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9 February, 2010

Health Care Made Simple

I don’t have a home-entertainment system. I buy my clothes off the rack at Macy’s. I drive an ordinary sedan. My dinner table is graced with wine costing less than $10. We shop sales. But my wife and I splurge on health care (as we did on our children’s educations).

Are the values reflected in these choices unusual? I doubt it. But this is the nub of the health care issue at the epicenter of American politics the past year.

We have had a confusing and dishonest debate. Senator Kennedy made this a crusade. Presumably, the reason for crusading was compassion for the uninsured, an estimated 50 million Americans who are not without health care, but who get less of it and of a lower quality. Fair enough. Had Obama had the political courage to ask the rest of us to kick in an extra hundred bucks, or whatever, in taxes so that these folks can get the same care most of us get, I’d have been ready to ante up.

But he didn’t think he could sell that, so he said the urgency of health reform was to save all of us money and reduce the deficit. This is what motivated Teddy’s last crusade: Reducing the deficit? Balancing the budget? Give me a break.

We were told that the reason for Obamacare was that health costs were eating up 17 percent of GDP and rising faster than inflation. Yes, and so are college costs. And for the same reason (i.e. these things are more precious to us), buyers will stint on them less than other things, tilting the market to the sellers’ advantage.

This is the basic engine of rising health costs. It is compounded not, pace Obama, by greedy insurance companies, (they are greedy, of course, but not more so than other companies), but by three factors sacrosanct to Democrats. First, malpractice suits, which add to the cost of practicing medicine and encourage excess treatment. Second, untaxed employer-provided health insurance that further diminishes cost-conscious shopping by health consumers. Third, Medicare and Medicaid, which are worthy programs that I support—but if the government is buying things for people they couldn’t afford themselves, the dynamic of supply-and-demand will drive up the price. Additional government subsidies, as Obama proposes, will increase it further.

Obama’s plan to reduce costs is a Rube Goldberg machine requiring a 2,500-page bill. But the issue can be simplified. Where will the savings come from, especially if 50 million people will now get more and better services? Will the providers get paid less? Then we will have fewer and less talented providers. Can the insurance and drug companies be squeezed? Perhaps some, but they are not earning more than other enterprises. If profit margins are reduced too much, capital will shift to other sectors. In short, the only way to hold down medical costs is by providing less or lower quality medicine.

Is that a goal worthy of a crusade? Why exactly is it bad that health costs are 17 percent of GDP? What percent should they be? So what if they rose to 20 percent? Here’s a question for my fellow aging boomers. Say medical breakthroughs make it possible for us all to live to 100 relatively spry. But the costs are high and will drive medicine to 25 percent of GDP. Would that be a tragedy?

SOURCE




Real Healthcare Reform: Kill the Lawyers

Now that a stake has been driven through the heart of the omnibus healthcare bill proposed and drafted by the Obama-Pelosi-Reid Axis (with an assist from Henry Waxman), we can get down to real reform. The President has stated that he wants to work with Republicans. Then let’s start with the most obvious cost control factor – malpractice/tort reform.

There is some truth to Democratic claims that several of the proposed reforms are interlocking and thus to address one specific issue might be difficult to accomplish. However, this in no way justifies their ridiculous proposal, including its huge growth in the federal government and its invasive government panels.

Unfortunately, the Democrats ignored the biggest opportunity for cost reduction: eliminating spurious lawsuits and getting ambulance-chasing lawyers out of the medical malpractice business. It is also clear that this reform is not interdependent on other reforms.

Doctors spend an enormous amount of time and effort protecting themselves from lawyers and avoiding lawsuits. They order extensive, expensive tests whose only purpose is to protect themselves from lawyers, and pay outrageous malpractice insurance fees just to rid themselves of these predators. Once lawyers get involved, a doctor’s world is always turned upside down.

Consider what happens in these situations. A lawyer takes on a case for someone who has real or imagined harm. The lawyer has no medical training except for the knowledge they have gained from working on other lawsuits. They run up significant costs that they front for the client, and then pursue a legal remedy. Frequently the insurance company settles (makes payment) to the litigant to minimize outlays. If not, the case goes to court in front of a judge (i.e., a lawyer) or jury, neither of whom typically has any medical training. Either way, the lawyer is reimbursed all the up-front costs plus 33-40% of the remaining funds. The person filing the case is often left with less than half of the proceeds.

We need to stop entrusting these issues to unqualified people through a legal system established mostly to enrich the participants as opposed to the truly harmed. Lawyers have no special knowledge or expertise to determine harm in these situations and neither do judges. We have allowed this system to get out of control and we, the American people, must insist that if any change is made to our medical system it starts right here.

Toward that end, I have a proposal. We need to establish a separate forum to handle claims of medical malpractice. We must accept that as dedicated as our medical personnel may be, mistakes are occasionally made due to stress, confusion or just human error, and the people who are harmed should be justly compensated for those mistakes. In addition, there is occasionally a bad apple in the medical field whose care and concern for patients does not meet established standards. Those patients should be compensated for any harm done to them.

The proposal that I suggest is to establish a five-person panel. The panel would consist of two retired judges, two retired doctors and one retired, respected businessperson. There would also be a Medical Advocate’s office – skilled in the issues of medical procedures due to their exclusive focus on medical claims and disputes – that would represent the patient. The advocates would be salaried employees, much like a public defender or district attorney, with no direct financial benefit from winning the case. The accused, be it a doctor or medical facility, would be able to have their own representative to defend themselves against any charges.

Any outcome would be decided by the five-person panel. The panel would not only understand the law, but would actually be able to examine the charges made against the accused and provide an educated medical analysis of any harm done. The businessperson would be able to judge credibility of the business practices used and weigh the economic effects of the decisions being made. The result would be a balanced decision made with analysis of all the ramifications – medical, legal and economic. No longer would lawyers be profiteering on the backs of the medical system and the American people.

I realize that this proposal has little chance of being adopted. After all, the trial lawyers have their hands so deep in the pockets of the Democrats you might assume they were Siamese twins. Despite “reforming” almost all aspects of the medical system in a bill rumored to have ballooned to over 2,600 pages, the Democrats managed to merely “suggest” that the nation might consider a pilot program for malpractice reform.

The Democrats have to decide whether they care more about American people or American lawyers. They have to decide whether they want to truly control the costs of our healthcare system or just launch platitudes. Ultimately the American people will have to choose between their doctors and their attorneys. The two just do not mix, and the national interest is clearly not being served. If they decide for the medical professionals – as they should – the Democrats will need to make real change, or have real change forced upon them: retirement.

SOURCE




The Mirage of Bipartisan Health Care Meetings

With the seating of newly elected Massachusetts Senator Scott Brown, Barack Obama has now agreed to hold televised meetings with Republicans and Democrats on health care reform. This feeble attempt by Obama and the Democrats to look bipartisan is nothing more than calculated damage control trying to prevent the inevitable losses in the coming 2010 mid-term elections.

According to Politico, Barack Obama stated that he wants to “look at the Republican ideas out there.” But the real question is, where was this idea six months ago when Congressional Democrats were having backroom meetings while crafting a bill like a one-party aristocracy?

This shows once again that Barack Obama and his Democratic colleagues in Congress will only listen to the American people when they are forced to. And in this case, it took the special election in Massachusetts.

If this government was truly created “by the people, for the people,” then why was it that the Obama Administration and Congress refused to drop their push for socialized medicine even though the American people were vehemently opposed to it? (Final Health care poll showed 58% opposed the current bill according to Rasmussen Reports)

And before we get all excited about Obama’s newfound ways, let’s remember he has only promised to “look” at Republicans and not to start over with bipartisan input. In fact, at the Obama-GOP Baltimore confab some weeks back, Obama explicitly said that he had “read every Republican bill.” Apparently, that gem now enters the growing repository of Obama “misstatements.”

This paper has repeatedly called for Barack Obama and his Democratic majority in Congress to go back to the drawing boards and take an honest and open look at ways to lower costs in the health care industry.

One major idea that has been ignored by Obama and his cohorts is to allow state-to-state competition. It’s simple, why should someone from North Carolina not be allowed to buy health insurance from South Carolina?

In almost every case, more competition equals lower prices.

Another major idea that has been ignored is tort reform. According to Legal Newsline, “the Congressional Budget Office director, Douglas Elmendorf, has said as much as $54 billion could be saved over the next 10 years if Congress enacts legal reforms including a $250,000 cap on damages for pain and suffering and a $500,000 cap on punitive damages and restricting the statute of limitations on malpractice claims.” And this doesn’t even include the likely savings that will occur based upon a reduction of defensive medicine often practiced by doctors today.

These are just two entirely obvious ideas that have been ignored by the Obama Administration and Congress. They should be included in the mix when Congress goes back to the drawing board. And they should start with a tabula rasa – to be filled in at the will of the American people.

SOURCE




Australia: Queensland Health a bureaucratic mess

ONE of the world's top medical experts has delivered a damning assessment of Queensland Health five years after the Bundaberg Hospital scandal. The unflattering report comes despite billions of dollars in extra funding being poured into the system after the Bundaberg fiasco. The top-level review, conducted by recently retired UK chief medical officer Sir Liam Donaldson, found the department and the independent watchdog set up following the 2005 health inquiries had little idea who was responsible for improving patient safety.

Obtained by The Courier-Mail, the August 2009 report said hospitals had overlapping and unclear safety standards, were too reliant on overseas-trained doctors while staff were burdened with duplication. There was also no strategy for remote and regional areas while the public was given a "weak voice" in the system.

In one of a raft of botched policies, Sir Liam identified an "ambiguity" between the roles of Queensland Health and the Health Quality and Complaints Commission. "(There is) no clear agreement on the respective roles of the (HQCC) and Queensland Health in quality improvement," the report said.

Sir Liam, who visited for a week last year focusing on clinical governance, said Queensland had made a "major commitment" to reform, including an impressive roll-out of programs, strong leadership and accountable services. But he also identified areas where policy was ill-defined or lacking, including unclear and varying reporting standards. "Some standards have strong clinical and managerial credibility, others are not valued," the report said.

Sir Liam, whose bill is expected to hit about $40,000, said recruitment was strengthened but that it took four to five months to hire doctors. "Many areas are still heavily dependent on locums (mainly international medical graduates)," the report said.

It also said that the role of the QH Patient Safety Board needed refocusing. "At the end of every meeting, the board should ask itself: 'Have we concentrated on the most important things?'," Sir Liam said.

Sir Liam noted patient safety was comparable to other countries but the PRIME incident reporting system was overburdening staff. "There is a clear sense of 'implementation fatigue' permeating the current system," Sir Liam said.

Predicting tensions, Sir Liam said QH should own responsibility for quality standards but said the HQCC was "ambitious" and wanted to be proactive in patient safety culture. "On the other hand, it is unlikely that Queensland Health's senior management would accept a wide-ranging quality improvement and cultural change role for the commission," he said.

Centre for Healthcare Improvement boss Tony O'Connell said it was moving in the right direction but admitted more work was required. "This is always a work in progress and we'd never say we'd completed all tasks," he said.

SOURCE





8 February, 2010

Higher pay, shorter hours... but complaints about British GPs soar 12 per cent in ONE year

Complaints against GPs have risen by 12 per cent in just a year. Grievances lodged by patients totalled almost 40,000, official NHS figures show. That means a rise of a quarter in a decade during which GPs have seen their pay increased massively and their workload slashed. Much of the increase in complaints has followed the introduction of a new GP contract in 2004, which sent family doctors’ salaries soaring by 47 per cent to an average of £106,000 a year.

At the same time, more than nine out of ten GPs stopped providing care at evenings and weekends – slashing their workload by an average of seven hours a week in exchange for an annual pay cut of £6,000.

Now figures from the NHS Information Centre indicate that this fall in the amount of work they are carrying out has damaged patient care. Some 7,448 complaints were termed administration errors, including GPs not communicating properly with out-of-hours doctors and, between them, failing to provide proper care. The largest group of complaints – 14,866 – was about clinical care, including failure to diagnose illnesses or refer patients to specialists.

Last week a coroner ruled that failings in NHS out of hours care led to the death of pensioner David Gray at the hands of Dr Daniel Ubani, an exhausted German GP who had just flown in on his first UK shift.

Out of hours care has been the focus of increasing concern since primary care trusts assumed responsibility. A shortage of GPs willing to take up the work means PCTs often employ private companies, many of whom use overseas doctors.

It also emerged recently that medical lawyers have seen the number of complaints about out of hours care shoot up by 50 per cent in two years.

The Daily Mail revealed last week that care is so bad in some parts of the country that you only have a one-in-50 chance of a home visit from an on-call GP.

The latest official figures from the NHS revealed that 48,597 formal concerns were lodged with primary care trusts about GPs and dentists in 2008/09. This was up around 10,000 in a decade – and up more than 5,000 on the 2007/08 total. Dentists accounted for 8,909 of the complaints.

The Patients Association said failings in out-of-hours services and difficulties getting an appointment with a GP were likely to explain the rise in complaints. Claire Rayner, president of the Patients’ Association, called for people unhappy with their GP to complain and do all they can to get onto a rival doctor’s list. She said: ‘Too often people who are ill and frightened are not getting the care they need, especially when they are trying to get care outside normal surgery hours. ‘When people are not happy with their GP, we would urge them to vote with their feet.’

Both major political parties want to see the end of formal boundaries between GP practices, so patients can go to any doctor they choose. But they face a tough battle with the British Medical Association, which would prefer to see them retained.

Tory health spokesman Mark Simmonds called the findings ‘extremely concerning’. He blamed the 2004 change to out of hours arrangements for much of the rise, with family doctors taking the blame when patients could not get adequate help in an emergency in some cases. Other complaints were triggered when out of hours services and GPs failed to share vital information.

Mr Simmonds said the Tories would tear up the 2004 contract and return responsibility for commissioning out of hours care to GPs. He said: ‘I have no doubt that this is in part due to Labour’s failure to put the patients at the heart of the NHS and their changes to the GP out of hours system, which took responsibility for the service away from GPs and gave it to local bureaucrats.’

Dr Laurence Buckman, chairman of the GP committee of the BMA, said that while poor clinical care and bad behaviour could never be excused, it was possible that patients were more likely to complain now than they were ten years ago. He added: ‘Putting this in perspective, there are nearly 300 million consultations every year in general practice and surveys show that, on average, nine out of ten patients are satisfied.’

A league table shows that the London borough of Islington had the highest number of complaints per head of population, followed by Lincolnshire, the London boroughs of Lambeth and Southwark, and Great Yarmouth & Waveney in Norfolk.

The NHS was forced to turn to foreign doctors to plug shortages in hospitals when Labour took office and set targets for cutting waiting times for treatment. Since them, many more Britons have gone through the seven-year training period for doctors and begun work on the wards. But the NHS still has to fly in foreign doctors to cover out of hours shifts since the vast majority of GPs were allowed to opt out of what was a traditional duty of care.

A Department of Health spokesperson said: 'It is important to note this is not representative of the picture across the NHS. The NHS treats millions of people every day and the vast majority of patients experience good quality, safe and effective care - the Care Quality Commission's recent patient experience survey shows that 93 per cent of patients rate their overall care as good or excellent. 'In April last year, we introduced a new, simpler complaints system, which encourages patient feedback and ensures Trusts act on this to make their services more effective, personal and safe.'

SOURCE




Is Obama finally practicing what he preached: Bipartisanship?

Probably just a publicity stunt designed to "prove" that the GOP are obstructionists

In the first major step to revive his health care agenda after his party's loss of a filibuster-proof Senate majority, President Obama on Sunday invited Republican and Democratic leaders to discuss possible compromises in a televised gathering later this month. Obama's move came amid widespread complaints that efforts so far by him and his Democratic allies in Congress have been too partisan and secretive.

The Feb. 25 meeting's prospects for success are far from clear. GOP leaders demanded Sunday that Democrats start from scratch, and White House aides said Obama had no plans to do so. "If we are to reach a bipartisan consensus, the White House can start by shelving the current health spending bill," said Senate Minority Leader Mitch McConnell, R-Ky.

House Republican leader John Boehner of Ohio also threw some jabs while accepting Obama's invitation. He said he was glad the White House "finally seems interested in a real, bipartisan conversation," adding that Americans have rejected "the job-killing, trillion-dollar government takeover of health care bills passed by the House and Senate."

Obama told CBS's Katie Couric that he and the leaders of both parties will "go through systematically all the best ideas that are out there and move it forward." Asked if he was willing to start from square one, the president said he wants "to look at the Republican ideas that are out there. And I want to be very specific. 'How do you guys want to lower costs? How do you guys intend to reform the insurance markets so people with preexisting conditions, for example, can get health care?"' "If we can go step by step through a series of these issues and arrive at some agreements," Obama said, "then procedurally, there's no reason why we can't do it a lot faster than the process took last year."

Congress' Democratic and Republican leaders have differed sharply on most major questions in the long-running health care debate. Only one Republican voted for the House health care bill approved in December, and no Republicans voted for a similar Senate version.

White House officials said Sunday that Obama does not intend to restart the health care legislative process from scratch. Many liberal groups and lawmakers want congressional Democrats to use all the parliamentary muscle they have to enact the measure that the Senate passed on Christmas Eve, employing rules that could bypass GOP filibusters to make changes demanded by House Democrats. The White House has not ruled out such a strategy. But Obama's recent talk of inviting Republican input and extending the debate for several weeks has caused uncertainty about his plans.

SOURCE




Your tax dollars buy TV talking head

MIT economist Jonathan Gruber has no qualms about speaking his mind on ObamaCare. He’s been one of the most outspoken independent voices defending the healthcare proposals. But there’s a catch. He’s not independent at all. As it turns out, the Department of Health and Human Services paid him nearly $400,000 to provide "technical assistance" in evaluating the healthcare proposals.

Funny how he forgot to mention this blatant conflict of interest on the many TV shows in which he’s touted the plan, or in the newspaper articles where he’s been quoted. He even wrote an Op-Ed piece on health reform in the Washington Post, and again declined to mention that he’s getting paid put a positive spin on the plan.

Yup — just one more elite who takes your money to tell you what’s good for you.

For the record, Gruber says it’s all fine because he told anyone who asked, and anyway he was paid to advise the administration — not for his media appearances. To paraphrase an old saying about ducks: If it speaks like a shill and it’s paid like a shill…it’s a shill.

Counting the days until the midterm elections,

SOURCE




A One Page Alternative to "Obamacare"

Seven Real Reforms That Lower Costs, Raise the Number of Insured and be Deficit-Neutral

In the week between Scott Brown's seismic win and the State of the Union address, the Obama administration tried mightily to explain away the verdict of the Bay State voters. Despite the fact that Brown had plainly made the election a referendum on Obamacare, the voters, according to the administration's narrative, had not rejected it.

Rather, they had rejected Martha Coakley. They had been voting on other issues. They hadn't understood the bills in question. They were frustrated that change wasn't coming quickly enough. Indeed, they were simply expressing the same frustration that had swept Barack Obama into office. (In other words, they had apparently decided to stick it to George W. Bush by filling Ted Kennedy's Senate seat with a Republican.)

In the State of the Union, Obama offered another response. The Massachusetts voters had rejected Obama-care, but that didn't mean that he had to abide by their wishes. "I never suggested that change would be easy." "Democracy," he said, "can be noisy and messy." "We can do what's necessary to keep our poll numbers high and get through the next election." Or we can do "what's best for the next generation."

House Democrats seemed a bit stunned by this language, responding with silence rather than applause. They will face the voters in just nine months, and many of them represent Republican-leaning districts. Now, in the wake of Scott Brown's triumph, President Obama wants them to "take another look" at his proposals.

The American people have already taken a long look at Obamacare, and they don't want it. They don't want a government takeover that limits choice and competition, funnels $1 trillion from American taxpayers to insurance companies in its first dozen years (2014 to 2025), cuts Medicare Advantage benefits by an average of $21,000 per enrollee (except in South Florida) in its real first decade, and contains enough shady backroom deals to make Jimmy Hoffa blush.

Most of all, the American people don't want a $2.5 trillion bill that does all of that and still fails to do the one essential thing: lower health care costs.

During his State of the Union address, Obama also said that "if anyone from either party has a better approach ..... let me know." Well, without seeming too presumptuous, Mr. President, here you go!



The small bill offers seven real reforms (the last a combination of smaller reforms) that together would lower costs, significantly increase the number of insured, and be deficit-neutral.

Its proposals are not revolutionary or even particularly novel. They reflect ideas that are widely shared by Republicans in the House and Senate, as well as by many of their Democratic colleagues. The bill incorporates proposals that Tevi Troy and I have previously advanced. And it reflects scoring by the Congressional Budget Office (CBO) of the House Republican bill-the one bill proposed so far that the CBO has said would actually lower health costs. But the small bill would meet the American people's goals for health care reform-while Obamacare wouldn't-and it would do so at only a fraction of the price.

The small bill would cut health costs by roughly as much as the House Republican health bill, which contains very similar cost-cutting provisions. The CBO estimates that by 2016, the House GOP bill would cut insurance premiums by 7 to 10 percent in the small-group market, 5 to 8 percent in the individual market, and up to 3 percent in the large-group market, in relation to current law. Under Obama-care, the CBO says that the average family's premiums in the individual market would rise by $2,100 a year in relation to current law. The small bill would achieve these favorable results despite costing only about $180 billion in its real first decade-just 7 percent as much as Obamacare. And, unlike Obamacare, which would not go into effect in any meaningful way until 2014, the small bill would start next year.

Under the small bill, approximately 10 million additional people would acquire insurance, at a cost of about $18,000 per newly insured person versus about $76,000 under Obamacare. In other words, for every $20 billion spent, Obamacare would result in approximately 260,000 additional people becoming insured, compared with 1.1 million people under the small bill.

When the federal government isn't limiting their ability to do so, Americans know how to shop for value, and they will have no problem identifying the small bill as a far better value than Obamacare. In truth, even the status quo is clearly a better value than Obamacare. But the choice needn't be between those two unpleasant alternatives. Real reform is within our reach.

A recent McLaughlin and Associates poll asked Americans whether they would prefer Obamacare or a bill that took "more modest steps like allowing the purchase of insurance across state lines to improve competition, creating a risk pool to help people with preexisting conditions afford coverage, and curbing lawsuits against doctors." By almost three to one-61 percent to 21 percent-respondents favored the more modest alternative to Obamacare. Among those who felt "strongly," the tally was 31 percent to 9 percent.

Let's start over and give the American people what they want.

SOURCE





7 February, 2010

A senior doctor swore at me for staying with a dying man... THAT'S how bad Britain's out-of-hours crisis has become

(In a classic British government bungle, very few British doctors are prepared to work after hours because the government makes it financial folly for them to do so)

By Dr Ellie Cannon

Since qualifying as a GP I have chosen to work in an out-of-hours co-operative. I am one of a huge number of home-grown GPs to do this for the clinical experience, the skills training and, yes, the financial rewards. Working out-of-hours was a crucial part of my GP training, and for me it remains a fundamental part of being a doctor.

It is time-consuming, tiring and inconvenient. But I never assumed the work of a GP was going to be nine-to-five and I don’t believe I stop being a doctor in the evening when I go home to my children.

I realise this isn’t a view shared by all in my profession. Since 2004, many doctors have opted out of doing work that, I still believe, is a vital part of general practice. They did so because the introduction of a new GP contract has meant surgeries receive just 6 per cent more for providing out-of-hours cover for a lot more work. After costs that means very little difference in salary.

With a swathe of doctors no longer willing to pick up the phone outside surgery times, the out-of-hours co-ops were born. These are GP-run, not-for-profit groups that cover a far larger area than any practice ever would – half of Kent, for example. Many doctors who work in this way are well qualified, sincere and skilled but there is no requirement to be a regularly practising GP.

Nothing could illustrate the risks of the system more clearly than the death of David Gray. The 70-year-old died at the hands of Daniel Ubani – I struggle to refer to him as ‘Dr’ – a locum who had just arrived in Britain. This case may be extreme but it has rightly put the out-of-hours system under scrutiny, something I personally welcome.

Working for an out-of-hours co-op put me in the most harrowing situation I have ever faced as a doctor. One develops a degree of emotional resilience, moulded by years of seeing physical pain and emotional suffering, but there are times when that resilience is tested to the extreme.

I do my out-of-hours work on a Saturday night, when my children are in bed and my husband can babysit. Early last year, I had to visit a 36-year-old man called James, who was dying from terminal cancer. My remit was simply to make him comfortable. At this point he was beyond communication, hours from death and struggling for comfort.

Normally such patients are cared for by district nurses and the wonderful service provided by Marie Curie sitters, who look after patients in their final hours. Unfortunately, in the area this man lived, there were none available and the district nurses had finished for the night. This was a cruel misfortune for a man already dealt such a terrible fate. It is not an understatement to say that the family were devastated, trying to keep their dying son at home in his final hours with no professional care. I remember his mother hugged me on arrival, so relieved was she that someone had appeared.

From the outset it was clear that James needed more medication to ease his agitation. I spoke to the local hospice and started to optimise his drugs with the telephone guidance of one of its doctors. While I waited for the medication to take effect, I discussed with James’s parents what would happen next. I would leave for my next house-visit and, if he was still in pain, they would call the co-op back.

Because guidelines dictate patients are not allowed to call doctors directly, another GP would come to help. I couldn’t guarantee how quickly that might be but I would ask the co-op to prioritise any calls from this house – in general even an urgent call can take two hours to mobilise. That could have been all James had left. Not convinced James had been made any more comfortable, I again tried to optimise his medication. A momentary air of calm prevailed. His family were desperate to have a professional with them, as he was clearly swinging in and out of discomfort.

At this point, I made the clinical and humane judgment that I could not leave James. I firmly believe that most doctors would have done the same. My shift at this point was over and I judged that it was appropriate to stay out of my own time to ensure James was given the death he wanted. It was midnight. I informed my co-op driver and the base team of my decision and continued to monitor James, giving him the necessary medication and comforting his parents.

Within ten minutes I was called by the clinical supervisor from the co-op, an older more senior doctor. I was greeted with a tirade of abuse. Why was I staying wasting co-op time when there were a huge number of visits outstanding? I should call the district nurses, not waste doctor’s time on palliative care. Was I expecting someone to come and replace me? You can’t spend three hours on one visit! When I tried to explain the situation, he swore at me before hanging up. To add insult to injury, James’s father overheard and apologised for the trouble his son’s death was causing.

You see, while my supervisor was supposedly ‘clinical’, his concerns were anything but. The new GP contract is a target-driven concern. Shifts are paid by the hour, calls must be answered within a certain time and, most troubling of all, a certain number of visits must be undertaken in a six-hour shift. These are not measured by the quality of care but by the volume of patients seen. It is an alarmingly similar approach to the targets introduced in accident and emergency wards, where it has become more important that a patient is seen within four hours than by whom or why.

We have moved so far into a target-based system that common sense has been left behind. The clinical supervisor I had to deal with had forgotten his compassion for the dying and his empathy for a distressed colleague. Compassion and sense had been replaced with performance and targets; I believe he had forgotten what it means to be a GP. The out-of-hours services have to prove on paper they are performing well, otherwise the Primary Care Trusts take away their contracts for the next year. This poisonous culture means that they need to fill all shifts with doctors to have any chance of meeting these targets.

Does this mean the recruitment of doctors may be compromised? Clearly it does, as shown in the case of Mr Gray.

I am in no doubt that there should be a return to a more old-fashioned approach because the fragmentation of the current system leaves little chance for continuity of care. GPs should treat patients they know, or at least ones they are aware of. Doctors and patients deserve that. I remained at James’s house, where I continued to monitor him and give him medication. I cried looking at the photos on the lounge wall of a schoolboy with a cheeky smile, who was now dying at just 36. Even thinking about it a year later I can’t stop a lump forming in my throat. I left the house when I felt that he was settled, about five hours after I arrived. He died at 4.30am in bed peacefully, with his family by his side.

Do I regret being involved? Absolutely not. Was I shocked, even as a jaded foot soldier of the NHS, by the reaction I received from my colleague? Absolutely. What could have been more important than making a dying man more comfortable in his final hours?

Meeting the time targets for my shift? Ticking the right boxes to show the co-op was performing well? There were no tick boxes for being a good GP, for compassion, or for helping someone to have a ‘good’ death.

For James, given the circumstances, I did the best I could have done. But his own GP, who would have known his family and had at least spoken to him about his death, would have been better than one who knew him for no more than five hours. The boy in the photographs, the boy with the cheeky smile and his whole life before him, deserved better than that.

SOURCE




A sad example of British government regulations leading to poorer health

DOCTORS have uncovered the first evidence that fathers of test-tube babies may be passing on their infertility to their sons. A new study has found that boys conceived through IVF treatment involving a single sperm being directly injected into a female egg often inherit shorter fingers, a trait known to be associated with infertility. The results raise the prospect of a new and growing generation who may be less likely to have children of their own.

There are now an estimated 1m children across Europe born through IVF treatment. Almost one in 50 British babies is conceived artificially and nearly half the couples having treatment go through a procedure known as ICSI (intracytoplasmic sperm injection). The technique bypasses the normal competition where only the healthiest sperm cell is able to reach the female egg and fertilise it.

Alastair Sutcliffe, a paediatrician at the Institute of Child Health in London, led the Anglo-German study which compared 211 six-year-olds conceived through ICSI with 195 naturally conceived children of the same age. The ICSI group were similar heights to the naturally conceived group, but the boys had significantly shorter fingers. It is known that men with low sperm counts often have ring fingers the same length as their index finger, whereas fertile men are more likely to have a ring finger which is relatively longer than their index finger. The effect is reversed in women, where the most fertile are likely to have index fingers significantly longer than their ring fingers.

Sutcliffe’s findings appeared recently in the journal Reproductive Biomedicine Online. “This is the first study of this kind on these children,” Sutcliffe said. “We don’t yet know the implication of the findings because the children are very young, but we need to inform people [about the possible risks of the ICSI procedure].”

Scientists have long suspected that the test-tube baby boom would bring its own problems. Infertility treatment began as a commercial operation only in the 1990s. The first ICSI baby was born in 1992 and there are now about 3,700 such births a year in Britain.

Finger length is known to be set within the first 14 weeks of pregnancy and is linked to testosterone exposure which is, in turn, governed by a specific group of genes. “This [research] is telling us that we should only use ICSI when it is absolutely necessary,” said John Manning, an evolutionary biologist at Southampton University who has examined the link between finger length and fertility and who is one of the authors of the latest study. “We know the extraordinary depression and pain that childlessness can cause and we have a responsibility to ensure that the focus on the wellbeing of the children born as a result of these techniques is as high as it can be.”

Josephine Quintavalle, from the pressure group Comment on Reproductive Ethics, pointed out that ICSI is becoming the preferred option in infertility treatment because of a shortage of healthy sperm. This occurred after the introduction of legislation requiring donors to agree to be identified to their offspring in adulthood. “Using ICSI is obviously counter-intuitive to good health and this research would demonstrate that may be true,” she said.

Allan Pacey, a senior expert in male infertility at Sheffield University and a spokesman for the British Fertility Society, said ICSI should be used “only when absolutely necessary”.

A spokesman for the Human Fertilisation and Embryology Authority, which regulates private IVF clinics, said doctors are expected to warn couples of the risks of treatment before they are enrolled as patients.

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The Public Option Threat Still Buried in the Senate Bill

Most Americans now believe that major health care legislation will not pass this year. But as Heritage Vice President Stuart Butler explains in The New England Journal Medicine one seemingly minor proposal in the Senate health care bill could end up having huge repercussions for our entire health care system:

The Senate legislation contains strong directives to the OPM, requiring it to negotiate medical-loss ratios (the percentage of premiums that insurers actually spend on medical care for enrollees), minimum benefits, profit margins, premiums, and “such other terms and conditions of coverage as are in the interests of enrollees in such plans.” Crucially, the legislation also specifies that the OPM-administered plans would automatically be deemed to meet all the requirements for plans to be offered through the health exchanges created by the legislation.1 This means that OPM-administered plans could in practice operate free of many of the financial regulations that exchanges might impose on other plans, allowing the plans to operate under their own OPM-designed regulations.

How might the health care system evolve if this OPM feature were implemented as part of a modest reform package? Congress rarely gives an agency powers that it does not intend to be used. It also seems reasonable to assume that the people appointed to administer the new bureau within the OPM will be more likely to embrace the adversarial and regulatory philosophy of the leading congressional reformers and the CMS than the traditional “hands-off” culture of the OPM. Managed by such a transformed agency, the private plans that were part of an OPM alternative would probably come, over time, to look more and more like third-party administrators of a federally designed competitor plan, operating under rules significantly different from those governing competing private plans. The result in a few years could be functionally indistinguishable from a public option.

Butler identifies another proposal seen in the House bill that also could spell the death of private health care. Read his whole article here.

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6 February, 2010

Death at hands of Nigerian doctor prompts out-of-hours shake-up for Britain

Doctors applying to work as weekend and evening cover for GPs will be put on a national database that will highlight all alerts over their competence, the Government said yesterday. The measure comes as part of a series of tighter controls on out-of-hours services after a coroner ruled that a patient given a fatal overdose by a underqualified locum was unlawfully killed.

The death of David Gray, 70, amounted to gross negligence and manslaughter, William Morris, Cambridgeshire North and East Coroner, said. He added that Daniel Ubani, the stand-in doctor who was carrying out his first GP shift in Britain, was “incompetent and not of an acceptable standard”. Mr Gray died after he was injected with 100mg of diamorphine — ten times the recommended daily dose. He was suffering from severe pain from kidney stones when he was treated by Dr Ubani, a German doctor, at his home in Manea, Cambridgeshire, in 2008.

Mr Morris said: “If he did not know the properties or the size of the drug he was administering he should not have administered it. If he had any doubts or queries I am satisfied he could seek advice. Nonetheless, he went ahead and injected the fatal overdose.” Referring to the standard of out-of-hours services offered to patients, Mr Morris added: “Weaknesses remain in the system.”

Dr Ubani, a specialist in cosmetic medicine based in Witten, Germany, had flown into England the day before and had a few hours’ sleep before starting a 12-hour shift.

Speaking after the coroner’s ruling yesterday, Mike O’Brien, the Health Minister, said that lessons would be learnt from the tragedy. He said that legal requirements for trusts to provide quality care would now be enforced with tougher regulations. These will include a shared database of doctors performing out-of-hours shifts, including alerts on those that have been refused work for failing competency assessments.

Dr Ubani failed a language test with the NHS in Leeds but managed to get on a performers’ list in Cornwall with fewer tests — allowing him to work in Cambridgeshire.

An official review ordered by the Government and published yesterday concluded that patients were being put at risk by out-of-hours services that were poorly monitored, chosen for ease rather than quality and delivered without guidance from local doctors. It said that, while there were robust requirements in place, there was “unacceptable variation” in how these were implemented and monitored.

Mr O’Brien said that all 24 recommendations made by the review, led by David Colin-Thomé, clinical director for primary care at the Department of Health, and Steve Field, chairman of the Royal College of General Practitioners, would be implemented.

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Australia: Shortage of public hospital operating theatres means tired surgeons operating late at night

HOSPITALS must stop the dangerous and inefficient practice of squeezing in emergency surgery in the middle of the night due to a lack of theatre space, surgeons say. Describing the situation as a "developing crisis in emergency surgery", the Royal Australasian College of Surgeons has called for hospitals to immediately restructure resources so that emergency surgery can be properly planned. "The current practice of performing cases unnecessarily in the evenings or late at night (simply because theatres become available) must cease," it said.

Patrick Cregan, the chairman of the NSW Surgical Services Taskforce, which recently developed a similar policy for the health department, agreed. Dr Cregan, who is also a surgeon at Nepean Hospital, said this week it was safer for patients if they were operated on in daylight hours rather than at night by fatigued surgeons, who were often junior. There was enough theatre space in NSW hospitals, he said, and it would not necessarily mean delaying elective or semi-urgent surgery.

He said developing an extra emergency surgery operating list, to manage conditions such as fracture repairs or appendix removals, would cost a hospital up to $500,000. "Manage the money, manage the staff, manage the resources so that patients get a safer, more effective outcome," Dr Cregan said. "The patient outcomes is significantly better. It's not money going down the toilet. At some stages we are running two or three theatres in the middle of the night at Nepean. It's crazy stuff."

Dr Cregan said emergency surgery was "the most predictable form of surgery around", and could be easily planned. "There's surges in demand every now and then but overall you know there's going to be 20 fractures a week," he said.

Several hospitals in Sydney, including Prince of Wales and Westmead, were developing acute surgery units but most of NSW has been slow to act.

The college said that unnecessarily operating overnight carried both a human cost - in terms of increased patient errors and fatigued clinicians - and a financial cost to the community from overtime payments of staff. "Regularly health workers face a choice between delaying an emergency surgical patient's treatment, thereby prolonging suffering (a potential for harm), and disrupting elective surgery - which unfairly prolongs the waiting time of a patient who may already have waited weeks."

This meant staff worked through the night on "less time critical emergencies" to clear the backlog of emergencies that could be days overdue.

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Obama admits health care overhaul may die on Hill

No, maybe he can't. President Barack Obama, who insisted he would succeed where other presidents had failed to fix the nation's health care system, now concedes the effort may die in Congress.

The president's newly conflicting signals could frustrate Democratic lawmakers who are hungry for guidance from the White House as they try to salvage the effort to extend coverage to millions of uninsured Americans and hold down spiraling medical costs. Obama's comments Thursday night came hours after Republican Scott Brown was sworn in to replace the late Edward M. Kennedy, leaving Democrats without their filibuster-proof majority in the Senate, and Obama's signature health legislation with no clear path forward.

"I think it's very important for us to have a methodical, open process over the next several weeks, and then let's go ahead and make a decision," Obama said at a Democratic National Committee fundraiser. "And it may be that ... if Congress decides we're not going to do it, even after all the facts are laid out, all the options are clear, then the American people can make a judgment as to whether this Congress has done the right thing for them or not," the president said. "And that's how democracy works. There will be elections coming up, and they'll be able to make a determination and register their concerns."

It appeared to be a shift in tone for the issue the "Yes we can" candidate campaigned on and made the centerpiece of his domestic agenda last year. In a speech to a joint session of Congress in September, Obama declared: "I am not the first president to take up this cause, but I am determined to be the last. ... Here and now we will meet history's test."

Sweeping health legislation to extend medical coverage to more than 30 million uninsured Americans passed the House and Senate last year and was on the verge of completion — though there were still disagreements between the two houses — before Brown's upset victory last month in a special election in Massachusetts. Since then it has been in limbo, and Obama has not publicly offered specifics to help lawmakers move forward. Congressional aides felt his remarks Thursday did not clarify matters.

"The next step is what I announced at the State of the Union, which is to call on our Republican friends to present their ideas. What I'd like to do is have a meeting whereby I'm sitting with the Republicans, sitting with the Democrats, sitting with health care experts, and let's just go through these bills. ... And then I think that we've got to go ahead and move forward on a vote," Obama said Thursday shortly after a White House meeting with Democratic congressional leaders that produced no apparent progress on health care. "I think we should be very deliberate, take our time. We're going to be moving a jobs package forward over the next several weeks; that's the thing that's most urgent right now in the minds of Americans all across the country."

White House spokesman Reid Cherlin said the president's position has not changed and he will not walk away from health care reform. "He used his remarks last night to motivate Democrats to come together and get this done, noting that the public will judge their leaders on what they accomplish," Cherlin said.

More here




Has Obamacare Already Won? Existing Government Programs to Take Over Health Care by 2012

For the past several months, Washington has exhausted every possible method to pass a health care bill designed to increase government’s control over health care. They haven’t been successful yet, but that may not matter: even without Obamacare, government health spending is set to increase far faster than private health expenditures, surpassing the private sector as soon as 2012.

Today the Centers for Medicare and Medicaid Services released its projections of national health expenditures for the next ten years. The report shows that spending by the public sector grew much faster in 2009 at 8.7 percent, compared to the private sector which only grew at 3.0 percent. Though public spending was heightened by the recession, as unemployment caused more Americans to lose employer-sponsored coverage and enroll in Medicaid, the trend is expected to continue into the next decade.

What is more, the report bases its projections on current law. In the case of Medicare, this underestimates future spending. Under current law, Medicare is set to reduce physician reimbursement rates by 21.3 percent in 2010. This would lead to growth in Medicare spending of just 1.5 percent in 2010. However, the likelihood of these cuts coming to fruition is slim to none, as every year, Congress votes to suspend them. 2010 will likely be no different. A report by Health Affairs cites that, if physician payment rates are held constant, the more likely growth in Medicare will be 5.1 percent in 2010. Whether or not these physician cuts occur is no small matter—with them, overall health spending growth would be 3.9 percent. Under the more likely scenario, health spending growth would be 4.7 percent.

Thus far, the debate on health care reform has focused on increasing government spending to reduce the number of uninsured. But government spending should be moving in the opposite direction. With government spending growing at a fast clip, rather than overhaul the entire system, lawmakers should channel reform towards high-cost (and largely cost-inefficient) government programs, like Medicare and Medicaid.

Medicare, Medicaid, and Social Security, the three entitlements big spenders, are duly in need of attention from Congress. These programs will be responsible for unsustainable growth in government spending in the years to come, and will quickly become insolvent. By reforming entitlement programs, Congress could kill two birds with one stone: achieve long sought-after health care reform and bend the cost curve in health care spending, all the while addressing the fiscal crisis facing the nation due to out-of-control spending.

Rather than increase government’s role in the health care system, Congress should see the current trend for what it is: a cry for reform of existing government health care programs. Getting public health spending under control would have a monumental effect on overall spending, directly and indirectly reducing costs for all Americans.

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Overwhelming Majority Say ObamaCare bills are ‘Unfair’

An overwhelming majority of Americans oppose the “marriage penalty” that currently exists in the House and Senate versions of ObamaCare, according to a new Zogby International poll conducted Jan. 19-21.

The Zogby Poll asked: "Both the House and Senate versions of the health care bill include a new tax whereby married couples making a combined annual income of $50,000, and who do not receive insurance through their employer, would have to pay up to $2,000 more per year for health insurance than an unmarried couple making the same combined income. Supporters say this will help pay for insurance for many that currently do not have it, while opponents say it is a penalty on marriage. Do you think this is fair or not?"

A strong 79 percent majority of American voters say that ObamaCare’s marriage penalty is not fair, while just 12 percent think it is fair. Among Independent voters, 85 percent think ObamaCare’s marriage penalty is unfair, and only 8 percent think it is fair.

A majority of married voters (86 percent) think the ObamaCare marriage penalty is not fair, and just 8 percent think it is fair. Even 65 percent of single voters say the penalty is unfair, while only 18 percent call it fair.

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5 February, 2010

Scathing British report rules foreign doctors will have to undertake English tests before becoming out-of-hours GPs

Foreign doctors should face tough English tests before being allowed to become an out of hours GP, a scathing report will rule today. They should receive basic training on how the NHS works and what drugs are commonly used in Britain before they are allowed to practise here. The report will add that some primary care trusts are so bad they are breaking the law and in future they will be ordered to inform all other trusts if they find a doctor does not come up to scratch - something that does not always happen at the moment.

The landmark study - written by leading doctors and commissioned by health minister Mike O'Brien - will lay bare the failings which have led to the creaking out of hours system that puts patients at so much risk. It is expected to say that many health trusts entered into contracts with out of hours providers and did not bother to set minimum quality standards. Often, local GPs play no part in the decision-making - meaning it is left to managers, who have more interest in cost than quality of care, to choose which company to employ.

Mr O'Brien was forced to condemn unacceptable variations in out of hours care after the Daily Mail revealed this week that, in some areas, doctors only make home visits in one in 50 cases.

Last night the Tories demanded wholesale reforms to the out of hours system....

PCTs have been in charge of commissioning private companies to provide out of hours care after the vast majority of GPs opted out of responsibility. Once a company has been taken on, the report will say PCTs are not good at reviewing their performance - so they do not take action if the quality is poor.

One of the biggest criticisms will be that trusts are not doing enough to ensure foreign GPs can speak English properly. Language tests are mandatory for doctors from outside the European Union - but not for doctors within it. The report will say that language tests should be put in place for all foreign GPs, and will call for better training and so they know about how the NHS works, what the area they will be working in is like, and which drugs are used.

The Tories blamed the GP contract of 2004 which allowed doctors to opt out of responsibility to patients in evenings and weekends. Tory health spokesman Mark Simmonds said: 'For too long the out of hours GP service provided by bureaucrats has let families down. For the sake of patients we must return responsibility for out of hours care back to GPs.'

The Department of Health said ministers would accept all of the report's 24 recommendations. A spokesman added: 'The quality of out of hours care for most people is better than it was in 2004, but some PCTs are not meeting their legal obligations. 'The department is determined to tackle this.'

DIAGNOSIS BLUNDER 'KILLED MY WIFE'

Barbara Mizen would be alive today if she had not been wrongly diagnosed by an out of hours doctor, says her husband. Retired Eric Mizen says his 65-year-old wife had severe chest pain - the classic sign of a heart attack - when he called their GP out of hours medical service Thamesdoc. But instead she was diagnosed with a stomach upset by a doctor providing temporary cover for the couple's home area of Haslemere, Surrey. Two days later the retired auxiliary nurse was rushed to hospital, but died later of a heart attack.

Mr Mizen, 73, has won a legal claim for 'tens of thousands' of pounds but says nothing can compensate him for the loss of his wife. He said: 'I have no doubt Barbara would be alive today if the out of ours doctor had picked up on the problems.'

Mr Mizen's solicitors, who won a settlement from the insurers of Thamesdoc's Dr Mukhtar Hussain, said it was achieved without any admission of liability on the part of the doctor or the Medical Protection Society.

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NHS kills another oldster

Hospital nurses did not help a dying man after they were given wrong information about whether he should be resuscitated. Peter Clarke, 86, lay for an hour before the error was realised and doctors tried in vain to restart his heart. On Tuesday Derby Hospitals NHS Trust apologised to Mr Clarke’s family and said that stringent measures had been put in place to prevent a repeat.

Mr Clarke, who suffered from heart disease, was a patient at the former Derby City General Hospital in January last year experiencing flu-like symptoms when he suffered cardiac arrest.

Ward staff told an inquest into his death that guidance provided to them in a hand-over note stated that a Do Not Attempt Resuscitation order had been made for clinical reasons.

Ann Proctor, a nurse, said that it was between 45 minutes and one hour before she discovered that there was no mention of such an order in Mr Clarke’s medical records, and that a blank Do Not Resuscitate form, which had been placed in the folder as a matter of routine by clerical staff, had not been filled in.

Dr Paul Webb, who was the first doctor on the scene, told the hearing: “I asked the nurses at the station what time he had collapsed and they said around 9am. “I said ‘do you mean 10am?’ and they said ‘no, 9am’.”

It has not been made public how or why the order was given not to resuscitate Mr Clarke on the hand over note, given that no such order existed on his medical records.

Offering Mr Clarke’s family the hospital’s “sincere apologies,” Alison Fowlie, the Trust’s Medical Director, said: “It was found that the cause of the mistake, for which we're very sorry, was the 'Do Not Attempt Resuscitation' instruction on the nurses' hand-over sheet and that it should not have been there.”

The inquest was told that that Mr Clarke's heart was so badly damaged that he could have suffered cardiac arrest at any time, and that he was in heart failure. Dr Alistair McCance, a heart specialist, told the hearing in Derby that even if staff had tried to resuscitate him immediately, the chances of saving his life would have been "very low".

Mr Clarke’s son, Keith, 57, from Belper, Derbys, said: “They said it was unlikely that he could have been revived but we’ll never know. “I think my dad was badly let down by the NHS.” Adding that it was “too late in the day for my father”, he said he hoped that changes in hospital procedures would protect other patients.

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Leftist health reform proving rocky in Australia too

In America, Obamacare seems to have stalled -- JR

AN OPPOSITION'S lot in life is a thankless task; there are the long hours, minimal resources and they spend most of their time hitting brick walls. But sometimes there are small victories. As the Federal Government was taking the wraps off the third Intergenerational Report – a road map to 2050 on the challenges of the ageing population – the Coalition was forcing Labor into a backdown that would help older Australians now.

The win came on cataract surgery, and unless you are waiting to get your eyes fixed and face being out-of-pocket, it might seem like a loose-change victory. But Opposition health spokesman, Queenslander Peter Dutton, was able to force Health Minister Nicola Roxon to limit the cut in rebates for cataract surgery to 12 per cent instead of the proposed 50 per cent.

Dutton points out that for the three months before Roxon and specialists striking a deal, patients who needed their cataracts rectified had to pay hundreds of dollars or go to the public hospital system. Ophthalmology has the longest waiting times of any surgical speciality.

Backdowns from this Government are rare, but the win on cataracts illustrates that Labor has chinks in its armour on health. Dutton is also adept at attacking state governments on their health policies.

Despite all the hot air on climate change in Canberra as federal politicians returned for the unofficial start of the federal election, voters remain concerned about the here and now of improved health and hospital care and getting a decent education for their kids.

Prime Minister Kevin Rudd and Roxon argue they have put money back into the hospitals system. Rudd repeatedly argues the former Howard Government took $1 billion from health and his administration has put $5 billion back in and helped reduced elective surgery waiting lists – but voters cannot actually see new beds with plaques on them or shorter waiting times to visit a GP.

Rudd's bold election promise to fix the nation's ailing hospital system and consider a federal takeover is still in the limbo-land of consultations. He has invested a lot of political capital in the issue, and his pledge that the buck would stop with him resonated with voters. But the Government has found it is far easier to say it will build super-GP clinics than actually get the construction off the ground, and massive reforms to the hospital system means having to navigate around state interests.

Roxon is now facing defeat again on the Government's budget measure to means test the 30 per cent private health insurance rebate. If it goes down a second time in the Senate, it hands the Government another double dissolution trigger.

Rudd argues the Intergenerational Report, prepared by Treasury, showed the Opposition's blocking of the scheme would rip about $100 billion out of the Budget by 2050.

But Dutton's detective skills from his former career as a policeman are still in good working order and he pointed out the figure was not in the actual report. It was instead provided to the Government in some briefing papers. Which brings us back to cataracts.

Dutton has also made mileage out of highlighting seemingly penny-pinching decisions by Rudd and Roxon such as the initial plan, before they reconsidered it, to cap the Medicare Safety Net for people seeking IVF treatment and the postponed proposal to reduce funding for chemotherapy drugs.

The Opposition is making inroads on health but they have a long stretch ahead in the lead-up to the federal election.

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How one man killed Obamacare

As most of Americans already know, Republican Scott Brown was elected to take over the “Kennedy seat” in the Senate, dispatching Democrat opponent Martha Coakley handily in Massachusetts’ recent special election. Thus ended Democrats’ filibuster-proof 60-vote majority in the Senate and prospects for ramming Obamacare through on a strictly party-line vote.

Yet had the House and Senate concurred earlier on a health care reform bill agreeable to both Brown’s election wouldn’t have mattered nearly as much. Instead, each body designed legislation to pass their own side and in the end the differences were irreconcilable.

House Speaker Nancy Pelosi finally threw in the towel, saying the one chance Obamacare had – passing the Senate bill as it was in the House – couldn’t draw the required 218 votes. A main sticking point was that the Senate bill lacked the prohibition on the federal government paying directly for abortions. That provision allowed the House to pass their bill with just two votes to spare and gave it the barest bipartisan fig leaf as GOP Rep. Joseph Cao of Louisiana was the lone Republican in favor.

Undeniably, part of Brown’s appeal was the prospect of killing Obamacare by being the 41st Republican vote and denying Democrats their supermajority. In the election’s aftermath, petulant Democrats threw losing candidate Martha Coakley under the bus for running a terrible, gaffe-prone campaign and openly spoke about changing the filibuster rules to allow Democrats to maintain their hammerlock, perhaps needing just 55 votes instead of 60. Decades ago, a compromise measure lowered the limit from a 2/3 majority of 67 Senators to the current 3/5 majority.

Cooler heads prevailed, though, and now the consensus on health care reform is to deliver it in a piecemeal fashion by removing some of the most objectionable portions and focusing on areas where broad agreement exists, such as eliminating the right to deny coverage for preexisting conditions. But gone will be the ability for Democrats to fashion closed-door deals such as the one exempting union workers from a tax on so-called “Cadillac” health insurance plans.

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The Hidden Cost of the "Doc Fix"

The convoluted, politicized and hugely expensive issue of the "doc fix" is back in the spotlight after falling by the wayside along with health reform. Unlike health care reform, however, the “doc fix” will likely be passed through Congress without a blink, incurring a $82 billion expense to the U.S. taxpayer. The "doc fix" provides a stopgap to Medicare payments that give doctors less than market value for their services. It doesn't even provide doctors with the full market value; usually, it only covers it to about 80% of what the private sector would pay. But without the doc fix—with Medicare alone—that reimbursement rate would be somewhere near 60%.

Medicare reimburses at a rate that much lower because of 1997 balanced budget legislation, which prohibits medical expenses from rising faster than inflation. However, medical expenses have risen much faster than inflation. So while the standard Medicare reimbursements are kept at the unreasonably low rate, the "fix" bumps them up just enough to make doctors accept them.

What's curious about this year's “fix” is the lack of political attention given to the issue in the wake of vicious political battles over payment options for Obamacare. A version of the "doc fix" was surreptitiously excluded from the health reform bill because lawmakers didn't want to make the bill any pricier. But passing it separately is apparently not a problem for lawmakers, who see a vote against entitlements as political suicide. It's in no party's interest to take on both seniors and the medical lobby.

Michael Cannon, director of health policy studies at the Cato Institute, says he doesn't even like calling the stopgap a "fix" because it's not fixing anything. Instead, it's allowing Congress to continue living in their alternate reality, where medical expenses cost whatever they say they cost. "Because the government's price controls are set in the wrong place, and you're going to put a ‘correction’ in place to fix it? C'mon," said Cannon.

This year, the price will be higher than normal, because Congress is planning on a 5-year "fix" to their problem instead of their usual 1-year fix. The total is estimated at $82 billion, which will prevent doctors from suffering a 21% cut in fees.

The $82 billion 5-year plan is nothing compared with the $200 billion cost of a 10-year plan, or what legislators like to call "permanent." The only reason it's considered “permanent” is because the budget outlook for this issue only extends 10 years into the future.

National Center for Policy Analysis president John Goodman said that there isn't really isn't an end in sight to this issue because of the lack of political will, the inability for Congress to ever effectively address entitlement reforms and the wrong-headed approach that Congress takes to the practice of medicine as a whole. "It never works to have the payers tell the providers how to practice medicine," said Goodman.

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4 February, 2010

Congress sacks White House claims of imminent touchdown on health bill

Despite assertions by the White House that Congress remains on the verge of passing health care reform, lawmakers in the House and the Senate have stalled in their efforts to move forward with a bill as they turned their focus to creating jobs. Senate Majority Leader Harry Reid, D-Nev., said he would meet with House Speaker Nancy Pelosi, D-Calif., to discuss how to proceed with health care, and he said congressional and White House staff have already been collaborating on a new plan. But, he warned reporters, "Don't pin me down as to days or number of weeks" before a new proposal emerges.

On Sunday, White House press secretary Robert Gibbs told CNN. "We're still inside the 5-yard line" on health care, in a pronouncement that caught some lawmakers off guard. "I wouldn't think so from a policy and a cost standpoint and what Americans feel about it," Sen. Olympia Snowe, R-Maine, said of Gibbs' remark. "That defines a huge gulf between the reality on Main Street and the reality in Washington, D.C."

Sen. Debbie Stabenow, D-Mich., said Gibbs' use of the 5-yard line analogy "is fine," but senators did not discuss any new health care strategy at their weekly caucus meeting Tuesday afternoon. "There was a lot of discussion obviously on jobs and what's happening with that," she said.

In the House, leaders were vague. House Majority Leader Steny Hoyer, D-Md., promised to disclose a new plan "as soon as a way forward is clear."

Democrats face a logistical and political problem in trying to tackle jobs and health care at once, in part because the health care proposal Democrats favor would raise taxes.

"The Medicare payroll tax is a good example," Snowe said, referring to a provision in the Democratic health care bill that would raise the payroll tax on those with higher incomes. "You can't say on the one hand that everything is OK and we have to work on jobs, then on the other adding to the cost of doing business, because that creates uncertainty."

Democratic leaders in the House and Senate still insist a health care reform bill will pass this year, but even the Senate's more liberal members seem more uncertain of the outcome. "I hope so," said Sen. John Kerry, D-Mass., when asked if he thought health care passage was possible this year.

Kerry said he believed the "best path forward" was for the House to pass the Senate health care plan, after which some changes could be made to the bill in the form of new legislation that the Senate could pass with just 51 votes through a process known as reconciliation. "I don't know if that is achievable," Kerry conceded. "I guess I feel the imperatives of doing nothing are very powerful and therefore I'm hopeful that in the end, common sense is going to win out. But I don't want to put odds on it. This is Washington."

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Whistleblower who was harassed when he criticised NHS cost-cutting wins damages

"Shut up!" -- the usual Leftist reply to criticism

A consultant urologist who was suspended after speaking out against cost-cutting at an NHS hospital has won damages at an employment tribunal in a landmark case. Ramon Niekrash, 50, was removed from duty at the hospital and called a "troublemaker" after he questioned the effects of cost-cutting on patients at the Queen Elizabeth Hospital in Woolwich, South London.

A tribunal ruled that he was entitled to damages because he has been acting as a whistle-blower in the public interest when he wrote letters to hospital management raising his concerns about the health of patients. The verdict also placed blame on government targets for raising tensions between management and clinical staff at the NHS hospital.

Mr Niekrash claimed he was the victim of bullying and harassment after he criticised cutbacks at the hospital, which he said included a shortage of senior medical staff and the closure of the specialist urology ward.

At one point a senior doctor at the hospital allegedly said she wished that Mr Niekrash, who was trained in Australia, was "in chains on a plane in Heathrow back to Australia."

Mr Niekrash's lawyers said the case revealed the way in which senior NHS whistle-blowers are punished for speaking out. One case he raised was of a prostate cancer patient who was allegedly not told that he had the disease, nor given treatment for six months after he was diagnosed.

In a letter, he also accused hospital management of behaving like a "plantation owner" towards doctors, The Independent reported.

A 50-page ruling from the tribunal found that Mr Niekrash's suspension from the hospital breached laws put in place to protect whistle-blowers. Judge Burton, sitting at the tribunal, said: "We have no doubt that the exclusion of a consultant, being a rare occurrence, must have an adverse impact on the claimant's reputation," adding that Mr Niekrash had been "hurt" and that his health had suffered.

The judge said tensions had arisen between the claimant's desire to provide health care and "the requirement of management to reduce or limit costs and also comply with varying targets laid down by the Department of Health from time to time."

A hospital spokesman said: "We are considering this judgment very carefully ... There are nearly always lessons to be learned from cases like this, and as soon as we have carefully considered the judgment, we will respond in full."

SOURCE




Australia: Couple sues government hospital over stillborn baby

PARENTS of a baby delivered stillborn at Redcliffe Hospital claim medical staff repeatedly ignored warning signs their unborn baby was distressed. Kym Marie Body and Robert Wayne Body, of Mango Hill in Brisbane's north, are suing the State Government which runs Redcliffe Hospital for nearly $300,000 in negligence and damages. Documents filed to the Supreme Court allege a midwife ignored and turned down the volume of an echocardiogram alarm that sounded for more than three hours while Mrs Body was in labour.

The documents also claim Mrs Body was diagnosed and treated for deep vein thrombosis and thrombophilia (blood clotting) at Redcliffe Hospital after the birth of her first child in 2004. She alleges the hospital ought to have known her medical history and the risks associated and failed to recognise a natural birth "could not be performed safely".

The documents show Mrs Body was admitted to hospital at 8am on February 26, 2007, and was monitored at half-hour intervals between 9.30am and 3pm. Her waters were broken by a doctor about 4pm and at 4.30pm an epidural was administered. It is alleged that at 5.10pm an echocardiogram alarm attached to Mrs Body began making loud noises, but the volume was turned down by a midwife. The documents claim four other times when the alarm sounded, indicating the baby's distress, it was turned down by the same midwife. The echocardiogram alarm continued to sound until 8.20pm but medical staff did not respond to it.

It wasn't until 9.30pm, when Mr Body requested for Mrs Body to have an internal exam that one was performed, court documents claim. By 10.40pm, Mrs Body was told the baby's heart rate was "low" and "we need to get her out now". Paige Hannah Body was delivered by vacuum extraction about 11pm. She was not breathing and could not be revived.

Mr and Mrs Body, who say they suffer anxiety and depression, are suing Redcliffe Hospital for $278,200. The State Government is yet to file a defence.

SOURCE





3 February, 2010

NHS "professionalism" again

Dad delivers own baby when nurse storms off

A FURIOUS father branded a British hospital a disgrace after he was forced to deliver his girlfriend's baby in a maternity ward because the midwife had stormed out. The Sun reported Thomas Howard, 33, frantically called for help when he realised that the birth was imminent, but nobody came to his aid.

By the time the midwife returned, Emily Baron had already given birth to their daughter Madeline.

Baron, who is now recovering at home with Madeline, said, "I was really worried about the bleeding. When Thomas asked if the midwife knew what was wrong and she said 'No', he asked her to find someone who did. "She then just stormed out and you could hear her stomping down the corridor. I think her attitude was unprofessional."

Thomas said his instinct kicked in when it became clear the baby was coming. He delivered the newborn, tapped her on the back to help her breathe, and was cleaning mucous from her mouth when the midwife finally returned. "I was in shock at what had happened but the nurse didn't say anything to me. She just carried on as if it was normal," Howard said.

The couple said they may file a formal complaint against Royal Blackburn Hospital in northern England.

A National Childbirth Trust spokesman said, "Being left alone in labour in hospital is unacceptable. As a civilised society, we must ensure this basic need of women is met. Having a midwife with you when you give birth is vital to ensure there are no complications."

Last month, the Nursing and Midwifery Council said the midwifery profession was "still playing catch up" after a report warned Britain's rising birth rate was leading to a shortage of staff.

SOURCE




Failing out-of-hours care almost killed British baby

In parts of the country one doctor is responsible for 300,000 people at night

It started with a bruise the size of a shrivelled raisin that slowly grew into a magenta plum. It was Sunday evening, our baby was sleepy as we lifted him out of the bath and I noticed the mark under his tummy button. But he’d been running round London Zoo with his brothers and sister and I thought he must have knocked himself as he raced from the gorillas to the flamingos.

I wasn’t concerned as he lay on the bed while the other children bounded around him. He didn’t even have a fever. But I rang the local surgery, which gave an emergency number. I left a message and put the other children to bed. By 9pm no one had replied, so I looked up NHS Direct. An “information handler” answered. When I explained the almost non-existent symptoms, she suggested that I could go to A&E if I was concerned. By now all four children were asleep in bed, and I felt that I was turning a bruise into a drama and was more worried that my 18-month-old would pick up a bug if we queued all night in hospital.

I finally rang a private GP’s surgery when I realised that he had a slight temperature. The doctor on call arrived on her moped in 20 minutes. She lifted our son out of bed, joked with him and asked him to show her his tummy. At that moment she stopped smiling and phoned the consultant paediatrician at the hospital.

“You both need to go to hospital just to be on the safe side,” she said. We drove through dark, empty streets, reassuring ourselves that our baby was still babbling. The consultant laughed when our son started playing with his stethoscope but then he lifted up his pyjama top and began issuing orders. We suggested that it might be a bruise but no one was listening as they inserted drips to pump drugs and fluids into his arms and legs, and started preparing him for a lumbar puncture, The nurse was told to wake him every 15 minutes to prevent him falling into a deep sleep. We finally realised that they thought he might have meningitis.

Our baby screamed, tied to the bed by his tubes, but every time he fell into a fitful sleep he had to be woken. By dawn he was receding into himself, the bruise was vast and pulsating, but he was fading away. The paediatrician with 40 years experience didn’t think it could be meningococcal disease, the surgeon arrived and suggested cutting away the bruise and cleaning out the infected area. It took eight hours to synchronise the anaesthetist’s and surgeon’s timetables. The surgeon was Lebanese, the anaesthetist German and the two nurses were from the Philippines. They were amazing in their dedication. It was only when the anaesthetist said in a mild German accent: “We are going to put your son down now. Do you want to kiss him goodbye,” that I cried.

We sat in the waiting room under the strip lights watching babies tottering past us, not thinking about our son’s first step or his first word until the nurse came back from theatre. As I cuddled my child, the surgeon told my husband that he thought that they had managed to clear the infection. His stomach had been mangled but he looked beautiful as he slept.

It is impossible to draw conclusions from one case, but as our son recuperated over the next two weeks, and we lived our lives in shifts by his side, parents, doctors, nurses and cleaners gave us their views. And I did learn lessons. No one should automatically think that a foreign doctor or nurse is second best. Ours were extraordinary. The hospital wasn’t particularly clean, but we could provide our own pillow cases and food.

Almost everyone in the hospital believed that the NHS out-of-hours service was defective. I kept thinking back to the Sunday night when we nearly left our son to sleep. And I still think about it when I read reports that in parts of the country a single doctor is responsible for more than 300,000 people out-of-hours.

Andy Burnham, the Health Secretary, has finally admitted that this may be “unacceptable” but it has been obvious for several years that Primary Care Trusts who were given responsibility for this in 2004 have, in many areas, failed to provide a safe service, as required by law.

GPs must take back control of their out-of-hours services. This is not because they are greedy professionals who only work from 8.30am to 6pm for average salaries of more than £106,000 a year, or even because one exhausted German locum caused a man’s death through an accidental drugs overdose. They should do it because the current system doesn’t work. A&E departments are overwhelmed because most evening inquiries are directed to them and the emergency services have to mop up much of the rest.

GPs used to act as gatekeepers night and day. Our private GP had seen four children that Sunday, two had colds, but one had croup and ours was the fourth. In our case personal contact was vital. GPs should know who is being sent to treat their patients if it isn’t them and should want to be informed if a patient is suddenly on the critical list.

The Confidential Inquiry into Maternal and Child Health, commissioned by the Department of Health each year, says that one in four child deaths in Britain could be prevented if a parent had realised the child was ill earlier or if a hospital had reacted more rapidly. GPs can help both patients and hospitals to make the right diagnosis whether it’s at 3am or 3pm. At the moment they are the missing link.

SOURCE





2 February, 2010

British GPs 'visit just one in 50 sick patients out of hours' in some areas

Major variations in the quality of out of hours care across the country mean that in the best areas one in four patients will receive a home visit if they call for a doctor at night or over weekends. But elsewhere the proportion is much lower, according to the report by the Primary Care Foundation.

The study, which compares the quality of health services provided by all of England's Primary Care Trusts (PCTs), has disclosed “gaping holes” in the out-of-hours provision. It shows huge variations in the quality of care across the country, although none of the trusts is named. The number of patients receiving home visits varied from 25 per cent in one PCT to 2 per cent in another, the report said. Meanwhile, the number of patients given only a telephone diagnosis also varied between 20 and 70 per cent.

The study also shows that many PCTs are failing to respond quickly enough to urgent calls. Government targets say a GP should visit, or at least telephone within 20 minutes, all patients whose cases are designated urgent. But just two PCTs met this target out of 84 surveyed. The worst achieved the target in only a third of cases. The study also showed large variations in the amount spent on out-of-hours services between PCTs, which ranged from £16 and £3 per person.

An investigation by the Daily Telegraph disclosed yesterday that in the worst areas, there is just one GP covering as many as 650,000 people. Just four GPs are on duty overnight for the 1.1m people living in east, north and west Hertfordshire, while 11 doctors are available to a similar number of people living in east, north and south Birmingham and south Staffordshire.

Katherine Murphy, director of the Patients' Association, called gaps in out of hours provision “scandalous.” "It is such a vital service because it can be very frightening for somebody to get ill in the night, knowing that there's nobody at their doctor's surgery,” she said. "We know from our helpline that this is a national problem. The situation is appalling and it needs to be resolved.”

SOURCE




Virginia Senate votes to nullify Obamacare mandate

If enough States get this through, it would destroy the funding for Obamacare -- because Obamacare needs mandated payments to get the money to pay its costs

The Virginia State Senate voted today 23-17 to add a provision to the Virginia State Code that would exempt Virginians from being forced by the federal government to participate in any health care plan. Furthermore, the provision exempts Virginians from having to pay a fine or fee for not participating.

The text of the legislation sponsored by Jill Holtzman Vogel reads as follows:

No resident of this Commonwealth, regardless of whether he has or is eligible for health insurance coverage under any policy or program provided by or through his employer, or a plan sponsored by the Commonwealth or the federal government, shall be required to obtain or maintain a policy of individual insurance coverage. No provision of this title shall render a resident of this Commonwealth liable for any penalty, assessment, fee, or fine as a result of his failure to procure or obtain health insurance coverage.

This is a big win for Virginians, the 10th Amendment, and liberty. The fight is not over though. I highlight the word “individual” above because it worries me. Does this mean the federal government can mandate family coverage?

Hopefully this ambiguity will be remedied as the bill moves further along in the legislative process.

SOURCE





1 February, 2010

500,000 British hospital patients sent home too soon every year (and 1,500 a day readmitted for emergency care)

More than 500,000 patients every year are readmitted to hospital after apparently being sent home too soon, alarming figures reveal. Labour's waiting-time targets have been blamed for the 50 per cent rise in emergency readmissions of patients within days of them being discharged. Critics said it was a scandal that almost 1,500 a day were apparently being released before they are well enough, harming their recovery. They say the targets put pressure on hospitals to discharge people early to free up beds and have turned the NHS into a 'revolving door'.

Elderly patients are particularly vulnerable if they are sent home too soon, charities warned. There are also fears hospitals are trying to cash in from being paid twice to treat the same patient.

The figures, obtained by the Conservatives, show the numbers readmitted through A&E within 28 days of being sent home from hospital has risen steadily in the past 12 years. In 1998, the figure was 359,719, but it has risen every year since then, reaching 546,354 in 2007-08. A large number of those affected are vulnerable elderly patients, with 159,134 being over the age of 75, up from 94,283 in 1998.

Under Labour's strict target regime, hospitals must ensure no patient waits more than 18 weeks for treatment after being referred by their GP. However, in recent years, the number of NHS beds has been cut by around 20,000, or 10 per cent of the total, meaning many are being discharged too soon from crowded wards to make way for new patients. This is despite a Government pledge to increase beds, as well as a tripling in health spending.

NHS trusts trying to save money have also cut back on community services. As a result a large number of patients do not receive the support they need in their own homes - and often end up back in hospital.

Conservative health spokesman Andrew Lansley said a Tory government intended to change NHS rules so hospitals are not paid for treating patients they have recently discharged. 'It's staggering that there has been such a huge increase in the number of patients having to be readmitted to hospital as emergencies almost as soon as they've been allowed home,' Mr Lansley said. 'It's also a deeply worrying sign that the quality of care in hospitals is being undermined. 'This raises real concerns that patients are routinely being discharged too soon. Hospitals should not have an incentive to discharge patients quickly and then get paid by the taxpayer a second when they have to be readmitted. 'I will ensure that through our payment for results approach, hospitals have to meet any costs arising from emergency readmissions themselves.'

Experts blame a number of factors for emergency readmissions, including early discharge, poor treatment, infections and badly organised rehabilitation and support services.

The figures show hospitals that send patients home more quickly than others - with lower than average lengths of stay for first admission - have higher readmission rates. There is also evidence that patients who have to be readmitted actually stay in hospital longer than after their first admissions.

Patients Association director Katherine Murphy said: 'The pressure on getting beds cleared to meet treatment targets should never be allowed to compromise patient care. It's indefensible that this might be happening and nothing is being done about it.'

A Department of Health spokesman said: 'Patients are only discharged from hospital if the clinicians involved consider it safe and in their best interests. 'Some patients might require readmission if their health deteriorates, but the numbers are small. Only about 5 per cent of patients discharged from hospital are readmitted within seven days of their discharge.'

However, the spokesman added: 'A high rate of emergency readmission after elective surgery is a matter of concern --so we are encouraging hospitals to measure the trends in order to improve the quality of care they provide.'

SOURCE




Australia: Training fails to prepare new doctors

An increased emphasis on "social" education has left less time for teaching such basics as anatomy. Many medical schools also now have a bias against very bright students in the name of "equality"

MEDICAL students are emerging from the nation's universities feeling inadequately prepared to deal with crucial tasks such as calculating safe drug doses and writing prescriptions.

In a challenge to Kevin Rudd's twin promise to improve university education and doctor shortages, a government study has also revealed that medical supervisors feel the abilities of hospital interns fall short of their expectations. The study reveals just 36 per cent of junior doctors think they have been adequately or well-prepared to do wound management. And only 29 per cent of final-year medical students feel they have been adequately prepared to calculate accurate drug doses.

The landmark review of the nation's medical education system was finalised 19 months ago but released only on Friday. Medical leaders warn that the extra influx of students since the Education Department commissioned the research has made the failings it describes even worse.

News of the concerns about medical education comes before today's release of a new Intergenerational Report warning that the nation's ageing population will impose extreme pressure on the health system, including the medical workforce. It also comes as The Australian has learned a Rudd government program aimed at addressing the drastic shortage of nurses in the nation's aged-care facilities has failed, attracting just 138 nurses in two years, against a target of 400.

In the past decade, the quality of medical training has come under increasing scrutiny, particularly since chronic doctor shortages have sparked an increase in medical school intakes and the creation of medical schools in regional universities. In 2007, The Australian revealed that almost three out of four medical students said they were taught too little anatomy during their medical degree, while more than a third questioned their own competence in the workings of the human body.

Such findings led the Howard government to commission the Department of Education, Science and Training to do a two-year study, conducted between 2005 and 2007, to find out how best to train the nation's doctors. The report found medical students feared for their skills in a number of key areas, including knowledge of basic sciences, while hospitals increasingly struggled to make time for effective teaching in the face of packed waiting rooms.

Only 48 per cent of final-year students and 64 per cent of junior doctors thought they were adequately or well prepared to write prescriptions. Interpreting X-rays was a concern for 69 per cent and 77 per cent respectively. And just 44 per cent of medical students and 48 per cent of junior doctors felt they had been properly trained to insert a tube through the nose and down the throat of a patient.

Health Minister Nicola Roxon refused to comment on the detail of the report late yesterday. Instead, she blamed it on Opposition Leader Tony Abbott, a health minister in the Howard government. "Tony Abbott failed to plan for the health workforce needs of Australia and even capped the number of people allowed to train as GPs - a cap that this government has lifted," Ms Roxon said.

The medical community warned that the situation had deteriorated since the report was completed. Australian Medical Association president Andrew Pesce said more needed to be done to properly fund medical training. "Nationally, there will be 2920 domestic graduates from medical schools by 2012, and over 500 international graduates - many of whom will want to stay in Australia," Dr Pesce said. "This will swamp the existing number of intern places - with only 2030 currently available across the country."

The executive director of surgical affairs for the Royal Australasian College of Surgeons, John Quinn, said the report was "a missed opportunity" to demand decisive action. Dr Quinn said the RACS was particularly disappointed, given it had been "vociferous about the dwindling and now inadequate teaching of anatomy" in all medical schools. "This would seem to be a failure to recognise the problem, and to propose some solutions to a problem that has been well-identified previously," Dr Quinn said.

Associate Professor Paul McKenzie, the president of the Royal College of Pathologists of Australasia, said the report was a "disappointment" for failing to recommend improvements to undergraduate science training.

SOURCE




Obama Admits CBO Cost Estimates of ObamaCare Are Incomplete

Yesterday — day #224 of the ObamaCare Cost-Estimate Watch — President Obama told House Republicans: "You can’t structure a bill where suddenly 30 million people have coverage and it costs nothing."

And just like that, the president admitted that the official Congressional Budget Office estimates of his health care plan do not reflect its full costs.

Both the House and Senate versions of ObamaCare would cover millions of uninsured Americans by requiring them to purchase private health insurance. As President Obama notes, even if you force people to spend their own money on health insurance, it still costs something to cover them. And if the government partly subsidizes those premiums, the remaining mandatory premium is still part of the cost of covering them.

Yet Democrats have systematically blocked the CBO from including those costs in its official cost projections. The Senate bill’s estimated price tag of $940 billion, for example, includes only the costs that bill would impose on the federal government. By my count, that’s only 40 percent of total costs. By Mr. Obama’s admission, that’s not the full cost of the bill.

Now that the President of the United States has acknowledged that the CBO’s cost estimates are incomplete, could we maybe get a complete cost estimate? Maybe just for the Senate bill?

SOURCE




Obama’s Not Alone In Thinking We’re Too Dumb To Appreciate Him

The Los Angeles Times reports today that Democrats are conspiring behind closed doors on methods to revive and pass health reform. You may be forgive for thinking the LAT didn’t put it quite that way, but I don’t believe I’ve mischaracterized their report. You decide:

President Obama’s campaign to overhaul the nation’s healthcare system is officially on the back burner as Democrats turn to the task of stimulating job growth, but behind the scenes party leaders have nearly settled on a strategy to salvage the massive legislation.

They are meeting almost daily to plot legislative moves while gently persuading skittish rank-and-file lawmakers to back a sweeping bill.

This effort is deliberately being undertaken quietly as Democrats work to focus attention on more-popular initiatives to bring down unemployment, which the president said was a priority in his State of the Union address on Wednesday.

And what of the often-promised but now forgotten “transparency that was supposed to accompany health reform? Again, Obama is not the only one who’s forgotten it.

In a 24-hour news cycle, with the Internet and bloggers and cable news, sometimes a lot more can be accomplished, especially with healthcare, when it happens behind closed doors,” said Drew Altman, a healthcare policy expert who heads the nonprofit Henry J. Kaiser Family Foundation.

Among those plotters behind closed doors is Arkansas Sen. Mark Pryor, described by the LAT as “a conservative Democrat who was among a group of centrist Democrats from the House and Senate” who’ve been meeting. “Formerly conservative” or “a Senator who would like to be thought of by his constituents as conservative” might be more accurate, but whatever his political coloration at the moment Pryor believes he has plumbed the depths of human nature, and he’s discovered that people, or at least voters, are not as smart as he is.

“A little bit of time and quiet could help,” he said.

“Human nature being what it is, it's always easier to be against something than to be for it. And if you create any uncertainty with change, opponents can jump on that and just try to scare people. . . . That has been hard to overcome politically,” Pryor said. “Maybe over time, people will have a chance to understand what is in the legislation.”

In other words, we were too dumb to understand what Obama explained to us in 29 (or was it 39?) speeches and endless snippets from them on TV. But maybe if they just keep quiet about it for a while and bring it up later, we will have forgotten that we don’t like it.

Democratic leaders do not reserve their condescending scorn for voters who disagree with them; they have similar contempt for many of their own skittish followers (or not) in Congress who were, for some reason, “rattled by Brown’s winning campaign in Massachusetts.”

House Speaker Nancy Pelosi (D-San Francisco) and Senate Majority Leader Harry Reid (D-Nev.) particularly want to give members time to recover from the shock of Republican Scott Brown’s victory in the Massachusetts Senate race two weeks ago. The election cost Democrats their filibuster-proof Senate majority.

But in the coming weeks, Pelosi and Reid hope to rally House Democrats behind the healthcare bill passed by the Senate while simultaneously trying persuade Senate Democrats to approve a series of changes to the legislation using budget procedures that bar filibusters.

But why should they recover from the shock? Will the threat to Democrats intent on passing unpopular legislation implicit in the message of Brown’s election lessen over time?

The Dem leaders thus assume not only that voters are too dumb to appreciate the wisdom of the Dems’ health reform but also that they are so dim they will forget their opposition, thus allowing the “rattled” Democrats in Congress to recover from their Brown-induced “shock” and stick by their former willingness to impose massively unpopular legislation on a forgetful public.

SOURCE







Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.


This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA


TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).


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


Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.


One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.


On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.


I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!