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21 November, 2009

Tragedy of girl, five, struck by swine flu: Three NHS GPs and a hospital doctor thought she had tonsillitis

Diagnostic tests? Never heard of them!

A five-year-old girl suffering from swine flu died after doctors took two weeks to diagnose her illness, it was claimed last night. Nida Qureshi was seen by three GPs and a hospital doctor who told her parents she may have tonsillitis. By the time doctors discovered that she had the H1N1 virus, the youngster was on a life support machine, her family said. She died eight days later.

Last night relatives said Nida's parents - Zubair, 28, and Raheela, 30, who is pregnant with their second child - believe that their daughter may have survived if swine flu had been detected earlier. Nida's uncle, Jawaid Qureshi, said: 'Her mum, herself a child carer, and dad are very angry that doctors and GPs failed to diagnose it earlier. It's devastating. She may have lived if it had been diagnosed earlier.'

Mr Qureshi said Nida - a 'bright' girl without any underlying health problems - fell ill with a temperature and vomiting on October 19. The family phoned a GP, who advised paracetamol. The next day she went to her doctor and was prescribed antibiotics. Five days later, the family took her back but were told to carry on giving the antibiotics. On November 1, after her condition worsened, the family took her to A&E at their local hospital, Wexham Park, in Slough.

Mr Qureshi said: 'When she was breathing she was in agony. She was coughing a lot as well. The doctor at hospital said it might be tonsillitis but they did not take any blood or urine samples. They prescribed her with more medicine and said: "Go back to the GP if she continues not to feel well". It was a very bad decision to allow her to go home.'

Two days later she had a seizure and never regained consciousness. She was put on a life support machine and finally diagnosed with the H1N1 virus. Nida was transferred to St Mary's Hospital in London.

A spokesman for NHS Berkshire East said: 'We can confirm that a young girl from east Berkshire died at St Mary's Hospital, London, on November 11. She had tested positive for H1N1 swine flu.'

Professor John Oxford, professor of virology at Queen Mary School of Medicine, said her death could have been caused when the swine flu virus moved into her central nervous system. Normally, the virus attacks the lungs. But in extremely rare cases, often affecting children, it can attack the nerve tissue and cause a seizure. He added: 'Diagnosing flu in a five-year-old is extremely difficult. It is also impossible to say if Tamiflu would have made any difference in this case.'

SOURCE




Civility and honesty coming to Britain's National Health Service?

Doctors and nurses should be more honest and open when things go wrong and offer an apology to the patient or their family under new guidance to the NHS. Clinicians are often fearful of saying sorry when a patient has been harmed by a blunder because it may influence any future legal action, but it is the 'right thing to do, the head of the National Patient Safety Agency has said. When patients file complaints or litigation, their aim is often for the people involved to say sorry and to ensure the same thing does not happen to someone else, research has shown.

New guidance, entitled Being Open, has been issued to the NHS highlighting the importance of effective communication with patients. Martin Fletcher, Chief Executive of the NPSA, said: “Being open is the right thing to do. Making a genuine apology to a patient and their family after an error has occurred is a very hard thing to do for any clinician. “Saying sorry and following the principles of Being Open does have other benefits too. It can also enhance an open and fair safety culture and reduce costs associated with complaints and litigation.”

Mr Fletcher added: “Apologising after an incident has happened must not be about blaming others for errors. "Doing so would serve no purpose - it would only drive the issue underground and we would never get to the heart of the problem. This would mean that risks are not identified and future patients have the potential to be harmed in the same way."

The NPSA collects data from the NHS on instances where patients have been harmed or near misses in orderto identify patterns and issue warnings to the rest of the health service so similar problems can be avoided elsewhere.

Mr Fletcher said: “Discussing patient safety incidents promptly, fully and compassionately is the best way to support patients and staff when something does go wrong. Evidence from other countries shows that by following the principles of Being Open, formal complaints and litigation claims can also be reduced.”

Managers in the NHS needed to take the initiative for the principles to succeed he said. Senior clinicians should be identified in each organisation to support doctors and nurses when things go wrong the guidance said.

NHS Medical Director Professor Sir Bruce Keogh said: “Being open with patients should anything go wrong with their healthcare is the right thing to do. Support is vital during what is often a difficult time for both clinicians and patients. "I commend the introduction of senior clinical counsellors to support fellow clinicians.”

Peter Walsh, Chief Executive, Action against Medical Accidents (AvMA), said: “Being open when things going wrong is the most important thing for patients and makes sense from everyone’s point of view. "The Being Open training and materials make it easier to do what must be the hardest job that a health professional has to do.”

SOURCE




Logrolling in the healthcare vote

What does it take to get a wavering senator to vote for health care reform? Here’s a case study. On page 432 of the Reid bill, there is a section increasing federal Medicaid subsidies for “certain states recovering from a major disaster.” The section spends two pages defining which “states” would qualify, saying, among other things, that it would be states that “during the preceding 7 fiscal years” have been declared a “major disaster area.” I am told the section applies to exactly one state: Louisiana, the home of moderate Democrat Mary Landrieu, who has been playing hard to get on the health care bill.

In other words, the bill spends two pages describing would could be written with a single world: Louisiana. (This may also help explain why the bill is long.) Senator Harry Reid, who drafted the bill, cannot pass it without the support of Louisiana’s Mary Landrieu. How much does it cost? According to the Congressional Budget Office: $100 million.

SOURCE




Senate, Help Your President -- Deep-Six ObamaCare!

"The political risks of failure are pretty high." A former congressional aide offered this ominous assessment following the House of Representatives' passage of "health care reform." Warning to the Senate: President Obama and his party face political catastrophe if you fail to do your part so that the President can sign a bill! Nonsense.

The political risks of success are much, much higher. Taxes would go up -- and not just on "the rich." And since "the rich" provide jobs, they would hire fewer people, spend less on their businesses, and take fewer risks. Costs would explode beyond government estimates -- which conveniently limit the estimated price tag to only the first decade.

Expect insurance companies to deny requests for medical treatment at a greater rate than today. Why? The bill would require insurers to take people with pre-existing illnesses, so denying requests for treatment would be the only potent weapon to reduce costs. And since those with pre-existing illnesses could not be denied coverage, people would simply wait until they required care before getting insurance -- only to drop it and risk paying fines once they were treated.

Government eventually will start "controlling costs" by rationing care -- denying requests; imposing waiting times for treatment; and withholding treatment from those with "bad" lifestyles (e.g., those who smoke cigarettes or those who fail to exercise and eat "appropriately") and those considered too old to "sufficiently benefit."

President Franklin D. Roosevelt, during the Great Depression, launched the New Deal -- a blinding array of expansive and expensive government programs designed to "rescue" the economy. Obama, as did FDR, calls this expansion necessary in order to achieve economic recovery. Government expansion -- in this case, ObamaCare -- and economic prosperity supposedly go hand in hand.

Henry Morgenthau served as FDR's Treasury secretary. Thus Morgenthau, who served from 1934 to 1945, was to FDR what current Treasury Secretary Timothy Geithner is to Obama. Morgenthau wrote in 1939: "We have tried spending money. We are spending more than we have ever spent before and it does not work. I want to see this country prosperous. I want to see people get a job. I want to see people get enough to eat. We have never made good on our promises. ... I say after eight years of this Administration we have just as much unemployment as when we started ... and an enormous debt to boot!"

Political Armageddon if ObamaCare fails? No. A recent Rasmussen poll shows more "likely voters" opposed than in favor. Preventing Obama from being Obama is job security for both the President and the congressional Democrats.

The then-Republican-controlled Congress stopped President Bill Clinton from passing HillaryCare. People soon forgot about his "failure" and re-elected him by a larger margin than he received in his first term. Republicans also blocked his first-term attempt to pass a multibillion-dollar "economic stimulus package."

Because of Republican pressure or support, Clinton signed measures unpopular with his base -- the NAFTA and GATT trade agreements; a reduction in capital gains taxes (as part of a larger budget compromise); and 1996's welfare reform act, which, for the first time, refused recipients more money if they had additional children and imposed benefit time limits. Many congressional Democrats opposed these measures.

Though he successfully blamed the Republicans for temporarily shutting down the government over a budget impasse, Clinton signed a budget more modest and less expensive than he wished. For these reasons, among others, Clinton left office with a budget surplus that Democrats constantly brag about -- never, of course, giving Republicans any credit for restraining Clinton's desire to spend.

Besides, if ObamaCare fails in the Senate, watch Obama and the sycophantic media round up the "usual suspects" -- "anti-women" pro-lifers who reject government money for abortions; anti-illegal-alien "racists" who wanted some teeth in the legislation to stop illegal aliens from receiving benefits; "in-the-pockets-of-insurance-company" opponents of the noble "public option" (government-subsidized insurance designed to keep insurance companies "honest"); "evil and greedy" health insurance companies that "misled" the public about the wonders of ObamaCare; "the rich" who selfishly resisted tax hikes; and, of course, Republicans who "failed to offer an alternative."

The media will praise the President for his "heroic" effort, for "going down swinging," for getting the House -- for the first time in history -- to pass health care "reform," for going further than any president since President Harry Truman first proposed government-based universal health care.

After spending trillions to "save" our financial system, signing an $800 billion spending package to "stimulate" the economy, and pushing government takeovers of financial firms, banks and car companies, the President stands -- pen in hand -- ready to enact a dangerous government takeover of one-sixth of the nation's economy.

President Clinton survived -- not in spite of but, in part, because of his "failure" to "reform" health care. Obama will survive -- and benefit -- from this "failure," as well. So, Senate, do the President, yourself and the country a favor. Stop him.

SOURCE




Obamacare Can Be Stopped: ReverseTheVote.org

Would a member of the House of Representatives vote to pass Obamacare if he or she knew it was going to lead to an electoral loss in November 2010? Even if a "yes" vote on Obamacare significantly increases the likelihood of a loss without guaranteeing it, would a member of the House still throw in with Nancy Pelosi and President Obama? Or would they brave the nasty e-mail from the left and the angry looks from Democratic leadership and vote instead to keep their job by voting in accord with the wishes of their district and thus voting no?

If at least three of the 220 House members who voted yes on Obamacare on November 7 fall into the category of those who would rather survive November 2010 than go down in a rush to single payer, then it will be possible to defeat the bill on its return engagement in the House. Possible, that is, if enough voters indicate to the House members that a yes vote on the government's takeover of health care means a "no" vote on their re-election in 50 weeks.

Which brings us to ReverseTheVote.org, a website launched this week by the National Republican Congressional Committee. ReverseTheVote.org identifies the 24 most vulnerable Democrats who voted for Obamacare, and it asks for contributions that will go into the war chests of the eventual GOP nominees against these 24 incumbents. Every dollar given gets split 24 ways. No money goes into a primary fight between Republicans. Every dollar gets spent to defeat a proponent of Obamacare.

The 24 Democrats who are targeted by ReverseTheVote.org come from across the country --from New Hampshire to Oregon and from New York to Arizona. Each one is listed by name at the web site. Each voted against the wishes of their district, and as serious public opinion shows, against the wishes of clear majorities of Americans.

If cash piles up in the common fund to defeat these two dozen Obamacare proponents, not only will they notice, so too will those Democrats who voted no the first time and are glad they are not on the list. When Democratic whips come round looking for new help to offset any defections, the ReverseTheVote.org list will be on the minds of every Democrat who voted no last time and stayed off the list. So too will the handful of Senate Democrats notice in whose hands Obamacare currently rests. If Arkansas' Blanche Lincoln sees a yes vote for Obamacare become the rallying cry of 2010, will she be more or less likely to vote for cloture when that key vote comes up.

Public opinion swung against Obamacare long ago, which is why the president and his Congressional allies are trying to rush it through now, as far in advance of next year's elections as possible.

But if vulnerable Democrats realize that the public has made up its mind and is now making a list and posting it on the fridge, the momentum behind the ill-conceived and gigantically expensive experiment in socialized medicine will evaporate.

If ReverseTheVote.org collects significant numbers of small donors, Democratic leaders won't be able to tell these 24 Democrats not to worry, that no one will remember this vote come next fall. Opponents of Obamacare have the opportunity to send the loudest message possible, one that even the most tone-deaf Democrat will hear.

SOURCE




Married couples face extra tax in Senate health care bill

Senate Democrats' health care bill would create a new marriage penalty by imposing a tax on individuals who make $200,000 annually but hitting married couples making just $50,000 more.

That's one of 17 new taxes imposed by the bill, which also creates a levy on elective plastic surgery - some call it "botax" - and places a 40 percent excise tax on those who have generous health care plans. "If you have insurance, you get taxed. If you don't have insurance, you get taxed. If you need a life-saving medical device, you get taxed. If you need prescription medicines, you get taxed," said Senate Minority Leader Mitch McConnell, Kentucky Republican, who is leading the fight against the bill.

The new taxes would be used to fund an expansion of government medical programs and to fund subsidies for lower-income individuals to buy insurance, extending health care coverage to 94 percent of eligible non-elderly Americans.

Democrats said the bill will offer lower health care costs for small businesses and families, and said the new taxes are aimed at upper-income earners, so costs would not go up for the middle class. They said that makes good on President Obama's campaign pledge not to increase taxes on families making less than $250,000 a year, which explains the reason for the new marriage penalty.

"We wanted to make this provision consistent with the president's pledge not to increase taxes on singles making under $200,000 and married couples making under $250,000," said Jim Manley, a spokesman for Senate Majority Leader Harry Reid, who wrote the Senate bill. "Yes, this structure can create a 'marriage penalty' for some couples. It also creates a 'marriage bonus' for others," he said. "A married couple with one wage earner can earn up to $250,000 without facing this higher tax, whereas a single person in the same job with the same pay would be hit by it."

But a married couple in which each earner makes $150,000 would be hit with the tax, whereas an unmarried couple living together with the same incomes would not.

Ryan Ellis, tax policy director at Americans for Tax Reform, said the new marriage penalty comes on top of an existing one that's always been part of the payroll tax, which funds Social Security and Medicare. He said when the payroll tax was created to fund Social Security during the New Deal, lawmakers didn't anticipate the freelance of two-income families, so there's always been a sort of marriage penalty for couples whose incomes topped the single-earner income taxation level.

More here



20 November, 2009

Condemned to an early death: British rationing body tells liver cancer victims that life-prolonging drug is 'too costly'

Liver cancer sufferers are being condemned to an early death by being denied a new drug on the Health Service, campaigners warn. They criticised draft guidance that will effectively ban the drug sorafenib - which is routinely used in every other country where it is licensed. Trials show the drug, which costs £36,000 a year, can increase survival by around six months for patients who have run out of options.

The Government's rationing body, the National Institute for Health and Clinical Excellence (Nice) said the overall cost was 'simply too high' to justify the 'benefit to patients'. However, relatively few would be eligible for the treatment - around 700, or one in four of those diagnosed each year with primary liver cancer.

Nice had claimed it was approving more drugs under End of Life policies introduced in January meant to benefit small numbers of terminally ill people. So far two drugs have been approved for three cancers. But two drugs have been banned under the rules, with a ban pending on three further drugs including sorafenib.

Its treatment of sorafenib contrasts sharply with that of breast cancer drug herceptin, which has received far more funding and attention after successful campaigns. Herceptin, under separate Nice criteria, has been judged to be cost effective. It currently costs £22,000 to administer an annual course of the drug to around 7,000 women - around £154million.

In contrast, the treatment for sorafenib would potentially cost £25million a year. Sorafenib, also called Nexavar, was assessed on different rules but still failed to meet the Nice threshold.

Kate Spall, founder of the Pamela Northcott Fund, which assists cancer patients denied new therapies, last night said cancer sufferers had been sold down the river. She said: 'These policies were specifically designed to help patients with rarer cancer such as liver to access new treatments for a previously untreatable disease. 'This decision will condemn patients to an earlier death than was necessary.' Only 20 per cent of patients with primary liver cancer - where the tumour originates in the liver - are alive one year after diagnosis.

Bayer, which makes the drug and plans to appeal the decision, had offered a scheme where it would provide every fourth packet for free. Dr Harpreet Wasan, a cancer consultant at London's Hammersmith Hospital, said: 'This cancer is not like any other cancer. There is no alternative treatment. Every other drug that has been tried fails to work. 'British doctors were heavily involved in the trials of this drug yet NICE will say we can't prescribe it.'

Nice rates the cost-effectiveness of a drug using a complicated measurement called a 'quality adjusted life year' or QALY. This determines the cost of new treatment by working out how much it improves and extends a life compared with existing treatments. Andrew Dillon, chief executive of Nice, said: 'We have recently changed our approach to appraising high cost treatments which can extend life for terminally ill patients. 'This has meant that more of them are now recommended.'

Professor Jonathan Waxman, a cancer specialist at Imperial College, London, said: 'The only reason Nice has approved any drugs under End of Life rules is because of a High Court ruling and doctors' protests. 'We must have a public debate about how it treats cancer patients.'

The Nice guidance applies to England and Wales. Scotland's equivalent body is yet to make a decision on sorafenib but tends to follow Nice.

Tony Almond, 46, went to the doctor complaining of indigestion in September. Three days later he was diagnosed with terminal liver cancer and told he had a month to live. Mr Almond, a truck driver living in Brackley, near Northampton, and his long-term partner Sharon immediately got married by special licence on October 16. He said: 'We'd been talking about getting married at Christmas but now I was told I had two to four weeks to live. 'It was pretty horrendous, especially when I found I couldn't have the only drug that would help because it was too expensive.'

Cancer specialists applied to Northamptonshire Primary Care Trust for funding, which is a necessary procedure for such drugs prior to approval by Nice, the drugs rationing body. But the request was rejected. With the backing of an NHS consultant in Birmingham, however, he appealed the decision and won. Mr Almond has been taking the drug for two weeks. He said: 'I can honestly say I no longer feel ill. It's a wonder drug and I feel angry that others may be denied the chance we had to fight so hard for.'

Could the Herceptin victory offer hope? It is three years since Ann Marie Rogers won her famous court victory which forced the Health Service to give her - and other breast cancer victims - access to the wonder drug Herceptin. The drug had been turned down by rationing watchdog Nice but Health Secretary Patricia Hewitt told trusts that they could not deny the drug on grounds of costs.

Now another group of cancer sufferers are facing a similar battle but it is unlikely that we will see Andy Burnham, the current Health Secretary, taking a similar stance --because this time the drug that has been turned down, Nexavar, is one that helps against liver cancer. The problem for campaigners is that liver cancer is not as high profile as breast cancer. This is partly down to the fact that fewer people get cancer of the liver than are diagnosed with breast cancer - around 3,000 a year compared with 45,000.

But that is not the whole story. Breast cancer has two charities fighting its corner - Breakthrough Breast Cancer and Breast Cancer Care - both of which attract millions of pounds in donations, and help boost the profile. Other cancers tend to fade into the background. There is, for example, still no prostate cancer screening programme that compares to the major screening programme for breast cancer. Yet around 10,000 of the 35,000 men in the UK diagnosed with prostate cancer each year die from their disease - a similar number to the 11,900 breast cancer victims.

SOURCE




Bending the Health-Care Cost Curve--Upward

Remember when President Obama said that the goal of health-care reform was to save money? The bill that passed the House a week and a half ago, according to the Senate Budget Committee, would cost a whopping $3 trillion after being fully implemented--more than three times the $900 billion that the president had promised. It turns out that Obama's oft-stated pledge that reform would "bend the cost curve" was accurate: the House bill would bend the curve straight up. Expect more of the same from the Senate's version when Democrats' bill in that chamber emerges, probably later today--earlier drafts came equally loaded with budget gimmicks, phantom cuts, and taxes on the middle class to go along ! with massive subsidies to the uninsured to buy government-mandated health plans. The Congressional Budget Office scored the cost of the coverage expansions in an earlier Senate version as rising at 8 percent annually. President Obama has repeatedly promised that health reform would lower costs, yet independent observers, from the CBO to Richard Foster, the chief actuary of the Centers for Medicare and Medicaid Services, have repeatedly said just the opposite. What gives?

Part of the reason is that whenever Washington micromanages markets, the pleasing of interest groups tends to take priority over good policy. (Republicans are no more immune to the temptation than Democrats: President Bush and congressional Republicans passed a drug benefit for Medicare without paying for it and without reforming the broader Medicare program.) Declaring victory requires greasing lots of palms, like those of California congressman Dennis Cardoza. Politico reports that Cardoza wheedled $500 million for rural medical centers (including a promise to fund one in his district) from Nancy Pelosi and the White House in return for his "yes" vote on the House bill.

Giving congressmen pork is surely expensive, but more costly still is the billions of dollars in subsidies that the bill would direct to the uninsured to buy government-approved (read: expensive) health insurance. The bill would also create over 100 new commissions, boards, and committees to dictate (among other things) what benefits and services your health insurance must cover--including, by 2018, all employer-provided health insurance. That's 100 new committees for lobbyists to jostle for handouts from Uncle Sam.

Meanwhile, Obamacare does almost nothing to control costs or fundamentally reform the government's massive Medicare and Medicaid entitlements. In fact, Foster estimates that 60 percent of the expansion of coverage in the House bill would come from new Medicaid enrollments. (The earlier Senate version did contain a tax on unions' "Cadillac" health plans, a measure that might slow health-care inflation. But in deference to union complaints, Senate Majority Leader Harry Reid is likely to replace the tax with a new Medicare levy on upper-middle-class families.) When it comes to cost containment, Democrats tout the bill's hundreds of billions of dollars in cuts to reimbursements for doctors, hospitals, and nursing homes. But these will undoubtedly be lobbied out of existence. Medicare doctor payments have been slated for deep cuts under a "sustainable" growth formula since 2003, but every year since then, Congress has voted to rescind those cuts. In fact, Reid already tried to! pass just such an adjustment (for $200 billion) separately from the Senate's health-reform bill, so that it wouldn't be scored as part of the bill's cost. Thankfully, 12 Democrats and one independent voted with Republicans to kill the charade.

Democrats also rely on a "super-committee" that's supposed to pass more automatic changes to rein in Medicare spending--unless the president and Congress override it. Count on them to do so whenever it's politically convenient.

In the end, the problem with Obamacare is that the president and his allies assume that the way to drive costs down is through price controls and committees, rather than market preferences. And that's an assumption that a century's worth of failed statist experiments should have buried. Sure, markets aren't perfect; businessmen cheat, lie, and steal, just as politicians do. But markets have one virtue over command-and-control systems: where competition, transparency, and consumer choice drive markets, bad actors go out of business, prices decline over time, and quality improves. If I want your business, I have to sell you something that's worth buying, and at a good price.

Health care, we are told repeatedly, is different. But it's only different because the government has made it different. Our health-care "system" is based on an IRS ruling from World War II that confers tax-deductible status on health insurance only if it's purchased through an employer. Health insurance is regulated in 50 separate sclerotic state markets--rather than in one big, truly competitive national one--thanks to the 1945 McCarran-Ferguson Act. Medicare sets prices for thousands of physicians. Government decisions have transformed what could have been a price-lowering market like any other into an expensive, convoluted mess.

Such old systems are notoriously difficult to change. But they can change, and there are some promising templates. The Dutch are shifting from a command-and-control system to one in which insurers compete and prices for hospital care are allowed to fluctuate, driving innovation. Closer to home, in Indiana, nearly 50 percent of state employees have Health Savings Accounts--saving taxpayers $42 million to date. Companies like Safeway and Whole Foods have created insurance plans that reward healthy behavior and lower health-care costs.

Neither Congress nor the president seems to be paying much attention. But until every American gets control of his or her own portable, affordable, private health insurance--until, that is, a true market exists in health care--costs will continue to spiral upward. And voters will get more of the same, packaged as hope and change.

SOURCE




U.S. health plans have history of cost overruns

As President Obama and Congress craft the largest national health insurance program since the creation of Medicare and Medicaid in 1965, they insist that the final product will add "not one dime" to the federal deficit. But cost projections are notoriously unreliable, and history is filled with examples of federal programs - especially in health care - that cost far more than originally predicted.

In 1965, the House Ways and Means Committee estimated that the hospital insurance program of Medicare - the federal health care program for the elderly and disabled - would cost $9 billion by 1990. The actual cost that year was $67 billion.

In 1967, the House Ways and Means Committee said the entire Medicare program would cost $12 billion in 1990. The actual cost in 1990 was $98 billion.

In 1987, Congress projected that Medicaid - the joint federal-state health care program for the poor - would make special relief payments to hospitals of less than $1 billion in 1992. Actual cost: $17 billion.

The list goes on. The 1993 cost of Medicare's home care benefit was projected in 1988 to be $4 billion, but ended up at $10 billion. The State Children's Health Insurance Program (SCHIP), which was created in 1997 and projected to cost $5 billion per year, has had to be supplemented with hundreds of millions of dollars annually by Congress.

Barely two weeks in office, Mr. Obama signed a $33 billion bill that will add 4 million mostly low-income children to the SCHIP program over the next 4 1/2 years.

All of these numbers were assembled and published in July by the Senate Joint Economic Committee.

The White House and Democratic leaders insist that the proposed health care reform being debated on Capitol Hill will be different. They also note that the costs of some federal health care programs, including the Medicare prescription-drug program, have come in below projections. But the official arbiter of costs in Congress, the Congressional Budget Office, hints that comprehensive health care reform could go the way of most other health care initiatives from Washington.

More here




Government Will Fail on Health Care Record Keeping

As the era of Big Government begins to wear on people, a multitude of evidence has come to the fore to show us just how inefficient and even dangerous the growth of government can be.

While many debate the role of Government in Health Care, one issue has emerged that should the argument to rest. Can the Government effectively manage the Health Care records of over 300 million people in an online database--as called for in the Obama Health Care bill?

This week we all learned that the Government couldn't keep track of the Stimulus spending on what they branded a revolutionary website, Recovery.gov. How, then, will they be able to keep track of all 300 million plus Health Care records in their “revolutionary” Health Care database? One must ponder this as we are being sold a bill of goods.

What will happen when the system inevitably collapses as the Recovery.gov system has? Will we simply get an explanation over Twitter? If that sounds outlandish, that’s exactly what they did yesterday when the buffoons behind Recovery.gov tweeted that “Unless an egregious error is noted, Recovery.gov posts data exactly as it is reported by the recipients.” Apparently no apparatus exists to provide the needed oversight. Troubling.

The current administration reminded us for the better part of the last year about a lack in oversight, a claim which is completely false. However, judging from the performance of the record keeping at Revovery.gov and by those in charge of the Stimulus spending, it’s hard to assert that there is oversight in any form. It appears that Government cannot provide quality oversight.

Fear of the new Health Care overhaul is natural. Claims that the Government will be able to provide accurate and efficient record keeping of our medical records is not natural in light of recent events.

SOURCE




Medicare paid $47 billion in suspect claims

The government paid more than $47 billion in questionable Medicare claims including medical treatment showing little relation to a patient's condition, wasting taxpayer dollars at a rate nearly three times the previous year.

Excerpts of a new federal report, obtained by The Associated Press, show a dramatic increase in improper payments in the $440 billion Medicare program that has been cited by government auditors as a high risk for fraud and waste for 20 years.

It's not clear whether Medicare fraud is actually worsening. Much of the increase in the last year is attributed to a change in the Health and Human Services Department's methodology that imposes stricter documentation requirements and includes more improper payments — part of a data-collection effort being ordered government-wide by President Barack Obama this coming week to promote "honest budgeting" and accurate statistics.

Still, the fiscal 2009 financial report — covering the first few months of the Obama administration — highlights the challenges ahead for a government that is seeking in part to pay for its proposed health care overhaul by cracking down on Medicare fraud. While noting that several new anti-fraud efforts were beginning, the government report makes clear that "aggressive actions" to date aimed at reducing improper payments had yielded little improvement.

In recent years, the suspect claims have included Medicare prescriptions from doctors who were dead, and requests for payment for medical supplies such as blood glucose strips for sexual impotence and diabetic shoes for leg amputees. Patients, many of them new citizens who barely speak English, are sometimes recruited by brokers who go door-to-door offering hundreds of dollars for use of their Medicare numbers.

Obama is expected to announce new initiatives this coming week to help crack down on Medicare fraud, including a government-wide Web site aimed at providing a fuller account of health care spending and improper payments made by various agencies. The Centers for Medicare and Medicaid Services also will launch a Web interactive next month that will allow users to track Medicare payment information by categories such as state, diagnosis and hospital.

According to the report, the Bush administration from 2005-2008 reported improper payments of roughly 4 percent in the fee for service program, or about $17 billion total in 2008. Government officials at the time, however, typically did not consider a Medicare payment improper if the medical documentation was incomplete or a doctor's signature was illegible. Since these were flaws that ordinarily bar payment, that methodology drew complaints from government auditors that the figures were understated.

For fiscal year 2009, the Obama administration began counting those claims as improper, but was unable to complete an official tally based on the new methodology. As a result, it officially reported improper payments for its fee for service program at 7.8 percent, representing a partial tally under the new formula. But it considers the unofficial tally of 12.4 percent to be more representative.

Beginning next year, the 12.4 percent figure — or a total of $47 billion in improper payments when counting both Medicare fee for service and managed care — will be used as the baseline estimate. The federal report sets a target of reducing improper payments in the fee for service program to 9.5 percent by next year, which would represent a savings of roughly $9.7 billion.

The findings come as the Obama administration is making Medicare anti-fraud efforts an important priority. In recent months, HHS has said it was multiplying by 10 the number of agents and prosecutors targeting fraud in Miami, Los Angeles and other strategic cities where tens of billions of dollars are believed to be lost each year. The new partnership seeks to have better sharing of real-time intelligence data on health care fraud patterns.

Officials say they also want to increase training and outreach among Medicare providers to reduce documentation errors, while proposed health overhaul legislation would increase background checks on Medicare claimants and impose stiffer penalties for false claims.

Other findings:

_In the Medicaid program for the poor, roughly $18.1 billion, or 9.6 percent of claims, are believed to be improper payments.

_Using a baseline of 12.4 percent in improper payments in the Medicare fee for service program, HHS is setting targets of reducing fraud and waste to 9.5 percent, 8.5 percent, and 8.0 percent, respectively, for fiscal years 2010 through 2012.

Records released in the past week showed that CMS for three years ignored internal watchdog warnings about swindlers stealing millions of dollars by scamming several Medicare programs. The agency received roughly 30 warnings from inspectors but didn't respond to half of them, even after repeated letters.

SOURCE




Reid finally has a bill

Setting up a historic year-end health care debate, Senate Majority Leader Harry Reid unveiled long-awaited legislation Wednesday night to extend coverage to all but 6 percent of eligible Americans and bar private industry from denying insurance because of pre-existing medical conditions. The Democrat's $849 billion measure is designed to remake the nation's health care system, relying on cuts in future Medicare spending to cover costs—as well as on higher payroll taxes for the well-to-do and a new levy on patients undergoing elective cosmetic surgery.

Aides said the mammoth, 2,074-page bill would reduce deficits by $127 billion over a decade and by as much as $650 billion in the 10 years that follow, citing as-yet-unreleased estimates by the Congressional Budget Office. "Tonight begins the last leg of this journey," said Nevada Sen. Reid, less than two weeks after the House approved its version of a sweeping remake of the health care system— and nearly 10 months after President Barack Obama's Inauguration Day summons to action.

Obama welcomed Reid's action, saying, "Today, thanks to the Senate's hard work, we're closer than ever to enacting solutions to these problems. I look forward to working with the Senate and House to get a finished bill to my desk as soon as possible." There was no mention of Obama's longtime goal of signing legislation by year's end.

Republicans vowed a protracted struggle to block the legislation and deny the president a victory that would cap a tumultuous first year in office. "This bill has been behind closed doors for weeks," said Sen. Mitch McConnell of Kentucky, the Republican leader. "Now, it's America's turn, and this will not be a short debate. Higher premiums, tax increases and Medicare cuts to pay for more government. The American people know that is not reform."

An early showdown on the Senate floor is expected by week's end.

Reid's Senate measure would require most Americans to carry health insurance and would provide hundreds of billions of dollars in subsidies to help those at lower incomes afford it. Medium and large companies would not be required to offer coverage, but they would be forced to pay fees if the government ended up subsidizing their employees' insurance.

Beginning in 2014, the bill would set up new insurance marketplaces—called exchanges—primarily for those who now have a hard time getting or keeping coverage. Consumers would have the choice of purchasing government sold insurance, an attempt to hold down prices charged by private insurers.

After weeks of secretive drafting, Reid outlined the legislation to rank-and-file Democratic senators at a closed-door meeting. "Everyone was positive," said Sen. Amy Klobuchar, D-Minn. That didn't mean there weren't problems—far from it. At his news conference, Reid pointedly refrained from saying he had the 60 votes necessary to propel the bill over its first hurdle.

Reid met privately earlier in the day with Sens. Ben Nelson of Nebraska, Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas, moderate Democrats who have expressed concerns about the measure. Nelson later issued a statement strongly suggesting he would vote with fellow Democrats on an initial showdown expected within days. Aides have said privately that Reid decided to retain an existing antitrust exemption for the insurance industry as a way of satisfying the Nebraskan's concerns.

Landrieu said, "I'm not going to be for anything that doesn't drive down costs over time." Lincoln, the only one of the three who faces re-election next year, told reporters, "We'll wait and see."

With the support of two independents, Democrats have 60 seats, the precise number needed to choke off any delaying tactics by the 40 Republicans who appear united in opposition to the bill in its current form.

In general, Reid proposed an outline that is similar to the House-passed bill, but there were important differences. He called for an increase of a half percentage point in the Medicare payroll tax for individuals with income over $200,000 a year, $250,000 for couples. He also included a tax on high-value insurance policies, meant to curb the appetite for expensive care. The House bill contains neither of those two provisions, relying on an income tax surcharge on the wealthy to finance an expansion of coverage.

Reid's measure also calls for hundreds of billions of dollars in cuts in future Medicare spending, an attempt to satisfy Obama's call to curtail the growth of health care spending that is fiercely opposed by Republicans.

On another controversial issue, Sen. John Kerry, D-Mass., told reporters Reid had decided to require the side-by-side sale of insurance policies that cover abortion services and do not, an attempt to satisfy both sides. That is far less restrictive than a House-passed provision that left liberal Democrats angry.

Ahead lie weeks—if not more—of unpredictable maneuvering on the Senate floor, where Reid and his allies will seek to incorporate changes sought by Democrats and repel attempts by Republicans to defeat the legislation and inflict a significant political defeat on the president.

Reid released his legislation more than a week after the House approved its version of the health care bill on a near party-line vote of 220-215. According to estimates from the Congressional Budget Office, that House bill, with a price tag of about $1.2 trillion, would result in coverage for tens of millions of uninsured, and provide 96 percent of the eligible population with insurance.

Two Senate committees approved different versions earlier in the year, and while Reid has said he would produce a blend of the two proposals, in fact he had a virtual free hand to come up with a plan that could command the 60 votes needed to pass.

Anticipating a major struggle, the White House deputized Interior Secretary Ken Salazar and former Senate Majority Leader Tom Daschle to join Vice President Joe Biden in trying to clear the way for the bill's approval over the next several weeks. Salazar, a former Colorado senator, is viewed as a bridge to moderate Democrats who are far outnumbered by liberals inside the Democratic caucus.

Daschle was Obama's first choice for secretary of health and human services, a position from which he was to try and oversee the administration's drive to enact health care legislation. He withdrew his nomination when it was disclosed he had not paid more than $120,000 in federal taxes over several years.

SOURCE





19 November, 2009

High dropout rates undermine stupid British plans for degree-only nursing

Plans to make nursing a degree-only profession could be thwarted by the high number of students who drop out before finishing training, the latest figures suggest. More than half of students on some nursing degree courses do not graduate because of pressures of time, money and the academic standards demanded. The figures, obtained using the Freedom of Information Act, show wide variations in attrition rates among England’s 10 strategic health authorities.

At one university, in the North West, 51 per cent of students fail to complete its degree programme in adult nursing. The highest attrition rates in London, the South West, West Midlands, Yorkshire and the Humber show more than a third of students dropping out.

The Department of Health is so concerned about the problem that it ordered an annual report on dropout rates from university nursing courses, Nursing Attrition National Aggregate. However, it has not published the findings.

The figures, obtained by Nursing Standard magazine,dropouts are even more common. One university lost 78 per cent of students on a children’s nursing degree course, and more than 54 per cent of students on a mental health nursing course failed to graduate.

The findings come a week after The Times reported on government plans to require those wishing to become a nurse to have a degree. Supporters claim that the move, which will be enforced from 2013, will improve the quality of patient care and raise the status of nursing.

Critics suggest that the changes will create an elitist profession and scare off recruits with the prospect of a long and expensive period of study. There are also concerns that some nurses would be “too clever to care” and refuse to carry out duties such as washing and feeding patients and helping them to the lavatory.

Norman Lamb, the Liberal Democrat health spokesman, said that the dropout rates cast degree-only plans into disarray. Concerns have also been raised about the millions of pounds of taxpayers’ money, given in bursaries, wasted on courses that were not completed. “These figures appear to massively undermine the Government’s new plans for nurses,” he said. “Such high dropout rates suggest there is something seriously wrong. Ministers are burying their heads in the sand by refusing to publish their own report into quit rates.”

Nursing education specialists said that financial difficulties and the high number of mature students who juggled families with their studies were among the main reasons for dropping out.

Nurses, who make up the largest part of the NHS workforce, now require the minimum of a diploma — a nursing course lasting two or three years — for trainee nursing positions. Under the new rules, candidates will require a degree in nursing or equivalent international qualification. The courses, lasting up to four years, will meet standards developed by the Nursing and Midwifery Council, the professional regulator.

Peter Carter, general secretary of the Royal College of Nursing, which helped to draw up the degree-only plans, said that losing potential nurses was “an entirely unnecessary waste of people who are willing to learn and want to care”. He added: “Of course, some people will not be suited to the demands of nursing, but with rates as high as 78 per cent, something is seriously wrong with the support offered to the nurses of the future. Financial support is very important but it is not the only kind of support that needs to be on offer.”

A Department of Health official said that an incentive scheme to pay universities with low attrition rates would start next year.

SOURCE




Is Obamacare Like Mandatory Auto Insurance?

Teaching introductory logic for ten years made me vividly aware of the low average quality of reasoning among college students. It also showed me how little improvement can realistically be accomplished by only one semester’s training in the art of thinking clearly. By all rights, then, I should have severely pessimistic expectations about public discourse in this country. Nevertheless, whether I suffer from my own strain of bad induction or just unquenchable naïveté, pandemic outbreaks of illogical memes still catch me by surprise.

That’s why I’ve been so shocked at the widespread assertion that a national mandate requiring individuals to carry health insurance is legitimate (and even Constitutional) because we already require everyone to purchase auto insurance. There’s just one small error this idea seems to forget: the federal government does not actually have a law requiring individual drivers to carry such insurance. Only states do.

And since federalism is at the center of the Constitutional concerns surrounding Obamacare, I find it stunningly bold to claim the federal government has authority for a project because of something similar the states currently do. The argument seems to be, “Congress can do it because it’s just like something else that Congress doesn’t do.” Now, obviously, if we were debating whether individual states could mandate health coverage, at least the levels of government being analogized would be the same. But the leap from what states do to what Congress can do betrays vistas of ignorance concerning our system of government. A college freshman would be embarrassed to make such a weak argument, yet members of Congress have said precisely this.

Senator Burris, for instance, recently told CNS News that it’s okay to make individuals purchase health insurance because, “Under state law, we have every one required to have automobile insurance … so, that’s the same thing proportionally to automobile insurance. I mean, it’s comparable.” The good news here, of course, is that the former Illinois Secretary of State (hence, overseer of the DMV) rightly situated the law at the state level. The sad news is that this United States Senator has taken an oath of office to uphold a document he apparently has not read. But perhaps we can forgive his lapse, seeing as how he’s the Senatorial equivalent of a baseball September call-up put into office by a now-deposed criminal of a governor. What excuse do his colleagues have?

See, in some sense, those of us who live in states (like Illinois) which require minimum coverage might understandably forget that not all things “the government” requires are things “the national government” requires. But I’m especially surprised that inhabitants of New Hampshire and Wisconsin haven’t immediately exposed this line of reasoning since their states have no such requirement at all—a barely publicized truth which underscores the fact that there is no national car insurance law.

Still, let’s put aside the equivocation between federal and state authority and investigate whether the analogy would hold even if mandatory auto insurance actually were a federal law. In so doing, I must apologize in advance for marching over slightly more well-traveled territory.

The reason states require car insurance is because of the risks to other people and their property which driving so obviously entails. The underlying legal basis here is tort law, which holds me liable for any harm I cause to others. Since driving increases both the likelihood and extent of such torts, mandatory insurance (or proof of financial ability to pay in New Hampshire and Wisconsin) “insures” that I can restore my victims to wholeness. In a world without car insurance, every accident would lead either to a court ruling or a settlement. Insurance payouts are rooted in this and are simply a more expeditious way of resolving torts. But in basing health insurance on this model, I’m naturally led to ask about the underlying rationale. Whom, exactly, should I have sued when I caught the flu or broke my leg falling down the stairs if I hadn’t had health insurance?

Unless I was deliberately coughed upon or pushed, there is no one to blame. So there simply is no parallel with tort law to draw upon here. Moreover, the two possible types of auto insurance which would fit fairly well with a health insurance mandate (collision and medical payments) are specifically not ever required by the states.

Additionally, you should note that no state requires you to have liability insurance until you positively engage in some enhanced risk activity, like driving, performing surgery, or opening a restaurant. Even though any of us at any time could harm another person (bicycling, playing softball or even just tripping on a crowded escalator), no one is required by law to carry bodily motion insurance.

Taken together, all of this means that, far from being a good example to draw upon, current auto insurance laws are actually quite a robust counter-analogy to mandatory health insurance because the two are so starkly asymmetrical. The similarities between the two types of insurance seem to begin and end with their shared name.

But wait, there’s more. One of the most debated aspects of current health care reform proposals is the “public option,” or government delivery of health insurance. Once again we find a glaring disconnect in the comparison with auto coverage. Although 47 individual states make insurance a precondition of driving (Virginia will allow you to simply pay a $500 annual fee in lieu of having it), no state to my knowledge actually supplies the required insurance to anyone. Geico, Allstate, Country Companies and State Farm do not have to compete with “Vermont Casualty Group” or “The Florida Collision Underwriting Consortium.” Thus, if auto insurance is a good object lesson, it seems to urge us to specifically not involve the federal government as a provider.

Is there anything else we can learn from mandatory car insurance to guide us in the current debate? One thing is that the presupposition behind such mandates (where they exist) is the recognition of driving as a privilege rather than an entitlement. Driving prohibitions can’t be litigated as deprivations “without due process of law” because there is no fundamental right to endanger others through the operation of a motor vehicle. But what privileged behavior am I engaging in before I must carry health insurance? I must breathe.

Since I’m forced to take Congress seriously when they make their arguments, I am driven (sorry) to conclude their use of the auto insurance analogy means they consider some aspect of my behavior to be a privilege rather than a right. The only contenders are existence and breathing. Since they don’t appear to be meta-physicians (sorry again), I have to infer that Congress views breathing as a privilege rather than a right. And since they want to insure all breathers, should I also anticipate the parallel institution of breathing licenses for which we must visit the DMV and pass a proficiency test? Perhaps I should begin studying now. I’d hate to have to refrain from breathing pending a make-up exam.

Furthermore, the actual car coverage levels required by most states are extremely low. Although I suppose some people are satisfied with $25,000/$50,000 coverage (a common benchmark), most drivers understand that $100,000/$300,000 is much more prudent. But if the more robust protections are so obviously smart, why aren’t they required? It’s simple. Because all of the states recognize the need to balance the wisdom of carrying insurance against the restraint all levels of government must exercise when infringing upon the core value of individual liberty.

Since the right to property (in this case to not pay insurance premiums) is so fundamental in our system, it must be violated only for the most extreme of reasons and only to the most humble of extents. Thus, basing health care reform on this same pattern would require at most only some sort of minimum catastrophic coverage. Suffice it to say that current proposals which cover every form of health care down to the most routine are not modeled on the same recognition of liberty and property rights.

So, having taken a more diligent look at whether mandatory automobile insurance justifies the imposition of health insurance, we now have a much better sense of its validity. In order to make the comparison justify current health care proposals, Congress (not the states) would have to currently require that all people (regardless of personal wealth or actual car ownership) owned an insurance policy provided by Congress itself that covered routine maintenance, periodic breakdown, and collision repair to their own cars, even ones they acquire with pre-existing defects (like from a junkyard).

Since not one single element of this hypothetical currently exists, and since breathing is not a privilege, my request is simple. During the two weeks that are fair to allow this column to circulate through society, simply boo anyone who makes the car insurance argument in public. Thereafter, I recommend noogies. It’s what one does to recalcitrant freshmen.

SOURCE




AP Poll: Americans fret over health overhaul costs

It's the cost, Mr. President. Americans are worried about hidden costs in the fine print of health care overhaul legislation, an Associated Press poll says. That's creating new challenges for President Barack Obama as he tries to close the deal with a handful of Democratic doubters in the Senate.

Although Americans share a conviction that major health care changes are needed, Democratic bills that extend coverage to the uninsured and try to hold down medical costs get no better than a lukewarm reception. The poll found that 43 percent oppose the health care plans being discussed in Congress, while 41 percent are in support. An additional 15 percent remain neutral or undecided. "Well, for one, I know nobody wants to pay taxes for anybody else to go to the doctor _ I don't," said Kate Kuhn, 20, of Acworth, Ga. "I don't want to pay for somebody to use my money that I could be using for myself."

There's been little change in broad public sentiment about the overhaul plan from a 40-40 split in an AP poll last month, but not everyone's opinion is at the same intensity. Opponents have stronger feelings than do supporters. Seniors remain more skeptical than younger generations.

The latest survey was conducted by Stanford University with the nonprofit Robert Wood Johnson Foundation. When poll questions were framed broadly, the answers seemed to indicate ample support for Obama's goals. When required trade-offs were brought into the equation, opinions shifted _ sometimes dramatically. In one striking finding, the poll indicated that public support for banning insurance practices that discriminate against those in poor health may not be as solid as it seems. A ban on denial of coverage because of pre-existing medical problems has been one of the most popular consumer protections in the health care debate. Some 82 percent said they favored the ban, according to a Pew Research Center poll in October.

In the AP poll, when told that such a ban would probably cause most people to pay more for health insurance, 43 percent said they would still support doing away with pre-existing condition denials, but 31 percent said they would oppose it. Costs for those with coverage could go up because people in poor health who'd been shut out of the insurance pool would now be included, and they would get medical care they could not access before. "I'm thinking we'd probably pay more because we would probably be paying for those that are not paying. So they got to get the money from somewhere. Basically I see our taxes going up," said Antoinette Gates, 57, of Atlanta.

The health care debate is full of such trade-offs. For example, limiting the premiums that insurance companies can charge 50-year-olds means that 20-year-olds have to pay more for coverage. "These trade-offs really matter," says Robert Blendon, a professor at the Harvard School of Public Health who follows opinion trends. "The legislation contains a number of features that polls have shown to be popular, but support for the overall legislation is less than might be expected because people are worried there are details about these bills that could raise their families' costs." If the added costs _ spread over tens of millions of people _ turn out to be small, it may not make much difference, Blendon said. But if they're significant, Obama could be on shaky ground in the final stretch of his drive to deliver access to health insurance to most Americans.

More than 4 in 5 Americans now have health insurance, and their perceptions about costs are key as Obama tries to rally his party's congressional majority. In the House, Democrats came together to pass their bill. In the Senate, Democratic liberals and a smaller group of moderates disagree on core questions even as Majority Leader Harry Reid, D-Nev., prepares to take legislation to the floor.

The poll suggests the public is becoming more attuned to the fact that in health care, details can make all the difference. For example, asked if everyone should be required to have at least some health insurance, 67 percent agreed and 27 percent said no. The responses flipped when people were asked about requiring everybody to carry insurance or face a federal penalty: 64 percent said they would be opposed, while 28 percent favored that.

Both the House and Senate bills would require all Americans to get health insurance, either through an employer, a government program or by buying their own coverage. Subsidies would be provided for low-income people, as well as many middle-class households. And there would also be a stick _ a tax penalty to enforce the coverage mandate. "I think it's crazy. I think it infringes on our rights as a citizen, forcing us to do these things," said Eli Fuchs, 26, of Marietta, Ga.

Among Democrats, only 12 percent oppose the broad goal of requiring insurance. But 50 percent oppose fines to enforce it.

The poll found a similar opinion shift on employer requirements: 73 percent agreed that all companies should be required to give their employees at least some health insurance. Yet when asked if fines should be used to enforce such a requirement on medium and large companies, support dropped to 52 percent. Uninsured workers are concentrated in small companies.

SOURCE




New CF&P Foundation Study: Government Run Health Care Will Be A Fiscal Train Wreck

The Center for Freedom and Prosperity Foundation (CF&P) today released a paper entitled "Government-Run Health Care Means Higher Deficits and Debt: Realistic Assumptions Show 10-Year Deficits Easily Could Exceed $600 Billion ." Authored by Dan Mitchell of the Cato Institute, the study explains the dangerous fiscal consequences of the House and Senate health care proposals. The study is a companion to a CF&P Foundation mini-documentary video on the same topic.

The paper notes that if current congressional forecasts are modified to be more realistic, deficits and debt will climb by at least $600 billion – and perhaps more than $850 billion – over the next 10 years if government takes over the health care system. Additionally, the paper examines the history of congressional spending projections and finds that almost all federal health care program over the past 50 years has been under-budgeted.

"We are not talking about trivial errors," said CF&P Foundation President Andrew Quinlan. "Medicare was 10 times more expensive than first forecast and a part of Medicaid cost 17 times more than taxpayers were led to believe. No wonder the American people do not trust Congress and its supposed forecasting experts," added Quinlan. The paper makes several key observations:

* Congressional estimates do not properly measure how people and businesses change their behavior in response to government handouts.

* The spending estimates also are far too low because they do not recognize that politicians in the future will be tempted to expand subsidies as part of routine vote-buying behavior, similar to what happened with Medicare and Medicaid.

* If revenues and offsets are 25 percent below the forecast and spending is 50 percent higher than estimated (and that almost surely is still too optimistic), the 10-year deficits will be $602 billion to $860 billion higher

The paper also explains that the federal government has a long history of under-budgeting and over-spending on health care programs.

* The federal government's ability to predict health care spending leaves much to be desired. When Medicare was created in 1965, the long-run forecasts estimated that the program would cost about $12 billion by 1990. In reality, it cost more than $100 billion that year (and now costs $500 billion).

* Medicaid was also created in 1965 and was supposed to be a very small program with annual expenditures of about $1 billion. It has now become a huge $250 billion entitlement.

* Medicaid's disproportionate share hospital (DSH) program is a sobering example. Created in 1987 to subsidize hospitals with large numbers of Medicaid and uninsured patients, the programs was supposed to cost less than $1 billion in 1992, but the actual cost that year was a staggering $17 billion.

Executive Summary:

The health care proposals in the House and Senate are bad news for taxpayers and would permanently damage the American economy with more spending, taxes, and debt. While the details differ, both plans add about $1 trillion to the burden of federal spending over the next 10 years according to congressional estimates. Some of this spending is financed with higher taxes, and both plans also promise to finance a portion of the new spending by curtailing the growth of other programs, particularly Medicare.

Supporters of a government take over of health care argue this approach is fiscally responsible because the higher taxes and promises of future spending restraint supposedly exceed the amount of proposed new spending. Making government bigger, however, is not fiscally prudent – especially when the estimates put together by the congressional forecasters are deeply flawed.

In reality, the proposals on Capitol Hill will make government more expensive and increase deficits. Government programs almost always cost more than the preliminary estimates, and projections for health care spending have been notoriously inaccurate. Moreover, tax increases will not collect as much revenue as politicians want because of "Laffer Curve" effects. Last but not least, the promised spending restraint is a farce. If congressional forecasts are modified to be more realistic, deficits and debt will climb by at least $600 billion – and perhaps more than $850 billion – over the next 10 years.

SOURCE




Health-Care Reform: The Government Run Public Option is Rooted in the Intellectual Laziness of Congress and the Administration

Comment below from a practicing physician

Consider the following syllogism:

(1) To ignore (or refuse to consider) alternative solutions to health-care reform* is intellectual laziness.

(2) Other than expanding the government’s role in health-care, (public option, Medicare for all), the US Congress and Administration ignore alternative solutions to health-care reform.

(3) The US Congress and the Administration are intellectually lazy when they fail to consider alternatives to their government expanding health-care reform proposals.

* or any other problem for that matter

What are the purported purposes of the government run public option (GoRPO)?

The administration and Congress are correct when they point out that, to reduce individual costs for health-care and to insure the uninsured, we must have competition among health insurance companies. You’ll get no argument there from me or just about anyone else on this. Many members of congress, with clandestine support from the administration, declare that the only way to achieve these goals is through the GoRPO. That is, the GoRPO with lower insurance premiums because there is no profit motive, will serve as the prime nationwide competitor to all private health insurance providers. What government run program is known for efficiency and cost containment? Having worked for the federal government for 27 years, I can attest to the inherent inefficiencies and wasteful monetary practices. Sure, it would be simple to add another entitlement program further bloating the federal budget with attendant cost escalation (more government run health-care will never be budget neutral; is Medicare?). To expand federal government involvement in our health-care system while ignoring not only failures of state run systems but also the efficacy of alternatives is nothing less than intellectual laziness. Moreover, the intended and unintended consequences have severe repercussions for the future US health-care and the very fabric of US society.

In addition to desiring to insure the uninsured and reduce costs of health-care, a key intended (though rarely discussed) consequence of the GoRPO is the progression to a single-payer (government managed) health-care system for Americans (this has been stated publicly as desirous by some members of Congress). How can this happen? At the present time, the federal government manages or provides insurance for 33% of the US population. It would only be a matter of time, through GoRPO mission creep, that the government will be responsible for over 50% of US citizens. With this majority stake, the federal government will have the power to dictate rates and services for most Americans, effectively controlling all aspects of US health-care.

The unintended consequences of a GoRPO are numerous and include, but not limited to: cost overruns (as example – the government program Medicare will be bankrupt by 2017; the Massachusetts program is $9billion in debt), rationing (the only way to reduce escalating costs), higher taxes (income tax rates in western European countries range from 40% to 60% for the middle class), fewer new drug and device developments (from a decline in medical research and development – the government will be unwilling to pay for costly new products; e.g. the U.K. refuses to offer certain effective anti-cancer drugs because of cost), reduced citizen productivity (from loss of work while awaiting procedures), slowed or arrested progress in medical advances (e.g. fewer clinical trials testing new drugs or devices), dissolution of the private insurance industry, demise of private medical practices (all health-care providers will essentially be de facto government employees), government will be forced to pay for all medical education as is done in western Europe because individuals will no longer be able to repay loans for their medical education (the President seemed astonished this past summer when a Georgetown University medical student informed him that her debt after graduation will be $300,000), reduced quality of individuals seeking to enter medicine (in the UK for example, many physicians refuse to works nights and weekends), more claim denials (Medicare already denies a higher percentage of claims than any private insurer) and destruction of the medical profession as we know it.

Are there non-governmental alternatives to the GoRPO? Sure there are. We can insure those without access to insurance (6 to 14 million people by most reasonable estimates) by creating a privately managed member-owned pool consisting of the 6 to 14 million combined with employees of small businesses. Furthermore, such a large pool will have substantial clout in negotiating rates with insurance companies, thereby lowering costs. Another way to reduce cost is to allow companies and individuals to select insurance across state lines as is done for auto insurance. This approach will provide the needed competition and reduce health insurance costs. Proof that this is effective already exists. The 9 million participants of the Federal Employees Health Benefits Program have over 250 options from which to select and have enjoyed a lower rate of rise in insurance premiums when compared to the industry as a whole. Lastly, tort reform is an essential ingredient to reduce costs in any health-care reform proposal and must be applied across the country; billions of dollars will be saved annually.

Government intrusion into the American way of life must be the absolute last resort for resolving the issue of health-care reform, not the first solution we consider. An April 1959 memo from the Department of Health, Education and Welfare to congress is germane today: "In our society the existence of a problem does not necessarily indicate that action by the Federal Government is desirable. The basic question is: Should the Federal Government at this time undertake a new program to help pay the costs of medical care…, or should it wait and see [first if other options are effective]?"

How many Nobel Prize recipients in Physiology or Medicine have been from the US? Since 1950, 58%. With a single payer system, future advances may never see the light of day in clinical practice. What nation other than the US can boast being responsible for bringing significant new technologies and drugs from the bench (laboratory) to the bedside (clinic or hospital)? That other nation doesn’t exist. The US has the distinct and singular honor for the primary development of new medical technologies not only for the US but for the entire human population.

The administration and congress have a mandate to establish health-care reform. But we want it done right, the first time. You know, sometimes neither the easy nor the get-it-done quick ways are the right paths. Don’t mess this up. Don’t be lazy.

SOURCE




Harry Reid’s death march

They're calling it the legislative equivalent of the Bataan Death March. Majority Leader Harry Reid says he's willing to force the Senate to work through every weekend in December to get a health care bill passed before the Christmas holiday. "Long nights, weekends -- constantly, from then until right before Christmas, when I think we'll have the votes, hopefully, to pass the bill," is how Iowa Democrat Tom Harkin described Mr. Reid's plans.

But some Senate Democrats are balking not just at such a schedule but at Mr. Reid's demand that the bill be delivered to the floor this week in the absence of final legislative language or a cost estimate from the Congressional Budget Office.

One Senate Democrat who finds herself in political hot water on health care is Blanche Lincoln of Arkansas. She trails some potential Republican challengers in polls and has said she's leery of supporting a procedural motion to bring a health care bill to the floor unless she can see the final bill.

Senators Ben Nelson of Nebraska and Mary Landrieu of Louisiana are also balking at forcing a health care debate so early. On the other hand, Senators Joe Lieberman and Evan Bayh have both indicated that, while they have problems with the health care bill, they will vote with Mr. Reid on a motion to proceed with debate.

Mr. Reid will need every single one of his 60 caucus votes to overcome a filibuster threat, since all 40 Republicans appear ready to oppose the legislation. But 91-year-old West Virginia Senator Robert Byrd is ill and has missed 130 Senate roll call votes this year, so any vote to begin the health care debate may hinge on his availability.

SOURCE





18 November, 2009

British Alzheimer’s patients neglected and come out of hospital 'worse than when they went in'

Half of Alzheimer’s patients come out of hospital in worse health than when they went in because of poor care, a hard-hitting new report warns. One in three never go back to their own homes and are discharged to a nursing home instead, the Alzheimer’s Society found. More than three-quarters of relatives say that they are dissatisfied with the treatment dementia patients receive in hospital and one in three has made an official complaint.

Poor care leads them to spend weeks or even months longer than necessary in hospital, according to the charity, which called for a target to cut the average time to discharge by a week.

The report come just days after an independent investigation found that almost 2,000 dementia patients a year are being killed by ‘chemical cosh’ drugs given to keep them quiet. A survey of relatives and NHS staff shows that almost half, 47 per cent, of dementia patients left hospital in worse physical health than when they went in. In an even greater number of cases, 54 per cent, the patients’ dementia was judged to have deteriorated while in hospital.

The charity warned that patients were being left unfed, with nothing to drink or sitting in their own urine because staff did not realise Alzheimer’s patients need extra help with simple tasks. Patients suffered weight loss, dehydration, pressure sores, incontinence and were even left unable to walk because they had been confined to bed for too long. One distressed patient was found beside a written note telling her “Don’t bang the table”, despite the fact that her condition meant she could no longer read.

Neil Hunt, chief executive of the Alzheimer’s Society, said: “We are talking about an issue that is vast and staring the NHS in the face. “We believe that the NHS is failing disgracefully on this. “And it is creating very serious outcomes for people with dementia and their families.”

People with dementia occupy up to one in four NHS hospital beds at any one time, the charity estimates. Cutting the average length of hospital stay by one week could save the NHS at least £80 million a year.

Official figures show that while the average length of stay for a hip fracture was one week, almost one in eight dementia patients with hip fractures stayed in hospital for more than two months.

The charity insisted that while in some cases it was right that patients with the condition should spend longer in hospital in many there were being delayed unnecessarily, harming their health. The charity surveyed 1,291 friends and relatives caring for a patient with dementia, 657 nursing staff and 479 ward managers.

Around 700,000 people in Britain have dementia, 400,000 with Alzheimer’s, the most common for, of the condition. That figure is predicted to increase to 1.7 million by 2051, in part because of an ageing population.

Dr Peter Carter, general secretary of the Royal College of Nursing, said: “For the majority of patients with dementia to leave hospital in a worse condition than when they arrived is simply unacceptable. "It is vital that the government invests in better dementia training for all healthcare staff to ensure these patients receive good quality care."

Rebecca Wood, chief executive of the Alzheimer’s Research Trust, said: “This is a wake-up call for a health system that has failed to take the challenge of dementia seriously. “We must tackle dementia by investing in research to find new preventions, treatments and cures, as well as reforming the way hospitals deal with dementia patients.”

A spokesman for the Patients' Association said: "The findings in this report are scandalous. "Not enough help with eating. Not enough help with drinking. Not enough help with personal hygiene. Not enough help with continence. “There is now an overwhelming amount of evidence that elderly patients are being neglected in hospitals across the NHS. "Whether they have dementia or not, if they are in need of help with personal care many of them won’t get it. “Ensuring patients receive essential personal care doesn’t tick any of the target boxes. Is it any surprise that it has slipped so dramatically?”

Phil Hope, the care services minister, said: "We have set priority areas for all hospitals to take urgent action, including appointing a senior member of staff to improve quality of care for people with dementia, proper training for all staff, and specialist older people's mental health teams working in hospitals.”

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Bureaucratic madness: British IVF couples face disease tests before each cycle

Couples undergoing IVF could face higher bills after European regulators said they should be screened for diseases between each treatment cycle. The EU Commission wants couples to be screened before each treatment cycle instead of just when they start their course. British doctors said it was extremely unlikely new cases of infections like HIV and syphilis would be picked up between cycles and it will add to the cost of treatment, which is currently around £4,000 for IVF. The move could mean couples needing to be tested every one or two months for HIV, hepatitis, Human T-lymphotropic virus and syphilis.

Dr Luca Gianaroli, chairman of the European Society of Human Reproduction and Embryology (ESHRE), said that at a recent meeting, the EU Commission had said all patients must be tested before each treatment and that all European countries "must comply with this and that it was not open for national interpretation". He has written to ESHRE members urging them to take action over the "quite alarming signals" over interpretation of its 2004 tissue and cell directive.

He said after 30 years of IVF, 15 million treatments and around three million children born, there had been no examples of viruses being transmitted in the areas covered by the directive. In Dr Gianaroli's letter he added: "All in all, this implies a major additional allocation of resources. "The consequence of this testing practice is that many couples living intimately together at home will have to be tested every one to two months."

At present, couples are generally tested for HIV and hepatitis before they undergo their first treatment but are then considered virus-free for the rest of their course.

Professor Peter Braude, head of the Department of Women's Health at King's College London, said: "This new interpretation of the EU directive is of extreme concern to fertility practitioners, as it will have substantial implications for the costs of fertility treatment to individual patients and for the NHS.

"Whilst we already comply with the bizarre EU idea that sperm samples from couples who have been married or cohabiting for many years are treated as 'partner donation', and men have to have infection screens done at least annually, this interpretation would mean that both partners in the relationship would now have to be tested for HIV, hepatitis, HTLV and syphilis every time they underwent an IVF or even an IUI (insemination) procedure, which could be two or three times a year or even more often. "Repeat infection or new infection during or between treatments would be extremely rare, if ever."

Dr Allan Pacey, secretary of the British Fertility Society and senior lecturer in andrology at the University of Sheffield, said: "The British Fertility Society (BFS) has some concerns about this interpretation of the EU directive and the impact it may have on infertility treatments within the UK and across Europe. "Whilst there are a number of reasons to screen patients for some infectious agents, including HIV, it is important that the timing, frequency and screening strategy is evidence-based. "A blanket screening policy applied uncritically is unhelpful and inappropriate."

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Canadian Patient Flies to India for immediate treatment of painful disability

Flying to a faraway country for medical care did not seem too outrageous an idea for Canadian Raghav Shetty - at least, in comparison to the alternative. The 61-year-old Calgary, Alberta man's bum hip had effectively immobilized him. Yet he faced several years of waiting in distress for surgery in Canada's "universal" Medicare health system.

Shetty had developed severe osteoarthritis in his left hip joint. He was in so much pain that, even with the aid of painkillers, each step was tormenting. "I'm in extreme pain," he admitted. "I'm stuck at home, I can't work. It is difficult for me to provide financial support to my family and the quality of my life is very bad." "He can barely walk. He drags his legs everywhere he goes," added daughter, Shilpa Shetty.

Shetty, a 20-year resident of Calgary, discovered the wait for partial hip replacement surgery would be up to two years. At the time, in 2004, some 25,000 patients were on waiting lists for surgery or diagnostic scans in Calgary's hospitals.

Facing a bedridden wait on Medicare [Canada's public health system], Shetty and his wife, Prema, looked elsewhere for quicker treatment. They discovered a private facility in Chennai, India offering immediate care. The entire out-of-pocket cost for the operation and for both to fly to India would be $15,000 (CAD), but the couple believed waiting up to two years for care locally was not a realistic option. "I had no choice but to try elsewhere for my surgery due to the long waiting period and severe pain in my hip joint," Shetty said. "I could not walk more than a few meters. Under these conditions, waiting for one to two years was simply not possible for me."

In September 2004, the Shettys traveled to Apollo Specialty Hospital for a successful five-hour surgery. Shetty, an Indian immigrant, said returning to his native country for a medical procedure was not something he would have considered had it not been for the excessive wait. "Of course, my first choice would have been always Canada," he said. "However, in recent years, the waiting period for major surgeries is too long for patients suffering from severe pain and serious medical conditions."

Daughter Shilpa objected to the tedious wait her father would have endured if he stayed in Canada. "We've given up on our health care system. Why don't they understand that some people are in so much pain that they just can't wait?" she asked. "We don't have any options and can't wait anymore."

Though the long wait forced Shetty to look outside Canada, the health department in the province of Alberta rejected his claim for reimbursement for his care in India. Generally, the government reimburses only such patients who go abroad when treatment is unavailable locally or if the patient's life would be in jeopardy while waiting.

As published in a 2007 Fraser Institute survey, an estimated 5,029 people in Alberta were waiting for hip or knee replacement surgery as of March 31, 2007. According to the same report, nationwide some "estimated 523,600 Canadians had difficulties getting to see a specialist, 200,000 had difficulties getting non-emergency surgeries, and 294,800 had difficulties getting selected diagnostic tests."

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The Real Issue is the "Public Option"

On Saturday, November 7th Nancy Pelosi secured the votes she needed to pass ObamaCare by allowing the controversial Stupak Amendment--which made it illegal for taxpayer-subsidized insurance plans to cover abortions--to be included in the bill.

More than 30 House Democrats had signed a letter stating they would not vote for the bill if it contained even a cent of federal funding for abortions. In the end, more than 60 members voted to strip the funding from the bill.

Unfortunately, when the Stupak Amendment passed, it provided enough political cover for vulnerable Democrats, many of whom are running in districts with strong pro-life constituencies--to then vote for the overall bill.

Given the success of the tactic, the Senate now appears poised to try the maneuver again as debate unfolds there. This leaves Senate Republicans and fiscal hawks like Senator Joe Lieberman with a daunting challenge.

To prevent Senate passage of the bill, they must effectively communicate to their colleagues—and the American people—that the Stupak Amendment is not the issue. Because even with the Stupak Amendment, this is still a bad bill. A very bad bill.

It still is a government health care takeover that will dismantle the finest health care system on the face of the Earth. It still opens the door for a single payer system. It still rations care away from seniors. It still would increase health premiums. It still would put bureaucrats between doctors and patients. It still would break the public treasury and leave taxpayers with a deepening debt that can never be paid.

Most Americans oppose this legislation, which Americans for Limited Government estimates will cost more than $2.1 trillion over ten years once fully implemented. According to Rasmussen Reports, 52 percent of voters want their representatives to vote “no.”

In order to overcome “public option” proponents, opponents of ObamaCare must be wary of political maneuvers that make it easier to pass this abomination. There is too much at stake.

That is not to say that pro-life Senators should not move to strip out abortion funding. But the Senate majority should not be allowed to use that maneuver to provide cover for the bill’s final passage. Their Senate colleagues—and their constituents—must hold their feet to the fire to hold the line on a successful filibuster. The point is to kill the bill, not just a single provision.

If government dismantles America’s health care system, it’s not just the lives of the unborn at stake. It’s the lives of the young and old, as well.

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A Health-Insurance Criminal Pleads His Case

Why I will ignore the mandate

If mandatory health insurance goes through, it will turn me into a criminal. I don’t have health insurance. I don’t want it. And I will refuse to buy it even though I can afford it. Before they lead me to the cells, perhaps the prisoner may be allowed to say a few words in his defense.

It’s understandable that politicians are eager to eliminate the medically uninsured. For years they’ve been told that we are the flies in the ointment of health care policy. It is said we are either a) wrecking the system by using services we don’t pay for, or b) we are deprived of needed medical care and therefore objects of pity and subsidy.

These points may apply to some uninsured but not to all. Some of us belong in what might be called the “successfully uninsured” category. We are not freeloaders. We believe we have an obligation to pay for the medical care we receive, and we always pay for it. I put no financial burden on doctors, hospitals, or taxpayers, and politicians are wrong to assume I am part of the country’s health care problem.

Politicians are also wrong to assume that I am an object of pity. Like many Americans, I have significant savings and can afford medical expenses out of pocket. (Census Bureau figures for 2000 show that over 18 million households had assets in excess of $250,000). Our savings make it possible for my wife and me to decline both private insurance and Medicare (we are 70). Those without savings are in a different situation: They probably need insurance, or a subsidy, or charitable help. My point is that if you can handle your own medical bills through savings and personal responsibility, this is a sound approach. Politicians should encourage this state of self-reliance, not make it a crime.

There are many advantages to being insurance-free. The first is flexibility. Several years ago, my wife had a serious bout with cancer. The successful treatment involved surgery and local radiation therapy. After much study she refused the more massive radiation treatment recommended by the doctor and pursued alternative therapies, including acupuncture, nutritional therapy, massage, and naturopathic medicine. Every decision was made in terms of what seemed best to treat this illness. We were not drawn into using inappropriate therapies because they were “free,” nor did we pass up desirable therapies because they were “not covered.”

The second advantage of being insurance-free is we avoid bureaucracy. We don’t fill out insurance forms; we don’t make phone calls trying to find out what’s covered; and we don’t play games (with the collusion of doctors) trying to get things we need paid for by someone else. If an aching back suggests the need for a different mattress, we go out and buy one and don’t waste time and money trying to prove to some clerk that it’s covered. When the government offered a new piñata of benefits in the form of prescription drug coverage, we entirely escaped the frustration of figuring out how to deal with its staggering confusion. While other seniors were closeted with lawyers and sons-in-law trying to decide what to sign up for, we went hiking.

Refusing health insurance may have advantages, but what will happen if I face a medical problem that requires more than my savings? To understand my answer, consider a parallel question about some other commodity, say, housing. I announce that I believe in paying for housing from my own financial resources. Someone points out there might be a house I want that costs more than I can afford. That’s just too bad: I don’t get to buy it. I limit my housing consumption according to my resources.

I look at medical care the same way: If something costs too much, I do without. This position, so obvious and sensible in other areas, is considered untenable when it comes to medical care. In this realm the prevailing assumption is that everyone is entitled to all the health services he needs or wants.

It’s one thing to announce this entitlement as an ideal, but quite another to make it work. In the real world medical resources are limited, and therefore all approaches to healthcare funding employ rationing.

In tax-based systems administrators establish waiting lists so that some patients die before their opportunity for treatment comes up. They ban the use of expensive treatments and alternative therapies. And, without exactly saying so, they underfund medical facilities, so that patients wait in the halls of emergency wards, for example. In commercial insurance plans rationing is implemented by restricting coverage to specific procedures and specific doctors — and by setting upper limits to coverage.

Paying your own medical bills is simply another way of limiting consumption: If a treatment costs too much, you don’t buy it. The advantage of self-rationing is it is frank and open, and thus avoids the whining and blaming that characterize bureaucratic systems.

Paying your own medical bills also lets you see that there are more socially constructive ways to use funds than spending on health care. Suppose that to fix your limping gait requires complicated care costing hundreds of thousands of dollars. If others pay for this care, you might accept it. But suppose you are paying for it with your own savings. Now you might think twice about spending the money on yourself. You might know of a school for autistic children that could put the money to good use. Or you might have a grandchild who needs the money to start a business.

Such decisions are indeed difficult, but we need to face them if we are to make sensible choices about health care. Today we are not facing them. We are hiding behind the confusion of a tangled government/corporate system that pretends we can have all the medical care we want.

Spending my own money on health care helps me set a rational limit to medical spending, even on spending to preserve my life. Not buying health insurance and not allowing politicians to force others to fund my needs helps me keep my consumption of medical resources within fitting bounds.

This way of looking at health insurance may be old fashioned, but should it be a crime?

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The health care rationing commission

Meet the unelected body that will dictate future medical decisions

As usual, the most dangerous parts of ObamaCare aren't receiving the scrutiny they deserve—and one of the least examined is a new commission to tell Congress how to control health spending. Democrats are quietly attempting to impose a "global budget" on Medicare, with radical implications for U.S. medicine.

Like most of Europe, the various health bills stipulate that Congress will arbitrarily decide how much to spend on health care for seniors every year—and then invest an unelected board with extraordinary powers to dictate what is covered and how it will be paid for. White House budget director Peter Orszag calls this Medicare commission "critical to our fiscal future" and "one of the most potent reforms."

On that last score, he's right. Prominent health economist Alain Enthoven has likened a global budget to "bombing from 35,000 feet, where you don't see the faces of the people you kill."

As envisioned by the Senate Finance Committee, the commission—all 15 members appointed by the President—would have to meet certain budget targets each year. Starting in 2015, Medicare could not grow more rapidly on a per capita basis than by a measure of inflation. After 2019, it could only grow at the same rate as GDP, plus one percentage point.

The theory is to let technocrats set Medicare payments free from political pressure, as with the military base closing commissions. But that process presented recommendations to Congress for an up-or-down vote. Here, the commission's decisions would go into effect automatically if Congress couldn't agree within six months on different cuts that met the same target. The board's decisions would not be subject to ordinary notice-and-comment rule-making, or even judicial review.

Yet if the goal really is political insulation, then the Medicare Commission is off to a bad start. To avoid a senior revolt, Finance Chairman Max Baucus decided to bar his creation from reducing benefits or raising the eligibility age, which meant that it could only cut costs by tightening Medicare price controls on doctors and hospitals. Doctors and hospitals, naturally, were furious.

So the Montana Democrat bowed and carved out exemptions for such providers, along with hospices and suppliers of medical equipment. Until 2019 the commission will thus only be allowed to attack Medicare Advantage, the program that gives 10 million seniors private insurance choices, and to raise premiums for Medicare prescription drug coverage, which is run by private contractors. Notice a political pattern?

But a decade from now, such limits are off—which also happens to be roughly the time when ObamaCare's spending explodes. The hard budget cap means there is only so much money to be divvied up for care, with no account for demographic changes, such as longer life spans, or for the increasing incidence of diabetes, heart disease and other chronic conditions.

Worse, it makes little room for medical innovations. The commission is mandated to go after "sources of excess cost growth," meaning treatments that are too expensive or whose coverage will boost spending. If researchers find a pricey treatment for Alzheimer's in 2020, that might be banned because it would add new costs and bust the global budget. Or it might decide that "Maybe you're better off not having the surgery, but taking the painkiller," as President Obama put it in June.

In other words, the Medicare commission would come to function much like the National Institute for Health and Clinical Excellence, which rations care in England. Or a similar Washington state board created in 2003 to control costs. Its handiwork isn't pretty.

The Washington commission, called the Health Technology Assessment, is manned by 11 bureaucrats, including a chiropractor and a "naturopath" who focuses on alternative, er, remedies like herbs and massage therapy. They consider the clinical effectiveness but above all the cost of medical procedures and technologies. If they decide something isn't worth the money, then Olympia won't cover it for some 750,000 Medicaid patients, public employees and prisoners.

So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer. It will also rule on routine ultrasounds for pregnancy, which have a "high" efficacy but also a "high" cost.

Currently, the commission is pushing through the most restrictive payment policy in the nation for drug-eluting cardiac stents—simply because bare metal stents are cheaper, even as they result in worse outcomes. If a patient is wheeled into the operating room with chest pains in an emergency, doctors will first have to determine if he's covered by a state plan, then the diameter of his blood vessels and his diabetic condition to decide on the appropriate stent. If they don't, Washington will not reimburse them for "inappropriate care."

If Democrats impose such a commission nationwide, it would constitute a radical change in U.S. health care. The reason that physician discretion—not Washington's cost-minded judgments—is at the core of medicine is that usually there are no "right" answers. The data from large clinical trials produce generic conclusions that rarely apply to individual patients, who have vastly different biologies, response rates to treatments, and often multiple conditions. A breakthrough drug like Herceptin, which is designed for a certain genetic subset of breast-cancer patients, might well be ruled out under such a standardized approach.

It's possible this global budget could become an accounting fiction, like the automatic Medicare cuts Congress currently pretends it will impose on doctors. But health care's fiscal pressures will be even stronger than they are today if ObamaCare passes in anything like its current form. And that is when politicians will want this remote, impersonal and unaccountable central committee to do the inevitable dirty work of denying care.

The only way to take the politics out of health care is to give individuals more power to control medical dollars. And the first step should be not to create even more government spending commitments. The core problem with government-run health care is that it doesn't make decisions in the best interests of patients, but in the best interests of government.

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17 November, 2009

Thousands of British Parkinson's disease sufferers wrongly diagnosed

Around 6,300 people in the UK who believe they are suffering from Parkinson's disease could have been wrongly diagnosed, a new study has claimed. Researchers in Scotland, who assessed patients on anti-Parkinson's medication, found that five per cent had little more than stiffness or hand tremors.

A report published in the Movement Disorders journal warned that millions of pounds was being wasted on unnecessary drugs each year. While the wrongly prescribed medication was not thought to have any adverse side effects, patients were subjected to years of anxiety.

Dr Keiran Breen, one of the authors of the report said Parkinson's was a notoriously difficult disease to diagnose accurately in its early stages, but recommended all suspected sufferers should be referred to specialists regularly. He said: "No two people with Parkinson's disease will have the same diagnosis. The three main characteristics are tremors, slowness of movement and stiffness, but not everyone will have all three symptoms. The patients should be referred to neurologists with more expertise and they will make a much more accurate diagnosis."

There are around 120,000 sufferers in the UK but during the study more than five per cent were found to have been misdiagnosed. Dr Breen said: "We didn't find evidence that taking drugs caused harm to the patients without Parkinson's but it could mean people were denied the correct drugs to improve their actual condition."

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Controversial electronic medical records to be rolled out across Britain

Anybody who trusts the British bureaucracy with their personal information has not been listening. There have been dozens of instances of "lost" records -- and the computer system concerned has long been full of bugs

Every patient in the country will have sensitive medical information uploaded to a controversial central database within two years. Ministers insist that the records will allow patients to be treated more efficiently no matter where they are in the country. But critics have warned that the centralised database could be open to abuse.

Experts said that patients could also feel “forced” to allow highly sensitive material on the system because ministers have decided to include all patients across the country unless they specifically opt out. Patients in London will have their confidential records uploaded by the end of next year on to the NHS computer network known as the Spine. Family doctor practices across every party of the country will be transmitting the data by the end of 2011.

The records will contain vital basic medical information including illnesses, medications and vaccination history. They could also include past conditions patients had suffered and previous medication they were given. Age and address would also be included but not other personal information, such as marital status. Ministers have admitted that extra medical information could also be added in the future, including controversial do not resuscitate orders.

In May, the Government performed a u-turn when they announced that patients would be allowed to delete electronic summaries of their treatment records from the new database. Previously, they had insisted that to do so would be too costly. Doctors have to ask a patients’ permission every time they wish to view their records, except in emergency circumstances, such as when they feel a patient may be at risk. Only medical staff directly involved in a patient’s care will be allowed to look at the information. But all patients will be added on to the database unless they specifically refuse.

Ministers insist that the records will improve care as doctors no longer have to rely on patient’s memories, which can often be incomplete or inaccurate. They claim that elderly and more vulnerable patients, including those who do not have English as a first second language will benefit the most. Pilot projects trialling the Summary Care Records scheme have taken place across the country in recent years and more than 700,000 patients currently have their records uploaded.

Mike O’Brien, the Health Minister, said: “Having the right information at the right time can make all the difference to patients’ experience of urgent care. “Summary Care Records can improve the quality and safety of treatment provided as well as increasing people’s comfort and reassurance. “We are particularly interested in the experience at Bury which has incorporated End of Life wishes for a substantial number of patients. “Moving the NHS from good to great needs improvements such as this.” Ruth Carnall, chief executive of NHS London, said: “Getting hold of health records for London’s highly mobile population often presents real challenges to doctors and nurses when patients need out-of-hours and emergency care.”

But Dr Grant Ingrams, chair of the British Medical Association's GP IT committee, warned that patients could feel that they were being forced to put highly confidential information on the system. He said: “Electronic Summary Care Records have the potential to improve both quality and safety of patient care but it is critical for the programme’s success that all patients receive balanced information and are made aware of their option to opt out. “If patients feel they are being coerced, or have a summary care record created without their knowledge or understanding, it will damage the credibility of the project.”

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No Free Lunch: The True Cost of ObamaCare

Far from providing "affordable" care for everyone, ObamaCare would come at a painful price - higher insurance premiums, more and higher taxes, fewer jobs, lower wages, a reduced standard of living and an erosion of privacy and individual liberty. Here's the real cost of ObamaCare.

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

Higher Taxes - Government cannot provide free or subsidized care for someone without taking money from someone else - and that someone else may be you. The Wall Street Journal puts it bluntly: ObamaCare will be paid for with "huge tax increases." How huge? According to Jeffrey H. Anderson, Ph.D, Senior Fellow of Health Care Studies at the Pacific Research Institute, one ObamaCare proposal would "raise taxes by $2.3 trillion" over the next two decades. Yes, trillion.

Lower Wages/Fewer Jobs - New taxes and fees imposed on businesses by ObamaCare would "discourage companies from hiring or continuing to employ low-income and moderate-income workers," according to the Heritage Foundation. And it won't just be low-income workers who see a smaller paycheck - according to FORTUNE magazine's Shawn Tully, ObamaCare would lead to "a steep, shocking decrease" in the incomes of middle-class workers.

Standard of Living - The massive government spending required to finance national health care would explode the federal deficit with ruinous consequences for every American's standard of living. According to the Congressional Budget Office, "Large budget deficits would reduce national saving, leading to more borrowing from abroad and less domestic investment, which in turn would depress income growth in the United States. Over time, the accumulation of debt would seriously harm the economy."

Medicare Benefits - ObamaCare would pay for itself, in part, with hundreds of billions of dollars in cuts to Medicare and Medicare Advantage. But the Congressional Budget Office warns that cuts to Medicare Advantage "could lead many plans to limit the benefits they offer, raise their premiums, or withdraw from the program," devastating seniors' health-care options. The Wall Street Journal confirms, "cuts in Medicare's price controls will cause many doctors to quit the program."

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

According to the Washington Examiner's Byron York, ObamaCare would mean "an expanded and more intrusive IRS," which would be empowered to target and punish violators of the new law. Additionally, an ObamaCare tax on employers would necessitate your boss knowing your family's entire income from all sources, information which would then be shared with the insurance company.

Your Freedom - Think you have the right to decide whether you even want insurance? Guess again. ObamaCare would require, under threat of penalty, every American to have insurance, fundamentally altering the relationship between citizen and state. As the CBO puts it, ObamaCare "would establish a requirement for [legal U.S. residents] to obtain insurance and would in many cases impose a financial penalty on people who did not do so." So much for 'land of the free.'

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

That's the kind of "free" care we just can't afford.

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Whose business is your health care?

Our ongoing debate about government’s role in health care is proving worthwhile because it forces people to focus on the real tradeoffs in a system mandated - if not directly operated - by government, rather than one selected by individuals or their employers. Today, our system is a dysfunctional hybrid.

To the extent that we cannot choose the health care coverage we want today, those restrictions are almost always the result of previous government interventions - tax incentives that make it easier for employers to buy insurance than for employees to purchase their own or laws requiring us to purchase coverage we may not need or cannot afford.

President Obama says all insurance policies will be required to cover preventive care and early screening for various maladies, as if he can force insurance companies - or doctors - to give us something for nothing.

Well, he can’t do that anymore than he can require restaurants to serve a free lunch every Thursday. Even under Barack Obama, Americans cannot be compelled to do business at a loss; they always have the right to lock the doors and close up shop.

That’s why there’s no free lunch - or free health care. Politicians aren’t “giving” us these services; they are forcing us to buy them - and to pay more than the actual cost.

It never ceases to amaze when politicians who demagogue against “greedy” insurance companies will, in their next breath, require us to buy things through an insurance company that we could purchase less expensively if we simply paid out of pocket.

If both you and your doctor know that you need a colonoscopy, how can it possibly be cheaper for you to send your payment to an insurance company, while the doctor files a claim with that insurance company, and the insurance company processes the claim and issues payment - rather than for you to simply pay the doctor?

Yet ObamaCare would establish a mandatory list of insurable procedures as well as maximum deductibles. For those with money-saving high-deductible plans and health savings accounts - like the one I’ve had for 12 years - the President’s promise that we can keep the plan we have just doesn’t wash.

Americans who are understandably frustrated by health care costs are recognizing that the more control you give to government the more control you give to government.

Today, if you, your doctor and your insurer agree on a procedure, you make an appointment and “get ‘er done.” And if you can’t agree, you are free to pursue other procedures that you can pay for yourself. (After all, what good is an extra $50,000 in your retirement account if you’re dead?) But if no one practices those alternative procedures because omnipotent health care bureaucrats won’t pay for them, you are out of luck.

The larger point is this: Why is it government’s business how much you pay, what doctor you see, or what treatment you receive, so long as you are paying the bill?

Health care, like any commodity or service, will always be limited by economic reality. Government health care programs are responsible for more cost-shifting than all of the “uninsured.” Yet despite paying below-market prices, Medicare will be insolvent in just seven years and has amassed all by itself a deficit of $37.8 trillion.

If the government is empowered to supervise everyone’s health care, then only two outcomes are possible: either everyone’s health care is rationed to control costs or no one’s health care is rationed and the cost of government health care finally breaks the camel’s back, ushering in a worthless dollar, runaway inflation and skyrocketing interest rates.

In either case, our impoverished children and grandchildren will forever curse our self-centered, shortsighted generation. There can be no health care utopia any more than everyone can enjoy all they want to eat or live in the home of their dreams. Sooner or later, someone must choose between what we want and what we can afford. Who do you want to make those tough choices - yourself or someone in government?

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One healthcare reform

Proponents of the current healthcare reform proposal in congress like to accuse critics of not offering any alternatives, of only opposing without offering anything. While that accusation is completely not true, it serve proponents of the fascist system well as a big lie, just as calling it socialist instead of fascist serves as another convenient lie.

Rather than dissect any particular part of the fascist bill, a refutation of the false charge that critics offer nothing is also useful. The reason the proponents say that critics offer nothing is because only big government solutions are allowed to be considered. Anything else is not a "constructive proposal" and thus they can get away with that big lie.

In spite of the psychological block against small government proposals being considered, it is always useful to suggest as many small government solutions as possible. That way the next time someone says that critics of fascist health care never offer solutions the critics can respond with "look at all the solutions I've offered that you refuse to consider."

Given the large number of problems, any single solution fails to address the full problem and appears short sighted. But one aspect is all that can be addressed at once.

One of the problems with the current system is that the patient is not the customer. When a doctor treats a patient, the patient isn't the customer. The insurance pays for the visit, and so the insurance is the customer. And who is the insurance company's customer? Since most people get their insurance through their employer, the employer is the customer and not the employee. It is true that sufficient employee complaints can cause an employer to switch companies, but the customer of the insurance company is the employer.

For a truly responsive insurance company, the patient needs to be the customer of the insurance company. For truly responsive health care, the patient needs to be the customer of the doctor. The only remaining question of this particular solution is how to make it possible. As proponents of fascist health care are quick to point out, the average person cannot afford a catastrophic illness.

The first part of the solution is to transfer the tax incentive for the purchase of health insurance from the employer to the employee. That way, unlike the Obama plan, people have a positive encouragement to purchase insurance instead of a punishment for failure to purchase insurance. Persuasion always being preferable to force, encouraging people to purchase insurance instead of punishing them for failure to purchase insurance is a better solution.

To make insurance affordable enough for a person to purchase it, the price needs to be brought down. That can be done through coercion or through encouragement. To do it through encouragement the best way to do it is through removing the rules that prohibit insurance companies from competing across state lines. Putting individual insurance policies in the hand of the customers while simultaneously increasing the number of companies and policies available, while giving people a tax break for purchasing insurance, will drive down the cost to the point where most people can afford it.

Another way to make insurance affordable is to remember that insurance is supposed to be for the unusual event. The way health insurance currently operates is absurd - it is comparable to using automobile insurance to pay for basic tune-ups, or even to pay for putting gas in the car.

Analyzing a standard insurance statement or doctor's visit statement, one finds that in general a large portion of a standard bill is an insurance negotiated adjustment. Another large portion is the patient co-pay. The smallest part is the payment the insurance company makes to the doctor. Ask most doctors what their cash price is and it turns out it is actually lower than the stated price for a visit.

People need to pay directly for office visits, and a good way to do that is through tax deductible healthcare savings accounts. But not the HSAs currently in use, that have an end of year use-or-lose for the funds. What is needed is a roll-over HSA, that allows people to put in more funds than needed while healthy so that the funds will be there many years later when people need more healthcare funds. This is similar to using a retirement savings account. In order to encourage use of a roll-over HSA account funds put into it should be tax free, just as in the current annual HSA.

That will give our current healthcare system another thirty years of operation before it gets as bad as it currently is.

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16 November, 2009

Catch 22 in Britain

Woman too fat for operation is too thin for weight loss surgery. Expect similar bureaucratic catches to affect YOU under Obamacare

A woman who was considered too fat for a hernia operation has now been told she is not heavy enough to be given weight loss surgery. Jo Thompson, who is 5ft tall and weighs nearly 18 stone, has found herself in the Catch 22 situation after years of failed dieting. “I have always had a problem with my size,” she said today. “I have tried every diet going to lose weight. “In the last two years I’ve cut down on my portions, and although I can’t afford to go to the gym I do a lot of walking.”

Miss Thompson, 37, from Parson Cross, Sheffield, recently complained to her doctor about heartburn and indigestion. He referred her to a specialist at the city’s Royal Hallamshire Hospital, telling her he thought she needed a hernia operation. However, the consultant there said she was too big to undergo the procedure and instead recommended the gastric bypass. This, he said, would help her lose weight and thereby ease the hernia problem.

“But when I saw another doctor I was told I could not have the bypass surgery because I am not heavy enough. “It’s a crazy situation and I just don’t know what to do. I’m not obese enough to have a gastric bypass, but I’m too big to have the hernia operation. Miss Thompson, whose body mass index is 46, went on: “It seems I must reduce my body mass index to 40 to have the hernia operation or increase it to 50 to have gastric bypass surgery. It’s a crazy situation and I seem to be caught in the middle”.

The refusal by staff at Royal Hallamshire to carry out the bypass operation while Miss Thompson’s BMI remains below 50 has been criticised by a specialist health group. Dr Matt Capehorn, of the National Obesity Forum, said: "Under National Institute for Clinical Excellence (NICE) guidelines, patients who have unsuccessfully tried other weight loss methods should be considered for surgery if their BMI is above 40. "Sheffield NHS have been very short-sighted in their view of the funding for this operation because the surgery would pay for itself within three years.” He added: “They are not following NICE guidelines and are therefore leaving this woman in a state of limbo."

A spokesman for NHS Sheffield confirmed that the trust had turned down Miss Thompson’s request to have the operation. Its criteria on the issue had been set by the Yorkshire and Humber Specialised Commissioning Group and was therefore in line with the rest of the county. The procedure was always used as a last resort “because it is a very serious operation.”

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Australia: Ambulances sit waiting for hours before public hospitals can take patients from them

Too bad that patients arriving by ambulance are generally seriously ill

MORE patients than ever are waiting over 30 minutes in ambulances "ramped" outside busy Queensland public hospitals because doctors and beds are not available. State Government figures reveal a 26 per cent increase in the number of sick and injured people being forced to wait before being seen by an emergency department doctor. Queensland Ambulance Service staff reported waits of three to four hours were not uncommon before they could hand over a patient.

In 2007-08, the cumulative hours spent waiting in the back of an ambulance were 10,528 across the state's 27 public hospitals. That jumped to 13,269 in 2008-09. Brisbane experienced the biggest jump, from 3879 hours to 5823 – a 50 per cent increase.

Opposition emergency services spokesman Ted Malone described the waiting as disgraceful and said it was costing taxpayers millions of dollars every year. "The Bligh Government's own statistics prove just how serious this issue has become," Mr Malone said yesterday. "Public hospitals have been in crisis for years and I have repeatedly questioned the Bligh Government to detail the costs of hospital ramping. "Emergency Services Minister Neil Roberts has arrogantly brushed my questions aside and refused point blank to detail what the considerable cost is to the QAS."

Mr Malone said the union representing ambulance officers had kept a tally of hours spent ramped outside southeast Queensland hospitals. He said Mr Roberts should have access to the information, but suggested it would embarrass the Government. "This is a critical issue and Queensland taxpayers deserve to know what the dollar cost of ramping is to the QAS," he said.

The Liquor Hospitality Miscellaneous Union said that on one day in September, 11 ambulances were ramped at Logan Hospital for more than two hours.

In an answer to an Opposition question, Mr Roberts said the average off-stretcher time across Queensland was 13 minutes. He said 92 per cent of all patients were in hospital beds within 30 minutes and it was not possible to work out the cost of what officials termed "access block".

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Defeat Obamacare in Detail

Harry Reid can pass a bill in the Senate that has no public option or an easy opt out, shallow subsidies for the uninsured, a low total cost, weak penalties for not having insurance, no coverage for abortion and no general tax increase (except for the premium and medical device taxes). And Nancy Pelosi can pass a bill in the House (on final passage) that has a public option with no opt out, steep subsidies for the uninsured, harsh penalties if they don't buy insurance, a higher cost, full abortion coverage and a surcharge income tax increase. The question is: Can either one's bill pass the other's chamber? Probably not. So here's how all this is likely to unfold:

Pelosi's bill is dead on arrival in the Senate. Reid is going to have to give up his insistence on the public option and pass a bill in the Senate very much like the Max Baucus bill that came out of the Senate Finance Committee. After extensive negotiations with his liberal wing on the one side and the moderates in the Senate on the other side (led by Joe Lieberman), he will eventually strike a deal.

He'll let the bill pass with no public option or with a generous opt-out provision. Meanwhile, he will placate his liberals by telling them that the final version that the conference committee will report back to the Senate will have a robust public option, not to worry. (Just as Pelosi told her liberals that the final bill would not ban payments for abortions, not to worry.)

After weeks of negotiations, the Senate will probably pass its version of the bill as a Christmas present to America. But ... in the course of all of these negotiations, Barack Obama and the Democrats are going to look worse and worse, more divided and less focused on the ultimate objective. Public antipathy to the bills will mount, and the worst-case scenario of each possible variation in the legislation will spark its own storm of opposition. By the time the Senate acts, the feminists will be angry, the uninsured will be angry, the senior citizens will be angry and the fiscal conservatives will be angry. Support for the bill will drop week after week during November and December.

By the time Congress reconvenes in January to wrestle with the two competing versions, support for the bill will have dwindled to a perilous point. This reduced level of support will just serve to make senators and congressmen more intransigent in the negotiations. Since the bill will need 60 votes in the Senate after the conference report, Lieberman, Maine's Olympia Snowe and Susan Collins, and a handful of other moderates will each have a veto. And, collectively, the liberals in each chamber will have onem as well. Weeks and months of wrangling will ensue. The result could be the defeat of the bill or its amendment in positive ways (for those opposed to it).

Our task is to reduce public support for the bill by publicizing its provisions, notably:

1. The $400 billion cut in Medicare.

2. The inevitable scarcity that will result from the addition of 35 million new patients with no new doctors or nurses.

3. The fine on the uninsured of 2.5 percent of their income if they don't buy insurance.

4. The high cost of these mandatory insurance policies ($15,000 per family).

5. The low level of subsidy available for the uninsured (only after they pay 8 percen to 12 percent of their incomes).

6. The likelihood of a $1,700 increase in the average family's premiums.

7. The possibility of up to five years in prison for failing to buy insurance or pay the fine.

8. The taxation of medical devices like pacemakers, wheelchairs, prosthetic limbs, hearing aids, etc.

9. The tax on sick people (increasing the threshold for deducting medical expenses from 7.5 percent to 10 percent of income.

10. The additional fiscal burden on the states of the increase in Medicaid eligibility.

11. The 40 percent tax on health insurance premiums that will effect households earning more than $75,000 by the fifth year of the plan.

We can still win this fight!

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CMS: House health bill will hike costs $289B

The House-approved healthcare overhaul would raise the costs of healthcare by $289 billion over the next 10 years, according to an analysis by the chief actuary at the Centers for Medicare and Medicaid Services (CMS).

The CMS report is a blow to the White House and House Democrats who have vowed that healthcare reform would curb the growth of healthcare spending. CMS's analysis is not an apples-to-apples comparison to the cost estimate conducted by the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) because CMS did not review tax provisions, which help offset the price tag of the Democrats' measure.

However, the CMS analysis clearly states that the House bill falls short in attaining a key goal of the Democrats' effort to reform the nation's healthcare system: "With the exception of the proposed reduction in Medicare... the provisions of H.R. 3962 would not have a significant impact on future healthcare cost growth rates."

Republicans immediately seized on CMS's conclusions. The long-awaited report should serve as a "stark warning to every Republican, Democrat and Independent worried about the future of this nation," Ways and Means Committee ranking member Dave Camp (R-Mich.) said in a statement on Saturday.

Though House Republicans pressed to have this analysis completed before the lower chamber voted on the Democrats' sweeping healthcare reform bill last week, it was not ready until late Friday. Chief CMS Actuary Richard Foster, who prepared the report, recently told The Hill that he and his staff had only a few days to review the bill before it was voted on.

Brendan Daly, communications director for Speaker Nancy Pelosi (D-Calif.), said, "The report shows that our health reform bill will extend the life of the Medicare trust fund by five years -- significantly longer than any proposal in recent years," adding, "Medicare actuaries estimate $100 billion more in savings than CBO from Medicaid and Medicare."

Minority Leader John Boehner (R-Ohio) highlighted the CMS report on Saturday in a written statement. "This report once again discredits Democrats’ assertions that their $1.3 trillion government takeover of health care will lower costs, and it confirms that this bill violates President Obama’s promise to ‘bend the cost curve.’ It’s now beyond dispute that their bill will raise costs, which is exactly what the American people don’t want."

Republicans predicted that if the CMS numbers were available last Saturday when the House voted on the Democrats' healthcare bill, the measure would not have passed. “This report confirms what virtually every independent expert has been saying: Speaker Pelosi’s healthcare bill will increase costs, not decrease them. I hope my colleagues in the Senate heed CMS’ findings and refuse to rush ahead until any bill under consideration can be certified to actually reduce healthcare costs," Camp said.

According to the 31-page report, the House-passed bill would increase costs, cut Medicare and expand Medicaid. “In aggregate, we estimate that for calendar years 2010 through 2019 [national health expenditures] would increase by $289 billion," the report notes. "About three-fifths" or more than 60 percent of the uninsured would gain coverage by an expansion in Medicaid eligibility.

Medicare would be cut by "more than one-half trillion dollars ($571 billion), ... possibly jeopardizing access to care for beneficiaries," according to the report, and smaller companies would be "inclined to terminate their existing coverage."

Camp said that the nonpartisan analysis demonstrates that the Democrats' bill "does the opposite of everything they've been wanting to do" in terms of reducing overall health costs. He added the CMS report shows that "this is not healthcare reform, this is entitlement expansion."

A Democratic aide said the CMS and CBO findings are not that different: "While the actuaries do not show tax increases, adding those amounts from JCT would also illustrated that the proposal reduces the deficit over the next 10 years."

In an interview with The Hill on Saturday afternoon, Camp pointed out that CMS actuarial numbers were cited by Democrats back in 2003 during the Medicare prescription drug debate. CMS estimated at that time that the GOP-crafted Medicare bill would cost more than $550 billion over 10 years while CBO estimated its pricetag at $395 over the same period. The CMS cost estimate did not emerge until after the final conference bill was approved by Congress.

CMS's findings are not binding on Congress, however. Congress must abide by CBO and JCT estimates.

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Health cooperatives: Fast lane to nationalization

Of the 1,990 pages in the healthcare reform bill passed by Congress Saturday night, page 206 is especially touted – and little understood. That's the page that creates a federal Consumer Operated and Oriented Plan (CO-OP) to establish not-for-profit, member-run health insurance cooperatives.

Supporters say these health cooperatives, or HCs, will reduce costs by giving smaller buyers of insurance (such as small businesses) the ability to act as a large buyer. HCs will level the playing field, giving the "little guy" much more leverage to negotiate lower prices. They won't. What they will do is put the United States on a track toward nationalized healthcare even faster than the government-run insurance plan called the public option.

The reason HCs won't lower costs has nothing to do with politics or economics but a simple error of logic called the "fallacy of composition." Senators should take a refresher course in logic before they review page 206 and the rest of the legislation in coming weeks.

What, exactly, is a fallacy of composition? The basic idea is that if something is true for the part, it is not necessarily true for the whole. For example, if the Red Sox improve their batting average next year, they'll probably win more games. But if all major-league baseball teams improve their batting average next year, will all teams win more games? Of course not.

Yet proponents of HCs are making a similar mistake in judgment. Their fallacy results because market power is a relative concept. The advantage of being a large buyer comes at the expense of small buyers, so it is a fallacy to expect that any benefit currently derived from large buyers can be enjoyed by everyone if everyone becomes a large buyer.

Suppose, for example, that a pencilmaker sells one pencil per month to 10 separate buyers. Each pencil costs $1 to make and overhead is $10. The pencilmaker needs at least $20 in revenue per month to stay in business, so the average price per pencil must be at least $2.

Now suppose some buyers form a cooperative and use their newfound market power to negotiate a price below $2. To continue generating $20 in revenue, the pencilmaker must now charge the remaining buyers more than $2 because overhead has to be paid by someone.

If the remaining buyers also form a cooperative they may to able to negotiate the pencil price back down to $2, but only if pencil buyers in the first cooperative experience a price increase. Once everyone is large, the advantage of being large disappears.

Similarly, if "Jane" switches from a non-HC plan to a HC plan, she will probably get to pay a lower premium because the HC plan can negotiate lower reimbursement rates. But that also means that she will now be contributing less to her healthcare providers' overhead expenses than before. This forces them to make up the difference by charging non-HC plan patients more.

So if we reform the system to make small buyers large ones, then as the number of small plans declines, the large plans will run out of small plans to shift costs to, so the benefit of being large will disappear.

Some liberals find HCs appealing because they believe them to be a first step toward nationalized healthcare. Most conservatives oppose them for that very same reason. Some conservatives, however, find them appealing because they appear to be less risky than having a government-run public option that competes with private policies.

It is true that a public option carries the risk of driving all private insurance out of existence because it can set terms and rates that no private plan can actually compete with. But if a public option plan began to drive private insurers out of business, then it is at least conceivable that political pressure could emerge to correct course.

Once government-supported HCs take effect, however, they would almost certainly mean the end of private plans, because forthcoming insurance regulations will leave non-HC consumers with added costs and subtracted benefits – nudging everyone into HCs. So by establishing HCs as the centerpiece of reform and then regulating them directly, lawmakers may end up providing a faster path to de facto nationalized healthcare than a public option, which is also included in the House bill.

Indeed, what makes the House bill especially galling is that it has both HCs and a public option. Either provision, on its own, would overwhelm private healthcare. That's why voters shouldn't take much comfort in the speculation that the Senate might exclude a public option. If the Senate's version of the bill includes a provision for HCs, then reform would ultimately nationalize healthcare in America.

Those who are serious about making sure everyone has health insurance need to stop adding more layers of complexity to an already complex system.

The solution is to abolish Medicare and Medicaid, abolish the favorable tax treatment of employer-provided insurance, impose a one-price rule on procedures, and issue a voucher to every single American citizen. The creation of a voucher program would certainly take less than 1,990 pages of legislative language. This will solve the problem of the uninsured completely, immediately, and permanently in a transparent way that works with, rather than against, competition. The big losers will be special interest groups because a transparent voucher system will rob them of their ability to manipulate the system. They know this all too well, which is why they oppose it.

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Insurance perks for healthy habits spur opposition

Who could object to rewarding people who quit smoking, lose weight or start to exercise? The American Cancer Society and the American Heart Association, for starters. Some companies now charge lower insurance premiums to workers who meet benchmarks for healthy living. The Senate's health-care overhaul legislation would expand the trend.

But instead of cheering the proposal, some patient-advocacy and health groups are worried that it would mean higher rates for less-fit Americans, possibly pricing them out of their employers' insurance plans. "It is a way of cherry-picking," said Dick Woodruff, senior director of federal affairs for the American Cancer Society. "We are all for workplace wellness, but when you tie it to the insurance-pricing system, it's a real problem."

Critics of the Senate proposal also say that giving special treatment to those who meet a company's fitness standards could undercut one of the marquee promises of the Democrats' proposed overhaul: preventing employers and insurers from discriminating against people on the basis of their health status and pre-existing medical conditions.

Under current law, companies can discount insurance premiums by 20 percent if employees meet benchmarks for weight, smoking or other aspects of their health. Earlier this year, two Senate committees, as part of the health-care overhaul, voted to allow such cuts to go as high as 50 percent.

Leading the charge for the idea is Safeway, the giant grocery-store chain, which already has adopted an incentive program that includes health-premium reductions. Last year, the company began to offer a 20 percent premium discount to its non-union workers who quit smoking, went on a diet, brought down their blood pressure and cut their cholesterol.

Jo Chiti, a Safeway employee who has lost about 30 pounds over the last year, said she has been swayed by Safeway Chief Executive Steve Burd's argument that health insurance should be more like car insurance. Just as good drivers should be rewarded with lower premiums than reckless drivers, Burd says, people who maintain a healthy lifestyle should pay less for coverage than people who do not.

A lobbying blitz by Burd, who has traveled to Washington 11 times this year, was instrumental in the two Senate committees' decision to include the idea in their health-care bills. Senate leaders are putting together the final version of a bill they will take to the Senate floor. "We believe that personal responsibility and financial incentives are the path to a healthier America," Burd said in a newspaper column.

Critics in the labor movement say the incentive scheme is a backdoor way for companies to cut their costs by driving less-healthy workers out of the insurance group. Indeed, most of Safeway's union workers, who are represented by the United Food and Commercial Workers and make up about 95 percent of the company's workforce, have not embraced the idea in their own health plan, which is established in a multi-employer contract.

What is more, critics worry that the program will unfairly penalize people whose health status is not solely the result of behavior they can easily control, such as a genetic predisposition to obesity or the weight gain that often accompanies smoking cessation.

Ken Schachmut, a Safeway senior vice president, says the company has a system for making exceptions if people bring a physician's note to explain why they cannot safely or wisely achieve the set goals. "We do not discriminate," he said. Opponents hope to water down the Senate provision in the legislative maneuvering ahead.

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15 November, 2009

NHS whistleblower 'sacked for revealing dumped x-ray scans'

A NHS whistleblower who claims that he was sacked because he revealed a leading hospital was dumping x-ray scans will take his case to an employment tribunal next week. Dr Otto Chan, a consultant radiologist, believes that he was labelled a troublemaker after the revelations about the Royal London. He claims that hospital bosses decided to get rid of him and that his dismissal has left him unable to get another job in the health service. He is suing the hospital for loss of earnings, future earnings and pension. But he says that he also want to set a precedent that could help protect future NHS whistleblowers.

Dr Chan, 52, said that problems began after he warned that 10,000 packets of films and scans had built up because the Barts and the London Trust, which runs the Royal London, had neither the people nor the money to analyse them. He also raised concerns about junior doctors treating patients unsupervised. “After that the Trust decided they were going to get rid of me,” he said. He claims he was then accused of causing “disharmony” within the department and was dismissed by the hospital in 2006.

Since then he has been unable to find a permanent job in the NHS since. Dr Chan said that he hoped his case would offer greater protection to other NHS whistleblowers, who he said had a responsibility to expose problems in the health service. He said: “As doctors we have a responsibility to protect our patients. If we do not report them then theoretically we should be taken to the GMC.”

The case, which will start in Stratford on Monday, is being supported by the Medical Protection Society and is already estimated to have already cost between £2 and £3 million.

A spokesman for the trust said: “Dr Chan worked as a consultant radiologist at Barts and The London NHS Trust between January 1993 and his dismissal in June 2006. His dismissal is now the subject of an industrial tribunal. “It would be inappropriate, therefore, to comment further until the conclusion of that process. Dr Chan’s dismissal followed a 19-month investigation, which included a formal hearing by an independent panel. "The panel concluded that there were grounds for dismissal. The dismissal was in no way connected with issues with our radiology processes."

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NHS hospitals treat Alzheimer’s patients so badly 'one in three carers complain'

Hospitals are treating Alzheimer’s patients so badly that one in three sufferer’s families have complained about their loved one's care. Even greater numbers of relatives and friends said they wanted to complain but had not, a new report by the Alzheimer’s Society shows. The figures are released just days after an independent review warned that 1,800 dementia patients are being killed every year by controversial ‘chemical cosh’ drugs given to keep them quiet.

Carers told the charity of sufferers left to sit in their own urine and nurses who complained that they had too many patients to look after. The report also heard of patients going hungry because they were not helped to eat or drink and many were generally treated with a lack of basic dignity and respect. One carer said that when nurses were asked for help with cleaning her mother they responded “that’s someone else’s job”.

The charity said that the situation was a “disgrace”. The study also found that almost eight in 10 carers, 77 per cent, were dissatisfied with the quality of dementia care in hospitals. The same number think that hospital staff do not understand the illness. Yet figures show that people with dementia occupy up to one in four hospital beds in England at any one time.

Neil Hunt, chief executive of Alzheimer’s Society, said: “It is a complete disgrace that so many families are receiving such poor care that they are being forced to complain. “People expect and deserve better but these new figures suggest that is far from the case. “As the numbers of people with dementia increase almost exponentially pressure on the NHS will also increase – we need to sort this problem out now.”

Earlier this week an independent report warned that four in five of the 180,000 dementia patients in hospitals and care homes on antipsychotic drugs were being wrongly prescribed the medications, which kill many of them.

Ministers have announced plans to try to cut the number of the drugs prescribed by two-thirds within three years.

More than 700,000 people in Britain suffer from dementia, of which around 400,000 have Alzheimer’s, the most common type. Experts warn that one in three people currently aged over 65 will die with dementia. The disease is also predicted to become increasingly more common in coming decades, as the population ages.

More than 1200 carers of people with dementia took part in the survey, which forms part of a major report the Society will launch next week on the huge variation of treatment of dementia patients on hospital wards across the country. A spokesman for the Patients Association said: "This survey confirms our fears that there is a widespread and disturbing failure in the hospital care of elderly patients."

A spokesman for the Department of Health said: "We have set priority areas for all hospitals to take urgent action, including appointing a senior member of staff to improve quality of care for people with dementia, proper training for all staff, and specialist older people's mental health teams working in hospitals."

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Britain's National Health Service Denied Sight-Saving Medicine to Its Own Employee

An employee of Britain's government-run National Health Service was denied medication that could save her from going blind in one eye. Sylvie Webb, a widow from Salisbury, England, worked for 18 years as a secretary at Salisbury District Hospital. Yet, despite her situation, Webb discovered that medical treatment under the public health service is anything but universal.

In February 2007, doctors diagnosed Webb, then 58, with the "wet" type of age-related macular degeneration (ARMD) in her left eye. If not treated in a timely manner, wet ARMD "can lead to blindness in as little as three months and people need prompt treatment if they are to minimize the risk of permanent sight loss," according to a statement by the Royal National Institute of Blind People in London. As such, Webb's medical consultant sought rapid treatment for Webb because her sight was "deteriorating 'day by day,'" as Webb explained, and an infection in one eye can spread to the other good eye.

But to Webb's dismay, for nearly a year her local public health authority, Dorset Primary Care Trusts, refused to provide Webb with the expensive "anti-VEGF" drugs she desperately needed to save her sight. Though two such effective drugs, Macugen and Lucentis, are licensed for general NHS use, the Dorset Trust, which controls funding prescriptions, dragged its feet. Dorset Trust said it has yet to formulate a policy in a "fair and equitable way" to treat Webb's condition and thus it could not provide her with the VEGF drugs.

As Webb explained at the time, "At the time, the PCT [Dorset Primary Care Trusts] said it hadn't got a policy and it would address the situation in April [2007] - but it has now postponed this until June. I'm extremely worried that time is running out for me and other patients." The prospect of going blind terrified Webb:

"I'm a young woman and want to carry on working, and then I'd like to do all the things I had planned for my retirement. I'm also worried about the health of my other eye. I know I'm at increased risk of getting wet AMD in that eye and this could mean I end up losing my sight. The women in my family live into their 90s; I can't accept the possibility of being blind unnecessarily for the next 35 years."

In May 2007, the Trust agreed to review Webb's case on an urgent basis. But for Tom Bremridge, CEO of the Macular Disease Society in Andover, UK, there is no excuse for Webb being without the available sight-saving drugs she needs. "It is outrageous that in this day and age Mrs. Webb faces losing her sight owing to bureaucratic idleness," he said. Steve Winyard of RNIB echoed Bremridge's outrage:

"This is disgraceful... It's little comfort for Mrs. Webb that she can't get treatment simply because her PCT has yet to decide a policy. The PCT needs to get its act together and ensure these drugs are available to patients now and without a struggle... There is a moral imperative to save the sight of people where we can."

Finally, in 2008 new health guidelines permitted Dorset Trusts to prescribe Lucentis for Webb. The guidelines published by the National Institute for Clinical Excellence, the government's health advisory authority, allow for funding for the first 14 injections of Lucentis once wet ARMD is diagnosed in one eye. If additional injections are necessary, the drug's manufacturer, Novartis, will pay for additional treatment.

Webb was delighted that she would at last receive the sight-saving drug. "I'm so relieved that Dorset PCT has finally realized the long-term benefit to me of this treatment and has agreed funding," she said. "I only hope that all patients are given treatment to help save their sight because while this is good news for me, there may be hundreds of others with wet AMD who cannot get the funding they desperately need."

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Who needs facts when theory will do?

"The number of US veterans who died in 2008 because they lacked health insurance was 14 times higher than the US military death toll in Afghanistan that year, according to a new study," Agence France-Presse reports, in a dispatch titled "Lack of Health Care Killed 2,266 US Veterans Last Year: Study."

Now, you can get a list of names of soldiers who died in Afghanistan last year. There is no such list here, because this is where the number comes from:

The analysis uses census data to isolate the number of US veterans who lack both private health coverage and care offered by the VA.

"That's a group that's about 1.5 million people," said David Himmelstein, an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program who co-authored the study.

Himmelstein and co-author Stephanie Woolhandler, also a Harvard medical professor, overlaid that figure with another study examining the mortality rate associated with lack of health insurance.

"The uninsured have about a 40 percent higher risk of dying each year than otherwise comparable insured individuals," Himmelstein told AFP.

Garbage in, garbage out. Even a reporter should be smart enough to realize that you can't derive a precise number like 2,266 from hazy ones like "about 1.5 million people" and "about a 40% higher risk." This is junk science with an obvious political agenda.

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Obamacare is a devastating tax on the working class

Given the recent announcement that the government's measure of unemployment has hit 10.2 percent, and given that the official House version of Obama's healthcare plan, HR 3962, has now passed, a close examination of the effects of "Obamacare" on the labor market is important. It will be no surprise to readers of this site to learn that the Democrats' bill will seriously harm precisely those poor and uninsured citizens it is ostensibly designed to help. The harm will come by compounding mass unemployment and depriving these citizens of consumption choices.

According to pages 269–273 of the gargantuan bill,Download PDF employers of full-time workers will be required to cover at least 72.5 percent of the premium of the least expensive health-insurance plan available that fulfills the bill's minimum criteria of "acceptable coverage." In cases in which family coverage is provided, 62.5 percent of the premium is to be borne by the employer. Depending on the specific plan and other variables such as location, this amounts to a direct labor tax of approximately $300 per month for an individual, or nearly $700 for family coverage.Download PDF

The implication of this increased cost is that workers whose revenue productivity is less than $300 per month higher than their wages will be laid off, or have their hours cut to the level that will classify them as part-time. Ignoring established labor law, the bill leaves the definition of part-time and full-time to the discretion of the Commissioner of Obama's massive new health bureaucracy. The lower the new "Health Choices Commissioner" sets the threshold in an attempt to maximize the number of people receiving the employer contribution, the more hours of production employers will have to shave off to push their employees under the threshold, and the less those workers will take home in wages each week.

Unfortunately, the bill also requires employers to cover a (smaller) percentage of the premium of the same minimum plan for part-time workers. The effects here are even worse than above, because they weaken the ability of an employer to escape the labor tax by employing his workers for fewer hours. Instead, with a labor tax on part-time workers as well, some low-productivity workers who are currently only working a few hours per week will be forced out of work entirely.

The Burden of Obamacare

We can say, as a mathematical certainty, that this labor tax is a regressive tax. Because the tax is defined as 72.5 percent of the same premium for all workers, that absolute tax will fall more heavily on workers for whom the tax represents a higher percentage of their wages or salary.

To understand this better, we will apply a $300 monthly labor tax to the differences between wages and revenue production for two different workers. If we make the simplifying assumption that a laborer is paid 99 percent of his revenue productivity, we can see that the absolute difference between productivity and wages is larger for high-income workers.

For example, a worker producing $50,000 of revenue per month will be paid $49,500 over the same period, delivering $500 in profit to his employer. A worker producing $10,000 in revenue monthly, meanwhile, will receive $9900, for a difference of only $100. Despite the differences in their absolute return, in a free economy, both laborers are profitable hires and thus employed.

In a post-Obama America, however, only the high-wage worker will be employed, leaving the low-productivity worker out of employment. When a $300 per month charge is added to the cost of employing either worker, it is plain to see that only the high-wage worker's absolute profit will remain positive.

The firm will continue to make $200 by employing the high-productivity worker, while it will be forced to lay off the low-productivity worker rather than lose $200 by employing him. The Obamacare health tax thus will fall directly on the same employees who are hurt by minimum wage increases: teenagers, the disabled, and disadvantaged minorities.

If they do not wish to be laid off or cut to part-time, these low-productivity workers will accept a lower salary to keep their position and work schedule. Thus, the worker who produces $10,000 monthly will offer to accept a salary of $9700 or less to save himself from a complete loss of employment or cut to part-time. These workers will offer to shift the cost directly onto themselves rather than burdening the employer with it, which would result in their unemployment.

Predictably, though, the Democrats fully intend to "protect" workers from the choice to save their jobs by working for less. Page 273 of the bill stipulates that any amount pledged for the minimum-health-insurance plan that corresponds to a fall in salary or wage will not be considered a contribution at all. Page 310 establishes a $100 per day, per case fine for any privately negotiated fall in wages. Thus, salaries will be locked in at current rates, with any cuts being considered an attempt to subvert the labor tax, and thus being subject to financial penalties.

In reality, this clause is no favor to workers, and instead acts as a wage floor to ensure that the unemployment effect will be immitigable and widespread. Because any drop in wages during the months following the bill's enactment would be considered a violation of the employer-contribution mandate and therefore would carry heavy fines, literally all wages will be prevented from falling below their current levels.

Implementing these indirect wage floors in literally every industry during a recession is downright ludicrous. During a recession, wages rise and fall in different lines of production to align producers' demand for laborers with consumers' demand for the goods each type of labor produces.

In a dynamic market — that is, any market in which people are free to change their minds — different workers' wages must rise and fall every day to accommodate changing consumer preferences. To prevent this process from taking place is to prevent the structure of production from being corrected.

These wage floors will also hasten the decline of industries that are less valuable to consumers than they were at an earlier time, but that may still be a productive use of resources at a lower price. Businesses in these industries will be unable to legally cut their labor costs to lower their prices and satisfy consumers who are less eager to buy their goods. Without this option, such firms will need to either lay off part of their labor force, or simply go out of business entirely.

Destroying Real Production

It is equally important to consider the other end of the production chain, which is to say the actual output of goods and services. By destroying the demand for marginally productive labor, Obamacare's labor tax will necessarily destroy that labor's end product, which is of course marginally-valued goods and services. Thus, it is rational to expect fewer late-night fast food options, less-cleanly hotel rooms, fewer sales associates at retail outlets, and the like.

While these effects may not be as easily visible as a plant closure, they are real losses of consumable utility. Free-market firms produce convenience and extra quality until the point at which it is no longer profitable to do so. Destroying the production of these goods and services would destroy the niceties that capital accumulation and progress allow Americans to take for granted.

The effect of Obamacare on the prices of produced goods is obviously inflationary. Increasing the cost of employing every single laborer by $300 a piece is certain to increase the price of all produced goods. Combining price increases with rising unemployment is hardly a laudable strategy for improving the lives of poor citizens.

Conclusion

The historic passage of HR 3962 by the House of Representatives is not an event to be celebrated. Obamacare will exacerbate the nation's rising unemployment and will prevent wages from fluctuating according to market demand. Just as with other sectors, a supposedly beneficial social policy hurts the poorest and least-able citizens the most.

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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!