Limits on British surgeons' working hours 'will harm training and place patients at risk'
New limits on surgeons' working hours will harm their training and place patients at risk, experts have warned. Controversial new European working laws mean all doctors, including surgeons, are allowed to work only 48 hours a week. Introduced in August they have provoked fierce criticism from surgeons who say that new trainees will struggle to master their complex specialism in such a restricted time.
But the Government insists that having fewer exhausted doctors on wards means that patients are safer. However, experts writing in the British Medical Journal say that complications and readmissions increase when restrictions are placed on how long surgeons can work. They highlight recent working hours restrictions in America and say that they had a negative impact on training because surgeons do not have enough time to practise their skills. This was even though doctors in America were still allowed to work almost twice as long as they are now able to in Britain.
John Tarpley and Gretchen Jackson, both from Vanderbilt Children’s Hospital in Nashville, warn that limited hours cause “alarming trends” in surgery. Studies have shown an increase in preventable complications and injuries caused to patients when working hours are restricted, they claim. They also say there is evidence that surgeons perform fewer complicated procedures to ensure they do not breach their weekly working hours.
They also point to evidence that following the introduction of an 80-hour week limit in America the amount of time that junior surgeons spent on cases involving fell by more than half. First year trainees also assisted in 85 per cent fewer operations overall than their predecessors.
The doctors estimate that it takes an average of between 15,000 and 20,000 hours to become a highly experienced surgeon. They called for fewer restrictions to allow flexibility over how long doctors work. “Surgery is a body contact sport, there is no question about it,” they write. “You cannot be a good armchair surgeon.”
John Black, president of the Royal College of Surgeons, said: “This BMJ paper provides yet more compelling evidence that the need for both cognitive ability and manual dexterity in surgery cannot be shortcut by reduced hours. “The European Working Time Directive has limited the hours that are available for surgeons in training well below the 15,000-20,000 the report suggests are optimal – a flexible approach that will allow surgeons to work up to 65 hours we believe will redress this balance and deliver future surgeons who can practice independently.”
A spokesman for the Department of Health said that there were no plans to allow doctors to wok longer hours. He said: "Our overriding priority will continue to be ensuring that patients experience high quality, safe and effective care in the NHS.”
Incompetent African doctor stood down from Australian public hospital
The cases of incompetent overseas doctors in Australian public hospitals never stop coming -- despite all the checks that are supposed to be done. Why? Because Australia does not train enough of its own doctors and public hospitals are desperate for staff
AUTHORITIES will investigate a doctor over concerns he was not fully qualified for his job and examine why it took a month for knowledge of a past criminal charge to reach the top. Queensland Health stood down Zimbabwe-trained Dr John Chibanda over concerns he was working outside the scope of his credentials at Emerald Hospital. The matter will be investigated by both the Health Quality and Complaints Commission and the state's Crime and Misconduct Commission.
Dr Chibanda, an Australian citizen, had previously worked at Katherine Hospital in the Northern Territory without incident. He started work in obstetrics at Emerald Hospital in late 2007 and was supervised due to the level of his experience. After complaints about the standard of his work around August 2008, he was stood down from obstetrics, but continued to work in emergency and other general areas of the hospital. He was again investigated after further complaints in May this year, and a Google search in late September turned up a criminal charge for fraud in Zimbabwe.
Health Minister Paul Lucas said Dr Chibanda was challenged about the information - which related to the fraudulent supply of a death certificate for insurance purposes - and he claimed the conviction had been quashed. "However, the form that one is required (to fill in) when one seeks registration as a doctor in Queensland clearly requires ... that one disclose not just criminal convictions but if one has ever been charged with a criminal offence," Mr Lucas said.
"I want to make it crystal clear. "I expect there to be a full and rigorous investigation of these matters. "If there is anyone who has misled, if the wrong thing has been done, then there will be no forgiveness, no mercy, there will be very, very strong action."
About a dozen complaints were made about Dr Chibanda - some from patients and some from nurses - but none relate to deaths or permanent injuries.
Also under investigation is why it took about a month for his criminal history to be reported to the top, with Queensland Health's centre for healthcare improvement chief Dr Tony O'Connell saying he only became aware of the matter this week.
Mr Lucas said the appropriate checks through medical bodies and referrals were done, in addition to an earlier Google search that had failed to pick up the fraud matter. "I would have thought that we would be bending over backwards to check these things," Mr Lucas said. "I would have thought that the relatively modest things that you can do in addition to the rigorous checks would be second nature, and I want it investigated as to why this happened."
Dr O'Connell said "a few dozen" obstetrics cases handled by Dr Chibanda and hundreds of other cases would be reviewed. Patients with concerns about treatment by the doctor were urged to come forward. Dr Chibanda is the second doctor to be stood down from Emerald Hospital within months. A doctor at the hospital was suspended in September over a disciplinary matter.
One of the strongest talking points of those who want a government-run medical care system is that we simply cannot afford the high and rising costs of medical care under the current system.
First of all, what we can afford has absolutely nothing to do with the cost of producing anything. We will either pay those costs or not get the benefits. Moreover, if we cannot afford the quantity and quality of medical care that we want now, the government has no miraculous way of enabling us to afford it in the future.
If you think the government can lower medical costs by eliminating "waste, fraud and abuse," as some Washington politicians claim, the logical question is: Why haven't they done that already? Over the years, scandal after scandal has shown waste, fraud and abuse to be rampant in Medicare and Medicaid. Why would anyone imagine that a new government medical program will do what existing government medical programs have clearly failed to do?
If we cannot afford to pay for doctors, hospitals and pharmaceutical drugs now, how can we afford to pay for doctors, hospitals and pharmaceutical drugs, in addition to a new federal bureaucracy to administer a government-run medical system?
Nothing is easier for politicians than to rail against the profits of pharmaceutical companies, the pay of doctors and other things that have very little to do with the total cost of medical care, but which can arouse emotions to the point where facts don't matter. As former Congressman Dick Armey put it, "Demagoguery beats data" in politics.
Economics and politics confront the same fundamental problem: What everyone wants adds up to more than there is. Market economies deal with this problem by confronting individuals with the costs of producing what they want, and letting those individuals make their own trade-offs when presented with prices that convey those costs. That leads to self-rationing, in the light of each individual's own circumstances and preferences.
Politics deals with the same problem by making promises that cannot be kept, or which can be kept only by creating other problems that cannot be acknowledged when the promises are made. Price controls are a classic example. At various times and places, in countries around the world, price controls have been put on any number of goods and services-- going all the way back to the days of the Roman Empire and ancient Babylon. Price controls create lower prices for open and legal transactions-- but also black markets where the prices are higher than they were before, because the risks of punishment for illegal activity has to be compensated. Price controls also lead to shortages and quality deterioration.
But politicians who take credit for lower prices blame all these bad consequences on others. Diocletian did this in the days of the Roman Empire, leaders of the French Revolution did this when their price controls on food led to hungry and angry people, and American politicians denounced the oil companies when price controls on gasoline led to long lines at filling stations in the 1970s. It is the same story, whatever the country, the times or the product or service.
The self-rationing that people do when prices are free to convey the inherent impossibility of any economy to supply as much as everybody wants is replaced, under price controls, with rationing imposed by government, which cannot possibly have the same knowledge of each individual's circumstances and preferences-- least of all when it comes to medical care, where patients differ in innumerable ways.
Here, as elsewhere, there is no free lunch-- even though politicians get elected by promising free lunches. A free lunch in medical care is one of the most dangerous illusions of all.
Waiting in long gasoline lines at filling stations was exasperating back in the 1970s, but waiting weeks to get an MRI to find out why you are sick, and then waiting months for an operation, as happens in countries with government-run medical systems, can be not only painful but dangerous. You can be dead by the time they find out what is wrong with you and do something about it. But that will "bring down the cost of medical care" because you won't be around to require any.
Members of the House could vote as early as this weekend on House Speaker Nancy Pelosi's 1,900-plus page proposal to create a government-run health care system in America. While virtually all House Republicans will vote against the Pelosi plan, a key question is whether the 40 or so conservative Blue Dog Democrats will cave to pressure from House leaders to support the Pelosi plan. If they do, they will have to start believing the following eight Obamacare fairy tales:
Tale #1: You can keep your coverage
Earlier this year, President Obama said "I intend to keep this promise: If you like your doctor, you'll be able to keep your doctor; if you like your health care plan, you'll be able to keep your health care plan." Not surprisingly, the administration walked back this statement, telling the Associated Press, "White House officials suggest the president's rhetoric shouldn't be taken literally."
This is partly because the bill will bury your doctor in tens of thousands of pages of new regulations. And although the federal government might not literally force people to change insurance, they may well force your insurance plan to disappear or change beyond recognition.
The bill will also create a new set of cost incentives such that your employer might benefit by getting rid of your company insurance plan altogether. The Lewin Group, an independent econometrics firm, estimated that under the original House bill, some 88 million Americans could thus lose their employer health insurance.
Tale #2: Health care will not be rationed under the government plan
The Obama administration has boldly declared "health care will not be rationed." If you make the perfectly logical assumption that the government cannot supply an unlimited amount of health care to everyone on demand, this is clearly false. Nor can private providers provide an unlimited supply of health care -- they, too, ration. However, when private providers ration, consumers have options. They can pay more to get the care they need, or in some cases they can resort to legal action to get the coverage they are owed. When you're denied treatment under a public plan, good luck suing the government.
Tale #3: The "public option" will be able to provide insurance at cheaper rates than the private sector
The Congressional Budget Office (CBO) says that a public health insurance plan could save money compared to private insurance through lower administrative costs. However, a major reason why public health plans have lower administrative costs compared to private insurance is the government's inattention to fraud. Medicare loses an estimated $60 billion a year in fraud, seven times as much as the combined profits of the 14 health insurance companies on the Fortune 500.
CBO warns that a public option is less likely to manage efficiently how much treatment each person gets and will attract more unhealthy patients, driving up costs. Costs will likely vary wildly depending on the state, but they could make the public plan's premiums "somewhat higher than the average premiums for the private plans in the exchanges."
Tale #4: The "public option" will keep private insurers honest by forcing their rates down
Even if the public option plan ends up charging higher premium prices to patients, it might still pay significantly less to health providers than private insurers pay them. And when government underpays, doctors and hospitals charge more to private insurers to make up the difference, which in turn drives up health insurance premiums for ordinary Americans.
This phenomenon is pervasive within the Medicare and Medicaid programs, which underpay doctors and hospitals for most services. Their underpayment results in an average $1,800 per year overcharge for every American household with private health insurance, according to the Milliman consulting firm.
The new House bill removes from the old one a provision setting public option payment rates at Medicare plus 5 percent -- which would have dramatically increased this cost-shifting. Still, the public plan's payment rates are left up in the air by the new House bill, to be negotiated by the Secretary of Health and Human Services.
Tale #5: Medicare benefits won't be reduced
At a teleconference sponsored by AARP in July, President Obama assured seniors they would not see a reduction in Medicare benefits. "What we do want is to eliminate some of the waste that is being paid for out of the Medicare trust fund," he said. As an example of waste, he cited $177 billion in subsidies given to insurance companies who participate in Medicare Advantage -- a program to get private insurance through Medicare.
Medicare Advantage is more expensive than Medicare, but that's because it provides more benefits and better access to doctors than regular Medicare. The number of seniors enrolled in a Medicare Advantage program has nearly doubled from 5 million to 10 million in the last six years and accounts for 22 percent of all Medicare patients, Thirty-five percent of all Medicare patients in California, 37 percent in New York and 42 percent in Oregon. Both the House and Senate bills contain deep cuts to Medicare Advantage.
Tale #6: Illegal immigrants won't be covered
The Senate health care reform bill was beefed up following Rep.Joe Wilson's, R-SC, "you lie!" outburst during the president's address to a joint session of Congress on health care. Since then, the White House has made it known that it does not want illegal immigrants covered or subsidized by health reform legislation.
Despite this, it remains an open question whether the House health reform bill will allow illegal immigrants to buy insurance from government-established health insurance exchanges.
Tale #7: Health care reform won't increase the deficit
Democrats have engaged in some shady counting to claim that health care reform is deficit neutral. The Congressional Budget Office only tallies a bill's cost over an immediate ten year horizon. The Senate bill begins collecting taxes immediately but the major spending provisions don't kick in until 2014. That makes the $800 billion bill appear deficit neutral through 2019, but in fact it will cost as much as $1.8 trillion in its first ten years of operation, according to some estimates.
House Speaker Nancy Pelosi insists that the House Health Care bill will cost a mere $894 million over the next ten years, but a recent reports put the House bill's cost at $1.2 trillion and rising. Nobody knows what the final price tag will be, but it's more than likely the House bill will add to the deficit.
Tale #8: Health care reform won't fund abortions.
Democrats have repeatedly insisted that their health care reform proposals won't fund abortion and is consistent with the Hyde amendment -- a 1976 law that bars almost ll federal funding of abortion. However, the House bill gives subsidies to people to buy private insurance plans that do cover abortion. The bill would therefore, in effect, fund abortions. Pro-life Democrat Rep. Bart Stupak of Michigan claimed last week that 40 House Democrats will vote against the House health care reform bill if it is not altered to exclude abortion funding.
If the Founding Fathers knew what Speaker Pelosi was up to, they'd be rolling in their graves.
America's Founding Fathers established a government based on the consent of the governed. They never envisioned a government that ran the lives of its citizens with or without their consent. Suffice it to say they would turn in their graves if they read the 1,900-plus-page health care reform bill the House of Representatives is scheduled to vote on Saturday. (Proponents of the bill have promoted it for months using multiple fairy tales that are ably exposed on page 21 by The Examiner's David Freddoso and Mark Hemingway.)
That American citizens should be fined or even put in federal prison for refusing to purchase government-approved health insurance is as un-American as any idea we can imagine. But such a mandate is the very heart of the bill written behind closed doors by House Speaker Nancy Pelosi and her privileged pals. If their bill is approved by the House tomorrow, we will be a big step closer to the day when everybody gets their health care insurance through the government or from an approved insurer offering policies that meet meticulously detailed specifications contained in thousands of pages of federal regulations.
Welcome to America, land of the formerly free, and home of citizens covered by a nationalized health care system crafted by the same government that can't care for American Indians on their reservations or deliver swine flu shots on time.
It would be one thing if Democrats were simply trying to insure the uninsured, but their bill goes far beyond this modest goal. Democrats believe they must first tighten their regulatory grip on what's left of the private health care industry, then squeeze with all their bureaucratic might to force costs down by effectively rationing health care.
Besides rationing care, the bill adds expensive new mandates on people (compulsory insurance for all), as well as costly new regulatory burdens on insurance companies (thus increasing premiums) and on your employer (which will reduce your wages). The Democrats' bill also creates multiple new layers of federal bureaucracy to look over your doctor's shoulder.
This plan is doomed to fail, but in failing it will likely inflict severe collateral damage on the quality of your health coverage and your health care. As Medicare staggers toward bankruptcy, Democrats in Congress -- led by Pelosi, Senate Majority Leader Harry Reid and, of course, President Obama -- want another massive, unsustainable new federal program to save the massive, unsustainable old federal program. When do we stop the vicious, self-defeating cycle of heaping government fiats upon government fiats to fix problems government creates?
Poor government hospital care 'could be killing patients'
Poor health care could be contributing to hundreds of deaths a year in British hospitals, a new report suggests
One in three patients who died within days of being admitted did not receive acceptable standards of care, an independent health watchdog found. The study reveals delayed operations, complications left untreated and surgery not carried out because theatres closed at night or during weekends. In one case a teenage cancer patient died after doctors took no action despite concerns that he might have the flesh-eating bug, necrotising fasciitis.
Although they cannot quantify figures, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) say that poor care contributed to at least some of the more than 3,000 deaths they analysed. Patients groups described the examples listed in the report as “shocking”.
More than half of patients suffered delays in being seen by a senior doctor that postponed “timely and appropriate care”. One in seven, 13.8 per cent, had surgery delayed, while for other operations which potentially have benefited their condition were not performed.
The report also found examples of patients not being given the right drugs to prevent potentially fatal blood clots and having a tube incorrectly placed into their airway.
The findings also suggest that Government targets are impacting on patient care. In many cases initial assessments of patients were made by junior doctors rather than more senior colleagues, possibly to avoid breaching a target to have all patients processed through casualty units within four hours, according to the report.
The study also warns that change in recent years had left doctors “transient acquaintances during a patient’s illness rather than having responsibility for continuity of care.” This has created problems around handovers likely to be exacerbated by new European rules brought in this summer which limit most doctors working hours to 48 a week, it warns.
The report also found that access to vital scans could be limited, especially at night, and that one in five do not resuscitate (DNAR) orders were signed by very junior doctors who may not experienced enough to handle the sensitive issue appropriately.
The study reviewed the care of 3,153 patients who died within four days of being admitted to hospitals across Britain between the start of October 2006 and the end of March 2007. Only half of the patients were not expected to survive when they entered hospital. Appropriate care of terminal patients, such as considering reducing the number of drugs they are given, were also not taken in many cases.
Katherine Murphy, from the Patient’s Association, said that the findings ran the risk of undermining “basic confidence” in the NHS. “For almost four out of 10 patients not to get high quality care is appalling, not just for the patients who died but for those nearest to them who were not only bereaved but may be left with terrible memories of what happened.
“Some of the examples are shocking. “Life-threatening complications left untreated, poor notekeeping, seriously ill patients deteriorating without prompt action, lack of facilities for emergency surgery, avoidable complications contributing to patient death. “We're told patient safety is the number one priority for the NHS - this report suggests otherwise.”
John Black, president of the Royal College of Surgeons, said: “This hard-hitting report highlights the loss of proper team working in UK hospitals, resulting in dangerous failures of communication which make it harder and harder for clinicians to provide safe care for patients. “Earlier this month the College published a survey into the early effects of the 48 hour European Working Time limit on surgeons and found that these new rotas had almost entirely removed adequate time for handover of sick patients.”
Around 300,000 people die every year in British hospitals.
British targets 'signalled lack of trust in doctors and nurses'
NHS targets signalled a lack of trust in doctors and nurses, the Health Secretary has admitted ahead of a meeting with President Obama’s health team. Andy Burnham told an audience in Washington that the approach did not win over the “hearts and minds” of frontline staff. Labour has faced fierce criticism over the number of targets in the health service. Some targets, including patients should be processed through accident and emergency wards within four hours, have led to accusations of more serious cases being ignored.
When he became Health Secretary earlier this year Mr Burnham pledged a cull of targets. But he has said that four-hour A&E target would be kept as well as the 18-week guarantee on operations, which he has criticised the Tories for planning to scrap. Speaking to the Urban Institute, a public policy think tank, Mr Burnham insisted that health service targets were necessary when Labour came to power in 1997. “Targets drove the system hard and were the right thing to do,” he said. “But we have come to learn that the top-down approach can only take you so far. “It is not a great way to win the hearts and minds of the people who must make it all work. “Looking back now, I can see that the emphasis on targets began to imply a lack of trust in staff at the front line that became disempowering.”
Other targets introduced by Labour include to link GP salaries to things like carrying out a certain number of check-ups on diabetics in their area.
Mr Burnham gave the speech ahead of a meeting with the First Lady Michelle Obama's policy director Jocelyn Frye. He is also due to meet Kathleen Sebelius, the US Secretary of Health, during the two-day visit to America.
The NHS has become the subject of heated debate in America in recent months, particularly among opponents of President Obama’s proposed health reforms keen to cast it as a model to which their country should not aspire. One American senator claimed that the late Ted Kennedy would not have received treatment for his brain tumour on the NHS, because he was in his 70s. Daniel Hannan, the Tory MEP, also caused controversy when he appeared on American television saying that he "would not wish it on anybody". David Cameron called his views “eccentric”.
President Obama is still hoping to pass significant health reforms by the end of the year, although his plans have been watered down in the face of a sustained campaign against them.
To coincide with Mr Burnham’s visit the Department of Health released a report by the independent Commonwealth Fund which surveyed doctors in 11 countries and ranked Britain top in a number of areas including short waiting times for specialist care, quality of care and the management of chronic diseases. However, a new analysis of figures by the Organisation for Economic Co-operation and Development (OECD) shows on international rankings on death from disease Britain has slipped from 9th to 10th out of 15 since 1997, behind countries like the Czech Republic.
The latest available figures, from 2006, show that the UK ranks in the bottom quarter of European countries on deaths from breast cancer and that deaths from lung disease are 75 per cent higher than the European average. The Tories, who did the analysis, said the figures showed that Labour had failed the NHS. A spokesman for the Department of Health said that the figures were old and did not take account of recent progress made on diseases including cancer.
Woman forced to wait six-hours in Australian public hospital emergency department after suffering suspected miscarriage
A WOMAN who presented at Geelong Hospital on Sunday after a suspected miscarriage was forced to wait six hours in emergency before being told her case was not serious enough to receive an ultrasound. The young couple last night told the Geelong Advertiser how they endured a frustrating day agonising over whether their first child was still alive as they waited in a crowded waiting room for medical attention.
Pregnant Jess, not her real name, was eventually seen late in the afternoon, but was told only urgent cases with a serious health risk were entitled to ultrasounds on weekends. Instead, Jess received a blood test, followed by a secondary blood test on Tuesday, revealing she had suffered a miscarriage.
Husband Rob, also not his real name, said they should have been told they were not eligible for an ultrasound upon arrival, saving his suffering wife six hours of languishing in a waiting room.
Barwon Health spokesperson Kate Nelson said all patients were categorised using the five triage categories identified by the Australasian College of Emergency Medicine. "Unfortunately, at times of high demand, which it was on this occasion, patients with a triage category of four may experience extended waiting times or stays in a cubicle," she said in a written statement.
One of the more revealing WNO soundbites in recent days was its interview with DC delegate to Congress Eleanor Holmes Norton. Not only did Norton – a close Obama associate – warn that “in our zeal to get a [healthcare] bill,” Congress may shift the cost to the middle class, she admitted that -- Obama’s assertions to the contrary -- there are no “revenues” to pay for the costly bill:
House Bill May Roil Retiree Health Care
Efforts by House Democrats to protect retiree health benefits could end up doing just the opposite while also undermining their vow to keep the health care overhaul from adding to the deficit. Section 110 of the House health care bill would prohibit employers from altering health benefits for retirees enrolled in employer-sponsored insurance plans. It would bar employers from increasing premiums or reducing benefits by more than 5% annually unless active employees get the same reduction in their health care benefits or the employer gets a waiver from the Labor Department.
But it would only apply to current retirees. Companies could discontinue benefits for future retirees. The provision might make that more likely, adding to federal health obligations down the road. The provision also would create temporary "reinsurance" subsidies for employer-based retiree plans. "This section is really troublesome," said Rep. Phil Gingrey, R-Ga. "Companies that need to make sound financial decisions, if they can't get retirees to pick up more of the cost, they'll just stop offering those benefits."
But liberal supporters say it offers much-needed protection. "This is an important provision that attempts to stem the tide in the erosion of retiree health benefits," said Alexander Hertel-Fernandez, a researcher at the union-backed Economic Policy Institute. "Employers are already shirking their responsibilities and pushing their employees onto public programs." If companies stopped providing retiree benefits, that could mean that retirees aged 55-64 could become eligible for Medicaid or government subsidies to buy health insurance on an exchange. Retirees 65 and over would likely end up on Medicare.
President Obama has pledged that reform will cost about $900 billion over 10 years. Upon releasing the latest version of the health care overhaul last week, Speaker Nancy Pelosi said: "The bill is fiscally sound, will not add one dime to the deficit." The Congressional Budget Office estimated that the bill would cost a net $894 billion and reduce the federal deficit by $104 billion over 10 years. (The gross cost was $1.055 trillion, and last-minute changes have likely boosted that to $1.2 trillion.)
The CBO stated that its initial estimate "does not reflect the impact of section 110." It did not respond to questions about whether it would estimate those costs. But they could be substantial.
In 2005, 12.5% of private-sector establishments offered retiree health benefits, according to the Employee Benefit Research Institute. That's down from about 20% in the 1997, though it has hovered around 12% since 2000. The Census Bureau reports that 22.9 million seniors aged 55-64 have employer-based coverage. The report doesn't say how many of those are retirees. Some 13.2 million seniors 65 and older receive some form of employer-based coverage — though the data don't make it clear if they get full private benefits or just "Medigap" coverage for expenses Medicare doesn't pay for. "The vast majority of private plans are Medigap," said James Gelfand, senior manager of health policy at the U.S. Chamber of Commerce.
Dropping Medigap benefits would not directly lead to higher Medicare costs. But critics suggest that seniors without such policies would push harder for expanded Medicare benefits — and fiercely resist any bid to curb Medicare spending.
The Chamber, along with 11 other business groups, including the National Association of Manufacturers and the National Retail Federation, sent a letter to Pelosi back in July arguing that "mandating benefits in this manner significantly increases both the cost and risk to the employer of voluntarily providing retiree health plans at all."
Gelfand also stated that Section 110 was a variation on a bill by Rep. John Tierney, D-Mass. Tierney sits on the Education and Labor Committee, one of three panels that drafted the House bill. His office did not respond to requests for comment.
Some argue that the reinsurance portion will stabilize employer-based retiree benefits. "The retiree health insurance pool is unstable," said Hertel-Fernandez. "Given its high costs and small size, costs can vary a lot from one year to the next. It's one reason employers drop coverage or decrease the value of their coverage. The reinsurance can bolster the prohibitions on reducing coverage."
Under Section 110, retiree plans can submit claims to the Department of Health and Human Services. If the claim is more than $15,000 but doesn't exceed $80,000, HHS can then reimburse 80% of the claim. HHS would pay claims out of a temporary $10 billion "Retiree Reserve Trust Fund." But nothing would prevent Congress from replenishing the fund if it ran short.
The Pelosi tax surcharge applies to capital gains and dividends
All of those twentysomethings who voted for Barack Obama last year are about to experience the change they haven't been waiting for: the return of income tax bracket creep. Buried in Nancy Pelosi's health-care bill is a provision that will partially repeal tax indexing for inflation, meaning that as their earnings rise over a lifetime these youngsters can look forward to paying higher rates even if their income gains aren't real.
In order to raise enough money to make their plan look like it won't add to the deficit, House Democrats have deliberately not indexed two main tax features of their plan: the $500,000 threshold for the 5.4-percentage-point income tax surcharge; and the payroll level at which small businesses must pay a new 8% tax penalty for not offering health insurance.
This is a sneaky way for politicians to pry more money out of workers every year without having to legislate tax increases. The negative effects of failing to index compound over time, yielding a revenue windfall for government as the years go on. The House tax surcharge is estimated to raise $460.5 billion over 10 years, but only $30.9 billion in 2011, rising to $68.4 billion in 2019, according to the Joint Tax Committee.
Americans of a certain age have seen this movie before. In 1960, only 3% of tax filers paid a 30% or higher marginal tax rate. By 1980, after the inflation of the 1970s, the share was closer to 33%, according to a Heritage Foundation analysis of tax returns.
These stealth tax increases—forcing ever more Americans to pay higher tax rates on phantom gains in income—were widely seen to be unjust. And in 1981 as part of the Reagan tax cuts, a bipartisan coalition voted to index the tax brackets for inflation.
We also know what has happened with the Alternative Minimum Tax. Passed to hit only 1% of all Americans in 1969, the AMT wasn't indexed for inflation at the time and neither was Bill Clinton's AMT rate increase in 1993. The number of families hit by this shadow tax more than tripled over the next decade. Today, families with incomes as low as $75,000 a year can be hit by the AMT unless Congress passes an annual "patch."
The Pelosi-Obama health tax surcharge will have a similar effect. The tax would begin in 2011 on income above $500,000 for singles and $1 million for joint filers. Assuming a 4% annual inflation rate over the next decade, that $500,000 for an individual tax filer would hit families with the inflation-adjusted equivalent of an income of about $335,000 by 2020. After 20 years without indexing, the surcharge threshold would be roughly $250,000.
And by the way, this surcharge has also been sneakily written to apply to modified adjusted gross income, which means it applies to both capital gains and dividends that are taxed at lower rates. So the capital gains tax rate that is now 15% would increase in 2011 to 25.4% with the surcharge and repeal of the Bush tax rates. The tax rate on dividends would rise to 45% from 15% (5.4% plus the pre-Bush rate of 39.6%).
As for the business payroll penalty, it is imposed on a sliding scale beginning at a 2% rate for firms with payrolls of $500,000 and rising to 8% on firms with payrolls above $750,000. But those amounts are also not indexed for inflation, so again assuming a 4% average inflation rate in 10 years this range would hit payrolls between $335,000 and $510,000 in today's dollars. Note that in pitching this "pay or play" tax today, Democrats claim that most small businesses would be exempt. But because it isn't indexed, this tax will whack more and more businesses every year. The sales pitch is pure deception.
As for the Senate, instead of the 5.4% surcharge, the Finance Committee bill raises taxes on "high-cost" health care plans. But this too uses the inflation ruse. The Senate bill indexes its tax proposal for the inflation rate plus one percentage point. But that is only about half as high as the rate of overall health-care inflation, i.e., the rate of increase in health-care premiums. So the Joint Tax Committee has found that a Senate tax that starts in 2013 by hitting 13.8 million Americans will hit 39.1 million by 2019.
The return of the inflation tax demonstrates once again the stealth radicalism that animates ObamaCare. In the case of inflation indexing, Democrats would repeal a 30-year bipartisan consensus that it is unfair to tax unreal gains in income, thus hitting millions of middle-class Americans over time with tax rates advertised as only hitting "the rich." Oh, and the House vote on this exercise in dishonest government will come as early as Saturday
Someone is attacked in an NHS hospital in England every three minutes as doctors describe Emergency rooms as 'war zones', official figures show
Nearly 170,000 violent incidents take place in England's NHS hospitals each year, data obtained under the Freedom of Information Act has revealed. Labour's laws on 24-hour drinking are being blamed for alcohol-fuelled violence in accident and emergency departments in particular. There have been several murders and rapes at hospitals in recent years and thousands of attacks annually involve the use of knives and other weapons. Almost one in four attacks results in injury, yet only a fraction of them are ever reported to the police.
The statistics reveal the dangers that doctors, nurses, paramedics, patients and visitors face in our hospitals on a daily basis. Some hospital A & E departments have been described as "war zones" on a typical Friday or Saturday night. Staff report having knives pulled on them and being punched, kicked and spat at while running battles between rival gangswith knives have been reported in in A & E departments.
Health unions and patients' groups branded the figures "shameful". Shadow Health Minister Mike Penning said the figures showed the Government's promises to tackle violence within the health service to be "worthless".
Of 247 NHS trusts in England, nearly half responded to the Freedom of Information Act request for the number of violent incidents that had taken place "on hospital grounds". They reported 80,831 violent incidents in 2006 and 74,712 in 2007 – in total and an average of 77,772 a year. The same scale of violence across the remaining trusts would see a total of 169,997 incidents taking place each year.
The responses revealed several murders and rapes at hospitals in 2006 and 2007. Among them, paranoid schizophrenic Telahum Tedola, 36, strangled Rosalind McManus, 58, to death. She was in the next bed on a mixed sex ward. Both were being treated in August 2007 at Birch Hill Hospital, Rochdale, Greater Manchester, which is overseen by Pennine Care NHS Foundation Trust.
In April 2006, trainee accountant and former altar boy Stuart Harling, 19, stabbed nurse Cheryl Moss, 33, more than 70 times in a frenzied attack. He had spent months playing violent computer games and researching how to kill. He picked her at random after spotting her taking a cigarette break on a secluded path in the grounds of St George's Hospital in Hornchurch, Essex.
Of the reported outbreaks of violence, 1,496 involved weapons in 2006 and 1,160 in 2007 – an average of 1,328 equating to around 2,902 across all the trusts each year.
In March, a report likened some wards at shambolic Stafford Hospital to a "war zone" and said that patients had been wandering around the hospital fighting each other. In May, police had to seal off Ealing General Hospital's A & E department in west London for six hours after a gang knife fight erupted in the grounds. Last year, rival gangs armed with knives clashed in supposedly secure treatment areas at London's King's College Hospital A & E unit until 20 police officers arrived.
In 2006, 18742 attacks were recorded as having caused injury and 18,236 in 2007 – an average of 18,489 which means around 40,414 incidents result in harm annually across all the trusts. But only 4,317 of the attacks were ever reported to the police in 2006 and 4,372 in 2007, an average of 4,345 a year which would equate to 9,497 across all the trusts annually.
Nottinghamshire Healthcare NHS Trust had the highest number of violent incidents - 14,725 in total over the two years with 554 involving weapons. Other trusts with a high number of total attacks over the two years include Kent and Medway NHS and Social Care Partnership Trust (11,624), North Staffordshire Combined Healthcare NHS Trust (9,603), Birmingham and Solihull Mental Health NHS Foundation Trust (7,735) and Lancashire Care NHS Foundation Trust (6,244).
Previously published statistics have only shown attacks on NHS staff with 55,709 in 2006/7 and 55,993 in 2007/8.
A spokesman for Nottinghamshire Healthcare NHS Trust, a mental health trust which oversees Ramptom Hospital, said the incidents classified as violent included verbal abuse, threats and vandalism as well as assaults. He said: "Due to the nature of some of the Trust’s services covering low, medium and high secure units, some of which are the only services of their kind in the country, we deal with patient groups with very complex and challenging behaviours which can result in a higher occurrence of violent incidents."
Karen Jennings, head of health for union Unison, demanded a "zero-tolerance" approach to violence in hospitals. She said: "There is no doubt that the binge drinking culture and more round-the-clock drinking has led to an increase in the number of attacks on staff. "Some A & E departments are like war zones on an average Friday and Saturday night. "It is not only frightening for the staff working there but also for the other patients turning up for care they need."
Michael Summers, vice-chairman of the Patients Association, said: "These figures are very worrying. "It is difficult enough for doctors and nurses to cope with the volume of work they face these days. It is really quite shameful that staff are also having to tolerate violence on a regular basis. "Particularly, in the London area, we are seeing knife-wielding teenagers following stab victims to A & E units, which are just not equipped to deal with that level of violence. "The amount of drunkenness among young people and the extending of the hours they are able to drink plays a part."
Shadow Health Minister Mike Penning said: "These figures are yet more evidence of a fearful problem that the Government has allowed to go on for far too long. "Assaults on patients and staff unjustly undermine the dedication of the NHS workforce. "Regrettably, Labour's promises to tackle violence and abuse within the health service seem worthless."
A Department of Health spokesman said: "Any violence in hospitals is unacceptable. "Violence not only harms the immediate victims. Incidents can also divert healthcare professionals from providing essential care to patients." "The NHS Security Management Service works with employers in the NHS to prevent violence where possible and to have offenders punished when it does occur."
The public's best option: Less government, more choice
by Jeff Jacoby
"MY GUIDING PRINCIPLE is and always has been that consumers do better when there is choice and competition." So said President Obama in his address to Congress on health care, making an argument for a government-run "public option" to sell health insurance that many Democrats have echoed. In 34 states, Obama noted, three-fourths of the insurance market is controlled by five or fewer companies. "Without competition, the price of insurance goes up and the quality goes down." But add a public option "administered by the government just like Medicaid or Medicare," he said, and competition would revive.
No, it wouldn't.
A government-run health insurer would radically tilt the health-insurance playing field. It would amount to a new entitlement program, able to undercut the price of private insurance by squeezing hospitals and doctors, reimbursing them at below-market rates. "Just like Medicaid and Medicare," which also underpay medical providers, the public option would force hospitals and doctors to charge private insurers more. Those insurers, in turn, would be compelled to raise their premiums, eventually losing millions of customers to the government plan.
Obama and other Democrats insist that any public option would have to be self-supporting, properly balancing its premiums and risk and not expecting the government to cover its losses. Sound familiar? The same assurances were made about Fannie Mae and Freddie Mac.
"I have no interest in putting insurance companies out of business," the president insists now. As a US Senate candidate in 2003, he sang a different tune: "I happen to be a proponent of a single-payer universal health care program. . . . But as all of you know, we may not get there immediately." Has he changed his mind? Or only his talking points?
More competition among health insurers is a consummation devoutly to be wished. But there are far better ways to get there than a public option. Here are three:
* Tear down the barriers to buying health insurance across state lines. Under federal law, states are permitted to regulate "the business of insurance" as they see fit, and most of them have seen fit to allow the sale only of insurance policies licensed by their own state insurance commissions. As a consequence, there is no competitive national market for health insurance; there are 50 state markets instead, most of which are dominated by a handful of insurers. This, says Michael Cannon of the Cato Institute, is the "original sin" of health insurance regulation.
When it comes to almost any other product or service, Americans would find a ban on interstate commerce and competition intolerable: Imagine being told that you could buy a car or a computer only if it was manufactured in your state. Consumers in the market for a mortgage are free to do business with an out-of-state lender; those in the market for health insurance should be equally free to do business with an out-of-state insurer.
* Repeal mandatory benefits that make health insurance needlessly expensive. Compounding the lack of interstate competition is the way states drive up the cost of health insurance by making certain types of coverage compulsory. Consumers and insurers should be free to work out for themselves just how comprehensive or limited a policy should be. But state mandates prevent such flexibility by requiring insurance companies to sell a fixed array of benefits that many customers may not want. Individuals seeking plain-vanilla health insurance -- a policy that will cover them, say, in case of major surgery or catastrophic illness -- may find themselves forced to pay for a policy that also covers acupuncture, in vitro fertilization, alcoholism therapy, and a dozen additional treatments.
When compulsion takes the place of competition, the result is invariably less choice at higher cost.
* De-link health insurance from employment. Nothing distorts America's health insurance market like the misbegotten tax preference for employer-sponsored health insurance. Until that preference is removed, tens of millions of Americans will continue to rely on their employers' health plan instead of buying health insurance for themselves, they way they buy every other type of insurance. Fix the tax code, and no longer could insurance companies routinely bypass employees and deal only with their employers. Instead there would be intensive competition for individual customers -- and the lower premiums such competition would yield.
Yes, Mr. President, consumers do benefit from choice and competition. The key to both is not more government regulation and control, but less.
New Video Warns Americans that European Style Healthcare is Not the Answer
In a video released today by the Center for Freedom and Prosperity Foundation (CF&P), Eline van den Broek of the European Independent Institute warns that European-style healthcare is the wrong approach and that problems in the U.S. healthcare system are the result of too much government intervention already.
In the CF&P video entitled, "Don't Copy Europe's Mistakes: Less Government Is the Right Way to Fix Healthcare," Ms. van den Broek specifically notes that universal health coverage is not the same as universal healthcare, that insurance mandates mean more government control, and that price controls simply do not work.
"As Ms. van den Broek explains, the right to healthcare often means the right to get in a waiting line," said CF&P Foundation President Andrew Quinlan, who also noted, "Copying Europe would undermine quality healthcare in America."
"The video shows that government intervention is undermining America's healthcare system," added Dan Mitchell, Cato Institute Senior Fellow and Chairman of the Board at CF&P. "So it is rather ironic that some politicians think the answer is to further increase the burden of government," he added.
Democrats in Congress are embracing the spirit of President Obama's call to slow the runaway rise of health-care costs but are shying away from some of the most aggressive techniques for achieving that. Instead of revolutionizing how care is delivered and paid for, experts say, the legislation being shaped takes a cautious approach to reining in costs. "The bills are directionally correct, but they're not going far enough," said George Halvorson, chairman and chief executive of Kaiser Permanente and the author of "Health Care Will Not Reform Itself."
In years past, policymakers tried taming health-care growth with price controls -- in government reimbursements and through managed care. The Obama administration has advocated a third way: moving away from fee-for-service payments, which reward providers for doing more procedures, to a coordinated system that pays doctors and hospitals for doing better.
Under that vision, providers would be given a few years to move to performance-based medicine, in which fees and results are published, money is directed to evidence-based therapies, and harmful errors such as preventable infections are reduced. In short, the goal is to save money by modernizing and improving.
Now, as the debate reaches a critical juncture, many are worried that the president's ambitious hopes to constrain costs could result in tepid half-measures on Capitol Hill. Among the concerns:
-- A Senate plan to tax high-priced insurance policies saves far less money -- and is less likely to change medical consumption -- than eliminating the tax exemption for employer-sponsored coverage.
-- Proposals on comparative-effectiveness research and a new Medicare cost-cutting commission have been watered down.
-- An array of Medicare pilot projects aimed at paying doctors and hospitals for quality rather than quantity would take years to be implemented nationally -- if they ever were.
-- None of the bills addresses medical liability, even though the Congressional Budget Office has concluded that tort reform could save $54 billion over the next decade.
Overall, Democratic lawmakers have turned to "tried and true" strategies for reducing spending that merely ratchet down payments rather than fundamentally changing how the health-care system operates, said Drew Altman, head of the nonpartisan Kaiser Family Foundation.
More than $110 billion worth of Medicare "savings," for example, simply comes from a cut in reimbursements to insurers that run the private Medicare Advantage program, and much of the $80 billion extracted from drug companies is in the form of higher Medicaid rebates to the government. Both proposals would reduce costs but have little to do with fundamentally refashioning health care.
What's more, Congress has a history of reversing itself on politically unpopular cuts, so it is risky to count on those savings, Altman said.
Unlike past reform efforts that barely gave a nod to tackling double-digit medical inflation, the bills this year "have some of the right rhetoric," but they fall short of real-world applicability, said Jack Lewin, chief executive of the American College of Cardiology. Without significant financial incentives and strict deadlines, he predicted, few doctors would rush to move toward the coordinated-care models reformers say are needed to save money and maintain high quality.
Ralph Neas, head of the nonpartisan National Coalition on Health Care, noted that "these bills do very little in terms of reining in long-term cost growth," adding: "There is not enough in the public sector and virtually none in the private sector."
While undoubtedly well-intentioned, President Barack Obama’s health care reform plan ignores a central concern of economics. Economics is the science of incentives. As most economists learn early in their careers, an efficient, productive society is one in which individual incentives are aligned as closely as possible with desirable social goals. Consider, for example, Adam Smith’s observation that in most markets producers find it in their self-interest to meet other peoples’ needs.
That is why most economists reject socialism, in which everyone at the bottom has a self-interest in undermining a plan imposed by a few people at the top.
It turns out there’s something worse than socialism. It involves giving everyone an incentive to undermine the top-down plan, then imposing a collective punishment on them when they respond to the perverse incentives. That is the way Obama proposes to control health care costs.
Obama is not alone. This is the way many European countries attempt to constrain health care spending. It also is the way our federal government tries to control Medicare costs. At the risk of oversimplification, it works something like this.
The federal government sets the fees for all doctor services, but leaves doctors free to decide how many of those services to perform. The fee for a patient visit is strictly regulated, for example, but the number of visits is not. Then the government announces if total collective Medicare spending fails to moderate, it will impose an across-the-board percentage reduction in all doctor fees.
This sets up a vicious cycle in which everyone’s incentives are perverse. The more the doctors act in their self-interest, the more social waste there is, and the more we are all punished.
From the individual physician’s point of view, after all, there is nothing he or she can do to affect the total amount of spending. The doctor’s own behavior is such a small part of the whole system, it is imperceptible. But the doctor knows the only way he can increase his own income—or just maintain his standard of living—is to increase the number of services. Care that might have been more efficiently delivered in a single patient visit, for example, gets spread out over two or three visits.
When the collective spending again fails to meet the target, the government imposes another across-the-board fee reduction and the cycle starts all over again.
Suppose, however, we could put the doctor in a room with a Medicare official and free them to agree on a different compensation system. Given that opportunity, every primary care physician in the country could think of ways to save taxpayers money and increase his own income at the same time! Services provided over three visits, for example, could be provided with one visit plus a phone call or two, or one visit plus an e-mail exchange—if only the government would pay more for the one visit.
Thus if doctors could freely re-contract with Medicare, they would repackage and re-price their services in ways mutually beneficial to them and to Medicare—and the taxpayers. They would substitute higher-quality visits for lower-quality ones and economize on resources and the use of patients’ time.
What makes all dysfunctional systems dysfunctional is that people do not have the opportunity to make such mutually beneficial adjustments. Unfortunately, most private payers today are every bit as bureaucratic as Medicare and tend to pay the same way Medicare pays.
What Obama should be doing: thinking of ways to free doctors in the manner just described. What Obama is going to do instead: impose more perverse incentives on all providers.
He said so himself. In his remarks to the joint session of Congress in September, Obama endorsed the idea of an “automatic trigger” to cut payments to hospitals and physicians if Medicare spending fails to meet a target.
If you like Congress’s health plan, ya wanna buy a bridge?
When I was younger, we thought the line “I’m from the government and I’m here to help you,” the height of hilarity, invariably greeted with derisive hoots of laughter. Today it seems that any government official’s exhortation to “Trust me” is greeted as holy gospel, with nary more to be said. A case in point is the newly unveiled health plan from House Democrats, which despite taking up 1,990 pages, does not include the details of what the government’s own insurance plans would include or what they would cost or who would be forced to participate under them. Instead, a “Health Benefits Advisory Committee” of political appointees, headed by a new health czar (a/k/a a “health choices commissioner”)—are to be trusted with a blank check drawn against all of our lives and deaths, and given 18 months to decide the terms and restrictions on our future access to health care. They are empowered to define “all covered benefits and essential, enhanced, and premium plans,” and what the “cost-sharing”—i.e., insurance premium—will be for plan participants. In short, the health czar will have extraordinary powers to define what health care services insurance—public or private—will cover, at what cost, for whom. Those claiming that participation in government insurance plans is and will remain voluntary are also advised to have a little less trust and a little more skepticism: in short, read the bill.
There is little argument that the health insurance industry is not chronically in need for reform—mostly of the current government mandates that have broken it—and many more expert than I have put forth well-researched and presented proposals that effectively resolve the problems of insurance being too expensive and unavailable for some: allowing individuals to purchase insurance from any firm, anywhere (currently prohibited by law); and extending the tax-deductibility of health insurance premiums to individuals. This would arguably incent those risk-takers who currently choose to spend their money on something other than health insurance to purchase coverage for themselves, and make insurance affordable to those many for whom it is not currently. Of the remaining uncovered, as demonstrated throughout our history, ours is a nation of extremely generous individuals who time and again have provided voluntary assistance to those in need. (See, for example, our “Health Insurance Before the Welfare State: The Destruction of Self-Help by State Intervention.“) The anecdotal horror stories offered up as evidence of the dire need for a nationalized solution to health care gaps have been largely discredited upon further investigation, and there is better evidence to believe that the voluntary sector can and will pick up those others than blind faith that a centralized bureaucracy will do so.
Bay Area commuters have been learning first-hand the irrevocable consequences of going along on pure faith and little evidence. Following the damage done to the Bay Bridge by the 1989 earthquake, sound proposals were made for relatively simple reform for the bridge’s shortfalls by seismic retrofitting and repairing the existing bridge. Initial projections were that the bridge could be retrofitted for $150-200 million, in about four years. And then the big thinkers entered the fray: Rather than just the same old bridge, why not a whole new one? The bureaucrats duly studied the question, and decided that for $843 million a replacement bridge could be built that would be safer and last longer.
But soon, rather than simply providing a secure form of transportation between the East Bay and San Francisco, the bridge was completely repurposed. As Berkeley’s mayor put it, the bridge “should make a statement about the beauty of our side of the bay.” Oakland’s public works director likewise chimed in, calling for a “world-class design”—a bridge capable of “creating an inspirational identity for Oakland and the East Bay.”
Eventually, the story was a floated—and bought—that a new bridge could be built for $987 million, and take eight years, versus retrofitting for $909 million. Hardly a dime’s worth of difference! And thus began a saga in which a politically-appointed “Bay Bridge Design Task Force” eventually selected a design for a bridge never before built, protested by knowledgeable engineers as unsafe, especially for the seismically active Bay Area, and for which no bids matching projections could be obtained—none of which interfered with actually proceeding to build to a “signature design” rather than a functional mode of transportation.
The bridge is currently projected to be completed in 2013, at a cost of $6.3 billion, but no one now expects those dates or dollar figures to hold, any more than any of the previous ones did. Two months ago, while work was being done to tie-in one of the newly-built sections to the existing bridge, serious problems began manifesting themselves. A retrofit to get the bridge reopened nearly on schedule was hastily fabricated, which dramatically failed last week in the middle of Tuesday evening’s rush-hour. Meanwhile, the previous bridge has been being dismantled, removing any possibility of a fall-back. Thus, one of the nation’s busiest bridges, carrying an estimated 270,000 vehicles per day, was closed for five and a half days as engineers experimented with fixes for a “signature design” gone wrong.
Low-tech, low-cost reforms to resolve current problems do not make heroes of elected officials and do not provide opportunities to enure vast new budgets and powers to them; vast new “replacement” schemes do. The current, largely extremely well-functioning, health care industry does not need replacing by a federal plan any more than our utilitarian but slightly flawed Bay Bridge needed this new “world class” design, so beautiful in the eyes of its bureaucratic proponents. If Americans buy this health plan, they can expect to see spiraling costs and shrinking benefits, in line with the actual record of every other government program. If politicians can’t fix our schools or our bridges, why do we want to hand over our very lives?
Top Dems: Obama Won't Get Health Care Bill in 2009
Senior Congressional Democrats told ABC News today it is highly unlikely that a health care reform bill will be completed this year, just a week after President Barack Obama declared he was "absolutely confident" he'll be able to sign one by then.
"Getting this done by the by the end of the year is a no-go," a senior Democratic leadership aide told ABC News. Two other key Congressional Democrats also told ABC News the same thing.
This may come as an unwelcome surprise for the White House, where officials from the president on down have repeatedly said the health care bill would be signed into law by the end of the year. "I am absolutely confident that we are going to get health care done by the end of this year, and Nancy Pelosi is just as confident," Obama said Oct. 27 at a fundraiser for the Democratic Congressional Campaign Committee.
Speaker of the House Nancy Pelosi may still be confident -- and her spokesman Brendan Daly said today, "We are going to get our part done" -- but the reason for the delay can be found in the Senate. Senate Majority Leader Harry Reid has yet to release the bill he eventually plans to bring to the Senate floor. Reid is still waiting for the Congressional Budget Office to come up with an estimated cost of several possible variations of his bill before deciding which one to introduce in the Senate. That cost estimate, Democrats tell ABC News, is not expected until next week.
Asked directly by ABC News, "Will you pass health care reform this year?" Reid pointedly did not answer "yes." Instead, he replied, "We are not going to be bound by any timetables," adding, "We are going to do this as quickly as we can." The delay is causing some frustration among Reid's fellow Democrats, but Reid said of his colleagues, "They want us to do this the right way, not the fast way."
"X Factor judge Simon Cowell showed his more generous side [yesterday] when he gave £100,000 [about $160,000] to help save the life of a cancer-stricken youngster," reports London's Daily Mail:
The pop Svengali donated the money for 18-month-old Sophie Atay--from Birtley, Gateshead--to fly to the US for pioneering treatment at the Memorial Sloan Kettering Hospital in New York.
He acted after learning the youngster's family launched a last-ditch appeal for £500,000 to pay for the treatment last week after they were told Sophie was suffering from a rare form of neuroblastoma and needed treatment within days.
Alexandra Burke, last year's X Factor winner, broke the news to Sophie's mum Karine, 33, on the telephone today that Simon had now dipped into his own pocket to top up the total to the necessary amount.
Wait, we're confused! Why does a little English girl have to come all the way to the U.S. to get medical care, and why does this Cowell fellow have to pay for it? We thought Britain had free medical care!
But wait, another Daily Mail story reports on what happens to older people who get cancer in Britain:
Alarming research is showing that elderly cancer patients are missing out on the breakthroughs in chemotherapy and surgery that have dramatically improved the outcome of younger patients.
In fact, up to 15,000 elderly people with cancer in the UK are dying prematurely every year when compared to the rest of Europe and the U.S., according to a report published by the North West Cancer Intelligence Service (NWCIS) which compiles cancer statistics. . . .
A major concern is that the NHS Cancer Plan, introduced in 2000 to improve cancer survival in the UK, has a cut-off point at 70. This results in hospitals having less interest in the elderly. "Yet half of all those diagnosed with cancer are over 70," says Dr Tony Moran, NWCIS research director. "It's an area that has been grossly neglected. . . ."
After more than a decade of public health care with mandatory coverage, so many Canadian doctors have left the practice and so many young people have entered other fields that Canada ranks 26th of 28 developed nations in its ratio of physicians to population. Once, Canada ranked among the leaders in the number of physicians -- but that was before government health care drove doctors out of the practice in droves.
The fundamental fact is that we cannot cover 36 million new patients without more doctors and nurses, much less with the declining census of medical professionals the Canadian experience points to.
A recent survey of doctors by the Pew Institute found that 45 percent of all practicing doctors would consider retiring or closing their practices if the Barack Obama health care bill passes. This scarcity of medical personnel heightens the likelihood of draconian rationing, lengthy waiting lists and lower quality medical care for all of us, particularly for the elderly.
This physician shortage leads to massive and never-ending waiting lists. In 1993, for example, there was an average wait of 9.3 weeks from the time a patient got a referral from a general practitioner to the time he could see a specialist in Canada. By 1997, the wait was up to 11.7 weeks. Now it's 17.3 weeks -- over four months just to see a specialist!
In Canada, unions control the entire health care process. In Manitoba, for example, there is an eight-month wait for colonoscopies, yet the unions do not permit weekend or evening procedures, thereby extending the waiting lists. The unions are doing to health care in Canada what they have done to education in America -- stifling creativity, reinforcing bureaucracy and extending waiting times.
Because of these long waits for colonoscopies, there is now a 25 percent higher incidence of colon cancer in Canada than in the United States. And, because the leading drugs that we routinely use to treat the malady in the U.S. are banned in Canada because of their high cost, 41 percent of Canadians who get the cancer die of it, compared with only 32 percent in the United States. Overall, the cancer death rate in Canada runs 16 percent higher than in the United States. Cancer does not wait for waiting lists to clear.
The potential of health care changes to shrink the doctor population, exacerbating scarcity and extending waits, is even worse now that it is apparent that we have overestimated the number of doctors in the U.S. Where we once thought there were 840,000 doctors, the total is now estimated to be only 760,000.
The proposed $400 billion cut in Medicare raises the probability that more and more of those doctors who do practice will refuse to accept Medicare patients, aggravating the doctor shortage among the elderly, the population that needs them the most.
As Obama's program moves through Congress, despite the fierce opposition of a majority of American voters in virtually all the polls, it becomes clear that those moderates who vote for it will face harsh retribution at the polls from their outraged constituents. A kind of suicide-pact mentality is gripping the Democratic majorities in Congress, akin to that which came over it when Congress passed President Clinton's tax package in 1993.
This disregard for the will of the marginal voter may make sense for those who come from safe districts -- it makes none for those who come from swing districts. For them, suicidal conduct leads to political demise.
Epic new spending and taxes, pricier insurance, rationed care, dishonest accounting: The Pelosi health bill has it all.
Speaker Nancy Pelosi has reportedly told fellow Democrats that she's prepared to lose seats in 2010 if that's what it takes to pass ObamaCare, and little wonder. The health bill she unwrapped last Thursday, which President Obama hailed as a "critical milestone," may well be the worst piece of post-New Deal legislation ever introduced.
In a rational political world, this 1,990-page runaway train would have been derailed months ago. With spending and debt already at record peacetime levels, the bill creates a new and probably unrepealable middle-class entitlement that is designed to expand over time. Taxes will need to rise precipitously, even as ObamaCare so dramatically expands government control of health care that eventually all medicine will be rationed via politics.
Yet at this point, Democrats have dumped any pretense of genuine bipartisan "reform" and moved into the realm of pure power politics as they race against the unpopularity of their own agenda. The goal is to ram through whatever income-redistribution scheme they can claim to be "universal coverage." The result will be destructive on every level—for the health-care system, for the country's fiscal condition, and ultimately for American freedom and prosperity.
•The spending surge. The Congressional Budget Office figures the House program will cost $1.055 trillion over a decade, which while far above the $829 billion net cost that Mrs. Pelosi fed to credulous reporters is still a low-ball estimate. Most of the money goes into government-run "exchanges" where people earning between 150% and 400% of the poverty level—that is, up to about $96,000 for a family of four in 2016—could buy coverage at heavily subsidized rates, tied to income. The government would pay for 93% of insurance costs for a family making $42,000, 72% for another making $78,000, and so forth.
At least at first, these benefits would be offered only to those whose employers don't provide insurance or work for small businesses with 100 or fewer workers. The taxpayer costs would be far higher if not for this "firewall"—which is sure to cave in when people see the deal their neighbors are getting on "free" health care. Mrs. Pelosi knows this, like everyone else in Washington.
Even so, the House disguises hundreds of billions of dollars in additional costs with budget gimmicks. It "pays for" about six years of program with a decade of revenue, with the heaviest costs concentrated in the second five years. The House also pretends Medicare payments to doctors will be cut by 21.5% next year and deeper after that, "saving" about $250 billion. ObamaCare will be lucky to cost under $2 trillion over 10 years; it will grow more after that.
• Expanding Medicaid, gutting private Medicare. All this is particularly reckless given the unfunded liabilities of Medicare—now north of $37 trillion over 75 years. Mrs. Pelosi wants to steal $426 billion from future Medicare spending to "pay for" universal coverage. While Medicare's price controls on doctors and hospitals are certain to be tightened, the only cut that is a sure thing in practice is gutting Medicare Advantage to the tune of $170 billion. Democrats loathe this program because it gives one of out five seniors private insurance options.
As for Medicaid, the House will expand eligibility to everyone below 150% of the poverty level, meaning that some 15 million new people will be added to the rolls as private insurance gets crowded out at a cost of $425 billion. A decade from now more than a quarter of the population will be on a program originally intended for poor women, children and the disabled.
Even though the House will assume 91% of the "matching rate" for this joint state-federal program—up from today's 57%—governors would still be forced to take on $34 billion in new burdens when budgets from Albany to Sacramento are in fiscal collapse. Washington's budget will collapse too, if anything like the House bill passes.
• European levels of taxation. All told, the House favors $572 billion in new taxes, mostly by imposing a 5.4-percentage-point "surcharge" on joint filers earning over $1 million, $500,000 for singles. This tax will raise the top marginal rate to 45% in 2011 from 39.6% when the Bush tax cuts expire—not counting state income taxes and the phase-out of certain deductions and exemptions. The burden will mostly fall on the small businesses that have organized as Subchapter S or limited liability corporations, since the truly wealthy won't have any difficulty sheltering their incomes.
This surtax could hit ever more earners because, like the alternative minimum tax, it isn't indexed for inflation. Yet it still won't be nearly enough. Even if Congress had confiscated 100% of the taxable income of people earning over $500,000 in the boom year of 2006, it would have only raised $1.3 trillion. When Democrats end up soaking the middle class, perhaps via the European-style value-added tax that Mrs. Pelosi has endorsed, they'll claim the deficits that they created made them do it.
Under another new tax, businesses would have to surrender 8% of their payroll to government if they don't offer insurance or pay at least 72.5% of their workers' premiums, which eat into wages. Such "play or pay" taxes always become "pay or pay" and will rise over time, with severe consequences for hiring, job creation and ultimately growth. While the U.S. already has one of the highest corporate income tax rates in the world, Democrats are on the way to creating a high structural unemployment rate, much as Europe has done by expanding its welfare states.
Meanwhile, a tax equal to 2.5% of adjusted gross income will also be imposed on some 18 million people who CBO expects still won't buy insurance in 2019. Democrats could make this penalty even higher, but that is politically unacceptable, or they could make the subsidies even higher, but that would expose the (already ludicrous) illusion that ObamaCare will reduce the deficit.
• The insurance takeover. A new "health choices commissioner" will decide what counts as "essential benefits," which all insurers will have to offer as first-dollar coverage. Private insurers will also be told how much they are allowed to charge even as they will have to offer coverage at virtually the same price to anyone who applies, regardless of health status or medical history.
The cost of insurance, naturally, will skyrocket. The insurer WellPoint estimates based on its own market data that some premiums in the individual market will triple under these new burdens. The same is likely to prove true for the employer-sponsored plans that provide private coverage to about 177 million people today. Over time, the new mandates will apply to all contracts, including for the large businesses currently given a safe harbor from bureaucratic tampering under a 1974 law called Erisa.
The political incentive will always be for government to expand benefits and reduce cost-sharing, trampling any chance of giving individuals financial incentives to economize on care. Essentially, all insurers will become government contractors, in the business of fulfilling political demands: There will be no such thing as "private" health insurance.
All of this is intentional, even if it isn't explicitly acknowledged. The overriding liberal ambition is to finish the work began decades ago as the Great Society of converting health care into a government responsibility. Mr. Obama's own Medicare actuaries estimate that the federal share of U.S. health dollars will quickly climb beyond 60% from 46% today. One reason Mrs. Pelosi has fought so ferociously against her own Blue Dog colleagues to include at least a scaled-back "public option" entitlement program is so that the architecture is in place for future Congresses to expand this share even further.
As Congress's balance sheet drowns in trillions of dollars in new obligations, the political system will have no choice but to start making cost-minded decisions about which treatments patients are allowed to receive. Democrats can't regulate their way out of the reality that we live in a world of finite resources and infinite wants. Once health care is nationalized, or mostly nationalized, medical rationing is inevitable—especially for the innovative high-cost technologies and drugs that are the future of medicine.
Mr. Obama rode into office on a wave of "change," but we doubt most voters realized that the change Democrats had in mind was making health care even more expensive and rigid than the status quo. Critics will say we are exaggerating, but we believe it is no stretch to say that Mrs. Pelosi's handiwork ranks with the Smoot-Hawley tariff and FDR's National Industrial Recovery Act as among the worst bills Congress has ever seriously contemplated.
Although it is cheaper to buy a pint of milk than to buy a quart of milk, nobody considers that to be lowering the price of milk. Although it is cheaper to buy a lower quality of all sorts of goods than to buy a higher quality, nobody thinks of that as lowering the price of either lower or higher quality goods.
Yet, when it comes to medical care, there seems to be remarkably little attention paid to questions of both quantity and quality, in the rush to "bring down the cost of medical care." There is no question that you can reduce the payments for medical care by having either a lower quantity or a lower quality of medical care. That has already been done in countries with government-run medical systems.
In the United States, the government has already reduced payments for patients on Medicare and Medicaid, with the result that some doctors no longer accept new patients with Medicare or Medicaid. That has not reduced the cost of medical care. It has reduced the availability of medical care, just as buying a pint of milk reduces the payment below what a quart of milk would cost.
Letting old people die instead of saving their lives will undoubtedly reduce medical payments considerably. But old people have that option already-- and seldom choose to exercise it, despite clever people who talk about a "duty to die."
A government-run system will take that decision out of the hands of the elderly or their families, and thereby "bring down the cost of medical care." A stranger's death is much easier to take, especially if you are a bureaucrat making that decision in Washington.
At one time, in desperately poor societies, living on the edge of starvation, old people might be abandoned to their fate or even go off on their own to face death alone. But, in a society where huge flat-screen TVs are common, along with a thousand gadgets for amusement and entertainment, and where even most people living below the official poverty line own a car or truck, to talk about a "duty to die" so that younger people can live it up is obscene.
You can even save money by cutting down on medications to relieve pain, as is already being done in Britain's government-run medical system. You can save money by not having as many high-tech medical devices like CAT scans or MRIs, and not using the latest medications. Countries with government-run medical systems have less of all these things than the United States has.
But reducing these things is not "bringing down the cost of medical care." It is simply refusing to pay those costs-- and taking the consequences.
For those who live by talking points, one of their biggest talking points is that Americans do not get any longer life span than people in other Western nations by all the additional money we spend on medical care.
Like so many clever things that are said, this argument depends on confusing very different things-- namely, "health care" and "medical care." Medical care is a limited part of health care. What we do and don't do in the way we live our lives affects our health and our longevity, in many cases more so than what doctors can do to provide medical care.
Americans have higher rates of obesity, homicide and narcotics addiction than people in many other Western nations. There are severe limits on what doctors and medical care can do about that.
If we are serious about medical care-- and we should be serious, since it is a matter of life and death-- then we should have no time for clever statements that confuse instead of clarifying.
If we want to compare the effects of medical care, as such, in the United States with that in other countries with government-run medical systems, then we need to compare things where medical care is what matters most, such as survival rates of people with cancer.
The United States has one of the highest rates of cancer survival in the world-- and for some cancers, the number one rate of survival.
We also lead the world in creating new life-saving pharmaceutical drugs. But all of this can change-- for the worse-- if we listen to clever people who think they should be running our lives.
As I was talking recently with the founder of a large American corporation, the conversation turned (inevitably) to health care reform. His employees in their 20s, on average, cost the company about $1,500 a year in health bills. Those in their 50s cost at least 10 times more. The effect of proposed health care reform -- which limits the ability of insurers to charge higher premiums for older adults -- would be, he said, a large shift of America's health care burden to the younger generation.
This is not an unintended consequence of reform; it is the whole purpose. It is not a side effect; it is the main funding mechanism. Precisely because younger people have lower health costs, reformers want to draft them into the broader health insurance system so their premiums can subsidize the health expenses of older, sicker health care consumers. Thus, in every version of health care reform, the young are required to purchase coverage, on penalty of an "excise tax."
This mandate explains the political coalition behind health care reform. Insurance companies are willing to accept tighter government regulation on matters such as the coverage of pre-existing conditions -- but only if they are given guaranteed access to millions of younger, healthier premium payers. Congress gets additional resources from the young to expand insurance coverage, with less need to raise taxes overtly. Advocates for the elderly welcome an intergenerational subsidy that reduces premiums for older Americans.
Amazingly -- out of idealism, ignorance or both -- people in their 20s remain the strongest supporters of health care reform. They are also the most likely group to wake up the day after passage of Obamacare with a health reform hangover -- forced to buy coverage at higher premiums to reduce the cost of someone else's health insurance.
Legislators, perhaps fearing that future anger, seek to soften the blow in a couple of ways. The Senate Finance Committee bill would allow insurance companies to charge older adults a maximum of four times more than young people -- reducing premium increases for the young by making the elderly carry more of their own weight. The House bill would set the maximum premium difference between old and young at two to one. This provision, supported by AARP, is likely to increase premiums for the young dramatically.
Both the House and Senate bills also provide subsidies for those with low incomes to make health insurance more affordable. Many of the young would qualify. Many would not. Offsetting the whole cost to the young through subsidies would make health reform fiscally unsustainable -- requiring new taxes on other groups.
There are arguments for mandating the purchase of higher-priced insurance by the young. It would, on the bright side, leave less disposable income for nose rings and tattoos. And perhaps the ownership of health insurance, in an ideal world, should be a social expectation, like the ownership of auto insurance.
But this burden on the young comes in a series. The most consequential element of the New Deal -- Social Security -- has been a large transfer of resources from young to old. The same is true of the Great Society's Medicare program, which has channeled massive spending toward health care for the elderly. Two-thirds of Medicaid spending goes to nursing homes. In 1965, there were four workers paying for the benefits of each retiree. Soon, there will only be two.
In our history, public programs helping the young -- say, the Civilian Conservation Corps or the GI Bill -- tend to be discretionary and temporary. Entitlements benefiting the elderly are eternal. And health insurance reform adds to the list.
America's 60-year, cross-generational transfer of wealth counts moral achievements. In the 1960s, 30 percent of the elderly lived in poverty. In 2008, that figure was less than 10 percent. And the compassionate treatment of the elderly serves our future interests. The young grow old, with a little luck and patience.
But limited resources require the interests of young and old to somehow be balanced. And a society that consistently shifts burdens from old to young at some point becomes selfish. We are proud to sacrifice for the sake of our parents and grandparents. We are less proud of imposing burdens on our children and grandchildren that diminish their opportunity.
This is the inescapable shame of overwhelming budget deficits. But it applies to health care as well. A nation that views the young as ripe for burdens instead of benefits has itself become old.
Daughter of British Alzheimer's patient defies NHS gagging order to speak out
Secrecy and censorship is the prime refuge of Leftists
A daughter has spoken out in defiance of a gagging order that was imposed after she won a £30,000 refund for care unfairly denied to her mother, an Alzheimer's patient. Pauline Hardinges was given the payout after she fought a year-long battle with Cornwall and Isles of Scilly Primary Care Trust for them to pay for her mother's 24-hour care. But when she went to collect the money she was asked to sign a confidentiality agreement, which she was told was routine in such cases.
Mrs Hardinges said she signed the agreement but has chosen to break the gagging order to publicise the fact that relatives of other dementia families could be eligible for refunds of private care costs.
The 65-year-old, from Looe, Cornwall, said: "When I took the matter up with the primary care trust I was told it was to stop me speaking to the media. I was appalled – I wanted everyone suffering from this horrendous disease, or looking after someone with it, to know they can claim for every penny of nursing care from the Government." She added: "There was no way I was going to keep my mouth shut, so I told my neighbour and he claimed for £130,000 for his dad's care – and got the lot."
Mrs Hardinges' mother, Dorothy, was diagnosed with Alzheimer's in 2000 at the age of 86. Her care needs were assessed but the trust ruled that she was only entitled to "social", rather than medical care. This meant that when her condition deteriorated Mrs Hardinges had to place her mother in a private care home. It was not until 2007 that Mrs Hardinges found out a retrospective review could be conducted into the way her mother's care needs were assessed. The review found that her mother should have been given round-the-clock care by the NHS and so she was entitled to be refunded all costs of care she had incurred.
"The NHS were dreadful and kept putting up obstacles – but in 2008, after a year-long battle, they finally told me my mother should have been fully funded from the beginning" added Mrs Hardinges. "They'd hidden the fact government money was available. To cheat sick and elderly people is outrageous." Pauline added: "When I was refunded the £30,000 I signed the confidentiality contract under duress. "But I couldn't have lived with myself by not speaking out. Even if one family gets help as a result of reading my story it will have been worth it."
Cornwall and Isles of Scilly Primary Care Trust defended the gagging order. An official said: "This standard clause has been in place for some years."
But Neil Hunt, of the Alzheimer's Society, said: "It is a very complex and confusing system and most of the time people are not aware of what type of care their relatives are entitled to. "Thousands of families face astronomical care bills. We want a more transparent and fair system that doesn't penalise people with dementia."
A Department of Health spokeswoman said: "We are currently consulting with the public on the future of care services. Under the proposals, a National Care Service would be created, making care for older and disabled people simpler, fairer and more affordable for everyone. Under the National Care Service, everyone will get at least some care for free.”
Mrs Hardinges added: "When I signed, I wrote "under duress" underneath. It was only later when I thought about all the people who might not have the wherewithal to do the same that I thought I would go public. "I was paying for medical care I believed she was entitled to, so I stopped – and was threatened with court." Mrs Hardinges said she turned to the NHS when she ended up in hospital with stress after giving up a restaurant job to care for her mother.
After months of work by Senate Committees, Senate Majority Leader Harry Reid stepped up to the microphone and pronounced that in his opinion “the best way to move forward is to include a public option with the opt-out provision for states.” Though there is little understanding of how an opt-out provision would work, it resurrected the seemingly dead government plan that, if enacted, will eventually destroy the private insurance market.
The inclusion of a public option in the Senate bill immediately resulted in Maine Senator Olympia Snowe, the only Republican who was lending a “bipartisan fig leaf” to any of the Democrat’s health care plans, withdrawing her support. Liberal Democrat Chuck Shumer lauded Senator Reid who, he said, “showed just how deep his commitment is” to the public option.
Reid knows that without the illusion of a bipartisan plan, he is likely to lose several middle of the road Democrats, especially those who must face the voters next year. Senator Joe Lieberman signaled weeks ago his concern that Obama was trying to do too much too fast in a weak economy and has now said he is likely to join a Republican fillibuster.
The likelihood of Reid getting the needed sixty votes to pass a bill out of the Senate with a public option, with or without the new gimmick of a “state opt- out” remains murky at best. So what is his motivation?
The Senate leader is facing a very difficult re-election campaign with polls showing him running behind Republican contenders. His liberal base demands a public option. The opt- out provision may be a meaningless gimmick but it allows Reid to appear strong with Democrat activist groups back home and perhaps gives cover to worried Democrats.
No one knows the language of the Senate bill, but it is certain that the public option will draw the greatest attention and debate. Even if Reid can’t get the votes for what will become, in reality, a government health care system, he will be credited by his leftist supporters in the Senate, as well as back home for having given it his best. He can then offer up Senator Snowe’s trigger, regain “bipartisan support”, and attract nervous Democrats.
All the while, with the media focusing on the fight over “public option”, “opt-out”, and “trigger” provisions, other equally destructive parts of the bill will be overshadowed.
As Harry’s shell game is played in Congress, voters need to keep an eye on the ball. The problems with this “reform” go far beyond the issue of a public option. With or without the public option, it will be at minimum a trillion dollar proposal with a new “Health Choices” Commissioner dictating health insurance plans.
With or without a public option, it forces everyone to buy a government dictated health insurance plan, imposes new job-killing taxes on employers, slashes Medicare for seniors, underpays doctors and hospitals, limits the deductibility of medical expenses on income taxes, imposes billions in new fees on manufacturers of life saving medical devices, creates taxpayer subsidies for abortion and illegal aliens, and leaves millions uninsured.
Harry’s shell game is about his tough re-election prospects in Nevada. Many think he is misreading his state. Unless the people of Nevada really want this new dependency on government, they are about to bury him in “you are fired” pink slips for attempting to destroy the finest health care system in the world.
Memo: It's officially safe to criticize Barack Obama
There's a lot of buzz on Capitol Hill about a new health care memo, by strategist/communicator Frank Luntz, which is filled with advice for opponents of the Democrats' reform legislation. The memo analyzes the public's concerns that national health care will result in lower quality care at higher cost, with an out-of-control deficit to boot, and Luntz recommends language to help critics make the case against the legislation more effectively. For example, he suggests opponents would be better off avoiding the phrase public option; calling it the government option is better.
The new memo updates a similar analysis Luntz wrote last May. Some of the advice is familiar. But one striking difference between the two documents is in the treatment of Barack Obama. Last May, Luntz advised politicians to stay away -- far away -- from criticizing the president. "Your political opponents are the Democrats in Congress and the bureaucrats in Washington, not President Obama," Luntz wrote. "Every time we test language that criticized the president by name, the response was negative -- even among Republicans." He continued: "If you make this debate about Republicans vs. Obama, you lose. But if you make it about Americans vs. politicians, you win." Therefore, the advice was to go after Washington bureaucrats and government health care, but never Obama.
That was then. Now, things are different. "In the spring, we counseled strongly that you should avoid direct confrontation with President Obama," Luntz writes in the new memo. "That has changed." The "thrill is gone" from Obama's relationship with the American people, Luntz writes, and it's now OK to go after the president's proposals with the president's name attached. "There is no change in support for the plan if it is called 'Barack Obama's plan' instead of the plan of 'Democrats in Congress,'" Luntz says. "So long as the attack is grounded in policy and NOT personage, you can talk about opposing 'President Obama's plan.'"
That said, Luntz still doesn't advise doing it. "While you no longer shoot yourself in the foot by criticizing the president, you would do much better to criticize Congress -- which has disapproval ratings that will clearly sink some re-election hopes," Luntz writes. While many Republicans insist on calling health care reform "Obamacare," Luntz says they would do better by attacking "Washington."
To many readers, Luntz's advice might seem more than a little late; obviously there is a lot of criticism of Obama in the public conversation. But Luntz's memo, based on extensive research and testing of political language, will mean something for the more cautious and timid Republican lawmakers on Capitol Hill. It will assure them that not only can they go after the worst Democratic policy proposals, but they can tie them to Obama without fear of backlash from their own voters. Obama's personal popularity rating, which hit 78 percent in a Gallup poll last January, has now fallen to 56 percent. Among politically-crucial independents, it has fallen from 75 percent in January to 52 percent today. Numbers like that mean Obama's intimidation factor has disappeared. Luntz's memo gives health-care opponents a road map for taking advantage of that fact.
Dems health care “reform”: The more you know, the less you like
I’d like to bring your attention to a few interesting articles from recent days which argue strongly against the Democrats’ so-called “reform” of our health care system, particularly if you are not very old or sick:
First, from Tyler Cowen in the New York Times, his article explaining “How an Insurance Mandate Could Leave Many Worse Off." Not only would the proposal force people to buy something they don’t want (more on this below), but the structure of the subsidy package would actually create a disincentive for people to earn more money.
Second, as reported in the Wall Street Journal, WellPoint, one of the nation’s largest health care insurers, has done a series of studies on the likely effect of the Democrats’ plans on health insurance premiums in the 14 states in which they operate. (You can access all 14 reports HERE.) The results are not pretty (for the Democrats)....
In other words, in order to fund a small theoretical decrease in the cost of insurance for the elderly and sick, young healthy people are going to see their health insurance costs explode. And keep in mind that the Democrats’ plans include massive custs to Medicare funding, so the scenario for the “older” segment is far worse than even this analysis appears.
The WellPoint studies are very detailed, showing each component of the cost increases, such as the impact of guaranteed issue, limiting the age discount, and new taxes on health insurers, medical devices, and pharmaceuticals.
With the subsidies built into Democrats plans, people below 200% or 300% of the poverty line may avoid some of the true cost increase, but only by shoving that increase off to the rest of society.
In other words, the Democrats’ plans are, not surprisingly, a massive transfer of wealth system from the young and relatively young who earn a decent living to the old and poor. It has nothing whatsoever to do with controlling health care costs and will in fact make recent years’ health care inflation look like a walk in the park.
And third, the Washington Times again brings up the issue of whether the proposed reforms, particularly a federal mandate requiring people to buy something, are constitutional. While it’s obvious (to me) that the Founders and anyone who understands the Constitution would say such a mandate is clearly unconstitutional, I think a Supreme Court case on the issue would end up 5-4 or 6-3 one way or another.
A particularly interesting aspect of the case would be that even the insane and destructive overbroad interpretation of the commerce clause has always been based on interstate commerce, because “regulating” (i.e. to make regular, not to make all kinds of regulations about, using the language of the time) commerce between the states was the purpose of the language. However, health insurance is explicitly not interstate commerce; insurers are prohibited from selling policies approved in one state across a border into another state. Indeed, making health insurance interstate is one of the most important true reforms we need to make.
The Democrats are losing the public debate over health care reform, despite what their pawns in the media would like you to belive. However, they still have enormous majorities in both houses of Congress and enormous debts to the unions who fund their campaigns. Therefore, it is certainly possible that legislation may pass (probably with fewer GOP votes than you could count on one hand…between both the House and the Senate). If it does, it will spell electoral disaster for the Democrats in 2010. And, reversing the order of impact (i.e. legislation on elections), the election results in New Jersey, New York, and Virginia next week could cause “moderate” Democrats in moderate districts to rethink any possible support for Obamalosireidcus-care.
A new proposal to put the government between you and your doctor
A new proposal from Medicare has been published in the Federal Registry and it provides a window on how medical care will be delivered in the future under a government-run system. Medicare is proposing to provide a fixed budget for the medical care of dialysis patients and the details of the plan guarantee that patients will have a private company intervening in physician decisions whether to provide expensive but highly beneficial drug therapies.
The end stage kidney disease program, better known as kidney dialysis, is the one aspect of Medicare that applies to persons less than 65 years old. This quirk in the system began in the 1960s in order to help fund the expensive dialysis programs that were feasible but enormously costly on a per treatment basis. These are life-saving treatments and could not possibly be affordable to most patients. Over the years, the program has grown larger and larger because more and more patients were found to benefit from the treatment. The cost per treatment is actually about 64% of the costs 20 years ago, factored for inflation, as tremendous efficiencies have been introduced. But the program has grown to now cost 6.4% of Medicare's total budget or some $23 billion in 2006. This is because over 350,000 patients receive dialysis treatments in the United States.
One way that the system has been able to keep per treatment costs low has been the entry and domination of the industry by large, for profit, public companies like Fresenius Healthcare and Da Vita Healthcare, that can provide the capital and the integration of services to be profitable under a highly constrained cost structure. Kidney specialists are not employed by these companies but supervise care for the patient and are paid directly by Medicare for their services.
But costs continue to rise because of rising numbers of patients receiving dialysis treatments and Medicare has now decided that since drug therapy is a rising source of costs for the dialysis program, a prepayment for drug treatment will be included in a "bundled" payment for dialysis services. The "bundle" of money will go to the for-profit dialysis provider and the company will have to buy and then dispense the medications prescribed by the independent physicians. These key medications will no longer be reimbursed under Medicare's Drug Plan, the so-called "Part D". So if the physician prescribes expensive medications compared to less costly but less effective ones, the company could and probably would lose money.
This is clearly an example of Medicare creating a system that potentially interferes with a physician's best judgment and looks to the possibility of rationing more costly medications. Dialysis unit administrators will have a strong incentive to restrain physicians prescribing the more expensive medications that will likely provide a long term benefit for patients. The particular medicines that will be most affected are those that help improve bone function over the long term in dialysis patients but have little obvious short term effects. It will take years to sort out the impact of this approach.
It is true that hospitals must pay for expensive medications required by hospitalized patients and hospitals try to influence physician utilization of these expensive medications. But hospitals use physician committees to modify utilization in an appropriate fashion. The dialysis providers in a community dialysis unit do not have the resources of a hospital to organize committees of physicians to oversee utilization. Patients in dialysis units will have no inkling whether their medication regimens are based on the best care available or on the bottom line profits of a commercial enterprise. Both the companies and the physicians are being put in a bind by the government plan.
The new approach is open to public comment at this time but this is clearly the new face of rationing. Restrict payments through providing a fixed budget for care. Welcome to the British National Health Service.
The Democrats are sucking the d*cks of the trial lawyers
Those of us who are not true believers in expanded government are certain of the following:
If the 1,990-page House Health Care Bill becomes law, the average American will receive worse health care, American physicians will decline in status and income, American medical innovation will dramatically slow down and pharmaceutical discoveries will decline in number and quality. And, of course, the economy of the United States will deteriorate, perhaps permanently.
However, we are also certain that there is one American group that will thrive -- trial lawyers. The very existence of a 1,990-page law guarantees years of, if not more or less permanent, lawsuits. And the law actually specifies that states that do not limit attorneys' fees in cases of medical malpractice shall be financially rewarded. What we are seeing here, therefore, is something unprecedented in our history: Many trial lawyers will earn as much as most physicians, and fewer and fewer physicians will earn as much as successful trial lawyers.
Nothing better illustrates the reorientation -- indeed, the transformation -- of values that will take place if the Democrats' health care legislation is passed. Thanks to trial lawyer/Democratic influence, for decades, we have been moving in the direction of litigation-based society. But with a Democratic health care bill, the movement will accelerate exponentially.
Much of our money, our innovation, our creativity and our ingenuity will gravitate from medicine to law.
Young people who wish to make a good living -- and even talk themselves into believing that they are also doing good for society -- will opt for trial law over medicine. As far back as memory goes for living Americans, a young person who wished to do well, as well as do good in life, would likely choose medicine as a profession if he were bright enough and willing to put in the great number of hours necessary.
In the last generation, many of the brightest chose finance -- as it turned out, another often unproductive and often destructive arena -- to make a lot of money while believing that they, too, were doing a lot of good for society.
With the financial professions in trouble and in some disrepute, and medicine being financially and socially devalued -- doctors are increasingly called "health care providers" (along with nurses, physician's assistants, lab technicians, etc.; they're all the same) -- law, especially trial law, will be seen as offering the most opportunities for making a great deal of money.
No rational person argues that society doesn't need law or lawyers, or that all lawyers, even trial lawyers, do no good. That is certainly not what is being argued here.
But it does say something about a society when those who sue physicians and hospitals make as much or more money than those who heal disease. It says something about a society when it glorifies and rewards those who litigate while it demonizes and punishes those who produce the drugs and devices that keep its citizens alive and well.
This is part of the upside-down world the left is bequeathing to us and our children in the name of health care "reform."
Equipment shortage plus untrained staff = a baby dead
A premature baby, Poppy Davies, died after being given a ''massive overdose'' of glucose following a series of blunders at London's Great Ormond Street Hospital. Poppy was transferred to the leading children's hospital in London for specialist care after she was born three months early on Christmas Eve last year, in Basildon, Essex. But she died after a "domino effect" of mistakes, an inquest was told.
Rebecca Tite, a trainee nurse, who had spent just three weeks in the hospital's neonatal intensive care unit, set up a machine supplying her with glucose incorrectly, flooding her body with the solution. The levels of glucose in Poppy's blood rose to 20 times the maximum level they should have been, causing ''devastating effects'' to her body, St Pancras Coroner's Court in central London heard.
The machine that nurses would have preferred to use to give Poppy glucose would have prevented an accidental overdose being given to her, the inquest heard. But the equipment was not available after being taken away to help threat a five-year-old boy suffering from meningitis who had needed it urgently.
Both Mrs Tite and Claire Kirk, the senior nurse on duty on January 11, the day of the overdose, failed to check the safety clamp on the syringe that was then used to provide glucose. As as result, instead of being carefully measured, a free flow of glucose entered Poppy's bloodstream and circulated for over an hour.
The nurses then failed to respond to alarms that sounded in the baby's cubicle which could have alerted them to the fatal error, as they were treating her for breathing problems instead. Doctors eventually tried to save Poppy's life by giving her insulin but she died on February 1.
Coroner Dr Andrew Reid recorded a narrative verdict outlining the circumstances of five-week-old Poppy's death, but said it was a ''tragic accident''. Police investigated the incident but concluded there were no suspicious circumstances.
Speaking after the inquest, Poppy's father David Daly, a fireplace fitter from Greys, Essex, said he hoped the hospital had learned from its mistakes. He said: ''It's heartbreaking, but what can you do. You've just got to carry on fighting.'' Poppy's mother, receptionist Karly Davies, was too upset to comment. She wept throughout the inquest and had to leave the court several times because of her distress.
Dr Reid said the errors contributed to a "domino effect" that ultimately caused the death of the little girl, who weighed just 1.63lb (740g) when she died - less than a bag of sugar. He said: "I have come to the conclusion that this was a tragic accident in the course of her healthcare. "It reflects a number of features recognised in terms of clinical risk management where there are a number of steps that have not been taken to prevent the outcome occurring. "A domino effect applies, and the failure of one preventative system leads to another, with the result that, sadly, a fatal overdose of dextrose was given from which Poppy could not recover.
"It is not possible to say on a balance of probability when, after the overdose started, the point of no return was reached. "This is a very rare occurrence and there is no literature to say what could or should have been done, other than in a child big enough and fit enough, dialysis may be an option." It is not possible to know if Poppy would have survived had the overdose not been given.
Mrs Tite, who was undertaking a year-long training course in intensive care, said she had over six years' experience of looking after "very sick children", however. She has now left Great Ormond Street Hospital, telling the inquest: "I found this incident devastating and distressing and was no longer able to continue my placement there."
The hospital has now changed the way it provides glucose to babies to prevent such a tragedy happening again. No post-mortem examination was carried out on Poppy, but the inquest heard that she died of multiple organ failure following the glucose overdose.
A spokesman for Great Ormond Street Hospital said: “We have apologised to Poppy’s family, conscious of the enormous loss they have suffered. At every stage of the investigation we have sought to keep them informed as the most important people who have to know. “Our internal investigation has shown that this incident occurred due to human error. No further disciplinary action has been taken. “Competent, caring and qualified staff made a mistake.” Policies and procedures have now been amended in the light of Poppy’s death, he added.
No reform is better than a public option, Lieberman says
Sen. Joseph I. Lieberman (I-Conn.) said Sunday that no health-care reform bill at all is better than legislation that includes some form of a government-run public option. "The truth is that nothing is better than that (a public option) because I think we ought to follow, if I may, the doctors' oath here in Congress as we deal with health care reform: Do no harm," Lieberman said.
Lieberman, a critical vote for Senate Democrats in the health-care debate, said a public option, unlike extending insurance coverage to the uninsured and controlling premium costs, was never a priority until recently. The former Democratic vice-presidential candidate, now an Independent who caucuses with the Democrats, said he would not filibuster to stop debate on health reform, but he feels strongly about discarding any public option. He called public option backers who have declared their stance as the only way to true reform as part of a "classic Washington" scenario that is stifling debate while broad bipartisan support exists for a host of other important reforms.
He pointed to a report from Congressional Budget Office, released on Friday, that figured "a less healthy pool of enrollees" would probably be attracted to the government-run option, resulting in higher premiums than the average private plan.
TWO THINGS supporters of a government-run "public option" for health insurance know for sure. One is that private health insurers are raking in obscenely high profits. The other is that only a government rival can force them to compete on price.
In a clever new commercial featuring Heather Graham as an agile sprinter named "Public Option," the left-wing pressure group MoveOn combines both themes, describing insurance companies as "lazy" and "bloated from the profits of raising our health care costs sky-high." Why, it asks, should anyone resist the competition a public option would generate? After all, "competition is as American as apple pie." In a less amusing print ad a few weeks ago, MoveOn charged that "insurance companies are willing to let the bodies pile up, as long as their profits are safe."
President Obama also attacks health insurers as avaricious profiteers: "The insurance industry is making this last-ditch effort to stop reform," he declared on Oct. 16, "even as costs continue to rise and our health-care dollars continue to be poured into their profits (and) bonuses." When he addressed Congress in September, Obama insisted that only a public option will "keep insurance companies honest." On the White House Blog, ObamaCare opponents are accused of "fighting to protect insurance industry profits."
Indeed, there is no shortage of voices characterizing health insurers as greedy villains. Earlier this year, House Speaker Nancy Pelosi praised her party for highlighting "the immoral profits being made by the insurance industry." On CNN last week, Ohio Senator Sherrod Brown demanded a public option "so the insurance industry can't continue to game the system and discriminate" against women and the disabled -- tactics insurers have used to "quadruple their profits in the last five years." If quadrupled profits don't seem rapacious enough, the union-backed Health Care for American Now! ups the ante, claiming, according to the AFL-CIO's news blog, that "during the past five years, health insurance company profits have soared by 1,000 percent."
Outbidding them all is Senate Majority Leader Harry Reid. Health insurance companies "are so anti-competitive," he said last month, "because they make more money than any other business in America today."
To such overheated agitprop, the only useful response is a cold shower of facts, and the Associated Press supplied a timely one last week. For all the impassioned talk about obscene profits and bodies piling up, AP's Calvin Woodward reported, "health insurance profit margins typically run about 6 percent" of revenues, a return "that's anemic compared with other forms of insurance and a broad array of industries."
87 cents out of every premium dollar pays for medical services, according to a PriceWaterhouseCoopers study for America's Health Insurance Plans. Insurance company profits account for just 3 cents.
On the Fortune 500 list of top industries, health insurance companies ranked 35th in profitability in 2008; their overall profit margin was a mere 2.2 percent. They lagged far behind such industries as pharmaceuticals (which showed a profit margin of 19.3 percent), railroads (12.6 percent), and mining (11.5 percent). Among health insurers, the best performer last year was HealthSpring, which had a profit of 5.4 percent. "That's a less profitable margin," AP noted, "that was achieved by the makers of Tupperware, Clorox bleach, and Molson and Coors beers."
For the most recent quarter of 2009, health-insurance plans earned profits of only 3.3 percent, ranking them 86th on the expanded Yahoo! Finance list of US industries. The application-software industry, by contrast, is pulling in profits of nearly 22 percent. Why aren't MoveOn and the Democrats demanding a "public option" to compete with Microsoft and Adobe and drive down their "immoral" profits?
There are certainly industries doing worse than health insurance -- airlines and newspapers, for example -- but the notion that health insurers "make more money than any other business in America today" is preposterous. Advocates of a public option may find it tactically expedient to paint insurers as insatiable predators, swollen with ill-gotten profits. The reality is otherwise.
Still, the critics do have one thing right: More competition would bring down health-care premiums. But the way to increase competition is not by adding a government-run health plan to the 1,300 private firms already providing Americans with health insurance. After all, there's no public option for auto insurance and life insurance, yet they're sold in a highly competitive national market. There is no reason health insurance can't be sold the same way.
Former Labor Secretary Robert Reich writing in the American Prospect, Oct. 26
While health reform, if done right, can help American families stay afloat in the economy, most Americans will not see any appreciable decline in the cost of health insurance nor clear improvement in the efficiency or quality of the health care they receive, and those who will benefit from the bill won't see it for several years. That's partly a result of Obama's sharpest break from Clinton—whose ambitious plan drew immediate fire from Big Pharma, the American Medical Association, and health insurers: The Obama White House bought off the medical-industrial complex by promising it fatter profits, bolstered by tens of millions of new paying customers.
That and other deals cut with industry—including promises to Big Pharma that Medicare wouldn't use its bargaining clout to reduce drug prices, to the AMA that doctors wouldn't have to face larger cuts in Medicare reimbursement rates, and to private insurers that the White House wouldn't fight hard for a public insurance option—will make the resulting reforms far more costly. These extra costs will be borne by those Americans who will be required to buy insurance but won't qualify for federal assistance, along with Medicare beneficiaries who will be paying more and receiving less. These people may not know they're indirectly paying the costs of buying off these industries, but they'll know they're getting shafted (Republicans will be sure to make them aware, even though the GOP has a much longer record of shafting the middle class for the benefit of big business).
It's possible that Obama can pivot off a health-care victory and launch some new initiatives that palpably and quickly spur job growth. The worry is that there aren't any—at least none that can work fast enough to reverse the tide of unemployment before the midterm elections. Fiddles such as a new jobs tax credit can help, but they won't make much of a dent. Even with a larger stimulus, a jobs recovery would still be far off. The tangible benefits of health-care reform are likely to be so elusive in the meantime that the public may become easy prey for demagogues on the right who blame Democrats for the insecurities that bedevil the nation next November.
If Obama and the Democrats lose Congress in the midterm elections, which is not a small possibility, it will be because the president learned only the most superficial lesson of the Clinton years. Health-care reform is critically important. But when one out of six Americans is unemployed or underemployed, getting the nation back to work is more so.
Speaker of the House Nancy Pelosi (D-Calif.) unveiled on Thursday the Democratic Leadership’s plan for expanding government control over health care. The bill would create a government-run insurance plan, expand Medicaid, institute new taxes on insurers, medical products manufacturers, businesses, and individuals, and create subsidies for moderate-income Americans to buy insurance.
Competitive Enterprise Institute Senior Fellow Gregory Conko issued the following statement today condemning the new draft of the House Democrats’ health reform bill:
The House Democrats’ health care bill is a recipe for exploding costs, and it poses a genuine threat to patient care and long-term medical innovation. The bill eliminates a substantial amount of consumer choice by dictating the benefits and prices for insurance policies, and it imposes billions of dollars worth of new taxes on the private sector. Worse still, the only mechanisms that could reduce the annual rate of health care cost inflation would erect government barriers between patients and their doctors.
The Affordable Health Care for America Act is anything but affordable. It will force millions of Americans to pay higher health insurance premiums, it taxes individuals who would like to purchase insurance options that don’t meet standards set by Washington bureaucrats, and it forces businesses and individuals to pay for insurance benefits they don’t want and don’t need.
House Democrats have also given us a bill that would create new programs designed to keep patients from receiving costly, but necessary, treatments. The revised bill stipulates that studies on the comparative effectiveness of various medical treatment options should not be considered as “mandates for payment, coverage, or treatment.” But, nothing in the bill would prevent other programs intended to eliminate wasteful medical spending from implementing these “recommendations” into physician and hospital payment practices.
Eliminating genuine waste and inefficiency from government programs is a laudable goal, but Democrats have been open about their desire to use comparative effectiveness review as a tool to control the practice of medicine. And that puts patient health at risk. Doctors know that what works for the average patient doesn’t always work for everyone. When it comes to medical treatments, doctors and patients need choices because one size definitely does not fit all.
Of all the problems facing the United States right now, none are more important than health care. President Obama says rising costs are driving huge federal budget deficits that imperil our future, and that there is enough waste and fraud in the system to pay for health care reform if it was eliminated.
At the center of both issues is Medicare, the government insurance program that provides health care to 46 million elderly and disabled Americans. But it also provides a rich and steady income stream for criminals who are constantly finding new ways to steal a sizable chunk of the half trillion dollars that are paid out each year in Medicare benefits. In fact, Medicare fraud - estimated now to total about $60 billion a year - has become one of, if not the most profitable, crimes in America.
This story may raise your blood pressure, along with some troubling questions about our government's ability to manage a medical bureaucracy.
If you want to find Medicare fraud, the first place you should look is South Florida, where 60 Minutes and correspondent Steve Kroft were told it has pushed aside cocaine as the major criminal enterprise. It's a quiet crime - there are no sirens or gunfire. The only victims are the American taxpayers, and they don't even know they are being ripped off.
FBI Special Agent Brian Waterman, who 60 Minutes rode with for several days, told us the only visible evidence of the crimes are the thousands of tiny clinics and pharmacies that dot the low-rent strip malls. You don't even know they're there because there's never anyone inside. No doctors, no nurses and no patients. "This office number should be manned and answered 24 hours a day," Waterman explained, standing outside one of those small, unstaffed businesses.
The tiny medical supply company billed Medicare almost $2 million in July and a half million dollars while 60 Minutes was there in August, but we never found anybody inside, and our phone calls were never returned.
Sometimes, they don't even have offices: we went looking for a pharmacy at 7511 NW. 73rd Street that billed Medicare $300,000 in charges. It turned out to be in the middle of a public warehouse storage area. "They've already told us that there's no offices here," Waterman told Kroft. "There are no businesses here. In fact they are not even allowed to have a business here."
Waterman is the senior agent in the Miami office in charge of Medicare fraud. And Kirk Ogrosky, a top Justice Department prosecutor, oversees half a dozen Medicare fraud strike forces that have been set up across the country.
The office Kroft visited operates out of a warehouse at a secret location in South Florida and includes investigators from the FBI, Health and Human Services, and the IRS. "There's a healthcare fraud industry where people do nothing but recruit patients, get patient lists, find doctors, look on the Internet, find different scams. There are entire groups and entire organizations of people that are dedicated to nothing but committing fraud, finding a better way to steal from Medicare," Waterman explained.
"Is the Medicare fraud business bigger than the drug business in Miami now?" Kroft asked. "I think it's way bigger," Ogrosky said. Asked what changed, Ogrosky told Kroft, "The criminals changed." "Sophistication," Waterman added.
"They've figured out that rather than stealing $100,000 or $200,000, they can steal $100 million. We have seen cases in the last six, eight months that involve a couple of guys that if they weren't stealing from Medicare might be stealing your car," Ogrosky explained.
Thousands of British women misled into breast cancer surgery by NHS
THE government has been forced to rewrite its advice on breast cancer screening after research showed that thousands of women have been misled into having unnecessary surgery. Women invited for screening by the National Health Service will be told that some of the cancers detected will be dormant and may never spread to other tissue.
Research published this year showed that for every 2,000 women screened regularly for a decade, one life would be saved but 10 healthy women would be treated unnecessarily. The information now given to women has been criticised for advertising only the benefits and not the risks to encourage women to be screened.
Joan Austoker, author of the NHS leaflets, admitted it had been a mistake to withhold information about potentially unnecessary treatment for a type of breast cancer called ductal carcinoma in situ. Austoker, director of the primary care education research group at Oxford University, who is writing the advice by the NHS breast screening programme, said: “We want to make sure that all the risks of breast screening are referred to in appropriate detail.
“Much of the ductal carcinoma in situ diagnosed will never surface clinically. Therefore it constitutes overdiagnosis — that is, you are diagnosing something that would not have become an issue.”
Ductal carcinoma in situ accounts for 20% of the diagnoses made through screening. Less than half of the dormant cancers will progress to become invasive but 30% are treated with mastectomies. The other downsides of screening, to be described in more detail in the advice, include missing some cancers and the anxiety caused by identifying others that do not exist, so-called “false positives”.
British senior citizen trapped alone in ambulance for five hours
A SICK pensioner was abandoned inside an ambulance for more than five hours after the its driver forgot about him and went home. The 65-year-old man was trapped inside the vehicle at Sharston ambulance station in Wythenshawe until he was found at 1.15am following a major police alert. The driver was supposed to take him back to his Northenden care home after he left a hospital appointment at 7pm. But it's understood that after dropping off three other patients, the driver took the vehicle back to the station and locked it up for the night when his shift ended at 8pm.
The North West Ambulance Service has launched an urgent inquiry and the driver has been suspended. Ambulance chiefs have apologised to the man, who was unhurt, in person.
The blunder has been slammed by other ambulance staff. A source said: "He was reported to police as a high risk missing person. I find it a disgrace that a member of the ambulance service can forget about a patient in the back of an ambulance and lock it up. Most staff are very annoyed about this." The kidney patient, who lives at Lee House on Longley Lane, Northenden, had attended a regular 7pm appointment at Manchester Royal Infirmary on Tuesday. Bosses at the care home said he was usually brought home by ambulance between 7pm and 7.30pm.
The man was collected from the hospital by a driver working for the patient transport service, a van-style ambulance used to take non-emergency patients to and from appointments. It is understood that three other patients were on board at the time.
The alarm was initially raised at his care home after the man failed to return home. The duty manager telephoned the hospital at 8.30pm and was told that he had already left. But by 10.30pm he still hadn't returned and the home again called the hospital, who contacted the police. Police launched an alert and he was classed as a 'high risk' missing person because of his treatment. The ambulance service said the man was found shortly after 1am in the back of the van parked at the station on Leestone Road, Sharston, which is open 24 hours a day.
The ambulance station is less than half-a-mile from the man's care home. Lee House. A spokesman refused to reveal anything further about the circumstances or say why the man wasn't taken home.
The man has now returned to the home. Police said the incident was a matter solely for the North West Ambulance Service and no criminal investigation would be launched.
Darren Hurrell, chief executive of the North West Ambulance Service, said the Trust was taking the matter 'extremely seriously' and had apologised to the family. He said: "The Trust was extremely concerned to learn of the incident which occurred on Tuesday October 27, concerning a patient left in one of our non-emergency patient transport vehicles. We are taking this extremely seriously and have offered our sincere apologies to the patient and his family. "A member of staff has been suspended with immediate effect and the Trust has commenced a full investigation has commenced. We have met with the patient and family to discuss the matter with them in greater detail and will continue to liaise closely with them throughout this process. "All possible steps will be taken to ensure that this never happens again."
It used to be said that there is no such thing as a free lunch. But when it comes to health care reform, President Obama appears to be offering up a free breakfast, lunch, dinner and bedtime snack. At the core of the president's proposal is the idea that he can provide more health care services to more people and have it cost less. A neat trick – but one that flies in the face of economic reality, not to mention common sense.
For example, the president wants to require insurance companies to cover people with pre-existing conditions, that is, people who are already sick. Doing so will cost money. And where will that money come from? Insurance companies will simply raise premiums for the rest of us.
Similarly, the president would mandate that all insurance plans provide a new government-designed minimum benefits package. In addition to the usual coverage for hospitalization, physician services and so on, all insurance plans would also have to include coverage for prescription drugs, rehabilitation services, mental health and substance-abuse treatment; preventive services and maternity, well-baby, and well-child care, as well as dental, vision, and hearing services for children under age 21. If that's not enough, he would also establish a new federal commission headed by the surgeon general, which will have the power to develop additional minimum benefit requirements. There is no limit to how extensive those future required benefits may be.
Those additional benefits may or may not help consumers, but insurers are not going to provide them for free. In fact, some—like mental health and substance-abuse treatment—can add as much as 10 to15 percent to the cost of a policy. The president would also limit the size of deductibles and co-payments and would prohibit lifetime limits on the amount of benefits that insurance companies pay.
Indeed, some estimates suggest that the president's plan could add anywhere from 75 to 95 percent overall to the cost of insurance premiums, especially for young and healthy people.
The president also wants to subsidize insurance coverage for millions of Americans, some of whom are uninsured, but millions of whom already have insurance today. The health care bills currently making their way through Congress include subsidies for families earning as much as 300 percent of the poverty level, $66,000 for a family of four. That's the main reason these plans cost $900 billion or more.
But not to worry. The president says he won't have to raise middle-class taxes to pay for all this. Health care reform will mostly pay for itself through greater efficiency, emphasis on preventive care, and electronic medical records. Of course, experts from across the political spectrum, not to mention the Congressional Budget Office, say that those measures won't come close to covering the bill's cost. Maybe that's why the House version of the health care bill contains more than $880 billion in new taxes. The slightly cheaper Senate version raises taxes by at least $357 billion, not counting the tax penalty on those who fail to comply with the bill's insurance mandate.
Of course, the president also promises that he can cut $500 billion from Medicare spending over the next 10 years without anyone getting less of anything. All he has to do is eliminate "fraud, waste, and abuse." Not to be overly cynical, but presidents have been promising to eliminate "waste, fraud, and abuse" since at least, oh, Ronald Reagan. More neutral observers acknowledge that Medicare cuts of that magnitude will inevitable mean reductions in services.
Back when he was running for president, Barack Obama used to talk about "making the tough choices" and "being honest about the challenges we face." That's all gone now. Today the president is head chef at the free lunch café.
The doctor doesn't look like much of a crusader, bent over the frail frame of 90-year-old Alberta Scott. He has a lavender stethoscope strung round his neck and some serious bedside manner at work on this stubborn nonagenarian who wants to be anywhere but where she is: in a nursing home bed, hoping to heal and get back home. "Squeeze my hand," Dr. Peter Boling prods. "Squeeze my hand. Come on. Hard!"
This is Boling's day job, providing medical care to some of Richmond's oldest and sickest patients. A geriatrician and head of general medicine at Virginia Commonwealth University Medical Center, he visits nursing home patients with a smile and an encouraging word, and he leads a team of specialists who take to the road, medical bags in hand, to see patients where and when they need it most _ in their own homes, before a crisis lands them in the ER or a nursing facility. Boling and his team make house calls.
And now he is on a mission: To convince Congress that the old-fashioned house call could be a fresh answer to the modern-day health care reform dilemma. There are house-calls programs here and there. San Diego. Boston. The Veterans Health Administration cares for thousands in their own homes, saving money by reducing unnecessary hospitalizations and emergency room visits.
But Boling wants to bring house calls to the masses _ up to 3 million of the most high-risk, high-cost Medicare patients in the country. The idea is not just cost savings, but to provide a financial incentive to persuade more doctors to return to this kind of work. It's also about improving access and providing patients the independence they so desire.
Mostly, it's about people like Alberta Scott and the questions that first came to Boling's mind when he heard she'd been admitted to an institution for treatment of a blood infection. In a few weeks, if all goes well, can she go home? If so, who will take care of her?
At 55, Boling has a vague memory of his own pediatrician standing in the kitchen of his childhood home. It's not an image many of us can conjure in an era of overcrowded ERs and specialty clinics and the type of "managed care" that often means a long wait in a sterile reception room followed by a hasty examination.
The visiting doc went out not long after the horse and buggy, as technology advanced and institutionalized health care became the norm. In 1930, house calls accounted for 40 percent of doctor-patient encounters. By 1980, that had dropped to less than 1 percent. Today, about 4,000 of the nation's 800,000-plus doctors make house calls a substantial part of their practices, although nurses and physician assistants have picked up some of the slack, the American Academy of Home Care Physicians reports.
Boling was just a young doc himself, finishing up his residency, when a mentor persuaded him to spend half his time doing clinic work, and the other half developing a house-calls program. Like most medical students today, Boling had never thought about making house calls a part of his practice. He nevertheless hung a giant map of Richmond on his office wall and began identifying patients who lived within a 15-mile radius of the downtown VCU medical center. Each home was marked on the map with colored pins, and visits were scheduled by geography _ north, south, east, west _ to maximize Boling's time. It took only a few stops, and some memorable patients, for Boling to recognize that home care made sense.
There was the stroke victim restricted to a second-floor bedroom in his home. Time and again his wife had to call an ambulance, whose crew carried him by stretcher down rickety stairs to an emergency room _ for a bloated gastrointestinal tract, high fevers and vomiting. Turns out, the patient had low blood potassium levels. Boling began drawing blood at the house and prescribed a medication that stabilized his potassium, and staved off ER visits. "It was so stark," says Boling, "the contrast between what he needed and what (the health care system was) giving him."
There was another stroke survivor, also blind and diabetic, who was being shuttled to a vascular surgery clinic to have surgeons scrape away foot ulcers. Boling began stopping by once a month, using his scalpel to do the very same work in the patient's home.
These are the types of patients Boling envisions being cared for under the proposal now pending in Congress. The so-called "Independence at Home" provision is but one small piece of the comprehensive health care reform measures being debated in the House and Senate.
Where other proposals have divided lawmakers, the house-calls idea is winning support from Republicans and Democrats alike. Perhaps because it targets the bane of the health care system: a Medicare program on the verge of insolvency and the small percentage of patients who account for the bulk of the program's costs. "This legislation offers a higher quality and more cost-effective way for these patients to get the coordinated care they need in the comfort of their own homes," says North Carolina Sen. Richard Burr, a conservative Republican.
The provision calls for the Medicare program to partner with home-based primary care teams like Boling's for a pilot project to test whether house calls would reduce preventable hospitalizations and readmissions, ER visits and duplicative diagnostic tests for high-cost, chronically ill patients. That means patients with at least two chronic conditions _ congestive heart failure, diabetes, dementia, stroke and so on _ who have been hospitalized in the past year and require assistance for at least two daily living activities, such as bathing, dressing, walking or eating. Patients with multiple chronic conditions account for some two-thirds of Medicare, the almost $500 billion federal health insurance program for those 65 and older or disabled.
Medicare officials declined to discuss the idea, but Mark McClellan, who ran Medicare under President George W. Bush, called the proposal one that "could lead to cost-savings and better outcomes" for patients. "It's definitely worth trying," said McClellan, adding that the strength of the proposal is that practitioners must demonstrate savings in their patients' medical costs in order to get a portion of that savings back from Medicare.
That might be easier said than done. Participating practitioners would have to coordinate care in a way that actually reduces all those visits to various doctors and hospitals and, McClellan said, "that's hard to implement in real-world health care."
The Department of Veterans Affairs launched its own house-calls program back in the '70s targeting an expanding population of older veterans suffering from multiple chronic conditions. There are now some 20,000 vets enrolled, and a 2002 internal study showed a 24 percent total reduction in their cost of care. Another analysis of one program in Missouri showed costs going from $45,000 per patient per year to $17,000, said Dr. Thomas Edes, who runs the VA program.
Boling and some other house-calls physicians came up with "Independence at Home" in partnership with the American Academy of Home Care Physicians. They've visited with Medicare officials to try to sell it, had sit-downs with members of Congress, urged friends to "write their congressman" to drum up support.
True believers, Boling calls these docs-turned-lobbyists. Urban cowboys in tweed jackets. People like Dr. Gresham Bayne, a former chief of emergency medicine at the Naval Regional Medical Center in San Diego who started his "Call Doctor" program in 1985, after determining that many of the folks he saw in ERs didn't need immediate physician attention. "We've never made any money, but we've never had any regrets," Bayne says of the effort.
Boling takes a "Field of Dreams" approach to the money side of things. If Medicare shared the savings, house-calls teams could recoup more expenses and pay better _ and the doctors would come.
But another challenge is persuading doctors to return to a practice that is unfamiliar now to many and looks much different in today's world than the romanticized house-calls practice of old.
Technology has certainly made the job easier. Electronic medical records are available via laptop computers. One bulky bag can carry diagnostic tools to test blood, urine and oxygen levels, a blood pressure cuff, an eye chart. Portable, digital X-ray machines are also available, as are portable EKG machines.
Path clears for House to OK compromise health bill
They may not like it, but many House liberals look ready to accept a compromise health care bill, putting Democratic leaders well on the way to delivering on President Barack Obama's call for overhaul. After claiming for months they couldn't vote for a bill without the strongest possible government-run insurance option, liberals are putting aside their disappointment over the weaker version in the legislation for a historic chance to remake America's medical system. "The current language is far weaker than what I would have preferred, and I think that is also true of the Progressive Caucus," Rep. Emanuel Cleaver, D-Mo., a member of the Congressional Black Caucus, said Friday. "But because I did not come up here to participate in gridlock and acrimony, I have told leadership that I am willing to compromise."
Obama privately told House liberals they should chalk up a win. Leaders from the Progressive, Black, Hispanic and Asian-Pacific American caucuses met at the White House Thursday evening with Obama, who listened to their concerns and praised their efforts. "He looked at us and he said, 'You guys ought to be walking around like you won because you brought back the public option,'" said Rep. Mike Honda, D-Calif. He was referring to the fact that prospects for any kind of government-run option looked grim after August's angry town halls.
House floor debate could begin late next week on the sweeping bill that extends coverage to 96 percent of Americans, imposes new requirements on individuals and employers to get insurance and provides subsidies for lower-income people.
The bill includes a new public insurance plan that would pay providers and hospitals rates negotiated by the Health and Human Services secretary. Liberals had pushed for payment rates to be tied to Medicare, which they argued would mean lower costs to consumers and the federal government. But moderates' concerns that those lower rates would hurt hospitals and other providers in their districts prevailed, even though House Speaker Nancy Pelosi, D-Calif., had backed the Medicare-based version.
In one bit of sobering news, the Congressional Budget Office estimated that only about 6 million people would sign up and that premiums for the government plan could be higher than for private coverage. The CBO says sicker people with higher costs probably would be attracted to the government plan. By comparison, 162 million people would remain covered through employer plans.
There are still concerns from moderates over the bill's cost _ $1.055 trillion over 10 years _ and long-term spending implications, and disputes to be resolved on how to block federal funding of abortions and prevent illegal immigrants from getting taxpayer-funded care. But the once-strident liberal opposition to the version of the public insurance option in the bill Pelosi released Thursday had all but disappeared 24 hours later.
It's the exact outcome Pelosi predicted in early August, infuriating progressives at the time. "Are you asking me, 'Are the progressives going to take down universal, quality, affordable health care for all Americans?' I don't think so," Pelosi said then, laughing at the question. Sure enough, they're not. "I hate to say the speaker was right, but in retrospect I guess the progressives are going to be the good soldiers on this one, one more time," said Rep. Raul Grijalva, D-Ariz., a co-chair of the Progressive Caucus.
Grijalva said progressives weren't giving up and would push to offer their preferred public insurance option as an amendment. But House leaders have indicated they won't be allowing amendments to the bill.
House liberals fear what will happen to their bill's version of the government-run plan when time comes to merge it with whatever the Senate passes.
Sen. Harry Reid, D-Nev., said earlier this week that the Senate bill would have a new federal insurance plan with negotiated payment rates. Unlike the House bill, though, states could opt out of the plan. It's not clear the proposal commands enough votes in the Senate to survive, and it could be replaced by a standby system pushed by moderates that would not go into effect until it was clear individual states were experiencing a lack of competition among private companies.
Grijalva said liberals voiced grave concerns about both the opt-out and "trigger" approaches during Thursday's White House meeting, but that Obama didn't engage on those issues.
Sen. Olympia Snowe, R-Maine, has been the leading proponent of the "trigger" approach but she told The Associated Press in an interview Friday that she didn't plan to offer it as an amendment because it didn't have the votes to prevail. Snowe is the only Republican in Congress to have supported Democrats' health care legislation, voting "yes" in the Finance Committee. But she said Friday she couldn't support Reid's current version.
Big retreat from government medicine in Britain: Patients who wait too long for NHS treatment will get private care
But no mention of how it will be funded: Reminiscent of the current American healthcare bill
Patients who do not get the treatment that they need from the NHS within 18 weeks are to be given the legal right to free private care. The Cabinet agreed this week that the legislation, placing maximum waiting times on the statute book for the first time, should be rushed through Parliament before the next election. Cancer patients, in particular, will receive funding for private treatment if they have not seen an NHS specialist within two weeks of GP referral.
Downing Street says that the two legal rights, which will be unveiled in next month’s Queen’s Speech, are designed to entrench the dramatic reduction of NHS waiting lists over recent years — as well as allowing Gordon Brown to “throw down the gauntlet” to the Conservative Party in the election campaign.
With NHS budget growth likely to be sharply curtailed whichever party is in power, No 10 believes that the legislation will prevent waiting lists drifting back up. “This will send a strong ‘no turning back message’ to voters,” a senior government source said. “David Cameron will have to decide whether he wants to repeal this measure and take rights away from patients.”
The Tories have promised to phase out all NHS targets, including those for waiting times, saying that patients should make “informed choices” about their care without hospitals being forced into a straitjacket of government regulation. “Labour always focuses on the process while we think what really matters is whether you are better after your treatment,” a Conservative spokesman said.
Patients are currently offered a choice from a range of NHS, independent and private provision only at the outset of their treatment. They are obliged to stick with that decision even when their treatment is delayed beyond the existing target time limits. The new rules will allow people to switch to a different hospital, including those in the private sector, if they have been made to wait longer than 18 weeks for treatment by a specialist after seeing their family doctor.
When Labour policy documents published this summer first raised the prospect of a legal entitlement on waiting times, ministers had still not agreed on the timing of legislation and the enforcement mechanism. The Queen’s Speech on November 18, setting out the Government’s legislative programme for the final months before the election, will promise that the measure for England and Wales will be in place within months.
Ministers plan to issue executive regulations that turn key waiting time pledges from the new NHS constitution into legally binding rights. Downing Street suggested yesterday that although parliamentary approval was not needed to amend the Health Bill, MPs were likely to be given a vote. Draft legislation is understood to say that primary care trusts must monitor whether patients are languishing in the queue and inform them of their rights for alternative provision. The trusts will be required to “take all reasonable steps” to ensure patients are treated immediately either by the NHS or the private sector.
According to the latest figures from August, about 37,000 patients had not received treatment from an NHS specialist within 18 weeks of their GP referral. There are legitimate clinical explanations for some — and others are caused by patients cancelling their own operations to go on holiday — but officials believe that about half have been “failed by the system”.
Andy Burnham, the Health Secretary, told Cabinet colleagues this week that the new legislation would mean that underperforming hospitals would lose funding from patients going elsewhere and “act as a powerful challenge for them to raise their game”.
Jennifer Dixon, of the Nuffield Trust, said the plans could be seen as “Tory-proofing” the NHS. “It would not only give patients enforceable health care entitlements but it would also prevent managers and clinicians from controlling waiting times as a way of limiting demand and saving money,” she said. “In the past requirements to make financial savings often resulted in hospitals stopping routine surgery for a couple of months before the end of the financial year.”
Incompetent British doctor ruled still OK to practice -- and to teach!
The family of a teenage girl who died after receiving a massive overdose of radiation while being treated for a brain tumour said last night that it was a “travesty” that the doctor held responsible was allowed to keep his job. A conduct and competence hearing held by the Health Professions Council yesterday ruled that Stuart McNee, who was in charge of planning treatment for Lisa Norris, 16, from Girvan, Ayrshire, “had learnt from his mistakes”.
Lisa died in October 2006. She had been exposed to 19 overdoses during radiotherapy treatment for a brain tumour at the Beatson Oncology Unit in Glasgow nine months earlier. She was given radiation doses that were cumulatively 58 per cent higher than necessary, leaving her with burns on her neck and head. A report by a leading cancer specialist claimed that her chances of long-term survival had been harmed by the error.
Her parents, who attended the hearing at the Western General Hospital in Edinburgh yesterday, branded the process a whitewash and pledged to continue with legal action against NHS Greater Glasgow and Clyde. Mr Norris, 53, said: “I’m very disappointed that a man can do what he did and walk away from it. I was expecting him to at least get reprimanded for it. It doesn’t matter that he had a good, impeccable record. What he did he shouldn’t have done.”
The panel’s chairman, Colin Allies, said that while all allegations of a lack of competence had been proven, it was their opinion that Dr McNee was still fit to practise. He said: “We are confident the registrant has learned from his mistakes and would act differently in similar circumstances today. We took into consideration the lack of staff and a lack of support from senior management.”
The panel agreed that Dr McNee had been responsible for planning the course of radiotherapy and said his biggest failing was not speaking out about staffing pressures and checking that procedures were being followed.
A report by Arthur Johnston, scientific adviser to the Scottish government’s health department, said that the overdose happened after an under-qualified staff member entered a wrong number on a form. Dr McNee also failed to have his proposed treatment plan verified or independently justified by a competent radiologist or radiographer or other trained staff.
Dr McNee is working in a new role at the Western General and Gartnavel hospitals in Glasgow, where he is involved in clinical trials, teaching and research and development. He did not attend yesterday’s hearing.
Australia's Prosperity Index result down because of poor public healthcare
By Greg Lindsay and Roger Bate. Greg Lindsay is the Executive Director of The Centre for Independent Studies in Sydney. Roger Bate is the Legatum Fellow at the American Enterprise Institute in Washington, D.C. The 2009 Legatum Prosperity Index is now available. A majority of Australians rely on "free" government hospitals, where low standards and long waits are common
The 2009 Legatum Prosperity Index rates Australia an impressive sixth out of 104 countries surveyed – the top five are all small Northern European countries with populations of less than 10 million.
However, inefficiencies in public hospitals are hurting Australia’s prosperity. While Australia is very strong on the economic fundamentals required for long-term growth, the nation’s ailing health care system is keeping Australia from reaching its full potential, in terms of both economic progress and quality of life. Legatum ranks Australia a lowly 21st in health care, behind countries like Singapore, Spain, and the Czech Republic; 28th in infant mortality; 47th for number of doctors per capita; and behind Slovakia and Hungary on available beds.
The Australian Medical Association recently found that waiting times far exceed acceptable levels. The median wait for hip surgery in Australian public hospitals is nearly three months. For cataract surgery, it’s more than two months. Major public hospitals throughout Australia are bursting at the seams with bed occupancy rates of well over 100% a daily occurrence.
Overcrowding and inefficiency have compromised patient safety. According to the Queensland University of Technology, $1 billion annually is lost in bed days because of hospital-acquired infections. Medical errors cost an estimated $1 billion–$2 billion annually, with half of these errors classified as ‘potentially preventable.’
These health care problems are draining billions from the Australian economy, both directly by taking money away from players in the health sector and indirectly by compromising worker health and undermining productivity.
Australians are among the most prosperous populations on the planet. But the country’s health sector is in need of significant improvement. Cutting away waste and improving quality in health care would go a long way toward making Australia even stronger.
The above is part of a press release from the Centre for Independent Studies, dated October 30. Enquiries to cis@cis.org.au. Snail mail: PO Box 92, St Leonards, NSW, Australia 1590. Telephone ph: +61 2 9438 4377 or fax: +61 2 9439 7310
Best Obamacare Slam: Congressman Rogers (R-MI)
You will not see or hear a better critique of Obamacare than this:
Pelosi Health Care Bill Blows a Kiss to Trial Lawyers
The health care bill recently unveiled by Speaker Nancy Pelosi is over 1,900 pages for a reason. It is much easier to dispense goodies to favored interest groups if they are surrounded by a lot of legislative legalese. For example, check out this juicy morsel to the trial lawyers (page 1431-1433 of the bill):
Section 2531, entitled “Medical Liability Alternatives,” establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But]…… a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys’ fees or imposes caps on damages.
So, you can’t try to seek alternatives to lawsuits if you’ve actually done something to implement alternatives to lawsuits. Brilliant! The trial lawyers must be very happy today!
While there is debate over the details, it is clear that medical malpractive lawsuits have some impact on driving health care costs higher. There are likely a number of procedures that are done simply as a defense against future possible litigation. Recall this from the Washington Post:
“Lawmakers could save as much as $54 billion over the next decade by imposing an array of new limits on medical malpractice lawsuits, congressional budget analysts said today — a substantial sum that could help cover the cost of President Obama’s overhaul of the nation’s health system. New research shows that legal reforms would not only lower malpractice insurance premiums for medical providers, but would also spur providers to save money by ordering fewer tests and procedures aimed primarily at defending their decisions in court, Douglas Elmendorf, director of the nonpartisan Congressional Budget Office, wrote in a letter to Sen. Orrin Hatch (R-Utah).”
Stay tuned. There are certainly many more terrible, horrible, no-good, very bad provisions in this massive bill.
Republicans Are Offering Better Solutions to Lower Health Care Costs
by John Boehner
Time after time, Republicans have reached out to President Obama and congressional Democrats to work together on common-sense solutions to lower health care costs for families and small businesses. President Obama promised the American people a bipartisan process. Unfortunately, Democrats have chosen a partisan, go-it-alone approach. It’s yet another broken promise, and it defies the will of the American people.
Through the month of August, the American people let Members of Congress from both parties know that they didn’t want a government takeover of health care. But instead of listening to Americans’ concerns, Speaker Nancy Pelosi (D-CA) and House Democratic leaders ignored them and wrote a bill behind closed doors designed to appease the liberal special interests.
Next week, Speaker Pelosi will attempt to ram through her 1,990-page government takeover of health care through the House of Representatives. This bill will raise the cost of Americans’ health insurance premiums and add to our already skyrocketing debt; it will kill jobs with tax hikes and new mandates; and it will cut seniors’ Medicare benefits.
For the sake of struggling middle-class families, small businesses, and seniors, Republicans are going to do everything we can to fight this monstrosity. We will stand on principle in opposing this bill, and we will offer a better solution to lower costs for families and small businesses.
In the national Republican address today, I am outlining Republicans’ plan for common-sense health care reform our nation can afford, emphasizing four common-sense reforms that will lower health care costs and expand access to quality care without a government takeover of our nation’s health care system that kills jobs, raises taxes on small businesses, or cuts Medicare for seniors.
Here are four smart, fiscally-responsible reforms that we can implement today to lower costs and expand access to quality care:
· Number one: let individuals and families buy health insurance across state lines.
· Number two: allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do.
· Number three: give states the tools to create their own innovative reforms that lower health care costs.
· Number four: end junk lawsuits that contribute to higher health care costs by increasing the number of tests and procedures that physicians sometimes order not because they think it's good medicine, but because they are afraid of being sued.
You can learn more about these and all the health care initiatives Republicans have supported by visiting http://healthcare.gop.gov and you can watch the video of the address HERE. http://www.youtube.com/watch?v=8DKDdVXs
Skyrocketing insurance premiums will slam millions of consumers next year because of "indirect taxes" contained in both the House and Senate versions of healthcare reform, according to various medical and insurance industry experts. Healthcare reforms that were supposed to contain costs actually will cause a sharp hike in premiums, they add. In fact, several studies indicate consumers' premiums could more than double next year if healthcare reform takes effect.
"So even though this bill tries to hide these costs as indirect taxes," Sen. Orrin Hatch, R-Utah, recently told a business symposium, "average Americans who purchase health plans, take prescription drugs, or use medical devices will end up footing the bill."
The rate hikes stem from the hundreds of billions in proposed fees and taxes levied on providers. For example, the Finance Committee's proposal would assess $322 billion in taxes and fees on insurance premiums, prescription drugs, and medical devices, according to the Senate's Joint Committee on Taxation. The committee and other experts say virtually all of those costs will be passed along to consumers in all tax brackets — despite President Barack Obama's pledge not to raise taxes "one dime" on those earning less than $250,000 per year.
Another likely frustration for consumers: The premium hikes will take effect right away, while the subsidies and benefits in healthcare reform won't kick in completely until 2014. Scott Gottlieb, a physician and American Enterprise Institute resident fellow, stated Thursday in a New York Post op-ed that, by front-loading the costs and back-loading benefits, Congress is resorting to "a gimmick that imposes a stiff price on the public." That "gimmick," Gottlieb claims: using 10 years of added fees and taxes on providers to offset about five years worth of benefits. Those costs "will immediately shift onto consumers, in the form of higher prices on medical products and rising premiums," he says.
Democrats have promised to insure an additional 35 million Americans, without raising taxes or increasing the tsunami of deficit red ink spilling out of Washington these days.
Douglas Holtz-Eakin, the former director of the Congressional Budget Office, appeared to concur with Gottlieb's assessment in a recent Wall Street Journal op-ed. "These costs will be passed on to consumers by either directly raising insurance premiums, or by fueling higher health-care costs that inevitably lead to higher premiums," he wrote.
The bottom line: Most voters will be paying higher premiums for years before they see any benefits. That could spell serious trouble for Democrats in the 2010 midterm elections.
The Senate bill proposes $2.3 billion in fees on brand-name drugs, $4 billion on medical devices, and $6.7 billion levied on insurance companies, plus more than $100 billion in Medicare reimbursements to medical providers — all costs that would be shifted back onto consumers. Speaker Nancy Pelosi's House bill appears even more expensive. It would impose $150 billion in Medicare cuts on the pharmaceutical industry, and a 2.5 percent tax on companies that manufacture medical devices.
"Most of astounding of all," Holtz-Eakin wrote, "is what this Congress is willing to do to struggling middle-class families. The bill would impose nearly $400 billion in new taxes and fees. Nearly 90 percent of that burden will be shouldered by those making $200,000 or less."
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!
