

SOURCE





25 October, 2009

ROUNDUP OF AUSTRALIA'S NEVER-ENDING MEDICAL MAYHEM

Three current reports below. Australia already has "free hospitals" for all, provided by kindly State governments. So why do 40% of Australians take out private insurance and go to Australia's excellent private hospitals instead? See below for a few hints

Unbelievable failure to learn at Queensland's Bundaberg Public Hospital

The deaths and injuries caused by an incompetent Indian doctor at the hospital became a national disgrace but the same casual disregard of qualifications is still happening there. And for all its legions of "administrators", Queensland Health has done nothing about standards at what is one of their own hospitals

A new report by Queensland's health watchdog reveals overseas-trained doctors continue to work at Bundaberg without their credentials being properly checked. And it accuses the hospital of attempting to cover up its credentialling errors.

The Health Quality and Complaints Commission quoted from a review by PricewaterhouseCoopers that said: "The report also found that retrospective granting of credentialling still occurs at Bundaberg Base Hospital. "That is, in some cases practitioners commence work before being formally authorised to do so by the district manager or CEO. "The report pertinently points out the legal and reputational risks involved."

The commission said in one case the hospital could not even find a doctor's employment application. In two other cases there was no evidence of referee checks and and in three cases there was no evidence of more than one referee check.

A second report critical of Bundaberg's emergency department says there are inadequate bays, inadequate staff, inadequate security, inadequate radiology services and inadequate training.

That report, released by Opposition health spokesman Mark McArdle, warns that most medical staff have never been involved in a performance appraisal and that only a quarter of the nurses have "post-basic" qualifications.

The report, by Dr Peter Brennan of Melbourne University, also warns the emergency department was not ideal for children. "The waiting area, triage area security room and reception are very small and cramped," Associate Professor Brennan said. "The environment is not conducive to calm behaviour. The physical layout has given rise to some shortcomings in triage. "There is no separate area for children or babies to wait. The reviewer witnessed toddlers being mixed up with verbally abusive patients."

Dr Brennan said the "failed implementation" of a discharge policy "is clearly an issue of leadership".

Mr McArdle said the State Government had broken its promise to fix Bundaberg Hospital and was attempting to hide problems from the public gaze. The commission was even more scathing of the hospital – and Queensland Health. Its report, by Dr Tim Smart and Dr Jill Newland, found "defects in a number of areas", including "incomplete documents and forms, inadequate database fields, incomplete, out of date, inconsistent and inaccurate database entries, incomplete filing, inadequate bring-up systems, inadequate resources". There was a "lack of clear accountability and active leadership for credentialling".

The Bundaberg Hospital claimed it had reviewed the credentialling process and that improvements had been implemented. "The Dr Smart and Dr Newland reports indicate this could not have been the case," said the commission's chief executive, Cheryl Herbert. In other words, Bundaberg was papering over the cracks.

Ms Herbert reserved some of her harshest criticisms for the department running the hospital. She said: "There is no evidence that Queensland Health assists its facilities by providing uniform and standard databases, training and resources for credentialling ... Further, the Health Quality and Complaints Commission is concerned that Queensland Health does not promote or support a leadership culture that insists on 100 per cent compliance with credentialling at Bundaberg Base Hospital."

Her report last month was ignored by the metropolitan media.

Ms Herbert's sharp words were followed this week by more bad news for the executives of Queensland Health. The Australian Medical Association's annual report card shows the State Government is failing to stem a decline in vital areas of service. There are long waits at emergency departments and intolerable waiting lists for patients waiting for even the most urgent of surgeries.

More than 180,000 Queenslanders are languishing on the so-called waiting list to get on a waiting list, which was exposed during the 2005 health crisis with a total of about 110,000 people waiting.

The AMA said so-called "access block" in emergency departments and bed occupancy levels above the recommended safe level compromised patient care. Again, it's all about the beds. Emergency rooms remain clogged with patients waiting to be admitted. Elective surgery is cancelled when accidents happen because there are not enough beds.

In private hospitals, surgeons start cutting at 7am and often don't finish until 11pm or midnight. In public hospitals, strangled by numbers and union regulations, operations are mostly restricted to nine to five.

Since July 2008, the total number of available beds statewide increased by only 76. This is despite a population growth of more than 1000 a week.

Health Minister Paul Lucas remains invisible. He has been warned the severe shortage of beds in Queensland's public hospitals has contributed to "access block" and hospital bypass, lengthy elective surgery and emergency department waiting times.

Clearly, our public hospitals don't have the capacity to cope. The result is that people are dying needlessly. Successive state governments have failed to repair the system.

SOURCE

NSW bureaucrats think they know more about medical problems than the doctors do

A WOMAN was denied a late-term abortion at a leading Sydney hospital, forcing her to carry a severely deformed foetus with no chance of survival for an extra week, in a decision that has infuriated senior doctors. The doctors at the Royal Hospital for Women in Randwick are angry senior management vetoed their clinical decision and have called for clarification.

The hospital's termination review committee, made up of senior clinicians and hospital managers, considered the case of the woman who was 32 weeks' pregnant. The foetus had severe brain abnormalities and would have had no functional life, the Herald has been told. The abnormalities became evident late in the pregnancy and a termination was sought for the mother's wellbeing and safety.

The Herald understands the hospital's director, William Walters, and its medical superintendent, George Bearham, opposed the termination although others on the committee - including a psychiatrist, a pediatrician and an obstetrician - supported it. The Herald has been told clinicians at the hospital are concerned about the role of the managers in the decision.

NSW Health guidelines on terminations after 20 weeks' gestation call for an assessment to be made by a multi-disciplinary team "with a mix of skills and experience".

The Herald understands the decision was made within the past two weeks. The woman went into labour about a week later and the foetus was stillborn.

A spokeswoman for the South East Sydney Illawarra Health Service said the case was given the "most complete medical attention and consideration by a wide range of highly specialised medical, allied health and nursing professionals'', who collectively did not support the termination. However, the service did not respond to specific questions about whether the clinicians had been overruled.

Lachlan de Crespigny, the doctor at the centre of a late-term abortion controversy in 2000 in Victoria, said: "If this is the way women are treated, what does it say about the state's abortion laws?" He said it was wrong for a woman's life to be put on trial by an anonymous committee and that the decision should be left to the woman and her doctor.

Other specialists told the Herald they feared a clampdown on abortion within state public hospitals. The NSW Government was anxious to avoid a backlash from people opposed to abortion generally or to late-term procedures, they said.

SOURCE

The huge and unproductive costs of Australia's Medicare

Huge explosion of bureaucracy following the introduction of a "public option" for health insurance

By Dr Jeremy Sammut

Under the rubric of stimulus and economic security, the role of government has been significantly expanded across a range of sectors, including education, banking and finance. This new era of regulation and micromanagement threatens to crowd out private enterprise and civil society for a generation.

It is therefore timely to ponder Australia’s last great leap backwards towards socialism in 1984, right at the start of the long period of economic reform of the ’80s, ’90s, and the 2000s. This year marks the 25th anniversary of the establishment of Medicare. This year, the CIS has published a trilogy of papers cataloguing the damage Medicare has done to the Australian hospital system.

The short version of the story is that the era of ‘free’ public hospital care has led to the misallocation of huge amounts of taxpayer’s money to pay for massive and unnecessary growth in the size and cost of the health bureaucracy. The massive government expansion into the health sector has resulted in fewer and fewer health dollars out of ever-increasing hospital budgets reaching the frontline to pay for the health care the community wants and needs.

The decline of public hospitals into their present state of waste and inefficiency is proof, if further proof is needed, of what happens when dynamic and independent parts of our society become subject to the dead hand of statist domination and bureaucratic command-and-control.

We should remember the anniversary of Medicare when we calculate the cost of the GFC. The impact on the national bottom-line won’t only appear on the balance sheets for 2008–09. I fear we will be paying the price for the revenge of the political economy nerds for many years to come.

In 2009, the CIS published Radical Surgery by Professor Wolfgang Kasper (February); Why Public Hospitals are Overcrowded by Dr Jeremy Sammut (August); and The Past is the Future for Public Hospitals by Dr John Graham (October).

The above is part of a press release from the Centre for Independent Studies, dated October 23. Enquiries to cis@cis.org.au. Snail mail: PO Box 92, St Leonards, NSW, Australia 1590. Telephone ph: +61 2 9438 4377 or fax: +61 2 9439 7310




Government Health Care Adds Insult to Injury

In 1997, Brian Booy of Bristol in the United Kingdom was diagnosed with angina, a chest pain caused by coronary heart disease, and was told he needed triple bypass surgery. Unfortunately, he made the grave mistake of getting ill in Great Britain, where government management of the health industry contributes to massive shortages of everything from doctors to hospital beds and vaccines. Mr. Booy waited a year and a half for his life-saving surgery, which he never received; he died of a massive heart attack in January of 1999.

His is just one of the many heartbreaking stories featured in "Shattered Lives: 100 Victims of Government Health Care," by Amy Ridenour and Ryan Balis at The National Center For Public Policy Research. Mr. Booy's case is no anomaly: According to the BBC, Dr. Peter Wilde, clinical director for the Bristol Royal Infirmary's cardiac unit, admitted that same year that "10 patients may have died because they had to wait too long for operations."

Long waits and shortages result from government control of the health sector. There are only so many hospitals, only so many doctors. When government promises that everyone will be treated (ostensibly) gratis, it does not simultaneously conjure more doctors into existence. Instead, doctors face more patients, who are now likely to seek treatment more often because they perceive it to be free. The result is long lines, long waits, substandard care.

But it's worse than that. Not only does the socialization of medicine fail to produce more doctors, it actually shrinks the pool. In our free-market system, being a good doctor can be financially rewarding. This matters, because becoming a good doctor is a long, arduous, expensive proposition. Remove the profit incentive and you are guaranteed to have fewer doctors.

The free market has been good to our doctors: General practitioners in the U.S. have almost twice the average monthly net income as their counterparts in Britain's National Health Service, according to worldsalaries.org. Unfortunately, American doctors see in Britain their future under ObamaCare: increased regulation and taxation coupled with decreased earnings. They are deciding en masse that it may not be worth it: A September 2009 Investor's Business Daily/TIPP poll of practicing physicians found that "hundreds of thousands would think about shutting down their practices or retiring early" if ObamaCare makes it into law.

Think about that. Obama promises to expand coverage to every American, but no new doctors will be co-created for this enterprise. In fact, many doctors are telling us that they will shutter their doors if ObamaCare is enacted.

But at least your medical care will be "free," under the new regime, just like Brian Booy's was.

And on top of it all, government will also add its standard bureaucratic idiocy and insult to the medical-care mix: One year after Mr. Booy died, his wife Pat received a letter saying that her husband had at last been given an appointment for his surgery.

Proponents of government-run health care will tell you that the free market unfairly rations health care by making it unaffordable to some, and that their solution will fix this gross inequity. But resources are always and everywhere rationed because resources are always and everywhere finite. Government control does not fix this it only makes it worse. Just ask the widow Pat Booy.

SOURCE




Pelosi lacks votes for most sweeping public option

Speaker Nancy Pelosi counted votes Thursday night and determined she could not pass a “robust public option” — the most aggressive of the three forms of a public option House Democrats have been considering as part of a national overhaul of health care. The California Democrat's count — coupled with a significant turn of events Thursday during a private White House meeting — points to an increasingly likely compromise for a “trigger” option for a government plan.

Administration officials have been telling POLITICO for weeks now that this is the most likely compromise because it can probably satisfy liberals — albeit only reluctantly and after many vent frustration and some even threaten to walk away from the bill. This would clear the way for backers to sneak a limited public option through the Senate by attracting moderate Democrats and then to win President Barack Obama's signature.

Speaking to reporters Friday after a meeting of House Democrats, Pelosi said “no decision of that kind has been made" on which public option to pursue. "By no means is the count complete or has the decision been made," she said.

"We had a very congenial - is that the word for a caucus? - a very lively, friendly caucus this morning where we are continuing to count the votes on this,” Pelosi said. “A robust public option is the preferred way to go because it saves the most money - $110 billion. It's not the only way to go, and at the end of the day we will have a public option in this legislation to keep the insurance companies honest and to provide real competition. Again, it's good, better, best. We're having that debate."

Obama told Senate Democratic leadership at the White House Thursday evening that his preference is for the trigger championed by Sen. Olympia Snowe (R-Maine) — a plan that would allow a public plan to kick in if private insurers don’t expand coverage fast enough, a top administration official told POLITICO. It’s also sign Obama is interested in maintaining a sense of bipartisanship around the health reform plan.

At that meeting, Obama did not sign on to a plan being floated by Senate Majority Leader Harry Reid (D-Nev.) to include a different variation of the public option in the Senate bill — a plan that would create a national public plan but allow states to “opt out.” Reid now believes he can get 60 votes to bring a bill with that plan to the floor by breaking an expected GOP filibuster — and then secure the 51 votes needed to pass it.

SOURCE




Obama's thug politics dirty health care endgame

So this is what "change we can believe in" done the Chicago way really looks like - Barack Obama and his White House capos muscling recalcitrant opponents and promising to crush those who don't get in line.

Obama has zeroed in on the U.S. Chamber of Commerce, Fox News and doctors. There's nothing coincidental about this trio of targets, either: They are, respectively, the nation's most powerful business lobby, the television voice for Middle Americans worried about where Obama is taking the country, and the professional group with the greatest potential power to kill Obamacare.

How the muscle is applied differs in detail from case to case, but the common message is there for all - you get in line or you pay a steep price for crossing Obama.

Things were different earlier this year when Obama welcomed the chamber's support for his $787 economic stimulus package, and the $3 billion Cash for Clunkers debacle. Now the White House actively encourages an exodus of high-profile firms from the nation's most prominent voice for business, with the prospect of billions of dollars of "green industry" subsidies being a prominent lure.

The goal clearly is to discredit, then bleed the chamber of its lifeblood, membership dues. Thus, Obama's recent attack on the chamber for "spending millions" on "completely false" ads opposing his financial reform proposals came, Politico reported, "on the same day as his energy secretary, Steven Chu, said it was 'wonderful' that companies had left the chamber of climate issues.' "

The message for the doctors was no less subtle. Senate Majority Leader Harry Reid convened a Capitol Hill meeting last week with "nearly a dozen doctors groups," according to the Hill. Chief of Staff Rahm Emanuel and Office of Management and Budget Director Peter Orzag attended just long enough to make clear the White House approved Reid's subsequent message for the doctors.

If the doctors would drop their demand for medical malpractice lawsuit reforms and support Obamacare, Reid would quickly move the $247 billion bill to spare them from scheduled cuts in Medicare reimbursement.

And if the doctors refuse?"Without the freeze, doctors would see their Medicare payments drop by 21 percent next year and by 40 percent by 2016," according to the Hill. Cuts of that magnitude would force many doctors to stop treating Medicare patients, and push others to retire early or stop practicing medicine entirely.

Large majorities of Americans are adamant about protecting their right to choose their doctors and most are outraged at the prospect of having government bureaucrats intervene in the process. But Obama knows that if the doctors say it's OK, opposition to government-run health care will begin to evaporate.

The attack on Fox News is the least likely of the three to succeed, but that may not matter. The White House can inflict serious economic pain on the chamber and the medical profession, but attacking Fox just drives the "fair and balanced" news network's ratings through the roof.

Keynoting the anti-Fox effort with Anita Dunn, an admirer of Chairman Mao - whose genocide total far exceeded those of Hitler and Stalin - was inept. Besides, singling out one news organization still brings back nasty memories of Tricky Dick and the White House enemies list for millions of older Americans.

Obama can't silence Fox, short of going the Hugo Chavez route (which is being tested, by the way, via the Federal Communications Commission). But he also knows that, if he can neutralize the chamber and the doctors, Fox could become just so much noise.

More likely, Obama and the boys are about to be reminded that mere mouse clicks can put Fox's Middle Americans right where they are needed most, on Capitol Hill. And thug politics can't stop them.

SOURCE




No Free Lunch: The True Cost of ObamaCare Report Released

Far from providing "affordable" care for everyone, ObamaCare would result in higher insurance premiums, more and higher taxes, fewer jobs, lower wages, a reduced standard of living and an erosion of privacy and individual liberty. This is the conclusion of a new report, "No Free Lunch: The True Cost of ObamaCare," by policy analyst Matt Patterson just released by the National Center for Public Policy Research.

"Instead of providing 'affordable' health care for everybody, ObamaCare will in fact lead to dramatically higher health insurance premiums, as well as higher taxes, reduced Medicare benefits, lower wages, and fewer jobs for low and middle-income Americans," said Patterson. The paper says adoption of one of the "ObamaCare" proposals percolating in Congress would lead to:

Higher Premiums - Billions in new taxes and fees would be imposed on medical companies and health insurers to pay for ObamaCare - costs which would be passed on to the consumer as higher insurance premiums.

Higher Taxes - ObamaCare would be paid for with massive tax increases, amounting to an estimated increased tax burden of $2.3 trillion in the coming decades.

Lower Wages/Fewer Jobs - New taxes and fees imposed on businesses by ObamaCare would result in fewer jobs and lower wages for low- and middle-income workers.

Standard of Living - The massive government spending required would explode the federal deficit with ruinous consequences for every American's standard of living.

Medicare Benefits - ObamaCare aims to pay for itself, in part, with hundreds of billions in devastating cuts to Medicare and Medicare Advantage.

Privacy - ObamaCare regulations would result in a larger, more powerful IRS and ensure that more personal information is shared with more people.

Your Freedom - ObamaCare would require, under threat of penalty, every American to have insurance whether they want or need it.

"ObamaCare won't save money, nationally or individually," says Patterson. "Instead, it will increase insurance premiums, raise taxes, depress wages, siphon jobs, explode the deficit, reduce living standards, rob privacy and erode personal liberty."

"No Free Lunch: The True Cost of ObamaCare" by Matt Patterson is available at www.nationalcenter.org/NPA590.html.

SOURCE





24 October, 2009

More medical indifference in a British government hospital

Meningitis girl's three-hour wait for drug that could have saved her

A TEENAGE girl dying from meningitis begged and pleaded with nurses to give her antibiotics, an inquest heard. But Melissa Watmough, 17, had to wait nearly three hours for the drugs after arriving by emergency ambulance to the Manchester Royal Infirmary. There was then a delay of almost two hours before she was seen by a doctor and then another hour before she was administered the antibiotics she hoped would save her life.

Melissa's mum Joanne told the inquest: "I might as well have let her stay at home and die quietly. In our view the hospital did not treat her quickly enough. "We believe that if she would have received the appropriate antibiotic treatment earlier in the process she would still be here today. Meningitis is a deadly disease. All the guidance suggests that time is of the essence. "Melissa was becoming very scared and concerned about her health and begged the nurse to give her antibiotics."

Her family are now considering legal action over her treatment.

Carolyn Singleton, Manchester assistant deputy coroner, ruled Melissa died from natural causes. She urged the hospital to discuss the case with her family and said: "Clearly they believe that had antibiotics been administered when she arrived at hospital, she may have had a fighting chance."

Sue Davie, Chief Executive of the Meningitis Trust, said: "Bacterial meningitis and meningococcal septicaemia are medical emergencies and need immediate treatment with antibiotics, together with admission to hospital. Early treatment with antibiotics can have a significant impact on the outcome of bacterial meningitis."

The inquest heard that Melissa, a hairdressing student at Mancat College, was rushed from her home in Abbey Hey, Gorton, to hospital by ambulance after showing all the classic symptoms of meningitis. She died three days later on the day before Christmas Eve last year. Her family are now considering legal action over her treatment.

An inquest heard Melissa woke up feeling unwell on December 20 and later complained of headache, sickness and a high temperature. A rash also developed on her legs. Her mother Joanne, 40, carried out the 'glass test' advised by the Meningitis Trust and the rash did not disappear. She telephoned an out-of-hours medical advice service and suspected meningitis was diagnosed.

The inquest heard that the advice pointed to three 'red flag' signs, meaning Melissa was displaying three recognisable symptoms of meningitis. An ambulance was sent to pick her up immediately and Melissa was taken as an emergency patient to the MRI. The inquest heard that she arrived at the hospital at 7.16pm but nurses downgraded her condition after an initial examination and it was 9pm before she was seen by a doctor. The doctor said he wished to take a blood sample before antibiotics were administered and it was only when her condition worsened that she was given antibiotics at around 10pm. She was transferred to Hope Hospital in Salford and placed on a life support machine but died on December 23.

John Bachelor, a consultant in emergency medicine at the MRI, told the hearing at Manchester Coroner's Court: "She did present with non-specific symptoms and went down hill very rapidly and developed severe complications of the disease. "It can be very difficult to distinguish between other viral infections." He said it was 'not common practice' to 'blindly' give antibiotics until patients were thoroughly examined and blood tests taken. Dr Bachelor said: "It would not have made any difference to the outcome if she would have been given antibiotics on arrival."

A spokesman for Central Manchester University Hospital's NHS Foundation Trust said: "The Trust would like to extend its sincere condolences to Melissa Watmough's family. We are aware that the family still have concerns after the inquest and we would encourage them to contact the Trust to discuss this further."

SOURCE




Zogby Interactive: Healthcare Reforms Important to Most, Yet Concerns Persist

More than 80% of likely voters rate most of President Barack Obama's healthcare reform proposals as important to them and their families, but majorities also share concerns about reform proposals that have been raised by Republicans. Those are findings of a Zogby Interactive poll of 3,694 likely voters conducted from October 16-19, 2009. The margin of error is +/-1.9%.

The poll asked voters to rate the importance of seven of Obama's primary goals for healthcare reform. Only one of the seven goals, making sure all U.S. citizens have coverage, had fewer than 80% rate it as important.

The second part of the survey provided six concerns about Democratic healthcare proposals that have been raised by Republicans. Voters were asked if they were concerned about each, and more than half, between 58% and 67%, were somewhat or very concerned.

There were very sharp partisan differences on all of the questions asked for both the importance of goals and concerns about what the proposals might do. More than 90% of Republicans were concerned about each of possible negative outcomes, and 90% of Democrats rate each of Obama's goals as important.

Majorities of Republicans say all the goals except universal coverage are important, and are within 10 points of the results of the whole sample. However, Republicans are much less likely than Democrats or Independents to rate any of as the goals as "very important." For example, on ending denial of coverage for pre-existing conditions, 41% of Republicans rate it "very important," compared to 84% of Democrats and 65% of Independents who say the same.

On universal coverage, 14% of Republicans say coverage for all citizens is very important, and 28% feel it is not at all important.

Among Democrats, the percentage who share concerns about the bill's possible effects range from a high of 41% on whether their taxes may increase to a low of 25% on whether they might be forced into a government plan.

Results for Independent voters for all of the questions asked are very close to those of the overall sample.

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Hidden Costs for Seniors in Senate Health Care Bill

On the New York Times Prescriptions health blog today, Milt Freudenheim has written about some buried provisions in the 1,500 page Senate health care bill that will be particularly costly for senior citizens:

The Senate Finance Committee has quietly recommended that millions elderly Americans who buy Medigap plans be charged new co-pays for doctor’s visits starting in 2015. ...

The new co-pays are intended to push elderly patients to think twice before consulting their doctors. Some studies have found that Medigap policyholders use at least 25 percent more health care services than the generally lower-income Medicare enrollees who do not have Medigap policies.

The Left howled and moaned when critics of the president's plan warned that it would lead to rationed coverage for senior citizens--all lies and falsehoods they said. But what do you call a co-pay specifically designed to make elderly patients think twice before seeing a doctor?

And where is the AARP to complain about this? As Sweetness & Light points out today, "Lest we forget, the Reagan catastrophic healthcare reform legislation was repealed once seniors and the AARP discovered that it might require the richest participants to pay up to $560 for their yearly deductible. How times have changed."

SOURCE




The AMA’s Quisling strategy

When Norwegian politician Vidkun Quisling was tried and shot for abetting the Nazi occupation of his country during WWII, his name entered the vernacular as a synonym for "collaborator." It is difficult to think of a more appropriate adjective to describe the health care "stakeholders" who have been genuflecting at the altar of "reform" since the Obama administration marched into Washington last January. While actual patients have protested at town hall meetings and organized demonstrations against Obamacare, the American Medical Association, the American Hospital Association, the Pharmaceutical Research and Manufacturers of America, America's Health Insurance Plans and a variety of other industry groups have been hard at work currying favor with their new masters.

The most transparently self-serving of these stakeholders has been the AMA. The waning but still influential physician association was among the first to join with the new administration in its effort to take over U.S. health care. The President of the AMA, J. James Rohack, began parroting the empty platitudes of reform shortly after the election and jostled with his fellow quislings for a conspicuous place at the May press conference at which Obama announced his "historic" cost-cutting deal with industry players. As Rohack put it at the popular medical blog, Kevin, MD: "In an unprecedented endeavor aimed at achieving health-care reform this year, the American Medical Association stood with President Obama and other key health-care stakeholders Monday to announce efforts to 'bend the spending curve' on health care."

But Dr. Rohack wasn't there to bend the spending curve or to promote genuine health care reform. He was there to protect his paycheck. Specifically, he wants to stop an imminent and deep reduction in the amount of money the government pays doctors. Medicare's physician payment scheme, the Sustainable Growth Rate (SGR) formula, mandates a 21% cut -- and it is due to be implemented next January. It is this "curve" that the American Medical Association is truly seeking to "bend." As it is phrased at the AMA website: "Permanent reform of the archaic Medicare physician payment system is among the core principles the AMA is urging Congress to include as part of comprehensive health system reform this year." Dr. Rohack is obviously hoping that collaboration on the Democrat reform charade will earn the AMA a presidential pardon from SGR-mandated cuts.

The American Medical Association was not always so ready to collude with the enemy. Motivated by well-founded fears that government-run health care would inevitably lead to bureaucratic interference in the practice of medicine, the AMA actively opposed Harry Truman's post-WWII attempt to impose nationalized health care on the country. Likewise, the organization vigorously opposed the enactment of Medicare during the early 1960s. It even launched what is often cited as the first viral marketing campaign, "Operation Coffee Cup," featuring an LP of Ronald Reagan describing the dangers of socialized medicine. During the early 1990s, after some early flirtations with the Clinton health care "reforms," the AMA eventually joined the coalition of health industry organizations that provided Hillarycare with its much-needed end-of-life counseling.

The once-feared organization has become far more pliant in recent years, however. Since the Sustainable Growth Rate formula was imposed in the 1990s, the AMA has repeatedly been forced to go hat-in-hand to its Beltway masters for stays of execution. Each time, Congress has issued a reluctant reprieve from payment cuts -- but not without a price. In exchange for its 2008 reprieve, the AMA was forced to cooperate with congressional Democrats in their disgraceful move to gut Medicare Advantage (MA), a program that has greatly benefited poor and minority seniors. In that tawdry episode, the Dems attached an SGR waiver to a bill that cut funding for Medicare Advantage, whereupon the AMA cravenly began parroting DNC talking points about insurance company profits. This collusion helped the Democrats push through the first of several cuts in MA funding.

This year, the price of the AMA's reprieve is support of whatever health care legislation emerges from Congress. And, so long as the final bill does away with SGR, the organization is obviously prepared to be a willing accomplice in whatever fraud the Democrats perpetrate. Thus Dr. Rohack rhapsodized about HR 3200, the widely-panned House version of Obamacare: "This legislation includes a broad range of provisions that are key to effective, comprehensive health system reform." HR 3200 includes nothing of the sort, but it does contain a provision that would repeal SGR. Meanwhile, the absence of such a provision in the Senate Finance Committee bill produced a noticeably tepid response from the good doctor, despite a $250 billion sop to Cerberus that purports to solve the SGR problem.

There are, of course, legitimate reasons to oppose the SGR. This payment formula, like the PPS methodology to which the federal government subjects most hospitals, is nothing more or less than a Soviet-style price control system. And, as with all price control schemes, the SGR has failed to control costs and created distortions in the market. One of its most conspicuous effects has been a shortage of primary care physicians willing to treat Medicare patients. Unfortunately, the current AMA leadership has decided not to seek any real change in this perverse and counterproductive system. Instead of using the association's leverage to force genuine free market reforms, Dr. Rohack has settled on a strategy designed to produce a special dispensation for his members, regardless of the damage it does to our health care system.

The tragic irony of this cynical strategy is that it will not work. As Vidkun Quisling discovered in October of 1945, the advantages of collaboration are always short-lived. A temporary reprieve from Medicare payment cuts is all Dr. Rohack will have gained by delivering his patients and colleagues into the hands of Washington's health care bureaucrats. Because socialized health care systems are explicitly designed to circumvent the market mechanisms that actually control costs, they must always revert to the only remaining alternatives: rationing services to patients and cutting payments to providers. All government-run systems do both, and Obamacare will be no different. Once the President has finished using them for political cover, the AMA and the rest of the "stakeholders" will be abandoned to the depredations of bureaucrats and the revenge of an angry public. This is the inevitable fate of all quislings.

SOURCE




New Survey Shows Providers Feel Left Out of Debate on Health Reform: Most Doctors, Nurses Believe Medical Expertise Excluded from Debate

Two-thirds (66%) of physicians surveyed and a majority (53%) of nurses surveyed believe that their expertise has barely been considered in healthcare reform. Beyond this, a substantial plurality of physicians (43%) and a majority of nurses (54%) indicate that they have not received enough information to understand the policy changes being proposed as part of healthcare reform, according to a survey released this week, as the Senate prepares to begin floor debate on health reform.

The online survey, conducted by Chandler Chicco Companies (www.chandlerchiccocompanies.com/), a global network of healthcare communications companies, was conducted from September 17 – October 2, 2009 among 385 physicians (+/- 5.1%) and 444 nurses (+/- 4.8%) nationwide.

"Physicians and nurses are feeling bypassed as it relates to the debate around healthcare reform," said Robert Chandler, principal, Chandler Chicco Companies. "Making sure this important group of stakeholders feel their voices are being heard should be the top priority for the President, the Congress and the media. After all, these are the people on the frontlines of healthcare delivery."

This survey also revealed that roughly 9 in 10 (88% of physicians, 90% of nurses) respondents describe news coverage of healthcare debate as being too focused on politics instead of policy.

"Patients rely on doctors and nurses who treat them for information about health and health care," said Chandler. "Given these findings, it is not surprising that many Americans are unsure about whether the health reform debate in Washington will actually result in better health care."

Additional survey findings:

* A plurality of physicians (43%) and majority of nurses (54%) surveyed say they don't understand the policy changes being proposed as a part of healthcare reform.

* 7 in 10 (70%) physicians surveyed believe that tort reform is not likely to result in less recourse for patients.

* Approximately 6 in 10 physicians surveyed believe that tort reform is extremely or very likely to lead to fewer unnecessary tests (63%) and lower insurance costs (59%).

SOURCE





23 October, 2009

British death panel refuses to approve life-extending cancer drug

A drug that can extend the life of women with advanced breast cancer has been turned down for use in the NHS by the cost-effectiveness watchdog. The National Institute for Health and Clinical Excellence (NICE) said it plans to block use of Tykerb (lapatinib) in the Health Service after a second review. The decision comes despite rule changes brought in to let people at the end of their lives have the chance of new and often expensive treatments. It also puts Britain at loggerheads with much of Europe where the drug is given, in combination with a standard chemotherapy drug called capecitabine.

GlaxoSmithKline, Tykerb’s manufacturer, said the latest appraisal would result in 2,000 British women a year being denied access to the treatment. As well as extending life by weeks or months, it has the additional advantage of being taken in pill form.Campaigners have questioned the decision to refuse it. They said the drug met all three conditions: it is used for patients with less than two years’ life expectancy, offers at least three extra months’ life and is licensed for a small number of patients.

Tykerb is the only drug licensed for women with advanced breast cancer for whom Herceptin is no longer working. However NICE said that at £1,600 a month for each patient, plus the added cost of capecitabine, the treatment did not represent a cost-effective use of resources.

Its complicated quality assessment valued the drug at £59,000 per life year — higher than the £30,000 threshold it normally applies, although no specific limit has been stipulated since the rules for end-of-life drugs changed.Nice concluded that the drug “is not recommended for the routine treatment" of women with advanced breast cancer once Herceptin has failed, although they can be given it in clinical trials. The appraisal is now open to consultation.

The treatment came to public attention after Jane Tomlinson, the charity fundraiser, became one of hundreds of British women to benefit from the programme. She died in 2007 at the age of 43.

Mike Tomlinson, her widower, condemned the ban when it was first proposed earlier this year, saying Nice had failed the “acid test” on being more flexible with life-extending drugs to terminally ill patients.

One of Nice’s reservations concerns the amount of extra life that Tyverb offers women. The evidence from trials suggested they lived for an extra 2.4 months on average. Under the new end-of-life rules, a drug should normally give an extra three months survival.

Gillian Leng, Nice’s deputy chief executive, said: “The appraisal committee considered the updated economic evaluation presented by the manufacturer but was not persuaded that the adjusted estimates of overall survival presented were robust. “The committee therefore concluded lapatinib is not a cost-effective use of NHS resources.”

SOURCE




NHS finally decides to treat the elderly as human beings -- in theory, anyway

Ageism in the NHS, which turns elderly patients into second-class citizens, is to be outlawed. Health Secretary Andy Burnham says all patients - whether 20 or beyond 80 - deserve the same care and attention.

Today's announcement follows alarming new evidence that older people are far less likely to receive a proper diagnosis and essential treatment. Many elderly patients miss out on the scans, drugs and even basic health advice routinely given to the young. Some doctors decide it is simply not worth the bother once patients pass a certain age.

But Mr Burnham told the Daily Mail: 'I have decided it will become illegal for any difference to be made on age grounds. That's quite a big undertaking. 'People in the NHS don't set out to make hard and fast rules that lead to older people getting inferior care. 'But it's perhaps judgments that are made and decisions that are made. 'As we live longer we are having to reassess some of our attitudes to ageing. 'We are saying there shouldn't be an age differential. We should have the highest aspirations for everybody.'

Ministers had been heavily criticised for not including the NHS and social care in the general age discrimination law due to come into force in 2012. But Mr Burnham said the Health Service's own age discrimination ban will now apply at the same time.

Earlier this year, a survey found that almost half of all doctors caring for older patients believe the NHS is 'institutionally ageist'. As many as seven out of ten specialists say the elderly are more likely to struggle to get conditions diagnosed than younger patients. Research suggests two-thirds of those with dementia are never diagnosed - at least in part because their symptoms are dismissed as an inevitable consequence of old age.

Those with easily identifiable conditions fare no better. Younger stroke patients are five times more likely to receive an MRI scan to check for bleeding in the brain than older patients. In other cases, the elderly have not received heart treatments, including clot-busting drugs, that are given to the young without question. There is also enormous concern about poorer provision of mental health services for older patients.

And a study of 9,000 older adults last year - half of whom had serious medical conditions - found many were not getting basic care for conditions such as osteoarthritis, incontinence and osteoporosis.

Ministers initially resisted a blanket ban on NHS age discrimination because of concerns over the cost implications and suggestions it could even have the perverse effect of allowing hospitals to stop some treatments targeted at the elderly alone. Mr Burnham said: 'There has been some progress in improving services for older people. 'But there are some cultural issues that we have to address. The costs are manageable. It's also morally the right thing to do. 'It says something about what kind of country we are, how we look after our oldest people.'

Having NHS age discrimination banned by law means those who believe they are victims will be able to mount challenges in the courts.

Mr Burnham said some NHS services should be exempt from the ban, where there is clear evidence that they need to be targeted at particular age groups. These are likely to include vaccination programmes, screening and IVF treatment. And doctors will still be able to deny treatment on clinical grounds - for instance, if they decide an elderly patient is too frail to safely have surgery.

'The NHS does often provide services on an age basis - a good example being the swine flu vaccine,' he said. 'We do often have recommended age groups and priorities. 'There's flexibility that's needed here so the NHS can target particular groups.

SOURCE




British Boy, 10, dies of meningitis after being wrongly diagnosed with a migraine... despite mother insisting he had killer disease

Careless government doctors looked at only one symptom in complete isolation from the overall condition of the boy. They should be shot

A boy of 10 died from meningitis after doctors wrongly diagnosed a migraine and told his mother to give him calpol, an inquest was told yesterday. William Cressey saw five doctors in three days before finally suffering 'catastrophic' brain damage. His mother, Cheryl, 48, repeatedly told doctors that she suspected meningitis but each time was ignored, she said.

Just hours before he died the schoolboy begged one of those doctors: 'Please help me. I'm going to die.' By then his face was so swollen that he could barely see and he was drifting in and out of consciousness.

Wiping tears from her face Mrs Cressey, a former statistician, told the hearing: 'They wouldn't accept that he had a serious illness. 'They just wouldn't consider meningitis as a possibility. They told me he had a migraine, but he was far too ill for that. 'The deterioration in his health was so sudden and the change so marked that I knew it had to be something very serious. 'I wanted them to investigate and eliminate it as a precaution...but they were adamant that it wasn't meningitis and that was the end of it. 'He was dying and they told me to take him home and stop off at the shops on the way for some calpol.'

The schoolboy fell ill at home in Darlington, County Durham, on Friday, February 25, 2005, the inquest was told. He was complaining of a headache, was feeling sick and had a high temperature. On the Sunday his condition deteriorated and he suddenly 'screamed' out in pain. He put his hands to his head and to the back of his neck and turned 'scarlet red', his mother said.

Miss Cressey, who is divorced from William's father, rang the out of hours GP service and was told to get him to the nearest hospital as soon as possible. She immediately drove to Darlington's Memorial Hospital and was quickly taken into a cubicle within its Accident and Emergncy unit. 'By the time we got there swelling had developed on his face, he was shaking and burning up,' she told the hearing. 'He was sweating, yet his hands and feet were cold. He started complaining of pain in his stomach and legs. 'I told the doctor that I was concerned it was meningitis. I had never seen William become so poorly so quickly.

'The doctor pulled William's pyjama legs up to check for a rash. He told me it wasn't meningitis and that he had a migraine. 'They wouldn't acknowledge that meningitis was a possibility. They dismissed it right from the beginning. 'I asked for blood tests to be carried out and antibiotics to be given to him as a precaution but it was just dismissed. 'The doctor told me to take him home and let him sleep off the migraine.'

Miss Cressey refused to leave and insisted that he be admitted to the children's ward at the hospital. That night his condition worsened. His temperature rose to 38.7C and he began vomiting violently. William was examined by a second doctor who looked at his shins and stomach and said there was no sign of a rash. Miss Cressey again asked for blood tests but was refused. 'She said he had a migraine and that was it,' she told Newcastle Coroners Court.

'The swelling had spread right across his face and his eyes were so swollen that he could hardly blink. 'I kept going back and asking somebody to come and look at him. The nurses wouldn't come. They rolled their eyes at me and turned their backs on me. 'They just didn't want to know.' He was seen by a third doctor on Monday morning but later that day they decided to discharge him.

'I had no choice,' added Miss Cressey, who was refused a second opinion. 'They had decided that he was alright and he was going home and whatever I said they wouldn't change their view. 'I thought (they) were going to help him. I kept going back and asking for somebody to come and look at him. 'I wish I had taken him somewhere else.'

William was discharged but minutes after returning home collapsed. Mrs Cressey returned to the hospital immediately and William was examined by two further doctors. But a few hours later, in the early hours of Tuesday March 1, he suffered a massive seizure which rendered him brain dead.

'I see it every day and every night of my life,' said Miss Cressey. 'I know what they did. They left him until it was too late.' He was transferred to Newcastle General Hospital where further tests confirmed that he was suffering from a rare form of meningitis and would not survive. His heartbroken mother turned off his life support machine.

SOURCE




The folly of work-based health insurance

Wife’s cancer prompts man to enlist in the army to get coverage. In Australia, your employer knows nothing about your health insurance. ALL health insurance is directly between the person and the insurer and is much more affordable than in the USA -- in part because you are more cost-conscious when you are paying for something yourself. And Australian private medicine is as good as any

Chelsea Caudle began signing her text messages this summer with a countdown. At 14 years old, she knew no better way to express what was coming. Day Zero was to be Oct. 7, the day Dad left for Army basic training in Fort Jackson, S.C. He was moving 950 miles from their home in Watertown, 950 miles from Mom.

He was leaving, even though Mom was sick with ovarian cancer. Even though he had been at her side through two long, miserable rounds of chemotherapy. Even though she now faced the likelihood of a third.

In fact, Dad was leaving because Mom was sick. In March, he was laid off from his job as a raw materials coordinator for a plastics company called PolyOne, where he'd worked for 20 years. His severance package had provided several months' salary, but by August the paychecks were winding down. Soon the cost of his family health coverage was going to triple, then a few months after that, nearly triple again. They needed coverage so Mom could fight her cancer. Dad's solution: a four-year hitch in the Army.

Mom and Dad are Michelle and Bill Caudle, high school sweethearts now 40 and 39, respectively. They have three children: Chelsea, the youngest; Alysha, a 21-year-old working at a nearby Holiday Inn; and Little Bill, an 18-year-old ex-high school wrestler.

The Caudles are not fond of politics. Michelle and Bill have paid little attention to the shouting this summer over health care reform. They have not gone to any of the town hall meetings. They are well aware that politicians and interest groups would like to trumpet their story or dismiss it to score points in the debate - and they would just as soon avoid all of that.

"We're not activists," Michelle said. But this year the national story of lost jobs became their story. And the saga of families losing health insurance was about to become theirs, too. Except that Bill wouldn't let it.

True, he had been interested in the Army for years. And he could always request an emergency leave to come home if Michelle's condition grew dire (Army regulations allow this if a family member's death is imminent).

But for weeks before enlisting, Bill had sought other options. He revised his résumé. He answered "help wanted" ads, then watched the companies cut workers instead of hiring them. He interviewed for one job that would have paid $13 an hour - less than half of what he was making at PolyOne. He didn't get the job. Finally, on May 13, his 39th birthday, he signed the Army papers.

Two weeks later, Michelle Caudle sat in the office of her doctor, Peter Johnson, at Aurora Women's Pavilion in West Allis. Johnson has been an oncologist for 13 years, and despite the immeasurable sorrow that comes with treating cancer, he loves the work for the hope in it. He has shared the joy of patients who've lived to see birthdays, anniversaries, and the graduations and weddings of their children.

On this particular day, Michelle's latest tests had come back. Just six months earlier she'd celebrated the end of her second chemotherapy treatment. Now, the tests revealed tiny "spots," or changes on her abdomen, neck and lungs. Not a good sign. The measure upon which cancer hopes rise and fall, the CA125 number - Please, let it stay low - was climbing.

"I could lie to you but I'm not going to," Johnson told Michelle. Although he could not say for certain the cancer was back, this early sign pointed to that possibility. The doctor compared her cancer to a chronic disease that would never be completely vanquished from the body. Michelle broke down. For three years she'd been nurturing her hope in the face of uncertainty. "I'm not going to beat this," she said.

More here




Bridge for sale, going cheap: Dem bill with public option said to REDUCE deficit

A preliminary estimate from the Congressional Budget Office projects that the House Democrats' health care plan that includes a public option would cost $871 billion over 10 years, according to two Democratic sources. CBO also found that the Democrats' bill reduces the deficit in the first 10 years.

This new CBO estimate, which aides caution is not final, is significantly less than the $1.1 trillion price tag of the original House bill that passed out of three committees this summer. More importantly, it comes under the $900 billion cap set by President Obama in his joint address to Congress last month.

CBO analyzed what House Speaker Nancy Pelosi calls a "more robust" public option -- one that ties reimbursement rates for doctors to current Medicare rates, plus a 5 percent increase.

At a meeting with House Democrats on Tuesday night, Pelosi did not release CBO's preliminary numbers, but told members that CBO told leaders the House bill would cost well below $900 billion. Aides say final CBO numbers could be released on Wednesday.

Senior Democratic aides told CNN that House Democratic leaders are likely to put this version of the public option favored by liberal Democrats in the final bill they are drafting. While no final decision has been made, on Tuesday night Speaker Pelosi made the case to House Democrats that this approach saves the most money and would put the House in a better negotiating position when it comes time to negotiate a final health care bill with the Senate.

Pelosi instructed House Democratic Whip Jim Clyburn, D-South Carolina, to begin canvassing all House Democrats on Wednesday to determine whether this bill had enough votes to pass in the House. According to several sources in the meeting, Pelosi acknowledged she did not currently have the 218 votes needed to pass this version on the House floor, but believed she was close to having around 200 votes.

Moderate, "blue dog" Democrats in the House largely oppose the robust public option and instead argue for a government run insurance option that could negotiate reimbursement rates directly with doctors and hospitals. CBO's analysis of that approach was not available according to Democratic sources, but aides say the preliminary analysis shows it does not save as much as the approach pushed by Pelosi.

SOURCE





22 October, 2009

Mother-of-two dies after NHS surgeon punctures heart during back operation

Another poorly trained Indian doctor by the sound of it

A 51-year-old finance assistant, Christie Burgess, bled to death after a surgeon punctured her heart three times during a routine back operation. Miss Burgess had been sent to Salford Royal Hospital for emergency surgery on a prolapsed disc but during the operation, Tarek Jallul, a temporary surgeon, pierced her heart.

The blunder wasn't spotted until Mrs Burgess, from Macclesfield, Cheshire, became seriously ill. Although a specialist heart surgeon from the Manchester Royal Infirmary tried to correct the damage she died a few hours later.

Her partner, Kevin Jones, 58, has been awarded an undisclosed settlement from the NHS trust after a three-year legal battle. [There had to be a battle??? Insult added to injury!]

But Mr Jones says the hospital have never apologised for the mother-of-three's death or fully explained what went wrong. He said: "I'm really, really angry. It would help me dramatically if I could get to the bottom of it and get some answers. "It would give me some kind of closure on Christine's death." Janet Lamb, her sister said: "She was the best sister anyone could ask for." ""She should be here to enjoy her grandchildren."

The hospital said it "deeply regretted" Mrs Burgess's death and there is now a specialist heart surgeon constantly on call.

Mrs Burgess, a financial assistant for a chemical company Ciba, had suffered back problems but was the told the operation in May 2006 was a simple procedure. It's understood locum consultant Mr Jallul, who was employed by the hospital on a temporary contract, now works overseas. The General Medical Council launched an investigation he was given a formal warning.

In a statement, the hospital said: "We deeply regret the death of Mrs Burgess. "Legal proceedings commenced earlier this year and both parties have agreed an-out of-court resolution."

SOURCE




Competition and Health Insurance

Contrary to Democratic rhetoric, repealing the insurance industry's antitrust exemption won't reduce prices or profits

During his weekly radio address last Saturday, President Obama attacked health insurers for allegedly making excessive profits and paying excessive bonuses, for spreading "bogus" misinformation about the impact of Democrats' reform agenda on the cost of health insurance, and for "figuring out how to avoid covering people." He opined that health insurers are "earning these profits and bonuses while enjoying a privileged exemption from our antitrust laws, a matter that Congress is rightfully reviewing."

Mr. Obama's comments followed hearings by the Senate Judiciary Committee last week. In an unusual move, Majority Leader Harry Reid testified as a witness, alleging that "exempting health insurance companies [from antitrust] has had a negative effect on the American people" and that "there is no reason why insurance companies should be allowed to form monopolies and dictate health choices."

Such populist rhetoric might exert additional pressure on insurers to fall (back) into line behind the Democratic reform agenda. But there is no evidence that their antitrust exemption has contributed to higher health insurance costs, premiums or profits, or, as implied by Sen. Reid, of "health insurance monopolies . . . making health-care decisions for patients."

The legislative basis for the insurance antitrust exemption is the 1945 McCarran-Ferguson Act, which also codified state insurance regulation as national policy. This statute exempts the "business of insurance" from federal antitrust law provided that the activities are (1) regulated by state law and (2) do not involve boycott, coercion or intimidation. Its passage followed a 1944 Supreme Court ruling that insurance was interstate commerce and therefore subject to federal antitrust law—a ruling that cast doubt on states' exclusive regulatory role, and the legality of then typical agreements among property and casualty insurers to use rates developed jointly by state or regional insurance rating organizations.

Most states responded to McCarran-Ferguson by enacting or modifying laws giving regulators authority over property/casualty insurance rates, including those developed by rating organizations. The next several decades saw a steady erosion of the role of collective pricing systems in conjunction with increased price competition, less price regulation, and a significant narrowing of the antitrust exemption's scope by the courts.

The traditional debate about the antitrust exemption involved property/casualty insurance and medical malpractice liability coverage. Subject to state regulation or prohibition, property/casualty rating organizations collect and analyze loss costs and disseminate projections of future losses. And insurers, subject to state law, can incorporate these forecasts in their ratemaking.

In principle, this system helps produce more accurate rates, thus improving financial stability. More important, it reduces entry barriers for small insurers or insurers entering new markets. Small property/casualty insurers are particularly strong supporters of the antitrust exemption, which allows the sharing of loss projections.

None of this is germane to health insurance, where insurers do not jointly develop forecasts of future medical costs for use in pricing. The antitrust exemption also does not prevent review and challenge of mergers of health insurers by the Department of Justice, which, for example, challenged the 2005 merger of UnitedHealth Group and PacifiCare, and obtained a consent decree requiring the divestiture of certain portions of PacifiCare's commercial health business.

Mergers and acquisitions of health insurers also are generally subject to approval by state regulators. Earlier this year, Pennsylvania Insurance Commissioner Joel Ario derailed a proposed merger between the state's two largest health insurers, Highmark and Independence Blue Cross.

Repealing the antitrust exemption for health insurers would not significantly increase competition, and it would not make health-insurance coverage either less expensive or more available. There is no evidence that the exemption has increased health insurers' prices or profits or contributed to higher market concentration.

Repealing the antitrust exemption would also not lower the cost of malpractice insurance, or prevent future malpractice insurance crises, such as those that occurred in the mid-1970s, mid-1980s, and earlier this decade. It would instead tend to reduce rate accuracy and undermine competition in already fragile malpractice markets.

In other words, the insurance industry's antitrust exemption is inconsequential to the health-care reform debate. It just distracts attention from important issues and further demonizes private health insurance.

Rhetoric about monopoly notwithstanding, Congress's reform proposals are not designed to increase competition in private health insurance. The House bill proposes a government-run insurer. The Senate Finance Committee proposes creation of quasi-public cooperatives. Both bills (and the Senate HELP bill) include restrictions on health insurance underwriting, pricing, profitability and policy design that would essentially turn private health insurers into regulated public utilities.

If the goal were to promote robust concentration in private health insurance, Congress would focus on reducing impediments to competition. It could do so by allowing consumers to buy insurance across state lines at terms that do not require them to subsidize other buyers or to buy coverage for state-mandated benefits they are unwilling to pay for. Congress could also eliminate tax and regulatory rules that favor employment-based coverage over individual coverage.

In short, the rationale for repealing the insurance antitrust exemption is—to borrow a word used by Mr. Obama in his radio address—bogus.

SOURCE




When the government controls medical care …

… patients are an expense or liability to be gotten rid of rather than a source of profit who must be served.

Much of the problems with government supplied health care can be traced to this truth concerning incentives. A hospital is not paid more if they treat people well. They don’t lose money if they do a poor job. They face no liability; any judgment the government permits to be levied against them is made up by taxes looted from the productive classes.

And, the goal of a medical care provider is to please his pay-masters rather than the patients he treats; and all to frequently when the interests of patients and the government clash, the patients will lose out.

This phenomenon is quite evident in the sad case of British Corporal Matthew Millington of the Queen’s Royal Lancers who died at the age of 31 from lung cancer, after receiving – in a transplant – the cancerous lungs of a smoker who averaged 30 – 50 cigarettes a day.

Why would a hospital implant the lungs of a person who smokes so many cigarettes a day into a patient? Was it the result of an inexperienced surgical team making a ghastly mistake? No. The surgery was performed by Papworth Hospital in England, which is the main transplant hospital in the United Kingdom, whose spokesmen claim that in fact everything was done properly!

A spokeswoman for Papworth, the UK’s leading cardiothoracic hospital, said that it was not unusual to use smokers’ lungs, adding that all organs are “screened rigorously” before a transplant. “We have a strong record of high quality outcomes and this is an extremely rare case.”

In the past year there were 146 lung transplants in the UK, and 84 people died while waiting on the transplant list, she added. “If we had a policy saying we did not use the lungs of those who smoked, then the number of lung transplants would have been significantly lower.”

Let us ignore the fact that the supply of organs is kept low by the superstitiously premised laws outlawing people from selling their own organs. Let us pass over the laughably implausible claim that transplanting smokers’ lungs results in acceptably good outcomes.

Let us, instead, focus on the question of how the hospital handled the case of Corporal Millington of the Queen’s Lancers and compare it to how a hospital that saw him as a customer would have treated him.

Often the detractors of free markets accuse it of being a dehumanizing system of cut-throat competition. What they do not realize is that when two people engage in trade, they are cooperating. The competition is between actors striving to be the best cooperators with prospective trading partners. In a free market, the providers of health care services would be competing to see which one of them could better care for a prospective customer.

Thus, in a free market, Corporal Millington would have contracted with the hospital that sought to cooperate with him most effectively. He would have chosen a hospital that committed to satisfy his need for undiseased, functional lungs at an affordable price. In a free market, the availability of disease-free lungs would have been much higher; people would be far more likely to sign up to supply their organs for transplant if their heirs or estate would be paid a fair market price for them, and the hospital would not have to worry about waiting lists.

However, had the new lungs developed cancer (and let’s not forget occasionally non-smokers get lung-cancer too), the hospital would have had a strong incentive to make it right, either out of a sense of obligation or out of fear of retribution; In a free market, there are two incentives to keep unscrupulous people treating their customers well. The first is, of course, the fear of lawsuits. the second, though, is their greed for future profits and their fear of losing these future profits should they ever develop a bad reputation. The latter can particularly devastating. The McDonald-Douglas Aircraft Company, for example, was nearly driven into bankruptcy by the perception that the DC-10 was an unsafe aircraft. To this day, the Massengill corporation has never returned to the drug-making business after the debacle of 1938. The yellow press would love nothing better to go after a hospital for transplanting diseased organs into a patient; the readership and viewership of such pieces would bring in a tidy sum in advertising dollars.

Thus the hospital, if nothing else to avoid the collapse of their business after a widespread accusation of incompetence/malpractice, would face a huge opportunity cost if they forewent transplanting in a new, second set of lungs.

But, unfortunately for Corporal Millington, he wasn’t the customer of Papworth. Rather, some officials of the NHS were. The desire of the actual customers (NHS) were to keep costs down by a) cutting corners on the type of lungs transplanted into patients, b) concerning themselves with patient outcomes in the aggregate, and reducing seemingly unnecessary, redundant duplication of services by centralizing transplants as much as possible.

Thus they faced no economic loss for allowing him to die of cancer. There was no profit to saving him; in fact, saving him would have been an expense. They didn’t have to cooperate with Corporal Millington and so they didn’t.

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When you make a (health care) deal with the devil, you’re the junior partner

Recent events have shown lobbyists across the health care sector the truth of Dick Armey’s axiom that “if you make a deal with the devil, you are the junior partner.”

In July, the pharmaceutical industry cut a “deal” with the White House in which the Administration promised the industry that health care “reform” won’t cost them too much (less than $80 billion), in return for the industry’s agreement to spend $150 million on ads promoting Obamacare. “Big Pharma’s” behavior was an understandable reaction to the Washington reality, especially in this Administration, that if you’re not at the table, you’re on the menu. But the effect was to put on the menu every American who takes medicine.

Within a month, however, the drug industry had already received their first stab in the back, from a House bill that would allow the government to negotiate drug prices – something the “agreement” had seemed to specifically preclude. The NY Times reported in August:

“We were assured: ‘We need somebody to come in first. If you come in first, you will have a rock-solid deal,’ ” Billy Tauzin, the former Republican House member from Louisiana who now leads the pharmaceutical trade group, said Wednesday. “Who is ever going to go into a deal with the White House again if they don’t keep their word? You are just going to duke it out instead.”

Indeed. Who is ever going to go into a deal with the White House again? How about the American Medical Association? The health insurance industry, the American Medical Association (which represents fewer than 30% of American physicians but misleadingly acts as if it truly represents “the nation’s doctors”), and various hospital groups have, until the Baucus almost-bill, tried to “work with” the Administration to tailor “reform” so that it would benefit them, regardless of how much it would cost everyone else.

The AMA thought they had a deal that any reform would be gentle on Medicare reimbursement rates for doctors. Indeed, the House bill seemed to promise a slight increase in those rates, at least for primary care physicians. No such luck once they saw what Baucus got passed. The Baucus measure includes massive cuts to Medicare payments and subsidies (which will never actually happen, just as required cuts have not happened each year since 2003). The story is the same for hospital groups which decided to support Obamacare early on, with the starry-eyed naivety of someone who has never dealt with a Chicago politician.

So another “agreement” bites the dust. Can you picture Rahm Emanuel sitting down with the industry lobbyists, crossing his fingers behind his back as he shakes hands over his “understanding” with drug makers, doctors, or hospital administrators?

And just in the past few days, we have the results of the latest Democrat betrayal. The PriceWaterhouseCoopers report which shows that the Baucus almost-bill will substantially raise health insurance premiums was commissioned by America’s Health Insurance Plans (“AHIP”), an industry lobbying organization. While the report is good ammunition against what will be a disastrously expensive government destruction of our health care system, those of us who oppose Obamacare in all its forms must not simply assume that AHIP is an ally.

Like the other medical industry groups who couldn’t resist the temptation to try to influence a government hell-bent on controlling everything, the health insurance industry sided with Obamacare, if somewhat more cautiously than the drug makers did. They even revived “Harry and Louise” who have suddenly switched sides from when the very same insurers used those very same characters to great effect to defeat Hillarycare.

The health insurers thought that government would force millions of young, healthy people (i.e. extremely profitable people to sell health insurance to) into their arms like so many herring being caught up in a giant net. That didn’t happen either in the Baucus bill, and the penalties being proposed for not having insurance are too low for the industry to believe they will effectively force people into insurance they don’t want or can’t afford. Apparently the insurers missed the fact that government is made up of politicians who can ill afford to alienate every young healthy voter in America.

In other words, AHIP released the PWC report not because they thought the Baucus bill was bad for medicine or for Americans, but because it wasn’t sufficiently coercive and because they thought they had a deal. And they did…Chicago style. Yes, the PWC information is useful for those who oppose Obamacare, that does not mean we should confuse AHIP with a friend of economic liberty or even a friend of the best possible health care system. If it were up to them, everyone would be forced to buy their product whether it was wanted or not, and at almost any price.

Really, who can blame them? If Obamalosireidcus is going to force insurance companies to take people with pre-existing conditions without charging them more and limit how much more the companies can charge old people versus young people (even though old people have much greater risk of expensive health problems), the insurance companies see two possible outcomes: Premiums rising well beyond what makes sense for the average healthy young or almost-young person to spend, leading to further “adverse selection”, i.e. healthy people dropping coverage, and continuing in a rising premium death spiral for health insurance. Or the government forcing young healthy people into the “pool” to “spread the risk”, forcing them to subsidize health care for old or sick people…with premiums still rising, just not quite as fast. Of course the health insurance industry wants an “individual mandate!”

Imagine how much auto insurance would cost if people were allowed to buy it just after getting into an accident. That’s what Obama wants to do with health care. Effectively, he wants to force people who don’t drive to buy expensive car insurance and subsidize the losses that the insurers will take by paying claims for accidents which happened before the accident-causing driver was even insured. It is economically and politically unsustainable, not least because it’s bad for both young adults and old adults, all of whom happen to have the right to vote.

Indeed, Obamacare is only good for two groups: the very small minority of chronically sick people who can’t currently get health insurance (but do we need to destroy the whole system to help them find an answer?), and (particularly if there is a public option) unions who hope to dump their health care costs on government, leaving them free to take the money they had saved for their members’ and retirees’ medical bills and spend it on getting Democrats elected. Any wonder why Democrats are so desperate to get this passed, given the rapid shift in the political tide against them in the past few months?

With this Administration, even the unions can’t be sure they have a deal – luckily for the rest of us. That said, when it comes to Armey’s axiom, in a deal between the Obama Administration and Big Labor, it’s hard to know who is the junior partner.

SOURCE




“Gifted hands” surgeon rips into Obamacare

As the Senate Finance Committee completed its work on a bill that would greatly expand the government’s role in health care – requiring nearly everyone to buy insurance, and designing that insurance through subsidies and mandates – President Obama is trying to rally doctors to his side. At an event last week at the Rose Garden, phalanxed by doctors wearing their white coats (as well as some that White House staffers had handed out), Obama declared, “nobody has more credibility with the American people on this issue than you do.”

Yet one of the nation’s top surgeons, with credibility and acclaim the world over for the pioneering surgeries he has and his personal story of overcoming hardship, recently ripped the dominant health care legislation before Congress in a critique similar to that of conservatives and libertarians. Benjamin Carson, director of pediatric neurosurgery at the Johns Hopkins Medical Institutions in Baltimore, Md., and recipient of numerous awards including the Presidential Medal of Freedom, criticized in a recent interview the approach of the current bills for their mandate, creation of a “public option,” and lack of malpractice liability reform.

“My biggest problem is I feel it’s going in the wrong direction,” Carson told reporters at TV station WLOS in Asheville, N.C. (Video here.)“It’s giving us more government and less autonomy. And I think we should be going in exactly the opposite direction. We should be having more autonomy and less government. And that is the kind of thing that brings the prices down.”

Considered one of the best neurosurgeons in the world, Carson gained acclaim in the ’80s and ‘90s for his pioneering operations separating conjoined twins joined at the head and other procedures that have saved children from epilepsy and brain cancer. But Carson is also celebrated for his personal story of overcoming poverty and prejudice. An African-American, Carson grew up in a single-parent home Detroit ghetto, but his mother pushed him and his brother to achieve excellence. He is the author of the popular autobiography “Gifted Hands: The Ben Carson Story,” which was made into a TV movie this year with Cuba Gooding Jr. portraying Carson. And he does much philanthropic work through charities such as his “Carson Scholars” fund.

Over the past few years, Carson has been writing and speaking more about public policy, including health care reform. He has railed against excessive litigation, pointing out how much malpractice insurance and other forms of “defensive medicine” to protect against lawsuits add to medical costs. In the interview with WLOS, Carson insisted that tort reform must go “hand in hand” as part of any true health care reform.

“We have to bring a rational approach to medical litigation,” he said. “We’re the only nation in the world that really has this problem. Why is it that everybody else has been able to solve this problem but us? Simple. Special interest groups like the trial lawyers’ association. They don’t want a solution.”

Carson also blasted proposals backed by Obama and most Democrats that would create a government-backed “public option,” saying it would inevitably lead to a “single payer” system like that of Canada, in which the government as the sole insurer would end up calling all the shots for patients. He pointed to how the Canadian government itself crowded out private insurance. “What happened to the private insurance companies in Canada? Just like that, they were gone, because they couldn’t compete with it (the government). Now, why would it be any different here? That’s one of the things that disappoints me about the lack of honesty … We can’t really debate when there’s all this subterfuge.”

Carson said that despite the problems with American health care, Canada and European countries were not models to emulate in their health insurance financing systems. “All we have to do is go to other places and see what’s going on. See how long people have to wait. Very, very long waiting periods. Why do you think so many people from Canada come here when they have a problem? I know a young man in England who has a problem with his knee. He needs an operation, and the waiting list is so long. … These are the kind of things that people in this country are not used to. But more importantly, it’s something that we don’t have to get used to. We can fix this without going to that kind of system that causes those kinds of long waits.”

As his main “fix”, Carson proposes a system of patient empowerment in which “individuals and families can own their own insurance; it doesn’t have to be through their employer.” Not all of Carson’s ideas expressed in the interview were free-market, though. He did propose that the government set insurance rates, and cover patients’ catastrophic costs above $250,000.

Above all, Carson was adamant that there transparency and deliberation, rather than a rush to force through a health care bill that no one had read. In fact, he proposed bringing health care to a national vote of the American people “I would say we should have a national referendum on it. People should be able to vote. That would really work, because now, people would have to explain it. They would have to know what was in it. When we do these big sweeping national things and just sort of jam them through and nobody even knows what’s in it, that’s not democracy. At some point, someone has lost their ideal of what democracy is.”

Carson’s colleagues at Hopkins – ranked by U.S. News and World Report for 19 years as the nation’s best overall hospital and lauded for the millions it spends on charity care for the poor –have also voiced concerns about the direction that health care legislation is going. Citing the cuts to hospitals to pay for the goal of universal coverage – cuts of more than $150 billion in Medicare and Medicaid payments to hospitals, according to the Congressional Budget office “preliminary analysis” of the Max Baucus’ Senate Finance Committee bill – the Hopkins officials have been warning about severe stress on Hopkins and other hospitals that Hopkins and other hospitals would face.

At a Sept. 18 “town meeting” on the campus of the main hospital in Baltimore, Md., Johns Hopkins Institutions Director of Federal Relations Beth Felder was blunt about the cuts in reimbursements. “That is going to come out of hospitals and health systems,” she said. “I think that’s not a good thing for us.” Similarly, Johns Hopkins Medicine health system CEO Edward Miller told C-Span on Sept. 16 that cuts in the reimbursement rates for Medicare and Medicaid, “There are going to be less physicians that will care for these patients.”

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21 October, 2009

Britain: Why did Indian doctor miss my daughter's fatal cancer EIGHT times?

The NHS imports a lot of poorly trained doctors from overseas



A young woman died of cervical cancer after her GP failed to spot symptoms during eight visits over four years. Nikki Sams repeatedly complained of stomach pains and bleeding but Dr Navin Shankar never carried out an internal examination, telling told her it was 'nothing serious'. It was only when she was referred to another practice - when Shankar, 59, was suspended for serious misconduct in a case involving a baby - that she was immediately given a smear test. Miss Sams had a hysterectomy the following week and began radiotherapy and chemotherapy but died around a year later aged 26.

The General Medical Council last week upheld a number of complaints against Shankar following the start of a fitness to practise hearing. It has been adjourned while his performance is assessed.

Miss Sams' father Michael, 54, who quit his job as an airport worker to care for his daughter, yesterday accused Shankar of a 'catalogue of unforgivable errors'. He added: 'Nikki was so brave, she never complained or said "Why me?" but she died unnecessarily. 'It is unbelievable that in this day and age a girl can go to her doctor so many times with all these symptoms and be told not to worry. 'The hysterectomy was such a blow for Nikki because she desperately wanted a family, but that was just the start of the nightmare. 'I have a younger daughter and Nikki was her role model. This has torn our family apart.'

Miss Sams' case will raise fresh questions about the age at which women are given smear tests on the NHS. It is only available to over-25s in England, but to over-20s in the rest of the UK.

Miss Sams, a saleswoman from Luton, Bedfordshire, first saw Shankar in 1999 at the Wigmore Lane Health Centre in the town. She was only seen by another GP in 2005 when Shankar, who qualified in India in 1971, was suspended by the GMC for serious professional misconduct after he blamed a nine-day-old boy's life-threatening blood clot on a tight nappy. The GP was later found to have altered his notes. He had told the parents that the baby was fine, despite the fact that his toes were becoming gangrenous.

After Miss Sams' new doctor immediately recommended a smear test, further examinations found a tumour on her cervix. She had treatment at the Mount Vernon Hospital Cancer Centre in Northwood, Middlesex, and was told the cancer was gone. But X-rays taken following a minor car accident in early 2007 revealed it had spread. She died at home six months later, in August 2007.

The GMC hearing on Shankar will be reconvened at a date yet to be set. If his fitness to practise is deemed to be 'impaired' he could receive a warning, have conditions placed on his registration, be suspended or struck off.

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What Singapore Can Teach the White House

Its health care is first class, cheap and market-driven

Critics of this island-nation often have fun referring to it as the "nanny state" for its laws against spitting, littering, or leaving behind an unflushed loo. When it comes to health care, however, Uncle Sam has better claim to the nanny title. From our federal price "negotiations" and state regulations to discrimination in the tax code, government distortions prop up a system that puts key health-care decisions in the hands of everyone but the patient. Each new government intrusion, moreover, begets only higher costs—and a call for more intervention to fix the problem.

In Singapore, by contrast, they already have universal coverage. They also have world-class quality care at world-competitive prices. And in a week when White House chief of staff Rahm Emanuel is meeting behind closed doors with Senate Majority Leader Harry Reid, Singapore's example might have something to teach them about the kind of reform Americans really need.

"When I'm asked to describe the differences between the U.S. and Singapore systems, my one-word answer is 'complexity,'" says Dr. Jason Yap, director of marketing for Raffles Hospital, a leading private care facility in downtown Singapore. "There are so many parties in the American system that do not really contribute to care."

Dr. Yap is referring to the higher costs that come from an American system that depends on regulation and oversight to accomplish what Singapore tries to do with competition and choice. At the Raffles lounge for international patients, he shows me an example of the latter. It's a one-page, easy-to-read list of fees. At the high end of accommodation, a patient can choose the Raffles/Victory suite for about $1,438 per night. That price includes a 24-hour private nurse, a refrigerator stocked with drinks, and an adjoining living room to entertain. At the other end of the scale, a bed in a six-person room goes for just $99. As Dr. Yap points out, the actual care is the same whether a patient decides to stay in a deluxe suite or a dormitory-style room. But the choice is the patient's; the financial incentives encourage the patient to think about those choices; and the low-priced options help keep the overall costs down.

This is no accident. Like ours, Singapore's system is a mix of public and private care and financing. Unlike ours, Singapore's system is anchored, as the Ministry of Health puts it, "on the twin philosophies of individual responsibility and affordable health care for all."

"Individual responsibility" is not just a buzzword. All but the abjectly poor have to pay for some of their care, another downward pressure on prices. Perhaps most important, almost all working Singaporeans are required to put money in a medical savings account that they use for out of pocket expenses. It's their money, and they control it. As a result, they are careful about spending it. "In Singapore almost everyone has to pay something for their care," says Dr. Yap. "When it's your money, you really ask yourself: Do I really need this?"

It seems to be working. According to a Raffles Hospital official, a knee replacement surgery runs between U.S. $12,000 and $14,000. Spinal fusion runs between $10,500 and $14,000, and a heart bypass (coronary artery bypass graft) from $23,000 to $26,500. Conservatively speaking, these prices are less than a third of what the same procedure would cost in the U.S.—that is, when you can even get the price.

As any American who has ever tried to make sense of a hospital bill or haggled with his insurance company over a payment can tell you, even for those who have decent coverage our system can be a bureaucratic nightmare. Singapore's system isn't perfect. It does suggest, however, that the Average Joe stands more to gain from a system where hospitals and doctors compete for patients, where patients have different price options for their hospital stays and appointments, and where they pay for some of it out of pocket.

Yes, a city-state with three million citizens has some advantages over a nation of more than 300 million people in 50 states. Yes, health care in Singapore is hardly the laissez-faire ideal. Still, there's intervention and there's intervention: What makes Singapore's health care work is that it is designed to swim with the market and not against it.

In macro terms, that means Singaporeans spend only about 4% of GDP on health care—against 17% for the United States. At the same time, Singapore scores better than the U.S. on life expectancy, infant mortality, and other key international measures.

In his address to Congress last month, President Obama complained that "we spend one and a half times more per person on health care than any other country, but we aren't any healthier for it." That's a good point. And the lessons Singapore has to offer suggests that what Americans need most in Washington today are fewer closed-door meetings and more open minds.

SOURCE




Government AIDS healthcare in DC a disaster of waste

In a city ravaged by the highest rate of AIDS cases in the nation, the D.C. Health Department paid millions to nonprofit groups that delivered substandard services or failed to account for any work at all, even as sick people searched for care or died waiting.

More than $1 million in AIDS money went to a housing group whose ailing boarders sometimes struggled without electricity, gas or food. A supervisor said she was ordered to create records for ghost employees.

About $400,000 was paid to a nonprofit organization, launched by a man who once ran one of the District's largest cocaine rings, for a promised job-training center that has never opened.

More than $500,000 was earmarked for a housing program whose executive director had a string of convictions for theft, drugs and forgery. After the D.C. Inspector General's Office could find no evidence that he was operating an AIDS nonprofit group, the city terminated the grant but never sought repayment.

All told, the Health Department's HIV/AIDS Administration awarded more than $25 million from 2004 to 2008 to nonprofit agencies marked by questionable spending, a lack of clients, or lapses in record-keeping and care, a 10-month Washington Post investigation found. Many of the groups have since closed or are no longer providing AIDS services.

Across the city, the sick are suffering. Renee Paige, 50, once threw birthday parties for her two daughters in her apartment in Southeast Washington, where she'd cook beef stew for elderly neighbors and always had bus fare for a friend. But AIDS and two bouts of pneumonia had left her weak, homeless and unable to care for herself. She came to a community meeting in April after spending the night on a park bench in heavy rain, with no place to go. "I have AIDS," she told the group, "and I am soaking wet." Weeks later, she died alone, on the bench, one mile from the HIV/AIDS Administration and within two miles of a dozen nonprofit groups that help people with AIDS.

"I couldn't understand," said Keena Stewart, who had known Paige for 15 years. "How could she die like that?" More than 15,000 people have HIV or AIDS in the District, 3 percent of the population older than 12. For black men, the rate is more than double, at 6.5 percent -- one of every 15 people.

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Budget tricks rife in health reform effort

Advocates of health care reform are relying on budget manipulations to stick with President Obama's pledge to overhaul the system without adding to the deficit, critics on and off Capitol Hill say. Both independent budget analysts and Republicans say a Senate vote expected this week on a 10-year, nearly $250 billion Medicare reimbursement bill is the perfect example. They say it was sliced out of the reform plans because it would send the cost of Mr. Obama's top legislative priority over $1 trillion.

Further, they argue that the health care overhaul bill has been front-loaded with revenue and backloaded with spending to make it look less expensive that it actually is. The reforms price tag will play a major role in the looming debates in Congress and across America. "It's a gimmick that is designed to allow the president and the Democrat majority to say our health care reform bill is deficit-neutral," said Sen. John Thune, South Dakota Republican. "And well, sure, if you take $250 billion and back it out, it's easy to say it's deficit-neutral."

The Medicare bill, offered by Sen. Debbie Stabenow, Michigan Democrat, would repair what physicians say is a flawed formula that underpays them for treating Medicare patients. Nearly every year, the math calls for them to face a double-digit cut unless Congress overturns it. "The very act of separately passing the 10-year physician-payment patch, without paying for it, before passing health care reform undermines [the Democrats'] credibility and the confidence that they will make the hard choices necessary to make sure that reform is fiscally responsible," said Maya MacGuineas, president of the bipartisan Committee for a Responsible Federal Budget.

But Senate Majority Leader Harry Reid, Nevada Democrat, says the move is simply to address an annual problem that must be fixed to ensure doctors can treat senior citizens. "Physicians, you know, they go into medicine to take care of people, and when they are faced with a situation where if they see a Medicare patient, they can't even pay their overhead, that doesn't speak well for our Medicare system," Mr. Reid said.

Both the American Medical Association and the AARP are lobbying hard in support of the measure. "Those who are concerned about waiving budget requirements should recognize that the past practice of 'temporary band-aids' on the [rates] has only served to increase both the size of future cuts and the cost of subsequent interventions. That is neither responsible budget policy nor in keeping with our obligations to provide access, choice and quality care," the groups said in a letter to Congress.

While there is near-universal agreement on Capitol Hill to fix the formula somehow, Republicans and some moderate Democrats warn that it's irresponsible to cut the fix out of health care reform and not pay for it.

"The physicians issue has to be addressed but it has to be addressed in a way that doesn't increase the deficit by $245 billion," Sen. Evan Bayh, Indiana Democrat, said last week. "That's just not responsible. ... If we're going to honor the president's promise to make this fiscally responsible, that's an issue that ought to be addressed."

More here




How Much Obamacare Costs the Average Family

Whether or not you now have health insurance, Obama’s health care bill will cost you dearly

If you don’t have insurance, you will be required to buy it. The legislation specifies how much you will have to pay for the coverage before any subsidy kicks in. All during the campaign, Obama kept speaking about affordable coverage. Now it appears that his definition of “affordable” might be a bit elastic.

If your household income is $66,000 a year, slightly above the national average, Obama’s health care bill will require you to spend 12 percent of your income -- about $8,000 a year or almost $700 a month -- to buy health insurance before you get any federal subsidy.

Even those making less will have to reach deep into their meager resources to satisfy Obama’s statutory requirement. Families scraping by on only $44,0000 a year will have to pay 7 percent of their income (about $3,000) on insurance. Even those making just $33,000 will have to ante up 4.5 percent of their income (about $1,500) for health insurance. The required payments reach so far down the scale that those who are living at the federal poverty level of $22,000 will have to shell out 2 percent of their totally inadequate incomes ($440) for insurance.

That Obama is charging premiums to those living at or on the border of poverty is absolutely incredible! And this from a candidate who pledged that he would not tax the middle class! If you have insurance, you will get hit by his proposed 40 percent tax on insurance premiums.

When the tax -- and the legislation -- takes effect in 2013, all families making about $120,000 or more in combined household income (14 percent of all families or one in seven) will have to pay the tax. By the next year, 2014, the tax will hit every family making more than $100,000 (about 18 percent of all families or one in six). By 2019, 10 years hence, the tax will reach down to affect every family making more than $75,000 a year (31 percent of families or one in three). The tax will take 40 percent of all premiums above $21,000.

So if you don’t have insurance, you will be socked with a mandate to buy coverage and pay a hefty proportion of your income to do it; and if you have insurance, you will be hit with an excise tax on the coverage. (In theory, it is the insurance companies that have to pay the tax, but the Senate Finance Committee “assumes” that they will pass the tax along to their policyholders).

These costs make a mockery of Obama’s oft-repeated pledge to avoid any tax increase that would impact those making under $250,000 a year. He finances about half of his health care plan on the backs of the elderly by cutting Medicare and inducing scarcity and the other half by premium taxes and insurance purchasing mandates on the middle and lower middle class.

SOURCE




What's In and What's Out of Health Care Legislation

As liberals rush Obamacare through Congress, let's review the disparity between promises and text. Joe Wilson's declaration "You lie!" is ringing truer with each passing day.

Barack Obama promised "transparency" and to give the public five days to read the bill, but Sen. Jim Bunning's amendment to require the bill, along with a final Congressional Budget Office score, to be posted online 72 hours before the vote was defeated. Reps. Brian Baird, D-Wash., and Greg Walden, R-Ore., have been trying to get the House to agree to post the bill 72 hours before the vote. Most Republicans have signed on, but the Nancy Pelosi leadership is unwilling.

The Democrats still hope to rush the bill through unread. The 1,100-page stimulus bill was posted online only 13 hours before the vote, and the 1,200-page cap-and-trade bill was posted only 15 hours before the vote.

Obama promised that the health care bill would not cover illegal aliens, but Sen. Chuck Grassley's amendment to require immigrants to prove their identities with photo IDs was rejected.

Obama promised that if you like your current health insurance, you won't have to change it, but Sen. John Cornyn's amendment to assure present insurance owners that they wouldn't have to change their coverage and that they could keep the coverage they have with their current employers without government driving up cost was defeated.

Obama's appointment of 34 czars includes a health care czar, but Sen. John Ensign's amendment to require any health care czar to be subject to the constitutional Senate confirmation process was defeated. Obama's new regulatory czar, Cass Sunstein, defends removing organs from terminally ill patients and from deceased people, even when they did not consent to be organ donors.

Obama promised that under his plan, "no federal dollars will be used to fund abortions," and his press secretary, Robert Gibbs, tried to divert attention from this bold lie by obfuscating the Hyde Amendment. But the Hyde Amendment is not a law; it's a one-year-at-a-time rider that applies only to current Medicaid programs, and it would not apply to the health care law.

The Democrats five times (twice in Senate committees, three times in House committees) defeated amendments to prohibit the health care plan from spending federal money or requiring health insurance plans to cover abortions. They also defeated Sen. Orrin Hatch's amendment to respect the conscience rights of health care workers who do not want to perform abortions because of moral or religious objections.

One amendment that did pass was Sen. Maria Cantwell's amendment, which would give the secretary of health and human services the power to define cost-effective care for each medical condition and to punish doctors who treat high-cost patients with complex conditions. That has been Obama's goal from the beginning and inevitably will lead to the "death panels" Sarah Palin warned about.

Former Sen. Tom Daschle, who was scheduled to be health and human services secretary or health care czar until he had to bow out, said that the law should be written in generalities so the bureaucrats can fill in the details. Dr. Ezekiel Emanuel, brother of chief of staff Rahm Emanuel and a key Obama health care adviser, may be behind the stimulus legislation that will send "embedded clinical-decision support" to doctors via computer to warn them about what is "appropriate" and "cost-effective," backed up by the threat to impose financial penalties on doctors who are not "meaningful users."

The Democrats' health care "reform" would carry a trillion-dollar price tag, vastly increase the national debt hanging over our children and grandchildren, impose socialist control over one-sixth of our economy, and force us to obey totalitarian dictates. The mandate on employers to provide health insurance would result in lower wages and fewer jobs.

The mandate on individuals to buy health insurance or pay a penalty, even threatening jail for those who fail to conform, amounts to a massive tax increase on individuals and families whose health insurance may lack all the new federally specified requirements.

Obama's "spread the wealth around" policy is evident in the big expansion of Medicaid combined with large cuts in Medicare. Former Health and Human Services Secretary Michael Leavitt says that the combination of mandates to buy insurance, guaranteed issue, and community rating amounts to massive income distribution that is hidden from public view and not even debated.

Finally, we are subject to the deviousness of what House Minority Leader John Boehner calls the 70 phantom amendments, which were added in secret after the bill was voted out by the committee. The bill may be even worse than we think.

SOURCE





20 October, 2009

British hospital trusts launch 'sinister' bid to reduce funding for more than 100 life-saving drugs

Health trusts are trying to reduce the number of life-saving drugs pioneered on the NHS, it was claimed yesterday. A number have joined a lobby group suspected of seeking to influence the type of treatments endorsed by rationing body NICE. The lobby group, the Commissioning Support Appraisals Service, is urging primary care trusts to sign up because they are under the pressure of 'tightening budgets'. It points out that they have to fund new drugs out of existing reserves, possibly at the expense of existing treatments. A promotional letter sent to the top managers of every primary trust suggests that more than 100 life-saving cancer drugs are in the pipeline.

The lobby group's actions are controversial because NICE is supposed to be independent of the Health Service and government. Health campaigners said it was wrong to waste public money on 'sinister' lobbying activities. Kate Spall, head of the Pamela Northcott Fund, which campaigns on cancer drugs, said: 'The subtext of the organisation seems to be to lobby NICE to ensure less cancer treatments are approved nationally. 'But believe me, NICE needs no encouragement to deny cancer treatments - they're doing a great job doing just that. 'Why aren't the managers lobbying the Government for extra funding for cancer treatments instead of fighting to ensure they are not approved? 'No wonder we have the worst access to treatment in Europe.'

Andrew Lansley, Tory health spokesman, said: 'It is extremely concerning that the Government has allowed NHS bodies to band together to spend taxpayers' money on a group whose intention seems to be to stop patients getting the life-saving drugs they need. 'It is utterly perverse when this money should be being spent on treating patients. 'The job of NICE is to undertake appraisals and offer advice on the basis of evidence not on the basis of lobbying. 'The last thing I want to see is primary care trusts using scarce NHS money to try and influence NICE appraisals into turning down what could be life-saving drugs. 'If they have clinical evidence to offer that is one thing, but if not they should stick to their job of providing services and treatments to the patients that need them.'

Professor Karol Sikora, a cancer specialist, said: 'The real tragedy is that we are so far behind Europe already that to put more restrictions on cancer drugs will make us fall even further behind. 'It's a crazy system of rationing, especially when PCTs have to fund newly-approved drugs out of existing budgets. 'But they should be pushing for more money - not trying to make the system work better for them.'

Andrew Wilson-Webb of the Rarer Cancers Forum said: 'NICE's job is to provide independent advice to the NHS. 'It is outrageous if NHS bodies try to influence this process by stealth.'

A spokesman for the Department of Health said: 'NICE invites patients, clinicians, manufacturers and primary care trusts to take part in consultations as it develops technology appraisal guidance. 'It is important that all these stakeholders engage in the process to ensure that the best possible decisions are made. The Commissioning Support Appraisals Service exists to help primary care trusts do this. 'NICE is an independent body which follows rigorous and transparent processes to consider all the available evidence and make the final decision on its guidance.' NICE declined to comment.

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Staffing shortages compromising patient care, warn British nurses

More than half of the RCN's members, 55 per cent, find they cannot provide the level of care they want to because they are so busy and the same number say there aren't enough staff to meet patient needs. And two thirds, 61 per cent, of NHS nurses say their workload is too heavy and they are under too much pressure.

The RCN is today calling for all political parties to commit to guaranteeing safe staffing levels for all nursing shifts. They are issuing a manifesto, ahead of the coming general election, with a series of demands including giving nurses time to train, regulating the drinks industry and improving care for those with long-term health conditions.

Dr Peter Carter, head of the RCN, said: ''Today's report shows that nurses and healthcare assistants feel up against it; worn down and exhausted by the pressure to make efficiencies and frustrated by being prevented from delivering the quality of care they want to be providing. Staff are concerned that they are delivering the basics but are unable to provide the full range of quality care they would like. ''With an average of 1,800 nurses and health care assistants in each constituency, politicians of all parties must pay attention to our call for safer staffing levels and sustained investment in the NHS.''

The RCN's annual survey of nurses also found that with 200,000 nurses expected to retire in the next ten years and fewer nurses entering training the number of trained nurses available in the UK could fall.

Dr Carter said: ''The nursing workforce has grown in recent years but only just enough to keep up with rising demands on healthcare. We expect the next few years will be the most challenging for staff levels in decades, especially with the drive to provide more services in the community. ''There is considerable pressure to focus on short-term funding constraints and cut staff numbers without taking patient needs into consideration. However, policy makers must look at workforce in conjunction with ability to deliver high quality and safe care. As we've seen too often, where there are not enough nurses, patient care suffers.''

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Majorcan hospitals a surprise for the English

What a difference extensive private medicine makes! Majorca (Mallorca) is a Spanish island in the Mediterranean which has a huge tourist industry



My son’s headmaster was on the blower. It was a Friday afternoon and the prognosis wasn’t great. Ollie had fallen during a sports lesson and his ankle had apparently swollen to the size of a tennis ball. We whizzed off to the school, stopping en route at the airport to pick up Sarah, a friend staying for the weekend, who happens to be a nurse. Palma has more hospitals than you can shake a thermometer at and since we’re entitled to use both state and private healthcare, we’re spoilt for choice.

Many Majorcans, even those on modest incomes, like to have state and private health care and at about half the cost of the UK or less, going private is a very affordable option.

We decided on the nearest hospital to our location and dashed in to paediatric accident and emergency. A smiling receptionist led us over to a state of the art children’s game consul and play area where she asked Ollie to wait until the doctor came. Only a few other patients were sitting in the palatial, marble tiled waiting zone.

A few minutes later a nurse arrived and carefully examined Ollie’s foot in a spotlessly clean surgery. She suggested x-rays. A charming young doctor arrived, had a chirpy conversation with Ollie about football and began examining him from head to toe. He wanted to check he hadn’t hurt his head in the fall. Two radiographers appeared with an English interpreter – just in case our Spanish wasn’t up to medical phraseology – and finally another doctor to give his verdict post the x-rays, and a prescription. A motherly nurse then bandaged up Ollie’s foot, pinching his cheek and telling him he’d be back on the playing field before he knew it. In just 45 minutes Ollie was x-rayed, diagnosed and treated.

As always we took this exemplary service in our stride but Sarah, a nurse at a busy NHS teaching hospital in London, was in some shock. “Am I dreaming?” she asked at least twice. We took her to the hospital out-patient canteen to recover. “I think I’ll have a red wine since it’s a Friday night,” my husband said cheerfully. The counter staff shared a joke with him and then asked politely whether he’d like his wine at room temperature or chilled. “You’d be lucky to get a cup of tepid tea in our hospital,” Sarah said.

On a roll, the next day we popped by out local state run medical centre in Sóller which offers a 24/7 service to its patients. We wanted to show Sarah a typical Majorcan local surgery. The receptionist chuckled when he saw Ollie’s bandaged foot. “What have you been up to my Ronaldo, too much football?” One of the doctors we know walked by, stopped and came back to shake our hands. “Do you need to see me?” he asked with some concern. “We’ve only got a few patients in the waiting room if you can hang on ten minutes.”

We explained that we’d already been to a hospital in Palma but wanted to show our friend around the clinic. “Be my guest,” he beamed. “We’re a humble clinic but we offer the best we can and it’s rare to wait longer than fifteen minutes for an appointment.”

Sarah wanted to know if the clinic had x-ray equipment. The doctor explained that if x-rays were needed an ambulance was called immediately to take patients to the nearest hospital. “It’s all part of the service,” he said. “We also have multi-lingual staff to deal with expat residents.”

She left the clinic reeling. “How,” she asked, “have the Majorcans got it so right?”

SOURCE




Gag Order Admission

Humana gets a slap on the wrist for disseminating TRUE information

There's nothing like a Friday evening news release to hide a Washington embarrassment. In last week's episode, President Obama's health appointees lifted their outrageous gag order against health insurers for the sin of informing their customers about how ObamaCare would affect their insurance.

In September, Humana Inc. sent a mailer to some 900,000 enrollees in its Medicare Advantage plans, the program that gives seniors a choice of private insurance options, warning that spending cuts would result in reduced benefits and some people losing their coverage. The Congressional Budget Office has said the same thing, but the Obama apparat went nuclear. At the behest of Senate Finance Chairman Max Baucus, Medicare's administrators menaced Humana with fines and regulatory punishments, and even told all insurers participating in Advantage to shut up too—or else.

In its Friday ruling, Medicare slapped Humana on the wrist for disseminating information that it claimed was "misleading to beneficiaries"—even though it was perfectly true—but also lifted the gag order. Insurers will be allowed to communicate with enrollees, provided they get permission. This is basically a concession that the critics are right, especially considering that Health and Human Services Secretary Kathleen Sebelius defended the policy as recently as two weeks ago while refusing to answer questions about this raw political coercion from a supposedly impartial federal bureaucracy.

Meanwhile, the Administration is now threatening to strip the insurance industry of its decades-long exemption from antitrust law. This would blow a hole in the industry's profitability, as would ObamaCare for different reasons. The industry now faces a choice of playing ball with Democrats and getting punished, or trying to defeat the bill and being brutalized as an act of political revenge. This is the industry's reward for spending millions to promote "reform" in the hopes of not becoming a political target. It's still a target, and now it's poised to lose the policy fight too.

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The Massachusetts lesson: Diminished choice for patients already in the offing

The state’s ambitious plan to shake up how providers are paid could have a hidden price for patients: Controlling Massachusetts’ soaring medical costs, many health care leaders believe, may require residents to give up their nearly unlimited freedom to go to any hospital and specialist they want.

Efforts to keep patients in a defined provider network, or direct them to lower-cost hospitals could be unpopular, especially in a state where more than 40 percent of hospital care is provided in expensive academic medical centers and where many insurance policies allow patients access to large numbers of providers.

But a growing number of hospital officials and physician leaders warn that the new payment system proposed by a state commission would not work without restrictions on where patients receive care - an issue some providers say the commission and the Patrick administration have glossed over.

“You can’t reap these savings without limiting patients’ choices in some way,’’ said Paul Levy, chief executive of Beth Israel Deaconess Medical Center. “It’s a huge issue, it’s huge.’’ Dr. James Mongan, president of Partners HealthCare, a Beth Israel Deaconess competitor, agreed that it wouldn’t “work without some restriction on choice.’’

A state commission recommended in July that insurers largely scrap the current fee-for-service system - in which insurers pay doctors, hospitals, and other providers a negotiated fee for each procedure and visit - and instead pay providers a per-patient annual fee to cover all of the patient’s medical care.

This new system of “global payments’’ would discourage overuse of expensive medical services, force providers to live within a budget, and improve coordination of care for patients, supporters argue.

There is little doubt that the state’s current system of broad choice and sometimes unco-ordinated care has helped push Massachusetts health care costs above the national average. It can lead to unnecessary duplication of medical tests, when patients see multiple providers, each often unaware of what the others have done. And thousands of residents get knee replacement surgery, have babies at teaching hospitals, or other care, when often a less-expensive hospital would be more economical and provide good-quality care.

In 1990, 36 percent of Massachusetts hospital patients were treated at teaching hospitals, but by 2007 the percentage climbed to 44 percent - more than twice the national average of 19 percent. The percentage of Massachusetts births at teaching hospitals also has increased. Some of this expanded use of teaching hospitals is understandable, because for many Boston residents academic medical centers in their neighborhoods are their community hospitals. In other cases, residents bypass less-expensive community hospitals, but this is a freedom many patients desire.

The Massachusetts proposal would involve a more ambitious restructuring of health care than any of the cost-cutting ideas being discussed in Washington. Under a global payment system, doctors, hospitals, nursing homes, and other providers would form large networks, called accountable care organizations, that would provide most of the care for individual patients and divvy up the payments. Doctors would try to coordinate patients’ care within these networks, which would share electronic medical records and treatment plans. And to manage costs, they would try to direct patients to the hospital within the network that could provide good-quality care at the lowest cost, while generally using teaching hospitals for advanced care.

The release of the report sparked a lobbying campaign by Massachusetts health care executives, who are urging Governor Deval Patrick’s administration and state legislators to move cautiously because they fear a new payment system could bankrupt some providers and compromise patient care. Many changes recommended by the commission would have to be approved by the Legislature before being put in place.

In its report, the commission, which includes high-ranking Patrick administration officials and legislators, said patients wouldn’t necessarily be restricted to providers within their primary care doctor’s accountable care organization. And, during a hearing at the State House Thursday, Dr. JudyAnn Bigby, secretary of Health and Human Services, said “the people benefiting from the new system should not even notice it.’’

Writing in the New England Journal of Medicine last month, staff writer Dr. Robert Steinbrook said the state commission failed to address the choice issue head-on. Global payments would save money only if networks “limited the volume of services, and denied certain requests from patients and providers,’’ among other measures, he wrote. “Since patient choice is such a sensitive issue, the commission waffled.’’

More here





19 October, 2009

Some British pigs are more equal than others

3,000 NHS staff get private care

THE National Health Service has spent £1.5m paying for hundreds of its staff to have private health treatment so they can leapfrog their own waiting lists. More than 3,000 staff, including doctors and nurses, have gone private at the taxpayers’ expense in the past three years because the queues at the clinics and hospitals where they work are too long.

Figures released under the Freedom of Information act show that NHS administrative staff, paramedics and ambulance drivers have also been given free private healthcare. This has covered physiotherapy, osteopathy, psychiatric care and counselling — all widely available on the NHS.

“It simply isn’t fair to have one service for staff and another for everyone else,” said Norman Lamb, the Liberal Democrat health spokesman, who obtained the figures. “If the NHS has to circumvent their own waiting lists the system isn’t working well enough. It’s an admission by the NHS that their own system isn’t able to respond to the mass of people desperate to get back to work.”

The number of health service employees sent to private healthcare facilities has more than doubled in the past three years. In 2006-7, 708 staff working for NHS trusts received private treatment at a cost of £279,000. Last year it increased to 1,641 at a cost of £828,413.

The health department defended the practice and said sending doctors, nurses and other key staff for private treatment helped to get them back to work. “If trusts want to get their staff back to work more quickly they can’t jump NHS waiting lists, so going private is an option,” said the spokesman. “There is evidence that early intervention in tackling sickness absence enables staff to return to work more quickly. “Other benefits include: reducing the risk of chronic illness that could result in ill health retirement, cost-saving on temporary staff and having a positive impact on staff health and wellbeing and, in turn, patient satisfaction.”

The East Midlands ambulance service recently set up a contract with a private occupational healthcare specialist worth £300,000 a year. It has sent its staff to the specialist for vaccines, health screening and to deal with needle injuries and blood tests.

Other big spenders include the south east coast ambulance service, which has sent more than 800 staff for physiotherapy, osteopathy and counselling at a cost of more than £279,000 over three years.

Humber mental health trust has spent more than £47,000 on private counselling, even though it specialises in offering this service along with psychiatric help. A spokeswoman said staff would feel awkward being counselled by NHS colleagues. “An appropriate and professional counselling and therapeutic service has to be free from any other existing pressures in respect of relationships and therefore cannot always be provided by an organisation,” she said. “Staff may also be referred externally due to peak of demand to meet the need in a timely manner.”

West Suffolk hospital has spent £56,000 over the past three years on private treatment for staff but said it would no longer do so.

SOURCE




British death panels "need more training"

Doctors and nurses need more training in how to care for people who are dying, Mike Richards, the Government's cancer tsar, has said, following concerns over the controversial 'death pathway' scheme

Prof Mike Richards, who was involved in the introduction of the Liverpool Care Pathway, said it was "essential" that medical staff were skilled in deciding who should be put on the scheme for those at the end of their lives. It follows concerns that patients with terminal illnesses are being made to die prematurely because they are incorrectly placed on the pathway, which can mean the withdrawal of food and fluids.

However, in an interview with The Daily Telegraph, Prof Richards said the Liverpool Care Pathway, worked well in the majority of cases. Prof Richards said: "The Liverpool Care Pathway is very valuable but its success depends on the skills and experience of staff who deliver it. It is therefore absolutely essential that every member of team delivering the pathway receives training."

In a letter to the Daily Telegraph last month, a collection of palliative care experts warned that patients may be wrongly diagnosed as dying and that putting them on the pathway became a self fulfilling prophesy. Since then families have come forward with concerns about the treatment of their dying relatives, sparking a debate about end of life care in hospitals.

Prof Richards warned that as the population ages and plans to help more people die at home are implemented, a wider range of clinicians will have to care for the dying. He said: "There are 1.3 million people working in the NHS and almost all of them have roles in end of life care. This includes GPs, hospital doctors, community and hospital nurses, physiotherapists and others. We need to increase the number of staff receiving training and a proportion of the funding for the end of life care strategy is dedicated for this.

"We train all clinicians in resuscitation though relatively few will use this skill in any one year. I would like to see a similar approach so that all staff are trained in end of life care. "Since the end of life care strategy was published 15 months ago we have succeeded in making training staff a priority for hospitals across the country but we need push this further so that we reach all staff groups." Prof Richards said e-learning modules were being developed to allow hundreds of thousands of staff to be trained in end of life care.

Meanwhile Marie Curie Cancer Care, which drew up the Liverpool Care Pathway, to help hospital staff provide the kind of end of life care that is provided in hospices, has called for mandatory training for all staff who use it. An audit showed in one in four cases family members were not told when their relative was placed on the Liverpool Care Pathway. The data also showed 84 per cent of nurses who use the pathway have received training. Thomas Hughes-Hallet, chief executive of the charity said: "We will be pressuring the NHS to ensure that the training does take place. We want 100 per cent of staff using the pathway to be trained. There is an issue around training, we can always get better." Mr Hughes-Hallett said the charity had never received a complaint about the LCP and it is now seen as a world-leading scheme which has been adopted in 17 other countries.

As part of the end of life strategy, surveys will be carried out among bereaved relatives of patients who have died to find out what they thought of the care family members received. The surveys which will begin next year will enable the Department of Health to compare the experiences of relatives of patients who died on the Liverpool Care Pathway with those who were not.

SOURCE




Insurance mandates: Kiss Your Money and Freedom Goodbye

Talk about personal responsibility is cheap. Legislating personal responsibility isn't. Take the movement to require everyone to purchase government-approved health insurance.

If at first this seems like a reasonable requirement necessary to reduce cost shifting by those who do not pay their own fare, then step back and think again. The damage caused by such a mandate is far greater than the problem it purports to solve.

Passing a law won't magically make everyone insured any more than laws against speeding cause everyone to drive carefully - and shaving a few MPH off your speed is a much milder behavior modification than involuntarily spending thousands of your hard-earned dollars on government's wish list rather than your own.

Many states, including Colorado, require drivers to have automobile insurance; yet the number of uninsured drivers is estimated at 14 percent nationally and 16 percent in Colorado.

Analyzing the newest health "reform" bill by Sen. Max Baucus (D-Mont.), the Congressional Budget Office found that its individual purchase mandate would still leave 25 million uninsured - out of some 30 million that CBO says are currently uninsured on any given day.

From a practical standpoint, the requirement to purchase health insurance will start badly and grow even worse. That's because the choice of what kind of insurance to purchase will no longer belong to consumers but to politicians and bureaucrats, relentlessly pressured by lobbyists to add to every conceivable screening or procedure in the nanny-state's wish list to your mandatory policy.

Politicians who resist that pressure and defend your right to choose your own level of coverage will be smeared at election time by dishonest advertisements accusing them of opposing mammograms and maternity care.

Requiring health insurance to pay for preventive screenings is like mandating that auto insurance must pay for oil changes and new tires. Only in health care do we forget that insurance was designed to pay for unforeseen catastrophes, not for predictable events for which we should plan and budget.

These are the types of mandates that turn a practical, affordable policy into an unaffordable one. In Massachusetts, which implemented an individual mandate in 2007, the average family insurance policy now costs $13,788 a year - the most expensive in the nation.

But, true to form, liberals in Congress seem incapable of learning from others' mistakes.

Worse still, the Senate bill's $829 billion cost estimate doesn't attempt to account for the total cost to Americans - only for the cost to government. Factor in the cost to businesses and families of buying government-approved health insurance and the total cost soars to $2 trillion, says Michael Cannon, health policy director at Cato Institute.

If Congress can order us to use our own money to buy goods or services that we might not otherwise purchase, what's to stop it from ordering us to drive hybrid vehicles, install solar panels on our homes, or eat our vegetables?

So let's say someone who still holds to the old-fashioned notion that America is "a free country" decides to spend her own money as she darn well pleases and buys health insurance that doesn't meet government's criteria. Then what?

According to a memo from the Joint Committee on Taxation, such independence would result in a $1,900 income tax penalty from the IRS. Refusal to pay the penalty would subject the taxpayer to a misdemeanor criminal charge carrying a fine of $25,000 and up to one year in jail.

What is so wrong with American health care that justifies this type of authoritarian government? And what does it say about Democrats who would jail those who spend their own money however they choose?

Contrary to President Obama's oft-repeated disinformation, health care spending had nothing to do with the implosion of the financial markets. In fact, the biggest problems in health care and the most expensive problems in government emanate from government health care programs. Medicare, for example, is nearly bankrupt and carries a long-term deficit of $89 trillion.

Only in Washington is it conventional wisdom that the cure for big government's errors is to make them bigger.

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Does Medicaid offer a glimpse into the future of American medicine?

Last week, my wife, a pediatrician, gave a patient a prescription for compounded Tamiflu -- that is, the preparation of a children's dose of the anti-viral drug by breaking down adult-dose capsules and turning them into a liquid suspension. The Swine flu scare has made children's Tamiflu scarce, so compounding is often the only way of getting the drug for kids. Before handing the patient the prescription, my wife's office checked with the insurer to make sure it would pay for compounded Tamiflu. Reassured that the drug was covered, the patient went to get the drug compounded at the only pharmacy in the area that will do the job (Wal-Mart, if you're interested).

Of course, when the pharmacy went to put the prescription through, the insurer refused to pay. Twice. Oh, no, not another health insurance company horror story! Well, yes it is -- but with a twist. You see, the insurer was AHCCCS -- Arizona's implementation of Medicaid -- a government program that may provide us all with a peek at the future of American medicine.

The problem was cleared up quickly enough once my wife heard about it. She set her staff to work calling the AHCCCS offices and demanding approval of the prescription. The government employees were all apologies and soon authorized compensation for the patient, who had already paid out of pocket.

But that's the way it always is. My wife and her staff play a frequent game of "guess what AHCCCS will pay for today" that has turned them into constant phone pals with bureaucrats down in Phoenix. The AHCCCS people are almost always polite and usually concede the point. But this happens over and over again.

Tamiflu wasn't approved for use at all just a few weeks ago, even after the CDC recommended the drug for treating Swine flu. Sure enough, my wife (and other doctors, I'm sure) got on the horn and AHCCCS added Tamiflu to the formulary -- the list of drugs for which it would pay.

Yes, she does this from time to time with the private insurers too -- they're no saints, and occasional arm-twisting is required. But not with such regularity as with AHCCCS, and not to the extent that it seems a system is at work.

If there is a system, it's not a system for refusing care and treatment. It's a system for making it a little more difficult to get things paid for -- unless somebody with savvy runs interference. But most physicians' offices don't provide this kind of value-added advocacy service. It's expensive to have staffers on the phone arguing with Medicaid bureaucrats, none of whom can be fingered as a specific villain in any given case. And without savvy advocates, medications and treatments don't get approved. Not incidentally, I'm sure, such how-did-that-happen refusals to pay for even pre-approved care, spread out across the entire system, must represent a fairly substantial cost saving.

This shouldn't come as a surprise. Medicaid is, after all, a political health-care system, rather than a commercial one. It doesn't just charge for services and raise rates as needed; it's given a certain budget to work with, and somehow it has to jam all the demands upon its resources within the limits of that budget. That's not easy.

In countries where politically run health-care systems are the norm, the cost-control measures are more overt. The Los Angeles Times recently published an article about the budget strains to which the government-run health-care system is subject in British Columbia, and the accommodations it has made in response.

Provincial officials recently announced a $360-million shortfall in the $15.7-billion healthcare budget for the fiscal year that ends in March.

The shortage will mean fewer surgeries and longer waits.

The Vancouver Island Health Authority has said it would reduce the number of non-emergency MRIs by 20%; non-emergency patients now are being booked for scans in March.

Vancouver Coastal Health, which serves a quarter of the province's population, said it would eliminate 450 elective surgeries, about 30% of the schedule, during the four weeks of the 2010 Winter Olympics. And in the rapidly growing suburbs east of Vancouver, the Fraser Health Authority plans to close its spending gap by, among other things, holding the number of MRIs to last year's total, ending $550,000 in service programs for senior citizens and reducing elective surgeries by about 14%.

How do you control costs in a politically run health-care system? You announce "this much care and no more." Ironically, that leaves one woman described in the article crossing the border and paying out-of-pocket for hip surgery in the U.S. to escape a year-and-a-half long waiting list, and has spurred the establishment of technically illegal private surgery centers in the province at a time when many Americans are touting the advantages of government-run systems like Canadian Medicare.

And like Arizona's AHCCCS.

Americans aren't yet ready to face the hard choices that are made by politically run health care systems. That's why we get one unexplained denial after another instead of hard limits on care as a matter of policy. But, when Americans wise up to the fact that state-run medicine has a hard-nosed attitude toward cost control, they're likely to discover that doctors like my wife can't always fix the problem.

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Crooked Democrat advertising

The Democratic National Committee has agreed to pull a TV ad featuring former Senate Majority Leader Bob Dole, R-Kan., following objections Dole conveyed to the White House that the ad twists his support for a bipartisan compromise for health care reform legislation into something else entirely.

The ad, which was set to launch Monday, features Dole and other Republican former officials advocating in general terms for health care reform. Dole is quoted saying, "I want this to pass. ... We've got to do something," and the ad attempts to contrast that attitude with that of current GOP congressional leaders, which the DNC describes as "siding with the insurance companies and just saying no to insurance reform."

"I wish they hadn't done it," Dole said of the DNC ad in a phone interview with ABC News on Sunday afternoon, saying that the ad's depiction of current GOP leaders "is just not my view." He found it a bit ironic that "all I've been doing is urging bipartisanship" and that was used for partisan purposes.

"The ad doesn't reflect what I was trying to do," he said. "I just didn't think it was fair when I've tried to be helpful in encouraging a bipartisan solution for the DNC to run an ad that I interpreted and I know others did as a backhanded comment about Republicans."

Dole also objected to any impression that the ad suggested he endorsed any specific legislation when he's tried to keep what he's supporting "pretty generic." Dole conveyed as much to White House chief of staff Rahm Emanuel yesterday, who told the DNC to pull the ad.

"We have great respect for Sen. Dole and his commitment to reform," a DNC spokesman told ABC News. "As soon as Sen. Dole's concerns were communicated to us we immediately agreed to pull the ad."

President Obama cited the support Dole and other Republican former officials have expressed for health care reform in his weekly address Saturday, though some of those Republicans -- former Senate Majority Leader Bill Frist, R-Tenn., for example -- have expressed misgivings about specific Democratic legislative proposals.

Dole told ABC News, "My whole message is you can't score unless you're in the game. I still believe a compromise is there. No one I know is flatly against health care reform." The 1996 GOP presidential nominee said that there's "still plenty of time to get a bipartisan result. And that's really going to start when bill gets to the floor" of the Senate and "amendments are offered." "I was up there a long time and I learned it's never over 'til it's over," Dole said. "I'm an optimist. I guess that's my problem."

Rejecting the arguments of some Democrats that the current crop of Republicans isn't as inclined to compromise as he was, Dole said, "there's a lot of good men and women in Congress from both parties. And come crunch time they will think long and hard -- depending on what's in it -- before they vote no."

"I'll take some of the blame for the Clinton failure," Dole said, referring to former President Bill Clinton's failure to pass comprehensive health care reform legislation in 1994.

The World War II veteran said he doesn't think a failed bill can be used the same way to hurt Democrats in 2010 as it was in 1994. "It's a different time," he said, "and the whole issue has become much more important. It's going to be drag on the economy if we don't figure out some long term way to fix it."

Working with other former Senate majority leaders former Sens. Tom Daschle, D-S.D., Howard Baker, R-Tenn., and George Mitchell, D-Maine -- before Mitchell resigned to serve as President Obama's special envoy to the Middle East -- Dole and others at the Bipartisan Policy Center have not only issued statements urging compromise, in June they suggested a framework for bipartisan health care called “Crossing Our Lines: Working Together to Reform the U.S. Health System.”

"Some of the recommendations we made are in the Baucus bill," Dole said, referring to the bill being offered in the Senate Finance Committee by Sen. Max Baucus, D-Mont. "I agreed on mandates which I don't really like. Daschle, for example, yielded on the public option, something that he strongly believes in. We understood and I think members of Congress ought to understand, there aren't any easy votes on this issue. Trying to avoid any political risk at all is going to be difficult."

Dole said if he were President Obama, he'd "want some of the other party on board for a couple reasons. It gives the president some protection if it's bipartisan. Secondly, the American people will feel better about it if both parties are involved."

He suggested the president add tort reform measures to the legislation which "would bring some more Republicans around."

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Bipartisan Facade Can't Hide Health Plan's Flaws

If the Democrats' health care package is so great, why are President Obama and Dem congressional leaders so hungry to share the credit for its passage with a Republican?

It's not as if D.C. Dems are opposed to hogging the glory when a federal program is popular. So why did Obama feel the need to announce after the Senate Finance Committee passed a health care measure with the support of Sen. Olympia Snowe, R-Maine, that the measure "enjoys the support of people from both parties" -- when this one bill enjoyed the support of one lone-wolf Republican?

Obama doesn't need Snowe's vote to pass a measure if he can draw the support of the Senate's 58 Democrats and two left-leaning independents. Snowe's vote was hardly pivotal, considering that the committee approved the measure by a 14-9 vote. Democrats hold a comfortable majority -- 256 members out of 435 -- in the House. So why are Obama and company so desperate to win over a token Republican or two?

Is it the idea that if ObamaCare fails, they want voters to blame the GOP? Or does the president want to be able to share the blame if a bill passes and inevitably fails to deliver as promised? No one knows what the final health care reform bill will look like, but plenty of reasons remain for voters to be skeptical. Until those who claim the mantle of reform acknowledge the cost of all the things they want to give families, they have too many incentives to over-promise and too few incentives to tell people they can't get something for nothing.

In Washington's standard hide-the-tax fashion, the Senate Finance Committee legislation would impose an excise tax on "Cadillac" employer-funded health care plans -- a 40 percent levy on premiums in excess of $8,000 per individual or $21,000 per family. So they're taxing a service to make it cheaper. Big labor is opposed because "Cadillac" policies can be very working class. But some on the left support this scheme, in the belief that taxing health care will control costs by providing employers with incentives to offer less-generous health coverage.

If this plan passes, workers will have to pay higher premiums and/or taxes for what they already have. That's more cost shifting than cost savings.

The worst suspicions of the plan's critics thus have been confirmed. Under ObamaCare, those who have health care will be paying more -- fair enough -- but for less health care -- which is not so fair.

As for proposed limits on what insurers can charge based on age or gender -- again, these schemes don't control costs; they shift costs. And cost shifting is the practice that has led to runaway health care spending in America.

With all the freebies thrown into versions of the package -- with millions of additional people covered, no denials for pre-existing conditions, free checkups and preventive procedures -- ObamaCare can only increase the nation's health care tab.

"When history calls," Snowe said to explain her vote, "history calls." Maybe, but history can be like the Delphic oracle: It doesn't always tell you what you think you hear. The more Washington pads the guaranteed benefits package, the less incentive Americans will have to look for savings in their own health care. Snowe and the Democrats may believe that their plans will cut health care costs, but history suggests that these paper savings will not materialize.

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18 October, 2009

Obama Hasn't Closed the Health-Care Sale

Wait until the voters figure out how Congress is proposing to pay for reform

By KARL ROVE

Now that the Senate Finance Committee has voted for the health-care bill drafted by Montana Democratic Sen. Max Baucus, negotiations over the real bill can begin in Senate Majority Leader Harry Reid's cozy Capitol hideaway. It won't be easy. Democrats now face a central problem for any governing party: How to pass a major piece of legislation when there are a lot of sharply different ideas about what should be in it. Trying to reconcile what Democrats in the House prefer with what Democrats in the Senate want is already opening up divisions among the party's supporters.

This week, for example, leaders of 30 labor unions called for Democrats to reject Mr. Baucus's bill because it doesn't include the government-run health insurance program better known as the public option. This only makes it more likely that Democrats will have a bloody fight over the public option.

Members of Congress have a tendency to take a hard stand on a particular portion of a controversial bill. That allows them to show a little independence and make a plausible claim to have influenced the eventual outcome.

The problem for Mr. Obama is that the Baucus bill is being sold on the strength of accounting tricks that make it appear that it won't add to the deficit. (This is true for the other health-reform bills, too). If fiscally conservative Democrats sign on to the bill now after publicly saying they are doing so because it doesn't add to the deficit, they may end up bailing once the tricks are revealed to the public.

One trick is easily explained. The bill imposes tax hikes and benefit cuts right away, including $121 billion of Medicare reductions between 2011 and 2015. But new spending really doesn't start until five years out (2015) and isn't fully operational until 2017. The bill uses 10 years worth of tax hikes and benefit cuts to fund a few years worth of benefits.

And that's just the start. For example, the Congressional Budget Office (CBO) released a report last week claiming the bill won't add to the deficit. But this assumes that employers who dump employee coverage under the Baucus bill will then increase worker paychecks by an amount equal to what they had spent on health care. This replaces a nontaxable event (providing health insurance) with a taxable one (increasing worker paychecks), magically producing $83 billion in revenues. Without this windfall, the Baucus bill adds billions of dollars to the federal deficit in the first decade.

Of course, why would a company drop employee coverage just so it could pay more (in fines, taxes and wages) than it did before?

The CBO report also estimates that receipts from the 40% excise tax the Baucus bill would levy on "Cadillac" insurance policies "would grow by roughly 10 percent to 15 percent" a year after 2019. That's nonsense. If you tax something heavily you'll get less of it. If this tax is enacted, there will be fewer Cadillac plans—and hence less revenue.

Under questioning at a Senate hearing Tuesday, CBO Director Douglas Elmendorf admitted that the $500 billion in tax hikes in the Baucus bill would be passed onto consumers, jacking up insurance premiums. That undercuts the argument that Democratic reforms will make health care more affordable.

Some governors are also figuring out that the proposal in the Baucus bill to expand Medicaid will shift a big chunk of the federal health-care tab to states. States, after all, pick up an average of 47% of Medicaid's costs —and expanding it will force states to spend more.

Then there are $400 billion in benefit cuts that are frightening seniors. Jeffrey H. Anderson of the Pacific Research Institute has pointed out that the Baucus bill cuts Medicare payments to physicians by 25% within two years and keeps payments at that level forever, without adjusting for inflation. If this becomes law, doctors who take Medicare patients will see their real income decline each year.

Democrats who support any final bill are at risk. They'll be held responsible for the mess that quickly emerges as premiums rise, taxes balloon, deficits soar, mandates expand, and government power grows. Mr. Obama's problem is that his Magic Kingdom Health Care World is colliding with reality. There is a big cost to any large government expansion—and the ways to cover the cost of Mr. Obama's plan are limited, unpopular, and sure to anger Americans once they are fully understood.

Ironically, the president who never stopped campaigning hasn't made the sale to Americans because he's forgotten a central rule of campaigning: Your arguments have to be clear and credible if voters are to believe them. His attempt to sell health care is neither. He still may win passage of a bill, but he's lost the public's enthusiastic backing.

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Senate health plan funding in doubt

A health care funding mechanism favored by Democratic leaders in the Senate -- a tax on costly health-insurance plans -- seems to be in big trouble as members balk at the idea.

But the tax pays for nearly a quarter of the $829 billion plan that provides the framework for the Democratic proposal and even a modest reduction would leave the plan billions of dollars short of being fully funded, which would be a deal breaker with moderate members. "It's a real problem, isn't it?" said Sen. Ben Nelson, D-Neb., a moderate who opposes the excise tax.

The tax on "Cadillac plans" is by far one of the biggest revenue raisers in the Senate health care bill from the Finance Committee. It would raise $201 billion over the decade beginning in 2013 by attaching 40 percent surcharge on health insurance plan that cost more than $8,000 for individuals and $21,000 for families. Democrats who initially balked at the tax last month were placated a bit when negotiators agreed to exclude policies for high-risk professions such as firefighters and coal miners, whose plans tend to cost more.

Democrats paid for that concession by raising excise the tax for other professions by 5 percent, angering members of labor unions whose deluxe coverage plans would be hit by the tax. Union officials had remained quiet on the issue at the behest of the White House but they broke their silence this week and began an advertising attack on the Finance Committee bill.

The unions are threatening to lobby lawmakers to vote against a bill that includes the excise tax and they may not have to work hard to convince them. In the House, 156 members have already sent a letter to Speaker Nancy Pelosi, D-Calif., telling them they oppose the Senate excise tax.

The $1 trillion-plus House bill is paid for in part by tax increases on the wealthy.

Senate Democratic leaders are well aware that the unpopular excise tax could sink their bill, so they are looking for ways to eliminate it or lessen its effect by increasing the threshold. "I think we are going to have to raise the level," Senate Majority Whip Richard Durbin, D-Ill., said. "But it costs money."

According to the Congressional Budget Office, the excise tax would bring in $46 billion in 2019 and that amount would increase by up to 15 percent each year in the following decade. That revenue would come from a growing number of policies getting caught by the tax as premiums continue to rise -- up to 40 percent of all plans by 2020, according to the Joint Committee on Taxation. Premiums will rise in part because Democratic reform proposals include a requirement that most people to buy comprehensive coverage, which is more costly.

"What they are basically doing is mandating Cadillac plans for everybody," said Diana Furchtgott-Roth, director of the Center for Employment Policy at the Hudson Institute.

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Redistributing health

Proponents of compulsory, government-designed health insurance can't seem to understand why others disagree. Perhaps the public is realizing that these proposals are fundamentally about redistributing health? Health-care "reform," that is, aims to shift costs and benefits of health insurance from some groups to others. And the losers are turning out to be less docile than politicians had hoped.

All the leading proposals involve massive redistribution from people with healthy lifestyles to those who take more risks. As the Congressional Budget Office explained, "Premiums in the new insurance exchanges would tend to be higher than the average premiums in the current-law individual market... because the new policies would have to cover pre-existing medical conditions and could not deny coverage to people with high expected costs for health care." That is, because the politicians want people who've already fallen ill to be able to buy insurance at the same rates as the healthy, rates would rise for everyone who has insurance now. That's why the bills would all force healthy people to buy this overpriced insurance, under threat of fines or prison.

There would also be redistribution from people with employer-paid insurance (particularly in risky jobs with high premiums) to those who would be induced to shun such benefits in order to qualify for taxpayer subsidies.

By far the largest redistribution, however, is from those on Medicare to those who'd become newly eligible for Medicaid or federal subsidies. The major proposals, the AARP Bulletin explains, "include around $500 billion in savings carved from future growth in Medicare spending over a 10-year period."

Even in the Obama era, $500 billion is a lot. Yet we're supposed to believe that less is somehow more — that seniors will benefit from these spending cuts. "The Obama administration and congressional leaders," intones a recent New York Times editorial, "are hoping to save hundreds of billions of dollars by slowing the growth of spending in the vast and inefficient Medicare system that serves 45 million older and disabled Americans. The savings would be used to help offset the costs of covering tens of millions of uninsured people."

President Obama, in an Aug. 16 Times op ed, made such redistribution seem easy and painless: "We'll cut hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid," he said.

Such efforts to appease seniors are not working because they are transparently dishonest. First of all, the Congressional Budget Office figures that cutting "waste, fraud and abuse" might save $200 million a year — that's millions, not billions. Second, the hundreds of billions in "savings" are to be carved out of the hides of Medicare providers and Medicare Advantage benefits, not Medicaid. In the Senate Finance Committee proposal, Medicaid gets $345 billion more money from 2014 to 2019.

Third, Medicare is already headed to insolvency. As its trustees openly warn, the program's trust fund will be empty in six to nine years, because its spending continues to grow far faster than the taxes that support it. That is, Medicare will undoubtedly be slashed again and again in the years ahead, and fees increased — simply to keep the program from eating into the general budget (which is already groaning under unprecedented deficits).

This harsh reality does not turn the insolvent Medicare mess into a congressional piggybank, so that cutting Medicare payments to doctors can be magically transformed into a newfound source of free money to lavish on Medicaid and health-insurance subsidies.

The Times claims the cuts should actually make Medicare better "for most beneficiaries," partly by "helping keep Medicare solvent." That is either a hoax or fraud. If "the savings would be used to help offset the costs of covering tens of millions of uninsured people," as the Times says, then the same savings can't also be used to shore up the Medicare trust fund.

In any case, the proposed Medicare cuts are unbelievably huge. As the CBO explains, the Senate Finance proposal "would increase payment rates for physicians' services for 2010, but those rates would be reduced by about 25 percent for 2011 and then remain at current-law levels... Under the proposal, increases in payment rates for many other providers would be held below the rate of inflation."

Amazingly, the AARP Bulletin describes these draconian cuts as "paying doctors more for practices that improve quality of care and save money; and paying providers (notably hospitals and home health agencies) a little less of an increase each year." Sorry: Slashing physician payments by about 25 percent in a single year (and 5.5 percent in later years) is not "a little less." And holding other fees below inflation translates to a perpetual drop in real wages for health-care employees.

Proponents of raiding Medicare to finance "reform" (redistribution) pretend that cutting Medicare payments for services, procedures, tests, devices and drugs is not at all the same as cutting benefits. Nonsense. If we pay health-care providers far less, then they will provide fewer services to Medicare patients. As President Obama suggested, just tell grandma to skip the hip surgery and pop pain pills instead.

The president and his allies in Congress believe they can use deep cuts in Medicare — plus steep new taxes on health insurance, drug and medical device companies — to pay for a vast expansion of Medicaid and new health-insurance subsidies. These grandiose redistribution schemes are grounded in lethal economics and suicidal politics. Because bad ideas are hard to sell, politicians and journalists have been peddling health redistribution with the rhetorical and statistical equivalent of waste, fraud and abuse.

American voters, particularly seniors, don't like to be lied to. They are just as leery of the political redistribution of health as they are of the redistribution of wealth.

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The inevitable Medicare cuts

One should never expect an overabundance of honesty in political debates. But in the current debate on health care reform, both Democrats and Republicans may well be setting new records for obfuscation.

Take Medicare, for example. The Democrats would have us believe that they can cut $500 billion from Medicare spending over the next 10 years without anyone getting less of anything. They are going to save that money, the president says, by eliminating "fraud, waste, and abuse." Undoubtedly that would be the same fraud, waste and abuse that presidents have been eliminating since at least, say, Ronald Reagan.

But, contrary to the president's rhetoric, the bills that Congress is currently debating do cut Medicare. For example, roughly 10.2 million seniors currently receive their health care through the Medicare Advantage program. That program offers many seniors benefits not included in traditional Medicare, including preventive-care services, coordinated care for chronic conditions, routine physical examinations, additional hospitalization, skilled nursing facility stays, routine eye and hearing examinations, and glasses and hearing aids. The bills currently making their way through Congress would cut payments to Medicare Advantage plans by $100 billion to $150 billion. In response, many insurers are expected to stop participating in the program, while others will probably increase the premiums they charge seniors. Millions of seniors will likely be forced off their current plans and back into traditional Medicare. The Congressional Budget Office makes it clear that, at the very least, the cuts "would reduce the extra benefits that would be made available to beneficiaries through Medicare Advantage plans."

The Democratic cuts also hit traditional Medicare. For example, the bills would reduce reimbursements for diagnostic imaging — things like CT scans, MRIs and X-rays — by as much as 25 percent. And the Senate Finance Committee's bill would penalize doctors who perform too many procedures or tests. Providers whose utilization is in the 90th percentile or above, compared to national averages, will have their Medicare reimbursements cut. The whole point of such provisions is to reduce services.

On top of that, the Senate Finance Committee assumes that there will be a 21 percent across-the-board reduction in what Medicare pays providers. This cut is scheduled under current law and is not technically part of the health care bill, but most observers had expected Congress to defer those cuts, as they have every year since 2001.

And the Republicans? They've reacted with the least-convincing outage since Inspector Renault discovered there was gambling going on at Rick's. Republican Party chairman Michael Steele issued a Seniors' Health Care Bill of Rights promising to "protect Medicare and not cut it." Hardly a day seems to pass without some House or Senate Republican vowing to save Medicare from the Democratic axe.

Having been on the receiving end of "Mediscare" politics so many times, it is probably comforting for Republicans to try turning the table for a change. But their outrage ignores the fact that back in February, these same Republicans proposed even bigger Medicare cuts as part of their alternative budget.

So who is really going to cut Medicare benefits? The truth is that, depending on which set of accounting measures is used, Medicare is facing unfunded liabilities of $50 trillion to $100 trillion. Yes, that's trillion, with a "T." As a percentage of GDP, Medicare costs are expected to rise from 2.7 percent today to 9.4 percent by 2050. We cannot and will not continue to pay all promised future Medicare benefits.

Of course, there are differences about how future cuts would be made and what we should do with the money. Democratic plans to simply plow the money back into a new government health care program, for example, would do nothing to help our long-term fiscal problems.

The fact is, no matter what they say, Democrats are going to cut Medicare and so are Republicans. Wouldn't it be nice if we had a politician, from either party, with the courage to tell us the truth?

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It’s not political, it’s personal

How one family would fare under the current health-care bills

By Joseph Coletti

I have spent a good part of the past few months reading and talking about health care. In the back of my mind is always the nagging question that many other Americans are asking themselves: “What about me? What will all this mean for my health care?”

I cannot answer these simple questions for my own family’s consumer-driven health plan. Complicating my job is the fact that the president has not endorsed or even summarized a specific policy or a plan. Which leaves us reading the bills or whatever is publicly available, though these items change on a daily basis.

Through all the obfuscation and dissimulation, the outlook for my family’s health insurance is not good. President Obama and Democrats in Congress still repeat the line, “If you like your insurance or your doctor, you can keep them.” But the clear effect of the House and Senate bills would be to take away my high-deductible plan and accompanying health savings account (HSA).

Start with the minimum requirements for health insurance under the House Democrats’ plan. Many of these are above and beyond my current level of coverage, meaning my insurance wouldn’t satisfy them — and I’d have to buy a more comprehensive (and expensive) policy. These requirements include medical equipment for the home, cost-free preventive services, limits on out-of-pocket expenses of $10,000 per family (my share of out-of-network services could be twice as much, so that’s a potential disqualifier), and oral-health and vision services for children under 21 (my children’s dentistry and vision care are not covered).

There’s also a minimum actuarial value of 70 percent, meaning that the insurance policy would have to cover 70 percent of my family’s expected cost of care (based on our demographics). Regulators would calculate my policy’s actuarial value without counting my Health Savings Account (HSA), which would guarantee a low actuarial value, and so mean my insurance does not cover enough.

The whole reason we chose the high-deductible policy and the HSA was to save money on premiums — with the full knowledge that the insurance policy would not cover our costs until we reached our deductible. Our preferences do not matter under the law, however, and my family would have to purchase a more expensive insurance policy deemed acceptable to the government.

We are not alone in this impending upside-down world of government protections. The Congressional Budget Office found that actuarial values for policies purchased in the individual market “range from 40 percent to 80 percent with an average value that is between 55 percent and 60 percent.” In other words, most of the 18 million of us who now purchase insurance on our own, and the millions without insurance who do not qualify for government programs, will either pay a fine for not having enough insurance or buy more expensive policies. (Obama has insisted this does not amount to a “tax,” even when confronted with dictionary definitions to the contrary.)

When Sen. Jon Kyl (R., Ariz.) offered an amendment that would stop the federal government from declaring my choice of health-care benefits insufficient, Democrats and Sen. Olympia Snowe (R., Maine) shot it down. Another amendment from Senator Kyl would have stopped the government from setting actuarial values for insurance plans, thereby providing protection for my insurance. Democrats killed that, too. Sen. Chuck Grassley (R., Iowa) offered an amendment that would have made HSAs count toward actuarial values. It died.

As the Finance Committee ended its work late in the evening of October 1, Sen. Max Baucus (D., Mont.) ruled Sen. Ron Wyden’s (D., Oreg.) Free Choice Act out of order. The Free Choice Act would have opened proposed state-run exchanges to businesses of any size as well as to individuals who, like me, choose not to take the coverage offered by their employers. Without the Free Choice Act, about two-thirds of workers would be ineligible to participate in the government-sanctioned exchanges the health-insurance bills would create.

If those bills pass, I will have less choice about insurance and care than I do today. My insurance policy and health savings account are not guaranteed. My family will pay more for insurance. We will be tied to my employer’s plan, which means that if I change jobs I will also have to change insurance providers.

Meanwhile, the evidence continues to build that HSAs and their cousins, flexible spending accounts (FSAs) and health reimbursement arrangements (HRAs), provide a chance for real reform that lowers the cost of health care while improving quality. A review of the literature by the American Academy of Actuaries found that these plans lead to lower costs the first year they are implemented, have smaller premium increases than traditional PPO plans, are tied to more use of preventive services, and make patients more likely to follow evidence-based care guidance.

It may be difficult to read and understand the health-care bills before Congress, but the end result is clear enough: fewer choices and higher cost for my family and millions of others.

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Why Health Care Is So Expensive in New York

Mario Cuomo and Blue Cross destroyed the individual insurance market in the state. Now Congress wants to impose the same rules on 50 states

Back in the early 1990s, New York Gov. Mario Cuomo pushed reforms aimed at fixing the state's health-care system. Those reforms were supposed to reduce the ranks of the uninsured as well as prevent insurance companies from unfairly charging people with health problems more than others or dropping sick people from the insurance rolls. They were also supposed to spark greater insurance competition.

If that sounds like reforms being proposed in Washington today, it's not a coincidence. One of the biggest things Mr. Cuomo did was to impose government mandates called community rating (CR) and guaranteed issue (GI). The former prevents insurers from charging people more based on their health or age, and the latter forbids denying coverage to anyone who wants to buy it. These two mandates are now a central part of reforms advancing in Congress. In New York, enacting them has been a mistake.

One of the biggest proponents of community rating and guaranteed issue in the early 1990s was Empire Blue Cross and Blue Shield. With more than eight million customers, Empire was the state's largest insurer. It was also the state's "insurer of last resort" because, as a nonprofit organization, it already had to comply with both mandates. It lobbied to extend CR and GI to every insurer in the name of fair competition.

But New Yorkers didn't get a more competitive insurance market. Within months of the law going into effect in April 1993, Manhattan District Attorney Robert Morgenthau opened a criminal investigation into Empire. It had admitted to misleading regulators about losses it had suffered in 1989, 1990 and 1991. The company also went through two shake-ups of its top leadership —the executives who had led the company when accounting mistakes were made were ousted, and then executives brought in to clean up the mess stepped down under pressure from State Insurance Commissioner Salvatore R. Curiale. Within a few years, Empire and others stopped selling insurance in the individual market in the state.

A 2007 report by the respected Seattle-based actuarial consulting firm Milliman surveyed the damage. It noted that "by 1996 GI and CR requirements effectively eliminated the commercial individual indemnity market in New York." While the reforms were supposed to help keep insurance affordable, "premiums for the two [remaining] standard plans increased rapidly," with one researcher noting "insurers increased premium rates 35%-40% in this period."

Today, New York's private individual insurance market is among the nation's most expensive and highly regulated. New York City residents buying private, unsubsidized individual insurance coverage pay at least $9,036 a year for individual coverage and $26,460 for family coverage. New York's average premiums in the individual market are more than twice the national average, according to a 2007 eHealth Insurance survey.

Today, 14% of New York's population lacks coverage, essentially the same as the national average of 15%. Partly because of the high costs of private coverage, nearly one in four New Yorkers is enrolled in Medicaid. New York's Medicaid program is the nation's most expensive, requiring high local and state taxes to support it.

Policy makers rarely mention that state mandates such as CR and GI can drive up prices and drive millions of people away from private insurance. New York has 51 mandates dictating coverage for a wide range of things including hormone replacement therapy (one of four states with this mandate) and drug abuse counseling (one of seven states). Each adds to the cost of insurance. William Congdon at the Brookings Institution and Michael New from the Heritage Foundation have separately done studies that suggest that 40 of the costliest state mandates in the country add as much as 20% to the cost of basic insurance coverage.

In 1994, about 4.5% (10.45 million) of the U.S. non-elderly population was covered by individual insurance. Today, that number has grown to 5.5% (14.35 million), a 20% increase. In California, 8% of the non-elderly population has individual insurance. But New York's individual insurance market represents a paltry 0.2% of its non-elderly population. Before Mr. Cuomo's reforms it was 4.7%.

In a recent study conducted for the Manhattan Institute, we estimate that market-based reforms could make insurance much more affordable, especially if the CR and GI mandates were repealed. Doing that would reduce the number of uninsured by 18% and 19%, respectively (37% combined), and would lower premiums by 42%. We also found that if the state allowed New Yorkers to buy health insurance sold in Connecticut and Pennsylvania, as much as 26% of the uninsured would purchase private policies costing 25% less than similar policies in New York. Offering mandate-lite plans to those younger than 45 could reduce the uninsured by nearly 10%, with an 18% decline in premiums.

Market reforms won't provide affordable coverage to everyone, so we suggest creating guaranteed-access risk pools for those with chronic diseases. Currently, 35 states have such pools. They could be financed in New York with a modest assessment on policyholders in the individual insurance market of as little as $6 per member, per month.

President Obama has called for insurance market reforms. We agree they're needed. Based on New York's experience, Congress should concentrate on changes that make the individual insurance market as competitive and affordable as possible. The right reforms would reserve scarce tax dollars for those who really need help and encourage more healthy people to buy insurance.

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17 October, 2009

VA Dept. hospitals botched treatments

The VA is an "already existing" socialized medicine system in America. It gives an idea of what a similar system for all Americans would be like. It wouldn't be better

The Veterans Affairs Department committed grave safety mistakes at several of its medical centers and delayed other needed educational and financial services to thousands of veterans, agency chief Eric Shinseki said Wednesday to a congressional panel. "While this process is at times painful, it is the right thing to do for veterans and the nation and will ultimately result in greater trust and better quality," said Mr. Shinseki about disclosing the problems at the Veterans Affairs Medical Center in Philadelphia.

Over a six-year period at the center nearly 100 brachytherapy procedures - used to treat prostate cancer by implanting radioactive seeds to destroy cancerous cells - were botched.

Additionally, VA personnel failed to properly clean endoscopic equipment at hospitals in Tennessee, Georgia and Florida, exposing 10,000 veterans to possible infections. The VA has reported that six veterans taking follow-up blood checks tested positive for HIV, 34 tested positive for hepatitis C, and 13 tested positive for hepatitis B. The VA most recently apologized to nearly 2,000 veterans who erroneously received letters for patients diagnosed with Lou Gehrig's disease.

"I am proud of our people and our accomplishments, but there have been challenges, missed opportunities and gaps in providing the quality of care and services veterans expect and deserve," Mr. Shinseki said.

The agency has seen some recent success for the 8 million veterans who are enrolled for health care, including the expansion of its system to more than 1,000 outpatient clinics and mobile clinics.

Testifying before the House Veterans Affairs Committee on the state of his agency, Mr. Shinseki cited other setbacks the agency has suffered recently, including a hold-up in educational funding for veterans who served in Iraq and Afghanistan. "Across the nation, veterans who applied for benefits under the GI Bill have been told their payments are being delayed because of an overwhelming number of problems at both the department and the schools," said Rep. Bob Filner, California Democrat and committee chairman.

Rep. Steve Buyer, Indiana Republican and ranking committee member, said the backlog of education benefits as well as disability claims continues to accelerate. "The challenges you have stepped into are almost a runaway train, so how do you stop that train?"

Mr. Shinseki said the VA will conduct an "emergency exercise" so it can "enter the spring semester with no backlog" of educational GI Bill funds. As for the backlog on disability payments, the VA closed 92,000 claims in July, as another 91,000 claims poured in for processing, Mr. Shinseki said. Mr. Shinseki said veterans suffering from post-traumatic stress disorder (PTSD) will get the care they deserve, but he did not address a new rule under consideration by his agency that would change the evidence required to prove that a veteran suffers from the malady. "If a stressor is related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD," veterans would be eligible for medical treatment.

However, Rep. John Hall, New York Democrat and chairman of the Veterans subcommittee on disability assistance and memorial affairs, led a separate roundtable with veterans' organizations who questioned whether diagnosis should be limited to VA doctors and what factors are the cause or trigger of PTSD. "When we send troops into combat zones, every moment of every day is not documented," Mr. Hall said. "So when the veteran files a claim for PTSD, the stressors are not always easy to verify, which has resulted in too many of our combat veterans being denied an earned benefit."

Added Mr. Filner: "America owes its combat veterans a debt of gratitude, not loopholes and hurdles."

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No quiet fadeaway for federal insurance option

Fears about high costs of the health care overhaul and mistrust of insurers are rekindling interest in letting the government sell health insurance as part of the plan. The leading congressional proposal as of Wednesday — a Senate Finance bill that relies on private coverage with no new government plan — could price out some 17 million Americans. And the insurance industry may have unwittingly helped the case for public coverage with a report over the weekend asserting the Finance bill would raise premiums for everyone.

Business groups and conservatives remain steadfastly opposed to government insurance — formidable political opposition that shows no sign of weakening. So advocates are getting creative, trying to reformulate the "public option" in a way that can gain the 60 votes needed to clear the Senate. Instead of an all-or-nothing approach, they're trying to provide choices.

What if each state could decide whether to offer public coverage instead of having it decreed from Washington — as proposed by Sen. Tom Carper, D-Del.?

What if states had a menu of options, from nonprofit co-ops to using their own employee health plans?

What if public coverage were offered only as a backstop in areas where one insurer has a lock on the market?

"We are all talking together, trying to find something that not everyone will love but the entire (Democratic) caucus will come to agreement on," said Sen. Chuck Schumer, D-N.Y., who for months has been seeking a politically viable compromise. "It's going to be something flexible, but not weak," Schumer added. His idea: a federal plan that states can opt out of.

The lone Republican to back health care overhaul legislation, Maine Sen. Olympia Snowe, has suggested a possible way out: allowing a public plan to kick in if competition among health insurance companies under a revamped system fails to bring down costs. Snowe is opposed to government insurance as a first-line solution.

What if Snowe's idea is combined with an approach that lets states make the call? "Those are all elements that one could easily fashion into an outcome that would seem to be elegant," said economist Len Nichols of the New America Foundation. "It would show the left: 'Look we will be there when we're needed if coverage is not affordable.' And it would show the right that this not some backdoor government takeover, because we're only going where we're needed."

What to do about the public plan is the most politically sensitive issue on the agenda of Senate Majority Leader Harry Reid, D-Nev., as he sets out to merge the Finance bill with a Senate health committee version that does include a government option.

The health overhaul drive got a potential boost Wednesday as a second Republican senator signaled she's open to voting for a health care bill. Sen. Susan Collins, R-Maine, told The Associated Press that the Finance bill needs substantial improvements to make coverage more affordable, contain costs and protect Medicare, but she joined Snowe in endorsing the goal of far-reaching changes. "My hope is we that can fix the flaws in the bill and come together with a truly bipartisan bill that could garner widespread support," Collins said in an interview.

On Wednesday, top White House aides, including chief of staff Rahm Emanuel and Health Secretary Kathleen Sebelius, traveled to the Capitol to meet with Reid, Democratic Sen. Chris Dodd of Connecticut and Finance Committee Chairman Max Baucus, D-Mont., about combining the Finance bill with the Senate health panel measure. Reid is giving no hints. Asked Wednesday if he thought it was likely there would be a public plan in his merged bill, he responded: "I'm not betting on health care. 'Likely' is in a game of craps."

Republicans say the fix is in for a public plan. Behind the scenes, Democrats will take Baucus' middle-of-the-road plan and turn it hard to the left, they say. "We know that the bill written behind closed doors here in the Capitol will be another 1,000-page, trillion-dollar Washington takeover," said Senate Republican leader Mitch McConnell of Kentucky.

Democrats did try one new tack Wednesday, on an issue involving doctors. Senate Democrats are now pushing for quick passage of separate legislation to spare doctors a $247 billion cut in Medicare fees over a decade. That would raise federal deficits, but the White House says the increase should not count in the price tag for the health care overhaul.

A senior Democratic aide said Reid is focused on what's politically achievable. The public option is being assessed in terms of what it would mean for health care overall and, just as importantly, whether it can win approval, said the staff member, who spoke on condition of anonymity because of the sensitivity of the negotiations. A drawback of the Finance bill is that its 10-year, $829 billion budget wouldn't be enough to guarantee access to affordable health insurance for everyone. People with solid middle-class incomes who buy their own coverage would still have to pay hefty premiums — even after tax credits intended to help them out.

For example, a family of four making $66,000 a year and headed by a 45-year-old would face $11,080 in premiums. After a tax credit of $3,182, the family in the example would still have to come up with $7,898 — less than a mortgage but probably more than a year's car payment. The ballpark figures come from the Kaiser Foundation's Health Reform Subsidy Calculator.

Because there isn't enough money in the bill for everyone, the Congressional Budget Office projects the Finance bill would leave some 17 million citizens and lawful immigrants without coverage in 2019, when it's fully phased in.

The insurance industry study asserting that the Finance bill would raise premiums for everyone only added fuel to the fire. "The report says costs are going up — the best way to get costs down is the public option," said Schumer.

The heated rhetoric was evident Wednesday at a Senate Judiciary Committee hearing in which Reid and Schumer called for repealing the antitrust exemption for health insurers.

Support for a public option runs high in opinion surveys. But opposition from influential interest groups stands as a formidable barrier. It's not just the insurance industry, but many medical providers and businesses big and small. One group, the National Federation of Independent Business, praised the Finance Committee for passing a bill with no government option and no requirement that employers offer coverage. But if Reid and the Democrats stick either of the two back in, "they will derail health care reform altogether," warned NFIB vice president Susan Eckerly.

NFIB, which represents small businesses, is well known in the health care debate. It was instrumental in killing then-President Bill Clinton's health care plan in the 1990s.

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The Trouble With Health Care Is Paying For It

The legislative process can also be a learning process, and as Congress considers health care legislation -- the latest act being the Senate Finance Committee's vote in favor of Chairman Max Baucus' bill, or "conceptual language" -- we have been learning something useful. It's that legislators would like to provide generous, even gold-plated health insurance coverage to almost all Americans, but that no one wants to pay for it.

The learning process should have started last February, when Congressional Budget Office Director Douglas Elmendorf indicated that the CBO did not back the Obama administration's assertion that preventive care would save money. But it still came as a shock when the CBO confirmed its preliminary finding in its June assessments of the cost of Senate Democrats' bills.

This should have been obvious all along. Early screening can reduce the cost of treating a particular patient. But the costs of early screening add up when you test lots of people who will never need such treatment. So much for "bending the cost curve" down by preventive care.

Then House committees passed a bill financed in part by a "millionaire's tax." But freshman Jared Polis of Colorado, a successful entrepreneur, and 20 other House Democrats came out against that, on the reasonable theory that a tax on high-earners is a job-killer in today's economy. And tax increases on high-earners, thanks to creative accountants, never net as much revenue as static analysts like the CBO predict.

Baucus' bill would impose $829 billion in added costs, financed by a variety of taxes and spending cuts that are just as dubious. One is a tax on so-called Cadillac health insurance plans. But unions that have negotiated such plans are opposed, and House Democratic leaders are uninterested. Another is a tax on makers of medical devices that will be paid for by consumers. Critics have pointed out that most of these taxes will fall on people with ordinary incomes, far below the $250,000-plus moguls that Barack Obama said would bear all his tax increases.

Another Baucus tax is the penalties that would be paid by those who don't buy health insurance. But the penalties in his bill are so low that many will choose to pay them and go uninsured, thus foiling the goal of lowering the uninsured percentage. And as the insurers' lobbying group has pointed out, this will increase premium costs for those who are insured -- a form of tax on those behaving the way Baucus wants.

Then there are the Medicare cuts that supposedly would finance the Baucus bill. But this Congress can't bind future Congresses, and Congresses controlled by both parties have regularly cancelled projected cuts in reimbursement rates. Democratic leaders have made this easier by exempting such actions from its pay-go rules.

So as Michael Cannon of the Cato Institute points out, "Universal coverage is so expensive that Congress can't get there without taxing Democrats." So when those taxes are cut on low and middle earners, there's not enough money to finance the deals the White House has been making with health care interest groups.

The insurers and medical device people are squawking now -- look for more squawking from pharmaceutical companies, hospitals and physicians' groups when they get targeted. House Speaker Nancy Pelosi has made it clear that she doesn't feel bound by deals the White House has made.

The Senate Finance Committee got bipartisan cover from Maine Republican Olympia Snowe. But Snowe says she was just voting to "continue the process" and won't necessarily vote for the bill Senate leaders will meld from the Finance and Health committee versions.

So the learning process may not be over. We know now that it costs a lot of money to pay for insurance policies with expanded coverage for an expanded number of people. And we know that no one wants to pay the price.

We may be in the process of learning something else. Which is that insurance coverage that further insulates patients from costs results in unanticipated increases in health care spending. Yes, it bends the cost curve, but in the wrong direction. That's what has happened with the much-praised Massachusetts system.

Democratic leaders may still have the votes to jam something through. In which case it could, as the Atlantic's Megan McArdle predicts, "spin out of control and eat a gigantic hole in the deficit." Who's going to pay for that?

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Health Care 'Reform' -- Getting Less for More

The Democratic-controlled Congress reached another hurdle in achieving health care "reform." The Senate Finance Committee passed a version, 14-9, with one Republican vote. At last, "bipartisanship"!

It requires people to get health insurance, expands Medicaid, provides tax credits to help low- and middle-income people buying coverage, creates "health insurance exchanges" for individuals and small businesses, and requires employers who don't offer coverage to help pay for employees' government-subsidized coverage.

The price? No one really knows -- and few really care. The only certainty is that whatever Congress says it will cost will fall woefully short of the real cost. Cost projections as grossly inaccurate as the ones government gave for Medicare and Social Security could land someone in the private sector in jail.

The Congressional Budget Office projects a cost of $829 billion over 10 years. But the CBO claims it actually would reduce the federal deficit by $81 billion! How? "Reform" curbs the growth of spending on federal health care programs. In Washington, when predicted future spending rises less than previously projected, we've "saved" money. The legislation would impose taxes on health insurers, pharmaceutical companies and medical device companies.

Under this latest legislation, insurance companies could not deny coverage or charge more for pre-existing medical problems. Initially, the insurance companies went along with that because they expected Congress to require everybody to get coverage. This would mean a windfall to the insurance companies. But wait! The bill would soften the penalties for those who fail to get insurance, and the insurance companies now oppose the bill. "The bill imposes hundreds of billions of dollars in new health care taxes and provides an incentive for people to wait until they are sick to purchase coverage," said Karen Ignagni, CEO of America's Health Insurance Plans -- an expense to insurance companies that would be paid for by all their customers.

Meanwhile, this latest bit of legislation needs to be reconciled with a measure passed by another Senate committee back in July. And a whole host of heavily Democratic-backed options are still on the table -- including requiring businesses to cover employees and a government-run public option.

It's not as if some states haven't tried this kind of something-for-nothing health care. Hawaii offered universal child health care -- for seven months. Then it dropped the plan. Why? People (and employers) with private plans dumped them to ride the "cheaper" government train. One of Hawaii's health care administrators lamented, "I don't believe that was the intent of the program." And Hawaii is a small state, without nearly the number of "health insurance needy" as we have on the mainland.

Several New England states offer health care "reform," using most of the ideas floated by the Obama administration. Vermont, Maine and Massachusetts all have "guaranteed issue," forcing insurance companies to provide insurance to everybody -- regardless of an individual's health conditions. And insurers can't charge different rates based on factors such as a person's state of health, age or gender -- a policy called "community rating." Maine also offers a "public option" (a government-run plan with taxpayer-subsidized premiums that competes with private plans), and Massachusetts imposes an "individual mandate" that requires everyone to purchase insurance.

New England boasts that its number of uninsured has gone down (although not as much as predicted). But health care in New England now costs more than anywhere else in America. Many insurance companies just abandoned these states, resulting in less competition and higher premiums. As health care subsidies consume more and more of the states' budgets, they turn to higher taxes, rationing and, excuse please, cost containment.

The Council for Affordable Health Insurance is a research and advocacy organization that includes, among others, free-market-oriented health care providers. It examined current rates in Massachusetts, the only state with "individual mandate," "community rating" and "guaranteed issue." The cheapest plan available for a family of four -- with a $3,500 deductible -- is more than $9,000 a year, and the most expensive is more than $19,000 a year. This about doubles what families currently pay in most other states.

"Reformers" point to the "unfair" number of claims turned down by private insurers. But Medicare, as a percentage of claims filed, actually turns down more than do non-government carriers. According to the American Medical Association, Medicare turns down 6.85 percent of claim lines, followed by Aetna at 6.8, Anthem at 4.62, Health Net at 3.88, Cigna at 3.44, Coventry at 2.88 and UHC at 2.68. All private carriers combined averaged a denial rate of 4.05 percent, making Medicare's rejection rate 170 percent higher!

Hold on to your wallets.

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Swing State Senators Face Health Care Reform Threat -- Losing Next Election

By and large, the pundit class has it that momentum now favors passage of a national health care program. There's a fly in the ointment, however. Too many of the Senate Democrats needed to pass such legislation hail from states where even if the concept of health care reform is tepidly endorsed by the people, that support breaks down when ways of actually paying for reform are considered. So ultimate passage of any bill is problematic.

Take the swing state of Florida. Democratic Sen. Bill Nelson is a moderate Democrat. Since our recent InsiderAdvantage survey of Florida shows a state equally divided on the issue, Nelson conceivably could vote for a health care bill. His problem is to figure out what to support in the funding of the bill. The state's senior population is dead-set against any more cuts in Medicare benefits. And they aren't wild about the reductions proposed for the Medicare Advantage program.

But other alternatives put forth in Washington, like a tax on sodas and sweet drinks, or even a tax on financial transactions, such as the sale of stocks or other equities, get low marks from the voters, too. Signing on to almost any of the proposed ways of paying the health care piper would likely be more politically fatal to a senator than voting for the reform bill itself.

In North Carolina, another presidential swing state, Sen. Kay Hagan's approval ratings have plummeted since her election last year. She could easily seal her eventual political fate this year. When she runs again five years ahead, she could be sunk by charges that her support for a health care bill triggered any number of finance mechanisms that might ultimately be needed to pay for it. The list of moderate Democrats in similar straits is not short.

And then there's the idea of charging a fee on Americans who don't sign up for health care under whatever reform bill that might emerge. Polling suggests that any lawmaker that supports that neat little twist might be doing the political equivalent of swallowing a time-released poison pill.

Most amazing is that Congress continues to fret feverishly on a potentially unworkable and even disastrous health care bill while so many other pressing issues go unaddressed. The suddenly resurgent stock market may be misleading Washington into thinking our economy has at last passed "Go" again.

Tell that to the people in most states, like Sen. Nelson's Florida. Voters there continue to say the recession has negatively affected them. A majority says Florida's economy is either as bad as or worse than it was six months ago.

My bet is that the oh-so-critical-vote in the Senate Finance Committee for a health care reform bill by the lone Republican to do so, Olympia Snowe of Maine, will melt like a snow cone in July before this whole reform movement plays out. Snowe tied her vote to enough caveats to allow her plenty of room to back away from whatever the final bill entails.

Recently, Newsweek extolled the virtues of Vice President Joe Biden. (Biden does seem to be one of the more likeable people in the administration.) The magazine noted that Biden had cautioned President Obama early on that it might not be wise to take on health care reform in his first year in office. That's likely because Biden's deep institutional knowledge of the Senate told him that no matter how excited the Democratically controlled House might get over a health care reform effort, his more moderate colleagues in the Senate would be given pause by being placed in the ultimate political pickle.

As of late this week, the pickle jar was still full of moderate Democratic senators. They continue to praise some form of national health care bill, but one by one, they're all coming to the realization that erasing the potential perils and pitfalls of such legislation may not be possible. They're right. The plan is too ambitious.

No matter how the pundits try to tell us that a significant bill will pass this year, I have trouble buying it. Too many polls in too many states -- states represented by moderate senators -- say that while the notion of health care reform is marginally palatable, the details turn the stomach.

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Senate Dems Stealing $247 Billion from Your Children to Pay for Obamacare

According to the Associated Press, at the direction of White House Chief of Staff Rahm Emanuel, Senate Democrats are plotting to pass a bill, by as early as next week, that grants doctors a $247 billion increase in Medicare fees over a decade. This will no doubt add to the deficit. Why are the Democrats so intent on spending $247 billion in one week? To pave the way for the White House to claim that Obamacare is deficit neutral.

Senate Majority Leader Harry Reid (D-NV) and Senate Democratic Leadership are meeting, as you read this, behind closed doors with White House staff . They are trying to cut and paste the complex provisions of the Senate Finance Committee health bill (the Baucus Bill) and the Senate Health, Education, Labor and Pensions bill ( the Kennedy-Dodd bill). They want to produce an overhaul of one sixth of the economy under federal control that is somehow coherent and yet not add “one dime,” as President solemnly promised, to the deficit.

The Senate leaders know that when they cobble all of this together they are going to have a big problem making the numbers come out right. So, fellow citizens, they are contemplating a classic shell game: Hide the increased spending under the shell of different bills. For example, Sen. Debbie Stabenow (D-MI) is proposing separate legislation (S.1776) that would repeal the Medicare payment update formula (one of the more bizarre Congressional administrative pricing creations), and the result would be a $247 billion increase Medicare spending by $247 billion. For the Senate leaders, it’s a neat little way around the public appearance of aggravating the already enormous “deficit problem” They raise ten year health spending by $247 billion, but keep it out of the Senate health bill. That way, they’ll be able to claim, with sort of a straight face, that the Senate’s final product, crammed with additional spending, is still “deficit neutral.”

It’s like maxing out on the company credit card. Then, to show the accountants that one is not running up debt on the card, one simply goes out and buys a new credit card. Then, continue to run up more debt on the new one. How convenient.

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16 October, 2009

Horrible British bureaucrats bar ambulance crew from helping girl, 9, with fractured skull 'because they were having their lunch'

And they are not backing down either. To their socialist brains, what they did was right. Fortunately, the paramedics themselves had a conscience

Ambulance staff battling to save a nine-year-old car crash victim were told the nearest back-up crew could not help as they were on their lunch break.

Bethany Dibbs was struck by a car as she crossed the road on her scooter and ended up in a coma with a fractured skull. An ambulance crew arrived and called for help, only to be told by their operator that under strict meal break regulations the closest additional crew still had a few minutes left on their lunch break. The paramedics were informed it would take 20 minutes for another crew to arrive.

In the end one of them called their colleagues directly and they abandoned their lunch and raced to help. They arrived only five minutes after the original crew and took Bethany to hospital.

An ambulance worker, who asked not be named, said: 'There isn't one staff member who would not go, but we have to be given two 30-minute meal breaks and can't be interrupted. It's a joke.'

Bethany's father Stephen 48, of Poole, Dorset, said: 'The world really has gone mad. 'My little girl was lying unconscious in the road and they are quoting statutory health and safety regulations? Every second counts in that situation. 'Bethany is recovering but she's still got a long way to go. We're waiting to find out whether she has any long-term brain damage.' Mr Dibbs added: 'I can't fault the paramedics. They were fantastic. It is the system.'

A spokesman for the South Western Ambulance Service Trust said it took its health and safety duties seriously. He added: 'In line with national guidelines which must be adhered to by all ambulance trusts, it is important all staff have dedicated 30-minute rest breaks which cannot be interrupted.'

SOURCE




Half of British hospitals do not fully meet core care standards, says regulator

Almost half of hospitals fail to meet fully the core standards of care despite a decade of Government investment in the NHS, according to the health regulator’s annual report. The Care Quality Commission (CQC) warns today that more than 40 health trusts are at risk of being refused new licences to operate, which will be issued next April.

The report, an annual assessment of quality of care and financial management of NHS organisations, concludes that while there have been significant improvements in waiting times, tackling superbugs and controlling budgets, many trusts are still failing the basic requirements of good care. These include the number of patients having operations cancelled, heart disease care, record keeping, infection control and child protection.

Cynthia Bower, the chief executive of the CQC, warned that there needed to be rapid improvements to meet the legal demands of the new registration scheme, which could see failing trusts hit with a range of sanctions, including fines, suspension of services and prosecution.

The registration process risks embarrassing the Government, which has spent an extra £50 billion in real terms on the NHS in the past ten years. It will take place weeks before a general election, widely expected for May 6.

The annual appraisals rate every trust in England from “weak” to “excellent” based on information provided by trusts, inspections, patient feedback and audits of hospital finances. Of the 392 organisations assessed in the year to March 2009, including hospital, primary care, mental health and ambulance trusts, only 58 scored “excellent”, compared with 100 last year. However, there was a rise in the number that scored “good” (186) and slight decreases in the numbers that were “fair” (128) and “weak” (20).

Ms Bower said that the most worrying trend was the number of trusts that continued to “bump along the bottom” despite repeated warnings. “They must do better for their patients. I want to ring alarm bells in the boardrooms of these organisations,” she said. She added that part of the fall in top ratings was down to a more rigorous focus on key issues such as hygiene and child protection.

Politicians and health specialists questioned why the NHS was improving so slowly and warned that the current economic climate would only make improvement harder. The Government set out essential care benchmarks to be met by all trusts as a matter of urgency more than five years ago in Standards for Better Health.

Niall Dickson, chief executive of the King’s Fund, said that the minority of trusts that repeatedly failed to sort out basic issues such as hygiene, patient safety and staff training were a cause for concern. He added that given current standards had been achieved in a period of funding growth, the big challenge would be maintaining the status quo.

The CQC raised registration concerns about a total of 47 trusts, 20 of which are rated “weak” and 27 that have not been higher than “fair” over the past four years. It said that the drop in the number of hospitals fully meeting the core standards — from 69 per cent in 2007-08 to 59 per cent this year — also needed highlighting.

A total of 37 trusts were rated “double excellent” on quality and financial management, including the Royal Marsden NHS Foundation Trust, which achieved the standard for the fourth year in a row. Only one trust, Barking Havering and Redbridge University Hospitals Trust, scored a “double weak” — an improvement on the six trusts receiving the rating last year.

The regulator has written to 54 trusts to congratulate them on consistently strong performances or improvements. “Those rated ‘excellent’ deserve to be commended,” Ms Bower said. “But it is clear that some trusts are struggling and that some issues are proving tough nuts to crack. It is clear that many have significant work to do and a short time in which to do it.”

Andrew Lansley, the Conservative health spokesman, said that the regulator’s report showed that the level of improvement was not as it should be. “Given the increases in taxpayers’ money spent on the NHS, patients rightly expect that basic standards will be consistently met and will actually improve year on year,” he said. “This has clearly not happened.”

Mike O’Brien, the Health Minister, said that the “tough assessment” showed improving standards across the NHS. He said that the Government expected “immediate action” to prepare trusts rated as “weak” for the new standards next year.

SOURCE




'We're Going to Let You Die'

Who said it? Hint: It wasn't Sarah Palin

If you're not part of a special interest but just a regular American who hopes one day to grow old (because it beats the alternative), NewsBusters.org has a timely reminder that proponents of "health-care reform" don't necessarily sympathize with that aspiration. NewsBusters links to another Morgen Richmond YouTube clip, this one of a speech that Robert Reich, who served as President Clinton's labor secretary, delivered on the subject in 2007:

I will actually give you a speech made up entirely--almost at the spur of the moment, of what a candidate for president would say if that candidate did not care about becoming president. In other words, this is what the truth is, and a candidate will never say, but what candidates should say if we were in a kind of democracy where citizens were honored in terms of their practice of citizenship, and they were educated in terms of what the issues were, and they could separate myth from reality in terms of what candidates would tell them:

"Thank you so much for coming this afternoon. I'm so glad to see you, and I would like to be president. Let me tell you a few things on health care. Look, we have the only health-care system in the world that is designed to avoid sick people. [laughter] That's true, and what I'm going to do is I am going to try to reorganize it to be more amenable to treating sick people. But that means you--particularly you young people, particularly you young, healthy people--you're going to have to pay more. [applause] Thank you.

"And by the way, we are going to have to--if you're very old, we're not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for another couple of months. It's too expensive, so we're going to let you die. [applause]

"Also, I'm going to use the bargaining leverage of the federal government in terms of Medicare, Medicaid--we already have a lot of bargaining leverage--to force drug companies and insurance companies and medical suppliers to reduce their costs. But that means less innovation, and that means less new products and less new drugs on the market, which means you are probably not going to live that much longer than your parents. [applause] Thank you."

As noted in our transcription, Reich's Berkeley, Calif., audience applauded the idea of taxing the young, killing the old, and stifling lifesaving innovations. One suspects that these ideas would not be greeted as warmly in most other American locales, which is why elected politicians who are actually trying to sell such ideas cloak them in euphemisms about "universal care," "reform," "cost cutting" and so forth.

Liz Hunt of London's Daily Telegraph reports on an even more chilling euphemism used in a country that long ago instituted "health-care reform":

"Mrs ------- has breathing difficulties," the night manager told her. "She needs oxygen. Shall we call an ambulance?"

"What do you mean?" my friend responded. "What's the matter with her?"

"She needs to go to hospital. Do you want that? Or would you prefer that we make her comfortable?"

"Make her comfortable." Here's what that meant:

Befuddled by sleep, she didn't immediately grasp what was being asked of her. Her grandmother is immobilised by a calcified knee joint, which is why she is in the home. She's a little deaf and frail, but otherwise perky. She reads a newspaper every day (without glasses), and is a fan of the darling of daytime television, David Dickinson. Why wouldn't she get medical treatment if she needed it?

Then, the chilling implication of the phone call filtered through--she was being asked whether her grandmother should be allowed to die.

"Call an ambulance now," my friend demanded.

The person at the other end persisted. "Are you sure that's what you want? For her to go to hospital."

"Yes, absolutely. Get her to hospital."

Three hours later, her grandmother was sitting up in A&E [the accident-and-emergency ward], smiling. She had a mild chest infection, was extremely dehydrated, but was responding to oxygen treatment.

As Hunt notes, "Withdrawal of fluids (and drugs) is one of the steps on the controversial palliative care programme known as the Liverpool Care Pathway, which has been adopted by 900 hospitals, hospices and care homes in England."

More here




The destructiveness of mandates

Because of regulations, New Jersey insurance costs are among the highest in the nation

A state requirement that health insurance must cover mammograms has come to play a central role in the New Jersey gubernatorial race between incumbent Democrat John Corzine and Republican challenger Chris Christie.

The Corzine campaign has flooded the airwaves with an ad claiming that "if Chris Christie was governor, insurance companies could drop mammogram coverage." Mr. Christie went from a 28-point lead in August among independent women to a one-point deficit earlier this month, according to the Monmouth University Polling Institute. But how true is the Corzine claim, and how effective are state mandates in improving health coverage?

State mandates make health insurance more comprehensive, but they also make it more expensive. A state can easily increase the cost of a basic health insurance policy by 25%, depending on the number of mandates it has and what they cover. The higher premiums drive some into the ranks of the uninsured.

New Jersey has arguably the highest health insurance premiums in the country, and health insurance mandates (the state currently has 45, about average for the country) are one reason.

In the early 1990s, New Jersey also passed legislation requiring insurers to accept all applicants, regardless of their health status (guaranteed issue) and charge them all the same price (community rating). President Barack Obama wants to do the same thing nationally.

There were repeated warnings that such legislation would drive up health insurance premiums. But New Jersey legislators ignored those warnings. Today, New Jersey residents have relatively few health insurance options, and coverage is significantly more expensive than in most other states. Just across the state line in Pennsylvania, for instance, a family can buy a comparable insurance policy for a quarter to half the price.

Mr. Corzine didn't create the New Jersey health insurance mess, but in the past four years he's done nothing to fix it. Yes, New Jersey has a mammogram mandate that requires insurers to cover the roughly $100 annual procedure. But that's little consolation to an uninsured person who's been priced out of the market for health insurance because of all the other requirements mandated by the state.

In order to address these problems, Mr. Christie has suggested giving people access to policies with fewer or no mandates. New York has done that for lower-income families, and it's been very popular.

In an Oct. 1 debate, Mr. Christie argued that there should be a range of polices available in New Jersey from "high-end" to "more bare-bones," and that "people should make a determination on their own" which policy they want. He emphasized choice, with the ultimate aim of giving patients access to "some kind of insurance rather than continue to have no insurance at all."

Mr. Corzine explicitly defended benefit mandates, even going so far as to claim his position on the issue is "one of the clearest differences between me and my opponent."

As for the Corzine ad about mammogram coverage, Mr. Christie denounced it as "deceitful." He's right. After all, not requiring health insurers to cover mammograms doesn't mean they won't. Large employers that "self-insure" (meaning they pay claims themselves, even though an insurer may handle the paperwork) come under federal, not state, law, and so are not subject to state mandates. And yet most employer-based plans cover mammograms without a government mandate. Why? Because it saves money and lives in the long run.

New Jersey could also allow its citizens to buy health insurance from other states—another Christie proposal. If New Jersey isn't willing to change its laws so that families can get affordable coverage, the state should at least let those families buy coverage in another state.

Mr. Corzine has tried to make the case that he is the only candidate protecting women and fighting breast cancer. Nonsense. His unwillingness after four years to do anything about the high cost of health insurance in New Jersey is increasing the number of uninsured and doing far more harm than any mandate-lite policy could ever do.

SOURCE




Here's what is stopping tort reform

In his September 9, nationally televised speech before a joint session of Congress, President Obama made news by saying that medical-malpractice litigation "may be contributing to unnecessary costs" in the U.S. health-care sys¡©tem.

Since then, trial-lawyer advocates--including their lobbying arm, the American Association for Justice (AAJ), and various allied "consumer" groups such as the Center for Justice and Democracy--have been engaged in a fierce counter-attack. Front-and-center among the lawyer-advocates' arguments is that litigation is too small a piece of the health-care puzzle to make much difference.

In a letter to Senate Finance Committee chairman Max Baucus, such self-styled consumer groups claimed that costs consumed by medical-malpractice litigation represent "less than 0.6 percent of all health care spending."

To reach this number, the groups are playing a deceptive fraction game, in which they embrace a small numerator based on a ridiculously narrow interpretation of litigation costs and a large denominator encompassing every dollar spent on health care.

The lawyer-allies would count as litigation expenses only the malpractice litigation claims paid out directly by insurance companies in a given year. Conveniently, the lawyers' advocates ignore self-insured hospitals and legal-defense costs, not to mention defensive medicine--the cost of excessive tests, procedures, and referrals that doctors order due to fear of liability.

Ninety-three percent of doctors say they have practiced defensive medicine, and the real cost savings from reforming malpractice liability stem from curbing such wasteful practice. Academic researchers have reached different conclusions on how much money tort reforms save by preventing defensive medical practice, ranging from two percent of all health costs in some studies to as much as nine percent in others.

Such a percentage itself is much larger than it might seem. If we look at the difference in U.S. health spending relative to that in other developed countries--such as Canada, Germany, or France--medical-malpractice reform would eliminate anywhere from six to 27 percent of all additional health costs.

While defensive medicine costs a lot, it is hardly the only cost-escalation stemming from lawsuit abuse. The lawyers' advocates try to ignore the vast health-related litigation, apart from medical-malpractice lawsuits, which targets nursing homes, pharmaceutical manufacturers, and HMOs.

And the cost of this litigation matters, too. From 1992 to 2003, the cost of litigation per nursing-home bed rose 700 percent. When trial lawyers almost sued the vaccine manufacturers out of existence in the 1980s, they drove up vaccine prices as much as 4,000 percent.

After that vaccine-liability crisis, Congress acted responsibly to establish an alternative compensation system outside the tort system, which hurt the trial bar's profits but preserved the vaccine markets. But Congress will not take any meaningful steps to curb lawsuit abuse as a part of comprehensive health reform this year, notwithstanding that 83 percent of the American public wants them to do so.

The reason is clear - money. The trial lawyers' political action committee is the second-largest donor to Democrats' federal campaigns, and lawyers gave $127 million to Congressional candidates in the 2008 political cycle--more than doctors and health professionals, hospitals and nursing homes, pharmaceutical companies, and HMOs, combined.

As medical doctor and former Democratic National Committee chairman Howard Dean admitted in a town-hall meeting this summer, "The reason why tort reform is not in the bill is because the people who wrote it did not want to take on the trial lawyers."

It's a myth to think that liability reform alone could cure the nation's health-care problems, but it is equally a myth to think it doesn't matter. Unfortunately, because of the trial lawyers' stranglehold on Congress, meaningful liability reform, this year, is simply wishful thinking.

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Obamacare Means $1,700 More in Insurance Premiums for a Typical Family

Will a young, healthy, childless individual or couple buy health insurance costing 7.5 percent of their income as required by Obama's health legislation? Not until they get sick. Then, they can always buy the insurance -- and the Obama bill requires the insurance companies to give it to them. And, if the premiums come to more than 7.5 percent of their income because they are now sick, no problem. Obama will subsidize it.

Instead, young, healthy, childless people will likely opt to pay the $1,000 fine (a.k.a., slap on the wrist) mandated in the bill. After all, even if they make as little as $50,000 a year, the fine is a lot cheaper than 7.5 percent of their income (or $3,500 a year)!

So ... these young households will not contribute to the coffers of any health insurance company until they are sick and need the coverage. By then, their costs will come to vastly more than their premiums.

Who will subsidize the difference? We will. The insurance industry estimates that the bill will drive up premiums for the average family by $1,700 a year. By the time the bill takes effect in 2013, it estimates that the average annual family health insurance premiums (now $12,300) will rise to $17,200 if the Obama bill is passed, but only to $15,500 if it is defeated. And who do you think the voters will blame for the hike in their premium? The Democrats who passed the bill.

Supporters of the bill are quick to counter that greater efficiency, etc. will hold down premiums. But they have little to answer the argument that, without higher fines, the young and healthy will not consent to pay an arm and a leg for insurance they don't need.

Any lingering motivation to pay the premiums will disappear once the Obama bill requires insurance companies to cover them when they do, finally, limp in the door, desperately in need of insurance. Why pay now when you can always pay later? And, with a government subsidy, you gain nothing by paying for all those years when you don't need insurance.

So Obama's program turns out not to be one to spread insurance and thus spread the risk of costly illness, but one to make people pay 7.5 percent of their incomes once they get sick, with the government picking up their remaining premium and the health insurance customers paying for the medical expenses. Some deal!

So tote up the cost of this bill on the middle class:

-- $1,700 more in insurance premiums for the average family.

-- Medical devices like wheelchairs and hearing aids get taxed.

-- Those who are sick must pay an average of about $600 more a year in income taxes because the bill raises the threshold for deducting medical expenses from 7.5 percent of income to 10 percent.

-- A $404 billion cut in Medicare.

-- Ending the subsidized Medicare Advantage insurance for costs over and above Medicare. Without Medicare Advantage, the elderly can only augment Medicare by buying Medigap coverage for which no subsidy is available and whose premiums are higher (offered, conveniently enough, by Obama's buddies at the AARP).

-- No importation of Canadian medicines and no competitive bidding to hold down prescription drug costs (Obama's deal to get Pharma's support and advertising dollars).

-- A shortage of medical personnel and equipment as 30 million new patients are added without any expansion of the population of doctors and nurses. This shortage will make rationing inevitable, even if it shortens life expectancies among the elderly.

And, all of this assumes that the House bill, which imposes a 4.5 percent payroll tax (which will discourage new employment), does not pass -- and that the cost estimates of this program prove realistic. Despite the Congressional Budget Office's concurrence, one can't help noticing that Massachusetts' program was estimated to cost $200 million in 2005 and now costs $700 million!

This health care bill is, indeed, Obama's first tax on the middle class.

SOURCE





15 October, 2009

Baby left severely brain-damaged by negligent hospital in socialist Britain

Arun Rees was born with severe brain damage after hospital staff waited 90 minutes to deliver him, starving his brain of oxygen. The medics failed to spot he was suffering complications in the womb, with one doctor even recommending that his mother simply needed to go the toilet.

Miss Rees’s pregnancy had already been judged high risk because she was 44 and had previously suffered a miscarriage. She was admitted to the University Hospital of Wales in Cardiff at 32 weeks suffering from abdominal pains but says she was not properly treated for more than two hours even though heart monitor readings ‘clearly showed’ the baby was in distress. She said: ‘I just couldn’t understand why they weren’t doing anything to help me and my baby. ‘At my last antenatal visit I was told my baby was breech and I would need a Caesarean section. It was a no-brainer – I knew my baby needed to be delivered urgently. I was screaming in agony and begging the midwives to get my baby out but they just left me. ‘I couldn’t believe it when a doctor arrived and said I wasn’t ready to deliver but had probably eaten something that had disagreed with me and to try going to the toilet instead.’

Eventually an emergency Caesarean was performed an hour and a half later on a second doctor’s recommendation. Arun was taken to the special baby care unit after he was delivered but had suffered irreversible brain damage. Miss Rees and Mr Govekar switched off his life support machine after ten days.

The couple who own a restaurant in Penarth, South Wales, said their lives had been completely devastated by the death of their son. Miss Rees, now 48, said: ‘After the upset of an earlier miscarriage, we were both thrilled when I became pregnant again. It was all we wanted and it was taken away from us.’ She added: ‘As far as I am concerned the hospital has robbed me of a family. I am 48 now, I will probably never have a family.’

The couple spoke yesterday after winning a four-year battle for an apology from the hospital along with £160,000 in compensation. Mr Govekar, also 48, said: ‘The last four years have been a relentless battle to gain answers. Arun’s death has taken its toll on us both. ‘It has affected our health, our ability to work and at times it threatened to break up our relationship completely. ‘We can only hope that we can now move forward with our lives.’

Their solicitor Guy Forster added: ‘Although baby Arun was premature he was well developed and experts have confirmed that in all likelihood he would have survived had the staff taken appropriate action.’ He continued: ‘For Johanne and Krishna, this case has never been about the money but about ensuring that lessons have been learned, as they do not want any other couple to go through the tragedy they have experienced.’

Katie Norton, director of primary services for the Cardiff and Vale University Health Board, said: ‘This was an exceptional and difficult case and we have worked with the staff to learn lessons. ‘I want to apologise again unreservedly on behalf of Cardiff and Vale University Health Board for the distress that Ms Rees and Mr Govekar have experienced and offer our sincere condolences to them.’

SOURCE




Australia: Government hospitals operating at dangerous capacities

Not one hospital in Sydney is operating at a safe level, with patients waiting longer for elective surgery and in emergency, the latest AMA Public Hospital Report Card says. Australian Medical Association NSW president Brian Morton said average waiting times for elective surgery patients in NSW had "significantly increased". This meant that one in four patients needing semi-urgent surgery, such as the removal of a breast lump, were being put at risk, Dr Morton said. "Our public hospitals are being forced to operate dangerously above capacity, compromising patient safety and quality of care," he said.

He said all major metropolitan hospitals including Westmead and Royal North Shore were often forced to operate at 95 per cent capacity or higher, which is well above the benchmark of 85 per cent.

Dr Morton said that a cash boost of $448 million by the Federal Government in 2007-08 had clearly not improved public hospital performance and partly blamed NSW Health for cutting its expenditure by $7 million for that year. He said that, to keep up with inflation, NSW should have provided about half a billion dollars in funding.

The performance of emergency departments was worse for 2008-09 than in 2006-07. Only 66 per cent of category three patients (urgent, to be seen within 30 minutes) were seen within the recommended time in 2008-09, compared with 71 per cent in 2006-07. Also, the percentage of category two elective surgery patients (recommended to be seen within 90 days) seen within the recommended time was 75 per cent for 2008-09, an increase of only 1 per cent from the previous year. The median waiting time for elective surgery has increased by four days to 39 days.

Australian Medical Association president Dr Andrew Pesce said it was the worst AMA report card ever. He said the Rudd Government and the states needed to be more transparent about where extra funding was going because it was not improving patient care. Even worse, the true waiting lists were hidden because many patients were waiting even to get on a list, he said.

SOURCE




Health bill doubters remain in spotlight

All eyes were on a moderate Republican with continued misgivings about affordability, a fiscally conservative Democrat worried about the deficit, and two liberals who wish the bill included a so-called "public option" as a health care overhaul bill cleared a major hurdle Tuesday.

All four Senate Finance Committee members voted in favor of the bill, but their concerns highlight the fault lines taking shape as the full chamber prepares to tackle health care reform.

Sen. Olympia J. Snowe of Maine was the only member to cross party lines in Tuesday's vote, though the Republican was quick to issue the caveat that her support did not guarantee a vote on the final package. "Is this bill all that I would want? Far from it," Mrs. Snowe said of Finance Committee Chairman Max Baucus' $829 billion plan, which was approved by a vote of 14 to 9. "There are many, many miles to go."

The Finance bill would extend health care coverage to millions of the uninsured, largely by expanding eligibility for Medicaid as well as by providing tax credits for individuals and families to satisfy a mandate requiring Americans to have insurance. Instead of a public option, the bill would create a network of nonprofit insurance cooperatives.

Mrs. Snowe cited numerous reservations with the legislation, chief among them affordability and the potential for "vast governmental bureaucracies." She also said she was apprehensive of how the Finance bill could change as it gets combined with a more liberal version from the Senate health committee, which includes a public option.

Of course, a big change is just what some Democratic members of the Finance Committee said they were counting on when they cast a vote in favor of the bill. Sen. John D. Rockefeller IV of West Virginia, who publicly was undecided prior to the vote, long bemoaned the absence of a government-run plan that he said would foster competition with private insurers. "It's regrettable to say so, but I believe the bill before us still falls short of what people need and what people expect from us," Mr. Rockefeller said. "This bill does not go far enough to protect vulnerable populations."

Like Mr. Rockefeller, Sen. Ron Wyden, Oregon Democrat, questioned whether the Finance bill would produce sufficient competition that would lower costs, and he said consumers would still have only a few choices.

At the other end of the spectrum, Sen. Blanche Lincoln, Arkansas Democrat, said her constituents are frightened by skyrocketing deficits and skeptical of lengthy health care bills. Mrs. Lincoln said she would like the bill's legislative language as well as the full cost estimate posted online for the public before a full Senate vote.

Americans are "alarmed about big bills that are difficult for them to understand, and they need to have time to look at them, just as we do, to ensure we get it right," she said.

Political operatives of both stripes pounced on the highly anticipated vote. The Senate Republican campaign arm took aim at Mrs. Lincoln for voting to "increase health care costs for American families." Meanwhile, the Democratic campaign organization blasted Republican Sen. Charles E. Grassley of Iowa for voting to "kowtow" to his party's right wing, aligning himself with insurance companies.

SOURCE




We've Figured Him Out

By Ben Stein

Why is President Barack Obama in such a hurry to get his socialized medicine bill passed? Because he and his cunning circle realize some basic truths:

The American people in their unimaginable kindness and trust voted for a pig in a poke in 2008. They wanted so much to believe Barack Obama was somehow better and different from other ultra-leftists that they simply took him on faith.

They ignored his anti-white writings in his books. They ignored his quiet acceptance of hysterical anti-American diatribes by his minister, Jeremiah Wright.

They ignored his refusal to explain years at a time of his life as a student. They ignored his ultra-left record as a "community organizer," Illinois state legislator, and Senator.

The American people ignored his total zero of an academic record as a student and teacher, his complete lack of scholarship when he was being touted as a scholar.

Now, the American people are starting to wake up to the truth. Barack Obama is a super likeable super leftist, not a fan of this country, way, way too cozy with the terrorist leaders in the Middle East, way beyond naïveté, all the way into active destruction of our interests and our allies and our future.

The American people have already awakened to the truth that the stimulus bill -- a great idea in theory -- was really an immense bribe to Democrat interest groups, and in no way an effort to help all Americans.

Now, Americans are waking up to the truth that ObamaCare basically means that every time you are sick or injured, you will have a clerk from the Department of Motor Vehicles telling your doctor what he can and cannot do.

The American people already know that Mr. Obama's plan to lower health costs while expanding coverage and bureaucracy is a myth, a promise of something that never was and never will be -- a bureaucracy lowering costs in a free society. Either the costs go up or the free society goes away.

These are perilous times. Mrs. Hillary Clinton, our Secretary of State, has given Iran the go-ahead to have nuclear weapons, an unqualified betrayal of the nation. Now, we face a devastating loss of freedom at home in health care. It will be joined by controls on our lives to "protect us" from global warming, itself largely a fraud if believed to be caused by man.

Mr. Obama knows Americans are getting wise and will stop him if he delays at all in taking away our freedoms. There is his urgency and our opportunity. Once freedom is lost, America is lost. Wake up, beloved America.

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Democrat speechwriter moves to Massachusetts, a state with universal health care, and she cannot afford the insurance there

For the first time in my life, I am without health insurance and it is a terrible feeling. In the past, I paid attention to the health care debate as a speechwriter who prepared speeches, talking points, op-eds, and debate prep material on the topic at different times for John Edwards, Barack Obama, Hillary Clinton and others. Now, I'm paying attention because I'm a citizen up the creek without a paddle.

Throughout my life, I have been very lucky because my insurance has always been there whenever I had a crisis. When my 10-speed hit a patch of leftover winter sand, and I went flying into a telephone pole, it covered the x-rays and stitches and concussion diagnosis. When a half a ton of sheet rock fell on me, my insurance paid for the cast on my foot. When my depression kicked in and I was hospitalized and painting ceramic pieces in art therapy to boost my self-esteem (sheesh), it made sure that when I got home my medical bills didn't make me reach for a razor. And when there were growths in my uterus, it covered that medical procedure and every regular check-up, lab test, broken bone, sports injury, and antibiotic prescription in between.

Since I care more about my country than my personal pride, here's how I lost my insurance: I moved. That's right, I moved from Washington, D.C., back to Massachusetts, a state with universal health care.

In D.C., I had a policy with a national company, an HMO, and surprisingly I was very happy with it. I had a fantastic primary care doctor at Georgetown University Hospital. As a self-employed writer, my premium was $225 a month, plus $10 for a dental discount.

In Massachusetts, the cost for a similar plan is around $550, give or take a few dollars. My risk factors haven't changed. I didn't stop writing and become a stunt double. I don't smoke. I drink a little and every once in a while a little more than I should. I have a Newfoundland dog. I am only 41. There has been no change in the way I live my life except my zip code -- to a state with universal health care.

Massachusetts has enacted many of the necessary reforms being talked about in Washington. There is a mandate for all residents to get insurance, a law to prevent insurance companies from denying coverage because of a pre-existing condition, an automatic enrollment requirement, and insurance companies are no longer allowed to cap coverage or drop people when they get sick because they forgot to include a sprained ankle back in 1989 on their application.

Even if the economy was strong and I was working more, I still couldn't afford my premium. I am not alone; I've got 46 million friends in a similar situation. We wake up every day worried that a bad cough, an accident while walking the dog, or that dreaded pain on the right side of the abdomen will send us into complete financial ruin.

As luck would have it, I didn't schedule a physical before I left D.C. I thought I could get that taken care of when I moved -- after all they had reforms, automatic enrollment, and universal coverage in Massachusetts, all the things I'd written about for politicians. Health care would be affordable. It didn't dawn on me that it would just be affordable for other people.

Now, sharing my experience doesn't make me an expert in health care policy anymore more than my knowledge that Kajagoogoo sings "Too Shy" makes me an expert in music. What my story does is serve as a cautious reminder that we need to get this right, not right away. A rushed bill will have consequences. Reforms will not be cheap and some people may be priced out.

How could all of these weeks and months go by and no one is examining and talking about what has worked and what hasn't worked in Massachusetts?

While the state has the lowest rate of uninsured, a report by the Commonwealth Fund states that Massachusetts has the highest premiums in the country. The state's budget is a mess and lawmakers had to make deep cuts in services and increase the sales tax to close gaps. The number of people needing assistance has at times overwhelmed the state. The mandate means that some people who can't afford insurance are now being slapped with a fine they also can't afford. There is no "public option" in the way the president describes it, no inter-state competition, no pool for small businesses and self-employed individuals like me to buy into groups that negotiate cheaper rates. So far I haven't found any "death panels," but if I get sick and need a hospital, I sure hope I can find one and a feisty granny to pull my plug.

What makes this a double blow is that my experience contradicts so much of what I wrote for political leaders over the last decade. That's a terrible feeling, too. I typed line after line that said everything Massachusetts did would make health insurance more affordable. If I had a dollar for every time I typed, "universal coverage will lower premiums," I could pay for my own health care at Massachusetts's rates.

More here




Democrats face two bad options on health plan

Congress faces two politically unpalatable options on health care: Higher fines for working-class Americans who don't buy insurance or increases in spending and taxes after insurance providers predicted huge increases in premiums under the main Democratic plan.

A report from America's Health Insurance Plans saying the cost of health coverage would be nearly 20 percent higher under a Senate Finance Committee plan -- $1,500 per year for an individual and $4,000 for a family -- has shaken things up in advance of a key vote scheduled for Tuesday.

The report blames a "weak coverage requirement" that might encourage younger and healthier individuals to opt to pay a new federal fine for not carrying insurance rather than paying for a more-expensive policy.

Insurers want the legislation to include stiffer fines for those who don't buy insurance. Higher fines would mean more subsidies to help people afford coverage, and that would raise the cost of the $829 billion plan. A more expensive plan means additional taxes and fees or further increasing the federal deficit.

The insurance industry report came as a blow to the White House and congressional Democrats, who had made a deal with industry leaders: New regulation and coverage requirements in exchange for millions of new customers forced into the system under a mandate. But experts say Democrats should have seen it coming, as the mandate was watered down significantly in the Finance Committee even as the regulations on the health care industry were stiffened.

"The health insurance industry made a calculation much earlier in the year that they would basically accept just about any regulation and requirement just as long as they had a guarantee of a captive customer base, which would mean a very strongly enforced individual mandate," said Thomas Miller, a health care expert with the American Enterprise Institute and a former senior health economist for the Joint Economic Committee.

The spokesman for AHIP, Robert Zirkelbach, said the Democratic plan will also drive up the cost of coverage by slashing Medicare payments, which he said would force medical providers to make up the cost by charging private health insurers more for services. Those costs would be passed on to the insured, he said. Zirkelbach told The Examiner that insurers want Democrats to consider cuts across the medical industry, not just for seniors. "If we are going to get cost under control it is essential to look at savings across the health care system," Zirkelbach said.

The finance committee is likely to approve the bill Tuesday. But the industry report will make it even harder to convince wavering party moderates to get on board when the measure goes to the full Senate.

"Without better subsidies to make health coverage more affordable, it is difficult to have the strong individual mandate that the insurance industry wants as the price for accepting more regulation," said Jon Oberlander, a health care policy professor at the University of North Carolina at Chapel Hill. "But making coverage more affordable means either adopting stronger cost control or raising more revenues to enhance subsidies, and neither of those are politically easy steps."

SOURCE





14 October, 2009

Man had beaten cancer, then British death panel wrongly told him it had returned and let him die

They refused to do tests which would have cleared him of having cancer. They WANTED him to die. Don't get old and sick under socialized medicine

Jack Jones was allegedly left to die after doctors decided his 'cancer' was terminal and stopped feeding him. His widow Pat has been paid an £18,000 settlement although health bosses refused to admit liability. To his family's horror, they were told he could have recovered if he'd been given the correct treatment.

Yesterday, after being given an £18,000 pay-out over her ordeal, his widow Pat branded his treatment 'barbaric' and accused the doctors of manslaughter.

Mr Jones was being cared for at a hospice which was central to the contentious Liverpool Care Pathway under which dying patients have their life support taken away, although the hospice claims it wasn't officially applied in his case. The scheme is used by hundreds of hospitals and care homes, and is followed in as many as 20,000 deaths a year. Supporters say it brings dignity to a patient's final hours, but critics fear that some are placed into it incorrectly.

Mr Jones, a retired bricklayer with two daughters, was diagnosed with stomach cancer in May 2005. After undergoing chemotherapy, he had his stomach removed by surgeons at Royal Liverpool Hospital that September. He was told he was in remission from cancer, but the grandfather of two continued to suffer pain following the operation as well as difficulties in eating, and on January 3, 2006, he went to the city's Marie Curie hospice for respite care.

While there, however, his family were told the cancer had returned by Dr Alison Coackley, a palliative medicine consultant who played a key role in drawing up the Liverpool Care Pathway. Despite the fact that no tests were carried out to confirm the diagnosis, his family say doctors instructed nurses to stop giving him food and fluids. The only medication he was permitted were painkillers, and he slipped into semi- consciousness without the chest infection being diagnosed and died on January 14.

But a post-mortem examination found he was free of cancer and had in fact died of pneumonia. Reports commissioned by Mrs Jones's solicitor concluded that with antibiotics and a rehydrating drip he could have made a full recovery and survived for at least another two years.

The hospice and the doctors who treated Mr Jones continue to deny liability, but his widow has now accepted an £18,000 out-of-court settlement after being told she would otherwise lose her legal aid. Yesterday she said: 'If they'd only treated his chest infection, my husband could well still be alive today. 'We fought in the hospice to get Jack the right treatment and they blocked us, making us feel we were a nuisance. 'I was worried it was pneumonia, I wanted them to check his chest, but they wouldn't.'

Mrs Jones and the family want to know whether her husband was treated under the Liverpool Care Pathway. She added: 'Jack was the life and soul of the party. He was a true gentleman. As far as I'm concerned, his death was manslaughter. It's barbaric and I don't want any other family to go through what we've had to.'

The 75-year-old, of Childwall, Liverpool, plans to report Dr Coackley and another doctor to the General Medical Council. Dr Coackley, 45, worked with Professor John Ellershaw at the hospice in Liverpool at a time when he was heading the writing of the LCP policy. One article they published together last year said: 'Futile treatments should . . . be discontinued at this time and consideration should be given to the discontinuation of antibiotics and blood tests.'

Mrs Jones's solicitor, Michael Danby, said: 'This is a particularly sad case as it was entirely preventable. If they had examined his chest, they would have diagnosed the infection, and he could have been treated.'

The hospice's lawyer, Dorothy Flower, said it had settled the case to enable Mrs Jones to grieve for her husband, but did not accept liability. 'Some things are done for economic reasons, and a case like this costs a huge amount of money, which would do nobody any good,' she said.

Marie Curie Cancer Care said it could not comment on Mr Jones's case due to patient confidentiality. However, it insists that the Liverpool Care Pathway requires doctors to monitor patients regularly.

SOURCE




Crooked British health bureaucrats defeated

Nasty secrets about ill-treatment of patients not sacrosanct. Nurse struck off for whistleblowing is allowed back to work

A whistleblower nurse who was struck off after raising concerns about poor standards of care has won her fight to return to work. Margaret Haywood secretly filmed the neglect of elderly patients for a television documentary and was struck off the nursing register for misconduct in April.

She admitted breaching patient confidentiality but said that she had agreed to film at the Royal Sussex Hospital in Brighton to highlight terrible conditions there. Her film was used in a BBC Panorama programme.

The Nursing and Midwifery Council (NMC) and the Royal College of Nursing (RCN) said yesterday that a High Court decision had been reached on an appropriate sanction for Ms Haywood, who is from Liverpool. The court replaced the striking-off order with a one-year caution, which means that she can return to work as a nurse. “All parties agree that the sanction decided by the court represents a fair outcome to this case,” a joint statement said.

Kathy George, the NMC chief executive and registrar, said: “Raising concerns about poor standards of care is a difficult and brave step for any nurse or midwife to take and is vitally important in driving improvements in patient care. “One of the lessons of Margaret Haywood’s case is that nurses and midwives need clearer information about how to appropriately raise and escalate concerns in a way that is safe for patients and in a way that will not bring them into conflict with their code of conduct.” She said that guidance on this was currently being developed and would be published next year.

“We are also taking steps to remind employers and managers of the need to establish clearer reporting procedures and to ensure that these are widely promoted amongst staff so that nurses and midwives can feel confident that employers will listen to and respond appropriately to their concerns.”

Peter Carter, the chief executive of the RCN, said: “We are pleased with today’s outcome, which means that Margaret will be able to continue practising as a nurse. “In reaching this conclusion it has been recognised that, while the case raised complex questions about competing duties, Margaret had an unblemished career as a nurse and contributed significantly to the care of patients. “We would like to thank patients and the public for the vast support they have given her. “We consider the matter satisfactorily resolved and all parties can now move on.”

The Panorama programme, which was broadcast in 2005, was the result of a three-month investigation. Ms Haywood, who has more than 20 years’ experience, wore a hidden camera during 28 shifts on an acute medical ward. In one scene a patient was left to die alone, while another had to wait hours to go to the toilet. The BBC journalist Shabnam Grewal also took a job on the ward with a private company that held the contract to clean the hospital and serve food.

Ms Haywood said at the time: “Seeing this kind of care makes me feel angry; it makes me ashamed of my profession. “We’re talking about basic human needs here, basic nursing care.”

SOURCE




A "RIGHT" TO LARGE BREASTS under socialized medicine?

This is the insanity to which government medicine inevitably leads: a British transsexual is suing for the "right" to breast enlargement surgery:

The legally aided gender dysphoria sufferer, who has been living as a woman for over 10 years, says breast augmentation is essential to her female identity and emotional well-being and the refusal to give her the op amounts to sex discrimination.

Her unique test case against the West Berkire Primary Care Trust (PCT), in which the the Equality and Human Rights Commission will also be playing a part, is now set for hearing at the High Court on October 20.

Any government medicine system suffers from a fatal contradiction: health care is a "right," but a right that must be rationed. Thus, the sort of craziness we are seeing here is inevitable:

[The PCT's barrister] told Judge Nicola Davies QC: "Public bodies who have to make rationing decisions, like PCTs, face enormous difficulties. Wherever you draw the line, there will be those who are disappointed. It would make the job of PCTs virtually impossible if their decisions were constantly attacked."

The transsexual plaintiff's theory is that she is being discriminated against by being treated the same as a "natal female:"

Her barrister, Stephanie Harrison, said it amounted to sex discrimination that she had been treated in exactly the same way as a "natal female", not suffering from gender dysphoria, applying for cosmetic breast enlargment on the NHS.

Arguing that C would "derive psychological benefit" from breast enhancement, Miss Harrison said the PCT's refusal "leaves a treatable condition and untreated" and exposed her to "significant suffering".

Breast augmentation would be "an appropriate and cost-effective treatment" that would enable C to achieve "a congruent physical, psychological and social identity".

But the PCT's policy that breast augmentation will only be funded in "exceptional" cases is so tight as to amount almost to a blanket ban, the barrister added.

Once you adopt the view that medical care is a "right" which the government must vindicate with taxpayer funds, there is no end to the insanity that will result.

SOURCE




Dems scramble after warning from health insurers

Insurance companies aren't playing nice any more. Their dire message that health care legislation will drive up premiums for people who already have coverage comes as a warning shot at a crucial point in the debate, and threatens President Barack Obama's top domestic priority.

Democrats and their allies scrambled on Monday to knock down a new industry-funded study forecasting that Senate legislation, over time, will add thousands of dollars to the cost of a typical policy. "Distorted and flawed," said White House spokeswoman Linda Douglass. "Fundamentally dishonest," said AARP's senior policy strategist, John Rother. "A hatchet job," said a spokesman for Senate Finance Committee chairman Max Baucus, D-Mont.

But the health insurance industry's top lobbyist in Washington stood her ground. In a call with reporters, Karen Ignagni, president of America's Health Insurance Plans, pointedly refused to rule out attack ads on TV featuring the study, though she said she believed the industry's concerns could be amicably addressed.

At the heart of the industry's complaint is a decision by lawmakers to weaken the requirement that millions more Americans get coverage. Since the legislation would ban insurance companies from denying coverage on account of poor health, many people will wait to sign up until they get sick, the industry says. And that will drive up costs for everybody else.

Insurers are now raising possibilities such as higher premiums for people who postpone getting coverage [which already happens in Australia], or waiting periods for those who ignore a proposed government requirement to get insurance and later have a change of heart.

The drama threatened to overshadow Tuesday's scheduled vote by the Senate Finance Committee on a 10-year, $829-billion plan that Baucus has touted as the sensible solution to America's problems of high medical costs and too many uninsured.

The Baucus bill is still expected to win Finance Committee approval. The insurance industry is trying to influence what happens beyond the vote, when legislation goes to the floor of the House and Senate, and, if passed, to a conference committee that would reconcile differences in the bills. It's at that final stage where many expect the real deal will be cut.

"We've got ourselves a real health care shooting war now," said Robert Laszewski, a former health insurance executive turned consultant. "The industry has come to the conclusion that the way things are going in Congress, we'll have a ... formula that will be disastrous for their business, so they can't stand on the sidelines any longer."

Questions about the technical soundness of the industry analysis by the PricewaterhouseCoopers firm was a big part of the discussion Monday. The release of the study late Sunday on the eve of the federal Columbus Day holiday had Democrats crying foul. "The misleading and harmful claims made by the profit-driven insurance companies are politicking for corporate gain at its worst," said Sen. Jay Rockefeller, D-W.Va.

Democrats have reason to worry. Insurance industry opposition helped sink President Bill Clinton's health care plan in the 1990s by fanning fears that people with coverage would wind up paying more.

Ignagni was unequivocal in her support for the PricewaterhouseCoopers conclusions. The company is "a world-class firm" with "a stellar reputation," she said.

The study projects that the legislation would add $1,700 a year to the cost of family coverage in 2013, when most of the major provisions of the Baucus bill would be in effect. Premiums for a single person would go up by $600 more than would be the case without the legislation, it estimated. In 10 years' time, premiums would be $4,000 higher for a family plan, and $1,500 more for individual coverage....

The industry is arguing that the consequences of the bill will be shifted onto those who are already covered. Insurers are not alone. Representatives of the hospital industry have raised similar concerns, though in less stark terms.

The study finds fault with what Baucus sees as one of the crowning achievements of his bill. Even with a tight budget, it would cover an estimated 94 percent of eligible Americans, up from about 83 percent now. The study - and the insurance industry - say that's not enough, particularly since senators have weakened the stiff fines Baucus originally proposed for ignoring a requirement to get coverage. "You really have to have a coverage level in the high 90s to make this work," Ignagni said....

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Healthcare bill looks cheaper than it is

Sixty years is how long Democrats say they've been pushing for legislation that provides health care access for all Americans. They'll have to wait another three if President Barack Obama gets a bill to sign this year. Under the Democratic bills, federal tax credits to help make health insurance affordable for millions of low- and middle-income households won't start flowing until 2013 — after the next presidential election. But Medicare cuts and a sizable chunk of the tax increases to pay for the overhaul kick in immediately.

The eat-your-vegetables-first approach is causing heartburn for some Democrats. Three years is a long time to wait for dessert, and opponents could capitalize on misgivings about the complex legislation to undo what would be a signature achievement for Obama. "The real danger is that health reform could be vulnerable to what we see with the stimulus package," said Democratic health policy consultant Peter Harbage, referring to criticism that Obama's $787 billion economic plan hasn't stemmed rising unemployment. "There needs to be more focus on what can you do quickly so that real people will start seeing change sooner, rather than later."

Said Judy Feder, a senior health official in President Bill Clinton's administration: "Just as we are fending off ideological attacks to get the bill passed, we will be fending them off as we implement the law."

Obama administration officials and Democratic lawmakers say the reason for the three-year wait is the time it's going to take to set up insurance marketplaces, write consumer protection rules and reconfigure the bureaucracy to carry out the legislation. It took President George W. Bush's administration two years to phase in the Medicare prescription benefit, a more modest undertaking. "It's very important to get the execution right," White House budget director Peter Orszag told The Associated Press in a recent interview.

There's another reason, less talked about: to make the costs of the plan seem more manageable under congressional budgeting rules. Lawmakers use a 10-year accounting window to assess new programs. Starting the Medicare cuts and some of the taxes in the early years — and pushing the bulk of new spending into the latter years — helps keep the cost of the health care overhaul within Obama's $900 billion limit. Bush used the same kind of maneuver to push the Medicare benefit through Congress. "It means that the full cost of the program is underestimated in the 10-year window that you are looking at," said Gail Wilensky, who ran Medicare for former President George H.W. Bush. "It's not like we've never seen this before, but people need to understand what's going on."

Congressional Democrats are defensive about their slow-motion rollout. Senate Finance Committee Chairman Max Baucus, D-Mont., addressed the concerns in a recent news release captioned: "What You Get Right Away." Among the major short-term improvements in his bill would be a benefit for people on Medicare, who already have insurance coverage. Starting in 2010, those who fall into the Medicare prescription plan's coverage gap would get a 50 percent discount off the price of brand-name drugs. In 2011 and 2012, certain small employers with fewer than 25 workers could get a tax credit for up to 35 percent of what they contribute toward the cost of employee coverage. That could encourage some companies that don't offer coverage to do so, but it's more likely to shore up those who already do.

To answer Obama's call for an immediate end to insurance company discrimination against the sick, Baucus would set aside $5 billion from 2010-2013 to help states provide affordable coverage to people denied because of a medical condition. The money would be apportioned to high-risk insurance pools that many states have set up. It may not go far enough. State high-risk pools now spend about $1 billion a year and cover only 200,000 people. "With $5 billion and (other) improvements, they probably can double that enrollment, maybe a bit more, but that may not reach everybody who needs the immediate help," said Karen Pollitz, a Georgetown University research professor.

The House Democratic bill tries to provide some immediate relief. For example, insurance companies could not cancel coverage just because a policyholder develops an intractable disease such as cancer.

Yet all of that has failed to make much of an impression on the Congressional Budget Office, the umpire of the costs and benefits of legislation. The CBO estimates that under the Senate Finance Committee bill, the number of uninsured will stay stuck around 50 million from 2010 through 2012, until federal tax credits start flowing the following year.

If there's a silver lining in the three-year wait, it's that it will give individuals and families time to prepare for a new federal requirement to carry health insurance, starting in 2013. That won't be a problem for the majority who with employer or government coverage. But even with the tax credits that Democrats are proposing, many middle-class families that buy their own coverage still may be unable to afford it, and risk being assessed a penalty.

But lawmakers may have figured out how to use time to their advantage. The Senate Finance Committee voted to pare down the penalties and postpone them until 2014. Because the fines would be collected through income taxes, no one will get a bill until April 2015. That would be a full two years after the government starts handing out carrots in the form of health insurance tax credits. Conveniently or coincidentally, it's also safely after the 2014 congressional midterm elections.

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13 October, 2009

Grandmother, 72, has leg amputated after British hospital wrongly diagnoses cancer

Sheer negligence

A 72-year-old grandmother had her leg amputated after being told she had cancer only to find out her leg was healthy all along. Doreen Nicholls underwent the surgery in 2007 and now needs a wheelchair to get about. According to the Sunday Telegraph, the grandmother was wrongly diagnosed with an extremely rare form of cancer and was told that without a leg amputation, she would die. Tests carried out after the operation revealed that her left leg, which had been cut off below the knee, was in fact healthy.

Mrs Nicholls told the newspaper that the misdiagnosis, at Birmingham's Royal Orthopaedic Hospital, has destroyed her life. Despite refusing to accept it was negligent in its treatment of Mrs Nicholls, the specialist hospital has agreed to pay her an out of court settlement which her lawyers described as a 'substantial six-figure sum'. Since being awarded the money, Mrs Nicholls has been able to buy a new prosthetic leg.

Mrs Nicholls, of Halesowen, near Birmingham, told the Sunday Telegraph: 'I shall never forgive the hospital for what they've done to me. 'I just want my leg back, money doesn't mean a thing.'

Mrs Nicholls told how the hospital called her to go back after the operation and said they had made a mistake and she didn't have cancer. She told the BBC: 'They called me back after the operation and the surgeon said: "I've got a bombshell to tell you - I'm very sorry, but we shouldn't have taken the leg off." 'I cried for days. It really was the worst part, worse than being told I had cancer, because I couldn't do anything, there was no treatment I could try,' she told the Sunday Telegraph. 'Every night I look back down and it's never going to change. 'It's ruined my life, I used to be active, go swimming, do gardening and walk a lot, now I can't do that any more. 'My little granddaughter asked me when it's going to grow back so we can dance and play together again, but it never can.'

Mrs Nicholls was referred to the Royal Orthopaedic Hospital in August 2007 due to a swelling on her left foot. A biopsy was carried out and the pathology results appeared to show the grandmother had an aggressive tumour. It was thought to be an extremely rare soft tissue cancer, sclerosing epithelioid fibrosarcoma. According to the newspaper, other clinical signs did not suggest cancer and the hospital team treating Mrs Nicholls was not unanimous in the diagnosis. But on October 10, 2007, her left leg was removed below the knee. Tests done after the operation showed that she was in fact suffering from a rare benign condition, pigmented villonodular synovitis.

Mrs Nicholls told the Sunday Telegraph: 'I still get so much pain. It's like pins and needles all the time at the stump where they cut the nerve endings. 'I've definitely lost faith in the medical profession. I'd never have another operation; I think I'd rather suffer the pain.'

A spokesman for the Royal Orthopaedic Hospital told the newspaper: 'The trust is deeply sorry about the outcome of Mrs Nicholls' treatment. 'We have been completely open and honest with Mrs Nicholls throughout and she has been fully informed of our findings. 'Our specialist teams are still regularly reviewing her progress.'

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Amazing NHS bungle

They just don't care



A British Iraq War veteran has died after he was given a pair of cancerous lungs donated by a smoker as part of a lung transplant. Matthew Millington, 31, a corporal in the Queen's Royal Lancers, needed the transplant because he had an incurable lung condition. But he ended up with cancer after the organs donated to him came from someone who smoked 30 to 50 cigarettes a day, the Daily Mail said.

He died in February last year. At an inquest, coroner Ian Smith said he had died from "complications of transplant surgery". His widow, Siobhan, said: "All he wanted was another set of lungs. He said 'They've given me a dud pair.'"

Papworth Hospital in Cambridge, which performed the transplant, said early X-rays did not find any sign of cancer in Mr Millington's lungs, the Mail said. But the tumour had been missed. Drugs given to Mr Millington to help his body accept the new organs sped up the spread of the tumour, it said. The hospital defended its use of smokers' lungs in transplants and said all organs were screened rigorously, the Mail said.

Mr Millington had served in the army since he was 16, but started to struggle with his breathing while in Iraq in 2005. A year later he was told he would die in two years unless he had a transplant.

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Hospitals across Australia forcing ambulances to queue for hours with seriously ill patients

With Westmead in Sydney again singled out

SERIOUSLY sick patients are queuing for hours to be unloaded from ambulances at busy hospitals across Australia. "Ramping" of patients is so common at major Sydney hospitals that ambulance officers routinely order pizza while they wait, ambulance union officials claimed yesterday.

In Queensland, more than 25,000 patients a year have had to wait at least half an hour to be unloaded from a waiting ambulance, Ambulance Service statistics reveal.

And in Melbourne this past winter, nearly 1000 patients had to wait more than an hour on an ambulance trolley. In 145 cases between May and July, patients waited more than two hours, according to data submitted by the ambulance union to a Victorian parliamentary inquiry.

The National Council of Ambulance Unions secretary, Jim Arnuman, yesterday said ramping was a growing problem in Queensland, NSW, Victoria and Western Australia. Ambulance officers attending Sydney's Westmead Hospital routinely ordered pizza because delays were so long, he said. "Unfortunately, the hospitals are using the ambulances as a labour pool to look after patients because of their own staff shortages," he said. "On bad nights in various areas of NSW, we have 40 to 70 per cent of our on-shift ambulances tied up in hospitals. "It is impairing the ability of ambulance services across the country to respond urgently to serious cases."

In Queensland - where the state government is probing the death of a critically ill elderly man when his ambulance was diverted from a busy hospital this month - new statistics reveal that more than 25,000 patients had to wait longer than half an hour to be unloaded from an ambulance in 2007-08. The figures, furnished by the Ambulance Service as part of an industrial arbitration, reveal 7 per cent of patients had to wait more than half an hour.

Liquor Hospitality and Miscellaneous Union spokesman Kroy Day said it was a "daily event" for ambulances to be diverted from the nearest hospital. "In the past 12 months, two patients died on ambulance stretchers waiting for a hospital bed," he said, adding this did not include the elderly man who died in transit this month. "It's an absolute tragedy, a disgrace and unacceptable."

Mr Day said ambulances had been forced to wait three hours to unload patients at Royal Brisbane Hospital, and up to four hours at the city's Princess Alexandra hospital. "It's a systemic problem and indicative of a system in crisis," he said. "The doctors and nurses and paramedics are doing a great job but they don't have the resources."

Steve McGhie, the general secretary of Ambulance Employees Australia, said he knew of up to 11 ambulances queuing outside a Melbourne hospital. "If your ... paramedics are all lined up for three or four hours waiting to offload their patients, you need more ambos to respond to the waiting emergencies," he said.

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Limiting medical lawsuits could save $41B

Limits on medical malpractice lawsuits would lead doctors to order up fewer unneeded tests and save taxpayers billions more than previously thought, budget umpires for Congress said Friday in a reversal that puts the issue back in the middle of the health care debate.

The latest analysis from the nonpartisan Congressional Budget Office estimates that government health care programs could save $41 billion over ten years if nationwide limits on jury awards for pain and suffering and other similar curbs were enacted. Those savings are nearly ten times greater than CBO estimated just last year.

"Recent research has provided additional evidence that lowering the cost of medical malpractice tends to reduce the use of health care services," CBO Director Douglas Elmendorf wrote lawmakers, explaining the agency's shift. Previously, CBO had ruled that any savings would be limited to lower malpractice insurance premiums for doctors, saying there wasn't clear evidence physicians would also change their approach to treatment.

On Friday, Elmendorf essentially acknowledged what doctors have been arguing for years: fear of being sued leads them to practice defensive medicine. Some doctors will order a $1,500 MRI for a patient with back pain instead of a simple, $250 X-ray, just to cover themselves against the unlikely chance they'll be accused later of having missed a cancerous tumor.

Republicans immediately called for liability limits to be incorporated in the health care overhaul legislation advancing in Congress. The Senate Finance Committee bill now gives a nod of recognition to doctors' concerns, but little more. Heeding a call from President Barack Obama, the legislation calls for promoting state experiments with programs to resolve cases before they go to court. "The more federal health care programs spend on unnecessary tests, the less money is available for necessary patient care," said Sen. Charles Grassley of Iowa, the ranking Republican on the Finance Committee. "Cutting medical liability costs would help preserve patients' access to care." Tens of billions of dollars in savings is "not chump change," added Grassley. "It's a no-brainer to include tort reform in any health care legislation."

However, Republicans were unable to pass malpractice limits when they controlled Congress and the White House, and it's unlikely that Democrats would do so now. For one thing, trial lawyers who file malpractice lawsuits have traditionally been heavy contributors to Democratic politicians.

But also, patient advocates argue that fixed limits on jury awards as in California and some states are unfair to those who have suffered the most harm because of a doctor's negligence. A patient who was given the wrong drug and had to spend several days in the hospital recovering from a bad reaction would likely be able to collect adequate compensation. But a family whose youngster was left brain damaged by an anesthesiologist's mistake probably would not be able to offset all the costs of lifelong care.

Obama has tried to straddle the argument, siding with the doctors on defensive medicine and agreeing with the lawyers who say limits on jury awards are the wrong remedy. He wants to promote alternatives to litigation; studies have shown anger over cover-ups by doctors is a principal reason that families sue.

Trial lawyers said Friday the projected malpractice savings have to be viewed in the context of the $2.5 trillion a year the U.S. spends on health care.

"Medical malpractice claims have almost no effect on overall health care spending," said Anthony Tarricone, president of American Association for Justice, which lobbies for lawyers. "The vast majority of empirical evidence suggests that there are only minuscule savings to be found in reforming our nations civil justice system."

But the CBO report means the malpractice issue will stay alive as the health care debate in Congress builds to a climax this year. The budget scorekeepers estimated the total effect of malpractice curbs could reduce the federal deficit by $54 billion over 10 years, once $13 billion in new tax revenues from economic ripple effects are taken into account.

Even in the health care debate, that's real money.

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Liberal Health Care Ideas: DOA

It’s one of the biggest myths in Washington, a powerful idea that hangs around year in and year out no matter how hard we try to kill it. It’s the claim that liberals offer ideas and conservatives merely oppose them.

Even the brightest conservatives can fall for it. “Republicans have to join the battle of ideas,” Louisiana Gov. Bobby Jindal wrote recently in The Washington Post. Jindal went on to outline 10 conservative ideas for health care reform.

But he’s incorrect to say conservatives have yet to “join” the battle of ideas. In fact, we’ve been mostly going at it unopposed.

Consider health care, the hot topic these days. Conservatives favor expanding competition by allowing insurance plans to compete across state lines. We favor policies to give individuals more control of their health spending. And we support ending federal tax breaks, so individuals can buy health insurance as they buy auto, life and homeowners insurance.

What’s the liberal response? Create a massive new entitlement that would, eventually, lead to a single-payer system.

“We’re looking at the possibility of universal health care by about 2010,” New York Times columnist and economics professor Paul Krugman announced on the TV show “Democracy Now!” two years ago. Discussing the plans floated by then-presidential candidates Hillary Clinton and Barack Obama, Krugman added they, “are not single-payer, but they can evolve into single-payer,” an outcome that would lead to something such as Medicare, which Krugman calls “the cheapest, most efficient plan.”

Is it? “The fact is that, in recent years, Medicare administrative costs per beneficiary have substantially exceeded those costs for the private sector. This despite the fact that, as critics note, private insurance is subject to many expenses not incurred by Medicare,” wrote industry expert Robert Book in a paper from The Heritage Foundation. “Moving millions of Americans from private insurance to a Medicare-like program will result in program administrative costs that are higher per person and higher, not lower, for the nation as a whole.”

Another reason Medicare seems more efficient is that it doesn’t spend much time or money cracking down on fraud. Instead, it just shells out for fraudulent claims it never determines to be fraudulent. Harvard Professor Malcolm Sparrow estimates that more than 20 percent of Medicare and Medicaid spending may be wasted through fraud. And Medicaid’s internal inspector admits the program has no way to track waste, fraud or abuse. No wonder Sparrow’s book is titled, “License to Steal.”

Medicare is already bankrupting states across the nation. So what’s the big liberal idea of the week? Expand the program. The Senate’s proposed Baucus bill (which isn’t really a bill, since the Finance Committee hasn’t bothered to write it down) would supposedly provide health insurance to millions more Americans. But nearly half of them would simply be dumped into Medicare. That’s not a solution; it’s merely a way to create a new problem. “Nobody’s going to put their state into bankruptcy or their education system in the tank” for Medicaid expansion, Democratic Tennessee Gov. Phil Bredesen told The Washington Post over the summer.

It’s ironic that liberals, who claimed to worry that George W. Bush wanted to use anti-terrorist FISA legislation to listen to their phone calls (all of them) and read their e-mail (even the spam) are eager to have the government-run health care.

After all, if the liberal dream comes true and the federal government becomes the sole provider of health care, it will have an interest in virtually every aspect of our lives. Look no further than North Carolina, which recently announced it will punish state employees who don’t take care of themselves.

“Tobacco use and poor nutrition and inactivity are the leading causes of preventable deaths in our state,” Anne Rogers, director of integrated health management with the N.C. State Employees Health Plan, told the Raleigh News & Observer. “We need a healthy workforce in this state. We’re trying to encourage individuals to adopt healthy lifestyles.” The state will “encourage” that by charging overweight individuals or those who smoke more for health insurance.

Once the government is in charge of health care almost everything you do -- what you eat, how fast you drive, whether you have a pet -- will be a federal concern. Denying care will be about the only way the government can hold down costs, so it’ll look for any excuse to do so.

Is that the goal of the liberal “thinkers?” Or is this potential outcome merely a happy coincidence? One suspects liberals really have no idea.

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The truth about the Baucus bill

Obamacare advocates in the White House, Congress and the newsroom of the New York Times were elated this week when a Congressional Budget Office statement said the health care reform bill by Senate Finance Committee Chairman Max Baucus, D-Mont., would cut the federal deficit by $81 billion annually. Hallelujahs ensued all around, including a Times headline proclaiming "Health care bill gets green light in cost analysis." But two words in the CBO statement -- "Preliminary Analysis" -- demonstrate that such celebrations were not only premature, but fundamentally misleading.

CBO had to qualify its observations because it was not allowed to score the actual text of the Baucus bill but rather had to rely on a legislative summary provided by Senate committee staff. So not only were CBO's analysts forced to look at language that put the bill in the best possible light, they were also denied the concrete details and precise legal wording that quite possibly could change their conclusions entirely. Such "close enough for government work" analyses suffice for Baucus and the Times, but for everybody else, by labeling its assessment as preliminary, CBO was clearly waving yellow caution flags.

Reading further, other yellow flags were present in the CBO analysis. As The Examiner's Susan Ferrechio reported Friday, enactment of the Baucus approach will add approximately $900 billion to the federal budget. That money will have to come from somewhere. Half of it will come from massive cuts in Medicare Advantage, while the other half will be generated by new taxes on high-end insurance, higher income taxes, and new levies on drugs and innovative medical devices. We will address these additional yellow flags on this page on Tuesday in Part 2.

There is another reason why the CBO's preliminary analysis should be taken with a grain of salt, though this one wasn't mentioned in the report. Whatever the content of the Baucus bill once it is voted out of the finance committee, it will disappear into a legislative black hole as Senate Majority Leader Harry Reid, House Speaker Nancy Pelosi, and their key aides do what they did on the economic stimulus package back in February -- huddle together behind closed doors to write the final bill, which will then be presented as a fait accompli in the form of a conference report. Everything else is mere sound and fury signifying nothing until Harry and Nancy do their thing in the dark.

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12 October, 2009

Daughter saves mother, 80, left by NHS doctors to starve

"Death panels" are already a reality in socialist Britain

AN 80-year-old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened. Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.

Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

Fenton’s daughter, Christine Ball, who had been looking after her mother before she was admitted to the Conquest hospital in Hastings, East Sussex, on January 11, says she had to fight hospital staff for weeks before her mother was taken off the plan and given artificial feeding. Ball, 42, from Robertsbridge, East Sussex, said: “My mother was going to be left to starve and dehydrate to death. It really is a subterfuge for legalised euthanasia of the elderly on the NHS. ”

Fenton was admitted to hospital suffering from pneumonia. Although Ball acknowledged that her mother was very ill she was astonished when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days. Ball insisted that her mother was not dying but her objections were ignored. A nurse even approached her to say: “What do you want done with your mother’s body?”

On January 19, Fenton’s 80th birthday, Ball says her mother was feeling better and chatting to her family, but it took another four days to persuade doctors to give her artificial feeding. Fenton is now being looked after in a nursing home five minutes from where her daughter lives.

Peter Hargreaves, a consultant in palliative medicine, is concerned that other patients who could recover are left to die. He said: “As they are spreading out across the country, the training is getting probably more and more diluted.”

A spokesman for East Sussex Hospitals NHS Trust, said: “Patients’ needs are assessed before they are placed on the [plan]. Daily reviews are undertaken by clinicians whenever possible.”

In a separate case, the family of an 87-year-old woman say the plan is being used as a way of giving minimum care to dying patients. Susan Budden, whose mother, Iris Griffin, from Norwich, died in a nursing home in July 2008 from a brain tumour, said: “When she was started on the [plan] her medication was withdrawn. As a result she became agitated and distressed. “It would appear that the [plan] is . . . used purely as a protocol which can be ticked off to justify the management of a patient.”

Deborah Murphy, the national lead nurse for the care pathway, said: “If the education and training is not in place, the [plan] should not be used.” She said 3% of patients placed on the plan recovered. [Despite all attempts to kill them, in other words]

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Doctors say EU working week is killing patients

SENIOR doctors say NHS patients are dying as a result of new European Union rules that impose a 48-hour week on hospital staff. The Royal College of Surgeons said, in a hard-hitting report, that lives were being lost because patients had to be switched between up to four doctors every 24 hours, instead of being cared for by the same team round the clock.

Junior doctors used to work 80-hour weeks, staying on call at all times and sleeping in the hospital. Surgeons said this guaranteed continuity of treatment. In August, EU rules were introduced limiting their working week to 48 hours. John Black, president of the college, said that, as a result, no doctor was monitoring patients for long enough to detect changes in their condition and vital medical details were being mislaid in a chain of “Chinese whispers”. The surgeons claim that the rapid changes in shifts mean that nobody is taking personal responsibility for patients. One surgeon who responded to the survey said: “No rapport is built with the patient and no responsibility is assumed by the junior for the patient care. An unmitigated disaster.”

The college has compiled a dossier from ward reports by surgeons, laying out the scale of the problem. This weekend the college released details to The Sunday Times of a series of “avoidable deaths” that it claims were caused by the way in which the new limits on the working week have been implemented since August.

— In one case a patient died of a rupture in her bowel because information about an obstruction had not been passed on from one junior doctor to the next when they changed shifts;

— A patient died of a brain haemorrhage following surgery that should not have been carried out. Information about the patient’s medical condition had become confused in handovers between three specialist registrars — doctors at the grade below consultant level

— A patient died of cancer after requests for tests were not passed on. An x-ray had detected an abnormality in the patient’s liver but no doctor took responsibility for chasing up the tests, and the patient was discharged from hospital. The college concedes the patient might have died even if the tests had been done.

The college also cited a series of other, non-fatal, errors that it had discovered by surveying 900 surgeons. They reported that a patient wrongly underwent surgery for a broken bone because instructions from a consultant were not passed to surgeons on the next shifts.

Another patient missed an emergency operation for a hernia because her case was not handed to the next shift. The patient then became “lost” in the hospital and was not seen by doctors on ward rounds for three days.

More than half of consultant surgeons and 44% of surgeons of all grades believe the 48-hour week has been achieved at the expense of patient safety, the survey showed. Black insists the deaths are an inevitable part of patients being looked after by a string of doctors working shifts, rather than because of poor communication by medics. “We now have a clear message from the front line that patient care is being made significantly less safe. “Multiple handovers are inherently unsafe. Every handover is an accident waiting to happen,” he said.

The college is lobbying the government to introduce an opt-out to the rules for surgeons to allow them to work up to 65 hours a week. The surgeons’ leaders say the government could introduce legislation that would allow this if it had the political will.

The Department of Health defended the EU rules. A spokesman said: “Hospitals which have been working a 48-hour week for over two years have produced evidence that shows the change has decreased hospital mortality. There is no evidence of harm being caused to patients.” [So the bureaucrat knows better than the doctors. Typical socialism]

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The Stressed German Model

It took the Germans 125 years to figure out that their health-care system doesn't work. What if the Obama health-care proposal turned out to be the biggest public-policy mistake in 125 years?

Yesterday, these columns discussed the Congressional Budget Office's efforts to push the square peg of the Obama plan through the round hole of affordability. Meanwhile in Germany, often cited by American liberals as the "model" of a well-run health-care plan, the political debate is running in the opposite direction. Chancellor Angela Merkel's new coalition partner, the Free Democratic Party, is pressing her to claw back the state's participation in a system that now insures nine of 10 Germans.

Germany's health-care system was brought to life in 1883 by Otto von Bismarck and became the model for virtually every such state-directed national insurance plan since. Alas, the German system is starting to come apart at the financial seams. Germany's system relies on a handful of state-supported health insurers. This week they informed the government that the system was on the brink of a financial shortfall equal to nearly $11 billion.

Pointedly, the insurers made clear that cutbacks alone won't solve the problem. They said the government would have to consider raising premiums on the insured or, you guessed it, raise taxes. Currently, German workers pay a fixed-rate premium into the insurance scheme; that rate is now set at 14.9% of gross pay.

Chancellor Merkel, something of a political acrobat, was previously allied in coalition with leftist Social Democrats. She's now resisting calls from the Free Democrats to get off the state-pulled health-care train. The FDP's spokesman on health, Daniel Bahr, wants a "shift in direction away from state-run medicine." Why? Because "the current financial figures have showed us that the health-care fund doesn't work."

With Congress inching ever closer to passing a greater federal presence in providing health insurance under ObamaCare, let's hope it doesn't take the U.S. until the year 2134 to figure out it isn't working.

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Politico Outs the Secret Plan to Pass ObamaCare

Politico (again) breaks a major story this morning with its outing of the Dem secret plan that Brian Darling of the Heritage Foundation has been warning of for more than ten days:

a former House and Senate leadership aide sent an email sketching out another route to passage. Instead of introducing a Senate bill, Majority Leader Reid could insert the merged health care reform language into a revenue raising House bill already languishing in conference committee. The Senate would pass it and send it to the House whereupon passage, it would go straight to the president’s desk – completely bypassing conference. Do not pass go, do not collect $200.

By cutting out conference, this single-bullet scenario eliminates weeks of expected wrangling and would make it possible to pass a bill by the Thanksgiving target so many Democrats are aiming for. Many insiders agree that a conference committee would make that goal next to impossible.

The Democrats are raping the Congressional process to pass ObamaCare:

i) create a Vapor Bill without legislative language to hide the legislative language from the American people and other Senators until the bill is already on the Senate floor;

ii) get a Vapor Score on a Vapor Bill — even though the Congressional Budget Office says they cannot provide an accurate score without the legislative language — which CBO did not get because it does not exist;

iii) move to the motion to proceed on a House bill that is not the health care bill, but is the AIG bonus bill, then gut it and amend it with the first-time-ever-seen health reform legislative language;

iv) add the public option AFTER ending a filibuster with 60 votes; and,

v) skip a House-Senate conference and have the President sign the bill.

This is why the Founding Fathers warned of the tyranny of the majority.

The U.S. Congress, under the Democrats, is being run like a banana republic where the dictator violates any and all fair processes with little regard for public opinion — that is, until the 2010 elections, where, if the Dems carry out these outrageous and flagrant flaunting follies they will have their heads handed to them.

All of these flags-on-the-play violations to pass a bill that Zogby finds 60% of the American people oppose? Or if you prefer the Pew Poll version, only 34% of Americans support it.

Really, the Dems need to take a breath, and seriously consider their politically irrational and lemming-like behavior.

SOURCE




Healthcare reform for the “party of no”

The basic axiom of free-market economics is that government regulations mess up a market, which leads to misdistributions, which leads to more cries for government regulation. You couldn't find a better example than the current health insurance "crisis." This week Congress is poised to take a problematic situation and make it much worse. There are indeed 45 million people who are uninsured in this country. Some of them (like my 23-year-old son) don't want to spend $100 a month for what seems like a useless precaution but others are in dire need of insurance coverage and can't get it. The basic reason is that, instead of allowing a free market to operate, we've done the following:

a) Allowed the states a free hand in regulating insurance, and

b) Shrunk the market by allowing 62 percent of the market to secure its coverage as employer-based "health benefits."

The result is that only 6 percent of the non-elderly population actually buys insurance directly from insurance companies and these tend to be a perversely self-selected group who are too sick to work or can't get a good job. As a result, the insurance companies can't create large risk-pools and have to charge everybody a high rate.

Understanding all this requires a little analysis, of which Democrats seem to be incapable, and so the easiest thing is to blame it on "greed." Thou and I are certainly not greedy, nor are our favorite politicians greedy, but someone out there is greedy -- the insurance companies! -- and therefore their greed must be countered by the government, mainly by getting the government into the insurance business.

I take my text from a 95-page report "Premiums Soaring in Consolidated Health Insurance Market -- Lack of Competition Hurts Rural State, Small Business," issued last May by Health Care For America Now!, a Washington lobbying organization sponsored by the AFL-CIO, Move On, the AFSCME, the teachers' unions, the Children's Defense Fund, La Raza, ACORN and a lot of other groups, the names of which are probably familiar. The report described an alarming situation:

Commercial health insurance premiums have risen four times faster than wages and have more than doubled in the last nine years. Shrinking competition among health insurance companies is a major cause of these spiraling costs. In the past 13 years more than 400 corporate mergers have involved health insurers, and a small number of companies now dominate local markets.

In 21 states, the top two insurance vendors control more than 70 percent of the market, while in nine states that portion has been captured by a single provider. In Alabama, for instance, Blue Cross/Blue Shield controls 83 percent of the market. In Rhode Island, Blue Cross/Blue Shield and UnitedHealth together own 95 percent. As the report notes, "The U.S. Justice Department considers a market 'highly concentrated' if one company holds more than a 42 percent share of that market, a level that is common in…more than 30…states."

Americans are paying for this unchecked private insurance industry consolidation in the form of higher health premiums and a growing number of uninsured people. Meanwhile, insurance company profits and compensation for the industry's top executives are surging…

The report quotes David Balto, former policy director of the Bureau of Competition at the Federal Trade Commission and now a fellow at the Center for American Progress:

Antitrust enforcement against anti-competitive mergers and exclusionary conduct is essential to a competitive marketplace. This unprecedented level of concentration and the lack of antitrust enforcement pose serious policy and health care concerns.

Then it turns to President Barack Obama for a summary:

"The consequence of lax [antitrust] enforcement for consumers is clear," then-Senator Barack Obama said is a September 2007 address to the American Antitrust Institute. "The number of insurers has fallen by just under 20 percent since 2000. These changes were supposed to make the industry more efficient, but instead premiums have skyrocketed." [brackets in original]

Health Care for America Now!'s solution to the problem is, of course, the "public option":

In several recent reports, leading experts on the American health care system have detailed how the injection of a robust new public health insurance plan as a competitor for private plans would expand choice for individuals and business and drive competition on price and quality in local markets across the country.

In other words, let's get the government in the insurance business.

A very dramatic and convincing case, no? Senator Charles Schumer, who was present at the release of the report, pulled no punches:

This is the starkest evidence yet that the private health care insurance market is in bad need of some healthy competition. A public health insurance option is critical to ensure the greatest amount of choice possible for consumers.

The Health Care Now! report has been the centerpiece of Democratic efforts since then.

So, what's wrong with this picture?

Well, let's try this for starters. Since 1945, the entire insurance industry has been governed by McCarran-Ferguson Act, in which Congress ceded its right to regulate insurance as "interstate commerce" and instead gave pre-emptive authority to the states. The first thing McCarran-Ferguson did was exempt the insurance industry from federal antitrust law. Antitrust does not apply to insurance. This is not the decision of the big, bad insurance companies. It is the will of Congress. Yet nobody -- least of all liberal Democrats in Congress -- seems to be aware of this.

Why was insurance exempted from antitrust laws? It's a long story. Until 1944 the states had routinely regulated insurance companies. The federal government stayed out of the picture on the polite fiction that insurance was not "commerce." Then in United States vs. South-Eastern Underwriters Association, the U.S. Supreme Court decided that the "business of insurance" was indeed commerce and that Congress could regulate. It left open the door, however, that Congress could delegate its powers to the states.

McCarran-Ferguson did just that. It exempted the industry from federal antitrust laws, except in cases where boycott, coercion or intimidation were involved. It also said that state regulations would not be pre-empted by federal law. States were free to license and regulate as they saw fit.

What happened as a result was what happens in all such instances. The regulations became an oligopolistic conspiracy between the regulators and the principal players in the field. Those who secured licenses quickly argued that no new competitors were necessary. More often than not, the regulator agreed. I have a brother-in-law in insurance who, after a series of grain silo explosions in the Midwest in the 1980s, tried for two years to persuade various Midwestern states to allow him to sell insurance backed by European reinsurers. The state insurance commissions told him, "No thanks, we're doing just fine." The same thing happens over and over with health insurance. Blue Cross-Blue Shield, which is run by doctors and hospitals on a nonprofit basis and always has strong local ties, is consistently able to persuade state commissions to grant it a near-monopoly. That is why, of the 25 states dominated by one provider, Blue Cross/Blue Shield controls 15 of them.

All this has become even more acute over the last decade as insurance commissions in some states -- particularly the smaller and more rural ones -- have decided the best way to deal with rising medical costs is to allow consolidation of the market into larger entities. "The idea is that the bigger insurance companies will be able to drive better bargains with doctors and hospitals," said a spokesperson at the National Association of State Insurance Commissioners. But these insurance giants have also found it easier to raise their prices to consumers, which is what Health Care Now! is complaining about.

So what we have is not the big health insurers versus the public. What we have is government versus government. The states have overregulated insurance, erecting barriers to entry and even encouraging consolidation on the theory that all this will help consumers. And when it has the opposite effect, the federal government decides insurance companies are the problem and they have to be supplanted by a federal entity.

There is a much more direct route to beneficial competition -- and it should be the agenda for the "Party of No."

a) Repeal McCarran-Ferguson or settle for its equivalent, Senator Jon Kyl's proposal to allow companies to sell insurance across state lines.

b) Override state mandates that force insurance companies to include coverage for things people don't want.

c) Expand Health Savings Accounts (HSO's), which already cover 8 million people and are rising.

d) Set up high-risk pools for people with serious conditions, as is done at the state level with auto insurance. Provide these people with small subsidies for basic coverage.

The result would be that, instead of today's oligopolized insurance market, a thousand Willie Lomans would start trudging door-to-door trying to sell people health insurance at prices they could afford. Congress could just sit back and watch -- until it found something else it can try to mess up. How about energy?

SOURCE




Paying the Health Tax in Massachusetts

Be warned: Even people with good insurance will risk fines if mandatory insurance becomes the national law

My husband retired from IBM about a decade ago, and as we aren't old enough for Medicare we still buy our health insurance through the company. But IBM, with its typical courtesy, informed us recently that we will be fined by the state. Why? Because Massachusetts requires every resident to have health insurance, and this year, without informing us directly, the state had changed the rules in a way that made our bare-bones policy no longer acceptable. Unless we ponied up for a pricier policy we neither need nor want —or enrolled in a government-sponsored insurance plan— we would have to pay $1,000 each year to the state.

My husband's response was muted; I was shaking mad. We hadn't imposed our health-care costs on anyone else, yet we were being fined ("taxed" was the word the letter used).

We've spent much of our lives putting away what money we could for retirement. We always intended to be self-sufficient. We've paid off the mortgage on our home, don't carry credit-card debt, and have savings in case of an emergency. We also have a regular monthly income of about $3,000, which includes an IBM pension. My husband, 61, earns a little money on the side, sometimes working as an electronics consultant on renewable energy projects. I'm 58 and make some money writing science books. We are not wealthy, but we aren't a risk of becoming a burden on society either. How did we become outlaws?

The turning point was three years ago, when then-Republican Gov. Mitt Romney pushed through the state legislature a health-care plan that he promised would provide universal coverage while lifting from the middle-class the burden of having to pay for those who do not have insurance. His argument was that the uninsured drove up the cost of health care for everyone by seeking care at emergency rooms and then skipping out on their medical bills. Hospitals make up for those unpaid bills by charging everyone else more than they otherwise would.

The central plank of the Romney plan was a mandate that required everyone to buy health insurance or pay a fine for posing a risk to society by walking around without coverage. There would be subsidies for those who couldn't afford insurance, and residents would be required to buy a minimum amount of health insurance, on the grounds that they might buy a policy that doesn't cover the cost of their care and end up skipping out on their medical bills. "We insist that everybody who drives a car has insurance, and cars are a lot less expensive than people," Mr. Romney told the Boston Globe in 2006.

Mr. Romney and Sen. Ted Kennedy publicly promised that the middle class —that is, people like us— would not be taxed and that our health-care costs would actually decrease if the plan became law.

My husband and I weren't convinced. It all seemed inane, but we are neither politically or socially conservative and figured the plan wouldn't affect us much. Besides, who could be against a plan that covers more people for less money?

For the first two years of the mandate, our IBM health insurance was seen as acceptable in the eyes of the state. This year the rules changed. The state requires that health plans cap out-of-pocket expenses for individuals (not including monthly premiums) at $2,000 a year. Our plan's cap is $2,500.

Ten years ago, we had excellent coverage through a more gold-plated plan. But we found that it was no longer worth paying the premiums and scaled back to a more modest policy. Today, we pay about $300 a month for catastrophic care. If we went with the next step up in plans offered to us by IBM, our monthly premium would increase to $800. We simply don't need to pay that kind of money for the amount of health care we actually consume.

Nonetheless, we now owe the state an extra $1,000. Ironically, that's about the extra amount we would pay out-of-pocket under our current plan if both of us actually fell ill in the same year.

We could choose a state-sponsored plan. It would mean paying more than what we pay now, but less than what IBM's next step up would cost. But we don't want to. IBM seems like a rock of stability compared to the state of Massachusetts. It's apparent that state health-care policies can change at the whim of politicians in Boston, and we might not be able to adjust to the new rules. The way we figure it, if we sign up for a state-subsidized plan we will be at the mercy of the state.

So we are sticking with our plan and paying the tax. But what bothers me most is that a similar health-care mandate is being proposed in Washington, and some of the same promises that were made here are being made again—such as that the mandate will never hit middle-class folks with a new tax. When asked about the mandate, Maine Republican Sen. Olympia Snowe said recently, according to the New York Times, "It surprises me that we would have these high-level penalties on average Americans."

Well, I don't find it surprising. The mandate in Massachusetts was sold as something that wouldn't penalize people like my husband and me. But those political promises were only good for as long as it took to get the mandate enacted into law.

SOURCE





11 October, 2009

Socialized medicine in Australia: IS WESTMEAD HOSPITAL SHAPING UP TO BE ANOTHER KING/DREW?

The management at this big government hospital in Sydney seems to be nearly as hands-off it was at the disgraced and now-closed King/Drew hospital in Los Angeles. Two brand new reports below plus re-runs of two previous reports -- one from yesterday and another from March 8th.:

Amazing bungle at Westmead leaves family seething

"He was in agony"... a feeding tube was wrongly inserted into the lungs of Francis Wilks-Tansley, 7. The bastards should be sued for millions for what they did to the boy

THE family of a boy who almost died after a ''breathtakingly basic'' hospital bungle nine months ago is still waiting for a written apology and a change in policy to prevent other children suffering the same fate. Francis Wilks-Tansley will be fed through a hole in his stomach for the rest of his life and is unable to breathe properly after a feeding tube was inserted into his lungs - and not detected for 36 hours.

During that time the seven-year-old, admitted to The Children's Hospital at Westmead for seizures, was given water and six medications through the tube, causing him to develop a life-threatening pneumothorax, where air gets trapped in the cavity around the lungs, and his right lung to collapse. One of the drugs, sodium valproate, causes severe chemical burns to lung tissue.

Up to six staff tended to Francis, who was born partially blind, deaf and with limited voluntary movement, over several shifts before the error was discovered, despite repeated calls from his mother, Sarah Wilks, that he was in respiratory distress. A chest drain was then inserted for 17 days to remove the fluid in his lungs. ''He was in agony, in extreme pain,'' she said yesterday.

One staff member, who did not want to be named, described the mistake as ''breathtakingly basic''. Staff must draw out some contents of feeding tubes as soon as they are inserted to test for the presence of stomach acid. A drop is placed on litmus paper, which turns a vivid pink if stomach acid is present. A chest X-ray can also be used to confirm the tube's placement, particularly in heavily sedated or unconscious children.

But Dr Wilks, who has a PhD in biology, said the lamp next to Francis's bed, used to check the colour on the litmus paper, was not working, making the room dim and difficult for staff to determine if the tube had touched stomach acid or lung secretions.

A case review carried out by the hospital found there had been three attempts to insert the tube, and its blood-stained contents had turned the litmus paper pink, leading staff to believe it had been placed correctly. But it also said difficult or repeated attempts should alert staff to the need for an X-ray to check position. After the incident, staff were sent a short email reminding them of the importance of correct tube placement.

''They almost killed my son and yet haven't changed their culture,'' Dr Wilks said. ''This is not an error made by one person. It was a group of people, which means there must be a systemic or cultural problem, and I want to make sure they can't do it again. I don't want them punished; I want them educated.''

Dr Wilks, who also has three teenagers, had bought a house in Hobart the day Francis was admitted to hospital and has been commuting twice a week to be with him. Yesterday the hospital offered to reimburse her air fares and promised a new policy would be in place by the end of the month.

But she is adamant the offers were made only because she contacted the NSW Health Minister, Carmel Tebbutt, last week. ''It's been an unconscionable length of time. An apology now is worse than no apology at all. There is nothing I can do to reverse the damage done to Francis but, at the very least, the hospital needs to ensure this doesn't happen to other children.''

A spokeswoman for the hospital yesterday said staff had verbally apologised to Francis's family. She said a statewide safety notice had been issued in February and a compulsory education program was being developed for all staff inserting feeding tubes, but it was not known when it would begin. ''The hospital sincerely regrets this incident and how it has affected Francis and his family. We are not denying we made a mistake, and we are sorry about it.''

SOURCE

Patients catching lethal bugs at Westmead

FOUR patients a week admitted to Sydney's biggest hospital, Westmead, are being infected with potentially lethal golden staph and MRSA infections picked up while in the wards, hospital documents show. An investigation into where every one of the reported 2392 hospital-acquired infections, some known as "superbugs", occurred in 2008 in public hospitals showed Westmead topped the list, but other big hospitals including John Hunter, Liverpool, Blacktown and Royal North Shore were not far behind.

Experts believe the spread of infection is largely due to poor handwashing and other hygiene controls by nurses and doctors, The Daily Telegraph reports.

Official NSW Health records, obtained by Channel 9 under Freedom of Information laws, reveal the numbers of infected patients at public hospitals for central line associated bacteremia, surgical site infection, staphyloccus aureus (golden staph), multi-resistant staphyloccus aureus (MRSA) and acinetobacter baumanni.

A report on golden staph and MRSA, published in the Medical Journal Of Australia this week, reported golden staph infections can prove fatal for up 21 per cent of those infected within a month. Survivors can face having treatment sometimes over years to beat the illness.

The documents show Westmead recorded 243 infections in 2008, including 201 cases of golden staph and its antibiotic-resistant variant, MRSA.

Newcastle's John Hunter Hospital came in second with 150 infection cases, including 126 golden staph and MRSA incidents. The third highest hospital was Liverpool, which had 144 cases including 100 golden staph and MRSA cases. Children's hospitals also reported potentially life-threatening infections.

The Children's Hospital at Westmead had 31 cases of hospital acquired infection while its sister facility at Randwick, Sydney Children's Hospital, recorded 28 cases.

NSW Health Deputy Director General Tim Smyth said the likelihood of getting an infection in a public hospital was very small. The Department reported in 2008 an average of just 3.8 cases of MRSA infection for every 1000 intensive care days in public hospitals and 2.5 infections for every 10,000 bed days for golden staph bloodstream infections.

SOURCE

Unmonitored patient left to die at Westmead

Staff switch off "annoying" monitors that are there to save lives

A YOUNG mother at risk of sudden death from a brain cyst was left without a heart monitor for 20 hours before going into cardiac arrest at Westmead Hospital. Monitoring systems in the hospital's high-dependency unit were ''less than perfect'' when Rashpal Hayer died in July 2007, the NSW Coroner Mary Jerram said yesterday.

She was delivering findings after an inquest into Ms Hayer's death, which examined the failure to reattach the monitor and heard evidence of ''a 'culture' of silencing irritating alarms in that ward''.

Ms Hayer, 36, went to hospital with a severe headache. A CT scan revealed she had a colloid cyst, ''a very dangerous condition in which sudden death is known to be a possibility'', Ms Jerram said. A neurosurgeon instructed staff to monitor her closely, but a cardiac monitor was removed before a scan on July 2 and was not replaced when she returned to the ward. Ms Hayer was found in cardiac arrest at 6am on July 3. She never recovered brain function and died four days later.

Ms Jerram said nurses on the night shift and three doctors - including neurosurgical registrars - either failed to notice or saw no problem with the fact that she was without a cardiac monitor. Ms Hayer could possibly have been treated if a monitor had been fitted and sounded when she went into arrest, she said.

The inquest also heard that a finger probe monitoring Ms Hayer's pulse and oxygen levels had detached half an hour before her cardiac arrest. It should have sounded warnings.

Ms Jerram said it was possible the alarm connection to the nurses' station was not working, or that ''the alarms were deliberately silenced at some stage … not necessarily from any malice''. She accepted evidence from a nurse that the ward had a culture of ''silencing irritating alarms''.

Ms Jerram made no formal recommendations, noting that the hospital conducted three investigations into the death and had policies to remedy some of the problems highlighted.

SOURCE

Westmead public hospital bankrupt and partly closed down

Bed numbers have been slashed this week at Sydney's biggest hospital, in a round of ward closures aimed at reining in a $70 million blow-out in the region's health spending. Ten of 16 operating suites have been closed and elective surgery has been cancelled, with staff forced to take leave, sources said. Forty-three cardiology and heart surgery beds have shut since late last year, said medical and nursing staff, culminating last week in the closure without notice of the heart surgery ward - which staff found empty and locked when they arrived for work.

The unprecedented axing of about 70 beds comes after the Herald revealed in late January that Sydney West Area Health Service, which oversees Westmead, owed $26 million to creditors - more than any other region and almost a quarter of NSW Health's outstanding debt to suppliers at that time.

Neurosurgery and general surgery beds have also closed, said the sources, while casual nursing shifts have been curtailed across the entire hospital, as displaced permanent staff are redeployed into vacancies on the roster. The closures represent about 9 per cent of Westmead's total capacity, and are the biggest round of cuts at a single hospital to strike the beleaguered state health system. The chairman of the hospital's Medical Staff Council, Andrew Pesce, said the closures were by far the most severe the flagship teaching hospital had seen. "It's a quantum leap [compared with] the modest bed closures usually built around [public] holidays," Dr Pesce said.

Coming a month before Easter and without any promise that beds would reopen or surgery resume, the closures were the equivalent of an extra Christmas closedown, said Dr Pesce - referring to the practice of selectively suspending services during the holiday period to save money. "If things continue the way they are going, the morale of the place will become so low that doctors and nurses will start leaving," he said. Hospital managers were not solely to blame because NSW Health gave them "unrealistic budgets".

Public hospitals had traditionally been insulated from state spending cuts, Dr Pesce said, but NSW's wider financial crisis meant they were no longer receiving favourable treatment. Health accounts for about one-third of the state's spending, and had blown out by about $300 million at the time of November's mini-budget. Area health services were ordered to save $943 million over four years.

A spokesman for the Health Minister, John Della Bosca, declined to address the Herald's specific questions about closures, offering instead in a written statement: "There have been adjustments to bed platforms and relocations of some services within Westmead's overall funding base . Westmead has further capacity to improve bed utilisation and this is a priority for management attention in the relevant services as part of the operational strategy." He also did not answer a question about the number of patients whose elective operations were cancelled, instead insisting elective surgery was still available but saying the hospital was "under resource pressure and needs to ensure that its priorities are met but not exceeded and that all opportunities to ensure it operates efficiently are explored".

The president of the NSW branch of the Australian Medical Association, Brian Morton, said he understood patients would be moved to general wards under the care of "staff who don't have the same skills". Patients would be at risk if already overcrowded hospitals were further stressed. .. That's when mistakes happen."

The Opposition's health spokeswoman, Jillian Skinner, said the closures would endanger patients. "The evidence is quite clear that delayed treatment makes conditions worse and makes the hospital stay longer - and therefore more expensive."

SOURCE




Bright side of the Donk health plan...?

An email from a reader:

Let me get this straight. We're going to pass a health care plan that:

1. Was written by a committee whose head says he doesn't understand it

2. Passed by a Congress that hasn't read it but exempts themselves from it

3. Signed by a president that also hasn't read it and who smokes

4. With funding administered by a treasury chief who didn't pay his taxes

5. Overseen by a surgeon general who is obese and

6. Financed by a country that's nearly already broke

What could possibly go wrong?






Does high-tech medicine mean higher health care costs?

A new report finds that medical innovation boosts life expectancy, but doesn't cost more

"About half of all growth in health care spending in the past several decades was associated with changes in medical care made possible by advances in technology," declared a Congressional Budget Office (CBO) report last year. "Health care economists attribute about 50 percent of the annual increase of health costs to new technologies or to the intensified use of old ones," writes bioethicist Daniel Callahan in his new book, Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System. Conventional wisdom holds that the nation is facing a massive health care bill thanks to our use (and potential overuse) of pricey new treatments and technology.

But is it true that expensive high-tech medicine is to blame for rising health care costs? Callahan complains that "American health care is radically American: individualistic, scientifically ambitious, market intoxicated, suspicious of government, and profit-driven." And he's right about America's high-tech vitality: The U.S. health care system does develop and deploy medical innovations much faster than other rich countries. New pharmaceutical products generally launch here two years earlier than elsewhere, according to a December 2008 report from the business consultancy McKinsey (which also blamed high-tech medicine for escalating costs). Plus, American physicians are "much quicker to adopt new surgical techniques and advances in anesthesia." The top five U.S. hospitals alone conduct many more clinical trials than any other single other developed country.

But in June, Columbia University economist Frank Lichtenberg published a new study that suggests advanced medical technologies are not contributing all that much toward rising U.S. health care expenditures. Lichtenberg begins by looking at how the rate of increase in longevity has varied among U.S. states between 1991 and 2004. He investigates how such factors as the quality of medical care, behavioral risks (obesity, smoking, and AIDS incidence), and education, income, and health insurance coverage affect life expectancy. To measure differences in the quality of medical care, Lichtenberg examines how quickly each state took up advanced medical diagnostics and new drugs. He also calculates what fraction of physicians in a state were trained at top-ranked medical schools.

Lichtenberg's key finding is that life expectancy increased faster in states that more rapidly adopted advanced diagnostic imaging techniques, newer drugs, and attracted an increasing proportion of doctors from top medical schools.

The good news is that between 1991 and 2004 average life expectancy at birth in the U.S. increased 2.37 years. During that time Lichtenberg finds that nationwide the use of advanced imaging procedures nearly doubled from about 10 percent to nearly 20 percent. Lichtenberg calculates that the deployment of advanced diagnostic imaging techniques (e.g., CT scans, MRIs) is responsible for boosting average U.S. life expectancy by 0.62-0.71 years during this period. In addition, he estimates that the adoption of newer drugs increased average U.S. life expectancy by about 1.5 years. On the other hand, the fraction of physicians being trained at top medical schools has declined, which Lichtenberg reckons has reduced overall life expectancy by 0.28-0.47 years.

Interestingly, Lichtenberg found that "growth in life expectancy was uncorrelated across states with health insurance coverage and education, and inversely correlated with per capita income growth." The last finding is a bit puzzling. Lichtenberg calculates that the average 20 percent increase in real per capita income resulted in lowering average life expectancy by 0.34-0.42 years and finds that states with high income growth had smaller longevity increases. He does not speculate on why higher incomes lowered life expectancy but perhaps richer people engaged in riskier behaviors that are unaccounted for in Lichtenberg's model. For example, binge drinking in older men correlates with higher incomes.

It's not too surprising that high-tech medicine and better physician training boost life expectancy, but what about their costs? To answer that question, Lichtenberg looked at per capita medical spending by state. The top six states used advanced imaging diagnostics roughly 30 percent more often than the bottom six, for instance, making them ripe for comparison. He found that the states with larger increases in high-tech diagnostic procedures, newer drugs, and higher quality physicians did not have larger increases in per capita medical spending.

"The absence of a correlation across states between medical innovation and expenditure growth is inconsistent with the view that advances in medical technology have contributed to rising overall US health care spending," he concludes. Lichtenberg further speculates that states that have more quickly adopted high-tech procedures have not seen their health care expenses increase because "while newer diagnostic procedures and drugs are more expensive than their older counterparts, they may reduce the need for costly additional medical treatment." In other words, high-tech medicine may initially cost more, but it reduces spending in the long run, while increasing the life expectancies of patients.

Cost cop Callahan has a solution to the alleged problem of escalating technological costs: Adopt the methods used by European universal government-funded health care systems:"They use—among other tools—price controls, negotiated physician fees, hospital budgets with limits on expenditures, and stringent policies on the adoption and diffusion of new technologies." In other words, stifle innovation.

"Cutting the use of technology will seem wrong—even immoral—to many," Callahan admits. Well, yes. And if Lichtenberg is right, slowing technological progress in medicine wouldn't save money, but it definitely would kill more people.

SOURCE




Health care tab to be paid by taxpayers, businesses, seniors

A Senate plan to expand health insurance coverage to an additional 29 million people would not come cheap, with taxpayers, businesses and the elderly poised to foot most of the bill.

The legislation by Senate Finance Committee Chairman Max Baucus, D-Mont., which is scheduled for a committee vote Tuesday, would cost $829 billion over the next 10 years. Yet in spite of that staggering price tag, it would slash the federal deficit by $81 billion, according to an analysis by the independent Congressional Budget Office.

That's $910 billion the government would have to raise over the next decade. The bill calls for getting half of that money through various taxes and the other half by slashing expenses tied to Medicare, the program that provides health care for Americans 65 and older.

The Baucus bill would raise $201 billion over 10 years through an excise tax on top-tier insurance policies. Beginning in 2013, insurance companies would incur a 40 percent tax on any policy that exceeded $8,000 for individuals and $21,000 for families.

Government coffers would get an additional $23 billion over the next decade from employers with more than 50 workers that don't offer health insurance. These companies would pay a fine for every employee who qualified for a federal health care subsidy. And anyone who does not have some kind of health insurance would pay a fee, up to $950 for an individual and up to $3,800 for a family, which the CBO estimates would add up to $4 billion in revenues in the coming decade.

The government would also levy more payroll taxes. Included in a footnote in the CBO report is the revelation that the government expects to raise an extra $83 billion in payroll taxes in the next 10 years thanks to the higher taxable wages they predict employers will offer in place of non-taxable health care benefits.

Added together, these new taxes total $311 billion, a number that critics say is far too high. "They tax us to the point that they reduce the deficit," said Michael Tanner, a health care policy expert at the Cato Institute, a libertarian think tank. "In essence, the deficit savings you have are simply because of the tax increases."

Even after taxes, the government would still need an additional $599 billion to achieve the cost-bending estimate provided by the CBO. The Baucus bill calls for getting the bulk of that money from cuts to Medicare spending. According to the CBO, the Baucus bill would trim at least $426 billion from Medicare, much of it from slashing the popular Medicare Advantage plan, which offers more benefits than traditional Medicare for seniors willing to pay higher premiums. Reimbursement rates for Medicare Advantage plans would be reduced by $117 billion over 10 years under the Baucus bill.

Karen Davenport, director of health care policy at the Center for American Progress, a liberal public policy research and advocacy group, disputed a claim by critics that the funding cuts would amount to a reduction in benefits for seniors.

"What it's doing is trying to push change in the health care system so they are using Medicare as a lever for hospitals and doctors practices to help change the trajectory of health care costs," she said.

SOURCE




Study Shows Interstate Competition Will Lower Cost of Health Insurance

The Center for Freedom and Prosperity Foundation today released a study examining how protectionist policies by states, combined with expensive mandates that benefit interest groups such as chiropractors, make it hard for families to afford health insurance. The study, entitled "The Health Care Choice Act: Restoring Competition in the Individual Insurance Market," explains that insurance will be more affordable if the Constitution's promise of unfettered interstate commerce is realized, thus enabling families to purchase insurance plans issued in other states. Authored by Dr. Sven Larson, the study specifically recommends Congressman John Shadegg's Health Care Choice Act (H.R. 3217), as a step forward.

"Dr. Larson explains how mandates drive up the cost of health care by denying consumers the freedom to buy inexpensive no-frills coverage. And since consumers are not allowed to purchase plans issued in other states, this creates an oligopoly that leads to even higher prices," said Andrew Quinlan, President of the CF&P Foundation.

"The Constitution's interstate commerce clause is supposed to prevent protectionism among states," added Dan Mitchell, Senior Fellow at the Cato Institute and Chairman of CF&P's Board, who also noted that, "Dr. Larson's study is another example of how competition between governments promotes better policy and protects individual rights."

The study can be found online here

Executive Summary

America's health care system has state-of-the-art technology, highly skilled medical professionals and access to cutting edge medical research. However, government restrictions are artificially boosting costs and making it more difficult for families to get health insurance. More specifically, regulatory intervention by state governments is a significant problem, particularly protectionist barriers preventing consumers from buying insurance policies issued in other states. Combined with expensive mandates that states impose on health plans – for everything from chiropractors to breast reduction, the results are less competition and higher premiums. Congressman John Shadegg (R-AZ) has introduced the Health Care Choice Act (H.R. 3217) to restore unfettered interstate commerce and let consumers shop for health insurance plans in a national market. According to one estimate, freedom to purchase insurance policies issued in other states could save some families as much as 30 percent on their health policies. Unleashing the Constitution's promise of unfettered interstate commerce is the most effective way of breaking up the inefficient oligopolies created by state politicians.

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10 October, 2009

Briton has badly busted arm but NHS won't fix it



THIS crippled plumber horribly broke his arm TEN months ago and is still waiting for surgery to repair it. Torron Eeles busted his left humerus bone leaving it grotesquely out of shape when he fell down stairs. Today he slammed the NHS for "unacceptable" delays - claiming they have cancelled FOUR separate operations.

His arm hangs limply by his side meaning Torron cannot work for a living and now faces the prospect of losing his home. Torron, from Welham Green, Herts, said he had applied for employment and support allowance but was denied both.

The dad-of-three said: "This whole situation is absolutely disgusting. I have never heard of anyone else having a broken arm for 10 months. "It's been so long the bones have knitted back together. Sleeping is really uncomfortable because whenever I roll over my arm gets in the way. "I'm a kitchen fitter and plumber by trade but I can't even slice a load of bread let alone work."

Torron fractured his arm on December 3, 2008, and rushed straight to casualty where doctors put his arm in plaster. The first two ops were cancelled due to a lack of beds and operating time, claimed Torron. Then two more were delayed because of Torron's high blood pressure and concerns over his smoking.

Nick Carver, the chief executive of the East and North Herts NHS Trust, insisted computer records showed the trust had only cancelled two operations - one in February and a second in May. He said proceeding with the operations could have put Torron's life at risk. Mr Carver said: "Mr Eeles' operation was cancelled only twice - and then both on clinical safety grounds." [Incomprehensible rubbish. Just shallow excuses]

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New drug could help 40,000 rheumatoid arthritis sufferers but too dear for NHS dependant Brits

You are just cattle to government health bureaucrats, an impersonal problem

An alternative new drug for rheumatoid athritis may help to ease the painful symptoms of 40,000 patients who do not benefit from current medications. Tocilizumab is the first new treatment for the condition to be developed for ten years, but to treat one patient will cost up to £9,300 a year, and it has yet to be approved for widespread use on the NHS. Five trials involving more than 4,000 patients have shown that the injected treatment can transform the lives of patients who cannot tolerate other therapies or no longer respond to them.

Six times more patients reported that they achieved clinical remission — a return to “normal” quality of life — with tocilizumab than with the standard drug treatment methotrexate. The drug, also known as RoActemra, targets a key signalling molecule that causes painful inflammation around the joints.

But this month the National Institute for health and Clinical Excellence (NICE) which assesses the cost effectiveness of new medicines in England, issued preliminary guidance that rejected the treatment as too expensive for use on the NHS. Without NICE approval, local health authorities are highly unlikely to pay for the drug.

The National Rheumatoid Arthritis Society, a charity supporting sufferers of the disease, described the decision as “extremely bad news”. But NICE could still reverse or alter this decision, before producing its final guidance in February.

Drug manufacturers said yesterday that negotiations with the watchdog were continuing.

Treating rheumatoid arthritis and related illnesses is estimated to cost the NHS more than £4 billion each year, as about 350,000 adults in Britain are estimated to suffer from the condition, many of whom are severely disabled.

Tocilizumab, made by the Japanese company Chugai Pharma and distributed by Roche, targets a specific molecule called Interleukin-6, which plays a key role in the immune system and generates inflammation which can exacerbate the symptoms of rheumatoid arthritis. It may be given either on its own or in combination with traditional anti-rheumatic drugs such as methotrexate, as a second- or third-line treatment where other therapies have failed.

In patients not responding to methotrexate or another altenrnative, anti-TNF (tumour necrosis factor) drugs, tocilizumab achieved 30 per cent remission rates after six months. After two years of treatment, 54 per cent of patients had seen their symptoms eased by the drug, based on their responses to clinical questionnaires.

Alisa Bosworth, chief executive of the NRAS, said: “The availability of this new drug is a significant breakthrough in the treatment of rheumatoid arthritis. Access to new treatment options is crucially important to enable more patients to have an opportunity of slowing disease progression and regaining their quality of life. Without access to these treatments, patients face a life of increasing disability and pain.”

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Scottish hospital infested by pests

PEST CONTROLLERS were called in to deal with bats flying around wards at Ninewells Hospital in Dundee on two separate occasions last month, The Courier can exclusively reveal. Bats were seen on the general medical Ward 6 on September 4, and on the surgical Ward 9 five days later.

The shocking revelation is contained in a breakdown of incidents of pests over the last year in Tayside hospitals obtained under Freedom of Information legislation. It shows that between October last year and this September pest controllers were called to NHS Tayside hospital premises on 462 occasions to deal with rats, mice, seagulls, dead birds and even a dead rabbit. The majority of incidents involved insects including, ants, flies, cockroaches, wasps, silverfish, beetles and even hornets.

Last night Dundee-based Labour MSP Marlyn Glen said that patients and their families would find the idea of pest infestations in Tayside hospitals “utterly repellent.”

Among the incidents logged by health officials were mice in the kitchen and main dining room at Stracathro Hospital, rats in Ward 4 of Little Cairnie Hospital in Arbroath, mice in the main kitchen at Ashludie Hospital in Monifieth, rats outside the Queen Mother Wing at Arbroath Infirmary, and a bird’s nest in the personnel office at Ninewells. There were silverfish in the food preparation area at Perth Royal Infirmary, and cockroaches in the dining room at Sunnyside in Montrose. Maggots were also found in the corridor near the kitchen at the hospital. Between October 2008 and the end of July this year NHS Tayside spent £11,137.50 on pest control within hospital premises, including the grounds.

Last night Ms Glen said, “This will be very concerning to patients and their families. “When someone we love goes into hospital we have a right to expect that they will be treated in clean and safe conditions. “The idea that our hospitals are infected with mice, cockroaches and even bats is utterly repellent. “Nicola Sturgeon (health secretary) needs to get on top of this and support staff instead of cutting budgets and piling pressure on our doctors and nurses. “Our hospitals must be properly maintained and made fit for purpose. “How can we have confidence that ministers will succeed in eradicating hospital superbugs such as C. difficile when they can’t deal effectively with bugs and rodents?”

NHS Tayside has a local pest control contract in place, which includes regular inspection of all premises, and pest controllers are called out to deal with outbreaks of pests as they occur.

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The Greatest Show on Earth

Step right up: A new entitlement that cuts the deficit!

Washington spent the week waiting for the Congressional Budget Office to roll in with its new cost estimates of the Senate health-care bill, and what a carnival. Behold: a new $829 billion entitlement that will subsidize insurance for tens of millions of people—and reduce deficits by $81 billion at the same time. In the next tent, see the mermaid and a two-headed cow.

The political and media classes are proving they'll believe anything, as they are now pronouncing that this never-before-seen miracle is a "green light" for ObamaCare. (What isn't these days?) The irony is that the CBO's guesstimate exposes the fraudulence and fiscal sleight-of-hand underlying this whole exercise. Anyone who reads beyond the top-line numbers will find that the bill creates massive new spending commitments that will inevitably explode over time, and that this is "paid for" with huge tax increases plus phantom spending cuts that will never happen in practice.

The better part of the 10-year $829 billion overall cost will finance insurance "exchanges" where individuals and families could purchase coverage at heavily subsidized rates. Senate Finance Chairman Max Baucus kept a lid on the cost by making this program non-universal: Enrollment is limited to those who aren't offered employer-sponsored insurance and earn under 400% of the poverty level, or about $88,000 for a family of four. CBO expects some 23 million people to sign up by 2019.

But this "firewall" is unlikely to last even that long. Liberals are demanding heftier subsidies, and once people see the deal their neighbors are getting on "free" health care, they too will want in. Even CBO seems to find this unrealistic, noting "These projections assume that the proposals are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation." Scratch "often."

Then there are the many budget gimmicks. Take the "failsafe budgeting mechanism" that would require automatic cuts in exchange spending if it increases the deficit. CBO expects 15% reductions in exchange subsidies each year from 2015 to 2018, even though the exchanges don't open until 2014. That kind of re-gifting should have been laughed out of the committee room, but the ruse helps to move future spending off the current budget "score."

Mr. Baucus spends $10.9 billion to eliminate the scheduled Medicare cuts to physician payments—but only for next year. In 2011, he assumes they'll be reduced by 25%, with even deeper cuts later. Congress has overridden this "sustainable growth rate" every year since 2003 and will continue to do so because deeper cuts in Medicare's price controls will cause many doctors to quit the program. Fixing this alone would add $245 billion to the bill's costs, according to an earlier CBO estimate.

The Baucus bill also expands ailing Medicaid by $345 billion—even as it busts state budgets by imposing an additional $33 billion unfunded mandate. The only Medicare cut that isn't made merely on paper is $117 billion in Medicare Advantage, which Democrats hate because it gives one of five seniors private insurance options.

Recall that when President Obama started the health-care debate, the goal was "bending the curve"—finding a way to reduce both Medicare and overall health spending. Budget director Peter Orszag talked about "game changers," which CBO has now outed as nonchangers. Comparative effectiveness research about what treatments work best? That will save all of $300 million in Medicare, even as it costs $2.6 billion in new taxes on premiums. More prevention and primary care will increase spending by $4.2 billion.

Meanwhile, the bill piles on new taxes, albeit on health-care businesses so the costs are hidden from customers. Insurance companies offering policies that cost more than $8,000 for individuals and $21,000 for families will pay $201 billion per a 40% excise tax, which will be passed down to all policy holders in higher premiums. Another $180 billion will hit the likes of drug and device makers, including $29 billion because companies won't be allowed to deduct these "fees" from their corporate income taxes. Then there's the $4 billion in penalty payments on those who don't buy insurance because all of ObamaCare's other new taxes and mandates have made it more expensive.

Senate Finance votes next week, and no doubt this freak of political nature will pass amid fanfare and self-congratulation that their new entitlement will reduce deficits. Never mind that such a spectacle has never happened in the history of the republic. P.T. Barnum had nothing on this crowd, and the bill hasn't even hit the Senate floor yet.

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The GOP Is Winning the Health-Care Debate

Gallup says independents now favor Republicans by nine points

Passing health-care reform could be harmful to the health of congressional Democrats. Just look at how President Barack Obama's standing has fallen as he has pushed for reform. According to Fox News surveys, the number of independents who oppose health-care reform hit 57% at the end of September, up from 33% in July. Independents are generally a quarter of the vote in off-year congressional elections.

Among college graduates, opposition to health-care reform is now 50%, while only 33% support it, according to Gallup's Sept. 24 poll. College graduates are slightly more than a quarter of the off-year electorate.

Among seniors, opposition to ObamaCare hit 63% in last month's Economist/YouGov Poll. But the number from that poll that should spook Democrats is this: 47% of seniors said they "strongly" oppose health-care reform, just 27% "strongly" support it. Seniors are the biggest consumers of health care, and their family members will probably take their concerns seriously. Seniors will likely cast about 20% of the votes next year.

The trend behind these numbers is that voters are turning away from Democrats. In 2006, the year the GOP lost control of Congress, Democrats enjoyed a double-digit lead in several "generic ballot" polls—a measure of voters' party preference. Democrats held that lead until this year. Today, Gallup's generic ballot shows Democrats have a razor thin 46% to 44% edge. According to Gallop's numbers, independents now favor Republicans by nine points.

The numbers may get worse for Democrats if they pass a health-care bill. Why? Because Senate Finance Committee Chairman Max Baucus (D., Mont.) wants to frontload the reforms with distasteful things. Under his plan, tax hikes and Medicare and Medicaid cuts kick in immediately, while new benefits are delayed for two-and-a-half years. Voters likely won't warm to reforms that slam them next year while promising benefits down the road.

Congressional Democrats could also be the first to feel a backlash against rising federal spending. An early September Gallup poll found that 38% approve and 58% disapprove of Mr. Obama's handling of the deficit (from 49% approve, 44% disapprove in March). In September, a Fox News poll found that 61% of independents think the Obama administration wants to increase spending too much; just 29% thought the amount of spending Mr. Obama wants is "about right."

After a $787 billion stimulus package and other spending binges this year that have the administration planning to double the deficit in five years, many voters are worried about the amount of red ink being spilled.

Voters likely won't react well to the price tag of Mr. Baucus's bill. Yesterday's Congressional Budget Office (CBO) report pegs its cost at $829 billion over the next 10 years. The CBO report claims the bill won't add to the budget deficit until 2015—but the bill only manages that feat by delaying benefits and imposing taxes and Medicare and Medicaid cuts up front.

The CBO report does shed some light on the cost for each person the Baucus plan would add to the ranks of the insured. CBO estimates the plan would insure about 29 million people. If that is right and if the total price tag is also accurate, the average cost per year per person for the seven-and-a-half years benefits will be in force during the program's first decade would be $3,811. That compares favorably to private insurance. On average, a single person now pays $4,824 a year for health coverage and a family of four pays $3,344 per family member per year, according to the Kaiser Permanente Institute for Health Policy.

But the CBO numbers are almost certainly overly optimistic —there has only been one large-scale federal health program that has come in at or under its projected cost, the Medicare prescription drug benefit enacted under the previous administration, which is costing 40% less than estimated.

The good news for the president is that his job approval ratings appear to be stabilizing. The Rasmussen tracking poll for Oct. 2-3 shows 46% of likely voters approve and 50% disapprove of his performance, essentially unchanged over the past month.

Independents, the college educated and seniors may oppose health-care reform, but if Mr. Obama has halted his slide congressional Democrats may be willing to bet on him and go for his whole health-care reform enchilada—public option and all.

This battle is far from over. But what Democrats have to keep in mind is that there are two fights going on here —one over health care and another over which party will control Congress after next year's elections. By waging the first, they may be setting themselves up to lose the second.

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Does Medicare Care?

Throughout the health care debate, insurance companies have been cast as greedy villains that gleefully deny medical claims. But when it comes to rejecting claims, they can't hold a candle to the government. Just days before Congress broke for its August recess, House Speaker Nancy Pelosi called the insurance industry's opposition to a government-run health plan "almost immoral" and accused carriers of profiting at the country's expense. "Of course they've been immoral all along in how they have treated the people that they insure," said the San Francisco Democrat who has taken more than $200,000 in political contributions from the insurance industry in the last two election cycles. "They are the villains. They have been part of the problem in a major way."

The complaints lodged toward the industry from the Democratic side are focused primarily on premiums -- too high, government health care supporters say -- and horror stories about private insurers denying care. Neither criticism, however, is fair. Premium rates are affected in no small way by government policy. Mandates handed down by lawmakers add significantly to costs. The Congressional Budget Office believes mandates such as requiring insurers to sell policies to anyone who wants one and rules on what treatments must be covered increase premium costs by 15%. The Council for Affordable Health Insurance says the increase is higher -- 20% in some states and as much as 50% in others.

As for denial of care, Medicare, which we've described as the government's public option for senior citizens, has the highest denial rate in the country, according to the American Medical Association's 2008 National Health Insurer Report Card. From March 1, 2007, to March 10 of last year, Medicare rejected 475,566 of 6.94 million claims for a rate of 6.85%.

Aetna was the only private insurer that had a similar number, denying 43,317 of 637,239 claims for a rate of 6.8%. But the average of seven carriers was 4.05% including Aetna. Dropping Aetna as an outlier takes the denial rate down to 3.08%.

Medicare's biggest reason for rejection (27.8%) was claims lacking information "needed for adjudication," the AMA report says. More than one-fifth (20.9%) of the rejections were in response to procedures deemed not to be a medical necessity by Medicare. Nearly 4% were rejected because they were noncovered services performed during a routine exam or screening. In 3.1% of the cases, Medicare said the expenses were incurred before the patient was covered -- a pre-existing condition. Other claims were denied because the patient wasn't covered by Medicare or couldn't be identified as a Medicare recipient, or there were paperwork problems.

Not surprisingly, the private insurers didn't deny a single claim due to corporate greed, Republican malevolence or any of the other criticisms the left uses to attack the insurance industry.

The lesson here is that a government program, even one as beloved as Medicare, is no more efficient, no more caring, no more morally superior than private coverage.

This isn't the only lesson that can help the public understand why government-run health care, even if it's just a camel's-nose-under-the-tent public option, would be a mistake. But it is part of a larger package of reasons that coherently argue against more intervention from the state, which controls 45% of U.S. health care spending as it is.

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9 October, 2009

Britain's bureaucratized ambulance service

Petty ambulance boss refuses to let crew treat man with broken back 'because he was lying in six inches of water'

A jobsworth ambulance boss refused to allow his staff to enter six inches of water to treat a man with a broken back - because it breached heath and safety.

Stricken Brian Bendle, 45, suffered the agonising injuries as he stood in shallow water at a leisure lake in Somerset. He was waiting to take his £10,000 jetski out onto the water when he was hit by another rider travelling at around 50mph. Shocked onlookers immediately ran into the lake as Mr Bendle, from Bristol, lay face down in the water. They floated the dad-of-three in the six inch ankle-deep water, where they supported him until an ambulance arrived amid fears moving him would aggravate his back injury.

But they were stunned when a paramedic arrived and refused his pleading staff to enter the water - because they weren't trained to deal with water rescues. They had to slide a spinal board under him themselves and carry him to ambulancemen, who were stood on the bank just 6ft away. One onlooker said: 'The paramedic wouldn't treat him. 'Two colleagues arrived in an ambulance but he stood in their way and told them, 'I'm incident commander - you aren't getting into the water.' 'The ambulancemen were pleading with him. I reckon a good ten or more minutes were wasted.'

Steve Cox, 47, who runs the Middlemoor Water Park in Woolavington with his wife Julie, said: 'The first bloke insisted they had to wait for the fire brigade. 'He kept saying, "Health and safety won't let me get in".'

Mrs Cox added: 'Brian was stood at a virtual standstill waiting to dock when he was hit by a jetksi travelling at some speed. 'He tried to avoid the machine but was sent tumbling into the water. 'He was lying in water at the side of the lake, which can't be deeper than six inches when people rushed in to help him.'

The drama unfolded at 3pm on September when Mr Bendle, an experienced jetskier, visited the lake with his son. He was one of three people using the lake at the time of the accident, which left him with a broken back, six broken ribs and bleeding lungs. Mr Bendle was eventually rushed to Musgrove Park Hospital in Taunton, Somerset, where he was yesterday being treated in the intensive care unit.

A spokesman for the South West Ambulance Service said only fire crews were trained for water rescues. He said: 'The incident was managed in accordance with procedures.'

In August, heart attack victim Melissa Proctor-Blain, 32, died after a paramedic feared it was unsafe to enter a pub in Spondon, Derbys. Last year Karl Malton, 32, of Crowland, Lincs, drowned in 18ins of water while 999 crews waited for a water rescue team 50 miles away.

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British Grandmother dies of ovarian cancer after being sent home FIVE times 'with trapped wind'

A grandmother dying of ovarian cancer was sent home five times by medics who said her crippling pain was caused by trapped wind. Barbara Collins, 68, was bed ridden for months with agonising pain and bowel problems, classic signs of the killer disease, but sent home with only laxatives.

The mother of four was correctly diagnosed with ovarian cancer a staggering four months after her first visit to Manchester Royal Infirmary, and died 10 days later.

Mrs Collins’ family criticised the medics, who they say made her feel like a nuisance. She could have survived if only her cancer had been diagnosed sooner, they claim. Daughter, Angela Stubbs, 44, from Partington, Greater Manchester, said: ‘It was tragic. ‘My mum went from being very active to lying in bed in pain in the space of a few months. ‘She was in agony and had terrible bowel problems, but time after time they gave her laxatives and sent her home - no one listened to her or to us. ‘When they finally did diagnose her ovarian cancer it had spread to her lungs and bowel but they said she could have chemotherapy - we were horrified when she died. ‘They call ovarian cancer the silent killer but my mum had the classic symptoms of the disease. ‘I feel so angry about the weeks she spent in bed and in pain. I hope people will hear about the symptoms and might be able to save their relatives.’

Mrs Collins first visited Manchester Royal Infirmary on April 6. Medics failed to pick up the condition during two separate visits to the walk-in centre and a visit to accident and emergency. The grandmother of ten was even sent home without a diagnosis after being admitted to the hosp